State hospital shuffles top leadership, again

Roughly six months before its goal of applying for federal certification of the Montana State Hospital, the state health department is again juggling turnover in key leadership positions at the state’s only public adult psychiatric facility.

The Warm Springs facility, a cornerstone of the state’s overall mental health system, has been a major challenge for the administration of Gov. Greg Gianforte. The facility lost federal certification from the Centers for Medicare and Medicaid in 2022 following patient falls, deaths and insufficient COVID-19 protocols. 

Since then, the hospital has cycled through four different administrators. On Wednesday, a human resources employee from the Department of Public Health and Human Services notified staff at the Warm Springs campus that the hospital’s interim CEO, Jennifer Savage, was out of the job, according to a copy of the email shared with Montana Free Press. Her replacement will be the hospital’s fifth CEO in about two years.

Savage had also been the administrator of the department’s Health Facilities Division, which oversaw Montana State Hospital and other public health care institutions. She had been filling the position at Warm Springs since January when the state prematurely ended the contract of another temporary administrator, David Culberson.

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But the email also explained that “as part of this exciting transition at MSH,” the division that Savage used to lead is also being replaced by the “Health Care Facilities Practice,” a new bureaucratic unit in the state health department tasked with overseeing the Warm Springs campus and other public institutions.

“DPHHS leadership continuously assesses and responds to the needs of our state-run health care facilities and patients in order to maintain a patient-centered system of care designed for Montana’s most vulnerable populations,” the email read.

Department spokesperson Jon Ebelt confirmed Thursday that Savage was no longer a state employee but declined to provide additional information about the reason for her departure, citing personnel matters. 

Ebelt said that the state had recently hired Dr. Kevin Flanigan, a hospital administrator from Ridgecrest Regional Hospital in California, as the hospital’s new CEO. Flanigan is scheduled to assume the role on August 12. State Medical Officer Dr. Doug Harrington will oversee hospital operations until then, Ebelt said, with support from the state-hired consulting group Alvarez & Marsal.

As Montana Free Press reported in April, Savage had been the target of robust criticism from hospital employees in recent months. Some questioned her judgment about clinical decisions and described her treatment of employees as disrespectful and unprofessional. At the time, state health department director Charlie Brereton defended Savage’s decisions and leadership style.

“Difficult decisions are being made and newfound accountability isn’t always popular — but Jennifer and DPHHS leadership will always put patient safety and quality of care above all else,” Brereton said in a written statement. “I have full confidence in Jennifer as a change agent at MSH.”

Several high-up medical providers, including psychiatrists and advanced practice registered nurses, quit their positions or were fired under Savage’s tenure. Many complained about burnout and unreasonable work requirements. Ebelt confirmed that Dr. Daniel Bemporad, a forensic psychiatrist who had previously submitted his resignation and then decided to stay, would be leaving the hospital on July 12 “due to family and personal reasons” but may continue on as a contractor.

“Recruitment is underway for a permanent replacement. A temporary replacement with 25 years of forensic psychiatry experience is already hired,” Ebelt said. 

The state is leaning on contracted employees to fill other positions that are also in flux. Under a contract with the staffing firm Traditions Behavioral Health, the hospital’s chief medical officer role was filled by Dr. Micah Hoffman, a Wyoming-based provider with other jobs in his portfolio who occasionally traveled to Warm Springs. But Ebelt on Thursday said that the state was “conducting final interviews for a new permanent medical director who will be based in Warm Springs full-time,” also through Traditions.

Ebelt said the “long-term, multi-year partnership” with the staffing firm is “showing great promise.” He added that the state is working with Traditions to hire “additional staff physicians, psychiatric mental health nurse practitioners, and psychiatrists, including Dr. Bemporad’s permanent replacement.”

As of the first quarter of 2024, the average number of patients at the hospital was 237, according to a May presentation to the hospital’s governing board. During the same period, the hospital’s employee vacancy rate hovered at 33%, a reduction from a recent high of 42% in 2023.

Despite those ongoing challenges, and the state’s goal of reapplying for federal certification by December or January, Ebelt cast the recent turnover as part of the administration’s overall efforts to stabilize the facility.

“This leadership transition is ultimately part of the facility’s ongoing and significant cultural, clinical and operational transformation following decades of neglect from previous administrations and historically inadequate oversight from Helena,” Ebelt said.