As Western State Hospital awaits an all-or-nothing review from federal auditors, lawmakers must ensure the state moves toward a more functional mental-health system.
ON some day before July 1, federal auditors will drop by unannounced at Western State Hospital. They have come repeatedly before and found so many lapses in patient care at the state psychiatric hospital in Lakewood that the state last year was forced to sign a very unusual all-or-nothing improvement plan.
If the state fails this next random audit, the feds will yank their $64 million a year in funding. No more second chances. High stakes.
The state Legislature, nearing the end of its 105-day session, has an unambiguous responsibility to make sure patients, and the state itself, aren’t in this situation again. There is bipartisan agreement to move away from the centuries-old model of a big psychiatric institution, in favor of decentralized services provided in communities. But with the clock ticking on this session, lawmakers are still squabbling over a commitment to preventive services and staff pay raises.
Gov. Jay Inslee went to the hospital last week to give the anxious staff a pep talk and to scold the Republican-led Senate for not funding pending union contracts, which would boost their pay. Inslee noted that Western State has added a net 388 new staffers since the wake-up call from federal auditors, with the help of temporary pay bumps and better management. Lawmakers need to ensure competitive pay, especially for nurses and psychiatrists, doing this vital but tough state service.
Inslee rightly noted that the state has clearly seen the consequences of running a state hospital “on the cheap.” During recession-era cuts, Western State’s budget dropped more than 10 percent, according to budget data. Staff fled, and ultimately the state was slapped with a series of damning court rulings that not only exposed inhumane warehousing of patients in emergency rooms and jails but also really ticked off federal auditors.
Inslee’s focus on the money was a little fuzzy, however. Western State’s budget — $188 million in 2017 — is now larger than it was a decade ago in inflation-adjusted dollars. The spending has bought more active treatment of patients — 11,000 hours since the improvement plan was signed — and resolved many of the safety gaps that allowed two patients to escape last year through an unsecured window.
But Western State still has deep problems. As of last week, nearly a quarter of the hospital’s total patients — 219 in all — were on a “ready to discharge” list reserved for patients with no medical reason to still be at the hospital. They wait an astonishing 175 days on average, at a cost of up to $600 a day, even as patients are waiting at the front door. What a colossal waste of taxpayer money.
This is not only about how much is spent — it has to be spent efficiently. The Legislature badly needs to open Western State Hospital’s clogged exit door with more places for “ready to discharge” patients to go, including specially-trained adult family homes, nursing homes and apartments with embedded support services. In the past, bargain-basement rates have offered little incentive for facilities to take the patients.
Inslee, and lawmakers on both sides of the aisle, understand the problem and must come to a bipartisan agreement in the waning days of the session that will not just patch holes in the creaky 146-year-old institution. Lawmakers must think broadly on reform.
Western State Hospital CEO Cheryl Strange, hired by Inslee last year, is credited by staff with turning around hospital care and detoxing once-acidic employee relations. She “did not want to take a guess” whether the hospital will pass the federal audit. Cross our fingers.
But the long term is just as important. Thousands of seriously mentally-ill patients and their families deserve a real safety net, and a competent hospital when they get sick. Lawmakers need to get the job done, and make sure the state is not back in the same soup again.