Western State’s failure rests with Gov. Inslee

The reasons Washington state’s largest psychiatric facility just lost millions in federal funding should come as no surprise to state officials.

Federal inspectors have been citing myriad problems at Western State Hospital since 2015. They even gave the hospital a rare second chance to shape up.

Finally, the Centers for Medicare and Medicaid Services this week decided enough was enough. After the Lakewood hospital failed yet another inspection, the agency announced Western State would lose its federal certification and $53 million in funding starting July 1. That’s money the state now has to make up.

This latest blow highlights the ongoing failures of leadership, internal governance and quality control that have persisted at the hospital under Democratic Gov. Jay Inslee’s watch, despite the state Legislature continually throwing money at the problem since Inslee took office in 2013.

During Inslee’s first term, lawmakers increased spending on the state’s two psychiatric hospitals by about $150 million per two-year budget cycle. Since 2017, lawmakers have spent at least another $100 million trying to help bring Western State into compliance.

Many of the stubborn problems that remain are issues of management, such as failure to keep adequate medical records and adopt quality-control measures for nursing care. Surveyors found the hospital lacked systems to root out problems and fix them before they came to the attention of federal inspectors; meanwhile, hospital staff failed to update patient treatment plans to ensure doctors’ orders were followed and not ignored.

“This goes back to the endemic cultural problems at the hospital,” said Laurie Jinkins, D-Tacoma, who chairs the House Judiciary Committee.

“To see that nursing care, and quality improvement and governance are still being cited — these are things that were being cited two years ago,” she said. “That is extremely frustrating.”

Such lapses have real consequences for some of our society’s most vulnerable, who end up at Western State either because they have been deemed a danger to themselves or others, or they have been deemed mentally incompetent to stand trial.

In the past, insufficient patient monitoring has contributed to a risk of patient suicide at Western, as well as patients injuring hospital staff and each other.

The Department of Social and Health Services, which Inslee oversees, has often cited an aging facility and short staffing as key contributors to Western State’s problems. Yet the agency also has slow-walked important internal changes, such as launching a long-awaited tool to adjust day-to-day staffing levels to match the needs of patients on each ward.

Additionally, the hospital has repeatedly let nursing-staff members work shifts that last only 7 hours and 45 minutes instead of the eight hours they are being paid for — a problem the State Auditor’s Office has pointed out since 2014. To the Auditor’s Office’s knowledge, that problem has not been corrected, despite wasting millions of taxpayer dollars over the years on staff hours not worked and creating potential problems at shift changes.

Last month, Inslee announced a five-year plan to start moving civilly committed patients out of Western State and into community treatment facilities.

But to some extent, his efforts are too little, too late.

Almost six years into his tenure as governor, Inslee deserves the blame for the state’s mental health debacle that his administration has lacked the urgency to address for too long.