For many, the furloughs announced last month at UW Medicine landed with a thud of uncertainty.
A mother of a woman with cerebral palsy worries an adjustment of her daughter’s wheelchair could be delayed with her physical therapist set for furlough. Nurses at a psychiatric unit fear their facility will remain closed. A medical-laboratory scientist wonders if a smaller staff can keep up with transfusion demand at the UW Medical Center blood bank.
UW Medicine administrators say they’ve designed the temporary cuts, needed because COVID-19 has devastated the hospital system’s budget, to ensure safe patient care and minimal impacts.
But some staffers are skeptical reductions of some 5,500 employees won’t strain a workforce already reeling in the pandemic’s clutch. And the furloughs foreshadow more difficult financial decisions, as administrators try to balance patient care with suddenly-reduced finances.
UW Medicine has sliced about $76 million from its budget, said Susan Gregg, a spokeswoman. The system has announced it faces an estimated $500 million shortfall by summer’s end.
The furloughs of 5,500 staffers, for between one and eight weeks, will save some $15 million. About 35% of the reductions are at ambulatory clinical sites, where Gregg said patient visits have dropped 20% to 30%.
UW Medicine reached agreements over reductions with three labor unions: SEIU 1199NW, the Washington State Nurses Association (WSNA) and the Washington Federation of State Employees (WFSE). Negotiations with SEIU 925 broke down.
Courtney Nygaard, who bargained with other SEIU 925 members, said the union anticipates pursuing grievances and an unfair-labor-practice claim against UW Medicine, over concerns about the layoff-notice timeline, seniority and managers dealing directly with employees.
The remainder of the cost reductions, some $61 million, are accounted for by the cancellation of some travel-nurse contracts, vacant positions that won’t be filled, medical-supply expense reductions, pay cuts for senior leaders and reduced capital expenses, Gregg said.
Some services are paused, including the UW Medical Center Gift Shop, the Eyes on James optometry service, Harborview Medical Center’s patient-resource center and hospital-based outpatient therapy at UW Medical Center.
Still, Gregg said that primary care patients shouldn’t see substantial changes and that UW Medicine clinics are available for telehealth and in-person visits as needed.
The furloughs could be a prelude to other painful cuts.
Among the employees furloughed are more than two dozen workers at a voluntary inpatient psychiatry unit known as Seven North, at UW Medical Center — Montlake, which UW Medicine has considered closing in the past.
UW Medicine administrators are weighing consolidation and whether to move its operations into a geriatric psychiatry facility at UW Medical Center — Northwest.
“We’re giving it serious consideration,” said Dr. Jürgen Unützer, professor and chair of Psychiatry & Behavioral Sciences at the University of Washington.
Consolidating would mean that seven geropsychiatric inpatient beds at the Northwest campus would be converted for use by younger adults, Unützer said.
Unützer said putting the programs in one location could benefit patients because the Northwest campus offers additional specialized services, including electroconvulsive therapy (ECT), a treatment for severe mental-health ailments Seven North does not offer.
Early in the pandemic, the Northwest campus experienced an outbreak of COVID-19 among patients and staff. All have recovered, Unützer said, but ECT services remain on hold as UW Medicine restarts elective procedures. Unützer said he hopes the program will operate again in a few weeks, though the ECT coordinator has been furloughed into July, too.
Seven North is licensed for 14 inpatient beds, but typically it serves a maximum of 10 patients. The program offers voluntary psychiatric treatment and often works with pregnant patients or patients involved in organ transplants.
Seven North staffers will be away and without pay for three-to-five week periods. Managers have told some staffers the unit will remain closed through July 31. Some have received reassignment notices.
Staffers held a demonstration last Thursday, urging administrators to stay open after the furloughs as the state deals with a mental-health crisis.
“I don’t mind doing my share of furlough. I just think that it’s very important to keep these beds open for people who need them,” said Anita Stull, a longtime Seven North nurse.
Another nurse, Caitlin Sellhorn, said that the program stopped admitting new patients on May 18 and that the last patient was discharged Tuesday.
“The unit is now completely empty, but we’re not furloughed yet,” Sellhorn said last Thursday, adding that she had turned down several emergency department calls from social workers seeking places for patients. “It felt awful to know what happened to these people who are sitting in an emergency room somewhere.”
Sellhorn said Seven North, which primarily accepts patients voluntarily seeking care and does not offer services to patients with histories of aggression, offers a unique “therapeutic milieu” where patients can relax, convene for group therapy and walk the grounds with staffers.
Heather Vargas-Lyon, another nurse at Seven North, questioned whether patients who would receive at Seven North could receive the same type and quality of treatment at the Northwest campus, which has focused on geriatric patients with different needs.
UW Medicine has spent more than a year updating the facility to comply with ligature-risk recommendations — installing things like new doorknobs, plumbing and beds — to reduce the risk of suicide.
Given the investment, “to possibly close the unit doesn’t seem responsible,” Sellhorn said.
Unützer said that the fixtures could be installed elsewhere and that UW Medicine could find another use for the space, which he described as dated for mental-health care because it was built in the 1960s.
UW Medicine is planning a new, 150-bed behavioral health facility at its Northwest campus, where programs like Seven North’s could one day be housed. The university Board of Regents in May approved a construction site and a budget, pending additional funding by the state Legislature, which already has appropriated more than $33 million for design.
Unützer said COVID-19 has forced considerations of consolidation to move up.
“We have to make these huge reductions and try to create efficiencies,” he said. “Where do we safely close the gaps?”
Unützer said he expected COVID-19 to intensify mental-health-care needs in a state that was struggling to provide adequate access to mental-health services before the pandemic.
“Let’s fast forward six months, and we’ll put ourselves in the middle of a Seattle winter and people have had tremendous fallout from all the stress that has come from this and the financial, economic crisis isn’t over yet,” he said. “We might see quite an increase in people struggling.”
When asked if he was concerned that a projected increase in mental-health needs could lead to more psychiatric boarding, in which psychiatric patients must wait in emergency departments, Unützer said: “I have had these concerns for the last 10 years, and I have them today, too. We just don’t have enough access.”
The furloughs could stretch other services, too.
As a medical-lab scientist in the UW Medical Center blood bank, Nygaard is part of a team of about 30 that performs pre-transfusion testing.
Nygaard said they have been asked to take a week of furlough in June, which concerns her because bleeding emergencies at the facility sometimes require “all hands.”
“When you reduce staff on the blood bank, we all get anxious,” Nygaard said.
Meantime, Laura Musso Escude, whose daughter, Teresa, is a patient with UW Medicine, worries furloughs could delay her daughter’s cerebral palsy care.
Teresa Escude, 23, spends much of her day in a wheelchair, and it helps provide her a connection to the community. Laura said her daughter, who is nonverbal, has not been positioned correctly in the wheelchair, which is crucial for her safety, her comfort and because she cannot control muscular movements.
The wheelchair needs a new footrest and a seating adjustment, Laura said. Getting the footrest will require a letter of medical necessity from Teresa’s physical therapist and then several fitting sessions.
The family has been isolated because of COVID-19 since early March and conducts therapy sessions through online video chats.
But the physical therapist now must take two weeks away on furlough, which began June 1, Laura said, and she expects a commensurate delay for Teresa’s care.
Laura said the family loves its team of caregivers (“Everybody is concerned about their patients,” she said), but it’s already hard to schedule appointments, and she worries it will become worse.
Amid COVID-19 concerns and the resulting financial upheaval, she said she hopes UW Medicine could find creative solutions to expand the availability of care.
“This is the new normal.”