New Western State Hospital CEO Cheryl Strange takes over a facility dogged by complaints about everything from assaults on staff to severe worker shortages and patient escapes. On Friday, officials announced an agreement that will have federal officials keeping a closer eye.
LAKEWOOD, Pierce County — In an empty courtyard at Western State Hospital, Cheryl Strange is comparing the old, imposing brick buildings with newer, better-designed facilities.
The new CEO of the hospital that houses more than 800 of the state’s psychiatric patients, says it’s hard to keep staff safe in these buildings. She wants to upgrade security and training.
She wants to spruce up this plain asphalt courtyard, maybe with basketball courts for the patients. Strange talks a lot about improving quality of life for the patients, about making them feel valued and respected.
“I would like to see the patient areas, the facility … looking better,” Strange said later on, sitting in her office. “I would like to see them painted.”
But she knows the basketball courts and paint jobs may have to wait. The hospital, the subject of years of complaints about everything from assaults on staff to severe worker shortages and patient escapes, has been at risk of losing its accreditation and $64 million in annual federal funding — and now will be under continuing federal watch.
Pat Lashway, acting secretary of the state Department of Social and Health Services (DSHS) has called securing Western State’s future with the federal government job “number one.”
On this day, Strange notes, her family is away, trekking the Pacific Crest Trail, that modern pilgrimage in the wilderness known for testing people’s endurance and limits.
Where she is right now, this troubled hospital might as well be Strange’s pilgrimage.
“You know what?” Strange, 58, said. “My job is my extreme sport.”
On Friday, officials announced that hospital officials late Thursday had signed an agreement with the Centers for Medicare & Medicaid Services. That agreement, which follows four threats last year to cut funding, will likely establish a plan and schedule for change.
Getting right with the federal regulators means dealing with the chronic staff shortages that bedevil front-line workers such as nurses, psychiatrists and counselors. About 170 of those jobs are vacant right now, including roughly one in four psychiatrist positions.
Meanwhile, the state in the last fiscal year approved workers’ compensation claims for 135 assaults on Western State staff members, costing a total of 5,957 work days.
And in early April the escape of two men — one an accused murderer — threw into relief flaws in security on the 264-acre campus.
Slipping through a compromised hospital window and sparking a statewide manhunt, Anthony Garver and Mark Alexander Adams prompted Gov. Jay Inslee just days later to fire CEO Ron Adler and appoint Strange.
But even before the escape, Strange, who will earn $173,352 annually, had been recommended by Lashway as Adler’s replacement.
“She knows behavioral health from every angle, and so she’s really able to think of it from a different perspective,” said Hilary Young, a vice president at Pioneer Human Services, who worked with Strange at the nonprofit from 2011 to 2014.
Even those who appreciate her skills describe the task ahead as daunting.
“When I got home the night she was appointed,” said Rep. Lauri Jinkins, D-Tacoma, “I had at least two longtime friends of mine call me, and say, ‘I’ve known Cheryl for a really long time. I told her not to take this job.’ ”
Strange wasn’t looking to run the hospital. She applied for a much bigger job: secretary of DSHS.
But to Lashway, Strange’s experience fit the complicated task of putting Western State back on course.
“She has wide experience throughout mental health and different settings and was successful in all those endeavors,” Lashway said.
From a mental-health nurse in her early career, Strange rose to become assistant director of DSHS’s mental-health division between 2006 and 2008. There, she managed an annual budget of $900 million and a staff of 2,000 — and kept the state’s psychiatric hospitals in compliance with federal regulations.
After that, Strange became a deputy secretary at the state Department of Corrections (DOC), a vice president at Pioneer Human Services and a director of operations for SEIU 775’s benefits group.
Her new role is tricky: part bureaucrat, part bean-counter, all cheerleader. And it involves running a hospital whose population includes patients found not guilty by reason of insanity to charges such as murder, or who await a competency exam to see whether they’re fit to stand trial.
Diagnoses are often severe, from schizophrenia to bipolar disorder. Patients arrive on referrals from the state’s regional mental-health systems, or because a civil court has committed them involuntarily.
Former colleagues describe Strange as an effective administrator and a persuasive advocate at the state Legislature, where social-service dollars are always competing against other needs, such as education.
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During her time at Pioneer Human Services — which runs a variety of programs on mental health, substance abuse and housing — Strange helped fend off cuts, according to Young.
There were all kinds of proposals, Young said, to reduce state funding for substance-abuse treatment. “And one of our programs was line-itemed for closure and we were successful in saving that.”
Kevin Bovenkamp, an assistant secretary at DOC, credits her with expanding mental-health treatment in the prison system, bringing in cost-control measures and focusing on “consistency and quality.”
Lashway said Strange will bring “communications skills and transparency” to the job.
Not everyone considers Strange’s stints at DSHS and DOC a virtue. The day of her appointment, former Port of Seattle Commissioner and Republican candidate for governor Bill Bryant described the agencies as “two of Inslee’s broken bureaucracies.”
The appointment, “looks more like musical chairs than a serious attempt at culture change,” Bryant added.
Relations with patients, staff
One new idea since Strange’s arrival: She and other top brass are adopting patient wards. She spent one morning in E-2, talking to patients and workers during the shift change.
“Like adopt-a-highway,” she said, adding later, “They were surprised to see us.”
Inslee and Lashway have also emphasized the need for better relations between workers and the hospital administrators.
Jess Jamieson, a former Western State CEO, says that to be successful, Strange and the union staff must be willing to work together.
Barbara Shelman, vice chair of Western State’s local union chapter of SEIU 1199 NW, said staff members had communication issues with Adler, the former CEO.
“I think that was a huge part of the problem, staff didn’t feel like there was a connection there,” Shelman said.
Reached by phone, Adler declined to comment, adding, “I wish Cheryl Strange all the luck in world.”
Strange also talks about giving senior managers more authority.
“I would like to see a nimble management team that feels like they can engage in debate without fear of retaliation,” said Strange, who later walks back the part about retribution: “I think the management team, for whatever reason, did not feel empowered to make decisions.”
“Humanity…regardless of the chaos”
Before a decadelong stint as a mental-health nurse therapist at Olympia’s Providence St. Peter Hospital, Strange first set foot in Western State for a training session in the late 1970s.
A dig through the news archives on the hospital since then recalls the line from Ecclesiastes about how there’s nothing new under the sun:
• Feb. 28, 1979: “Accreditation for Western State Hospital’s adult psychiatric program has been suspended … because of inadequate state funding and staffing.”
• Aug. 13, 1989: “Western State and its sister hospital, Eastern State near Spokane, have become the symbol of how far the public mental-health system has unraveled. In the next few years, they will be the barometer for gauging the success of the state’s ambitious plans to reform that system.”
• Dec. 3, 1993: “Western State Hospital announced new security measures yesterday in response to the escape last month of a patient charged with murder.”
• July 12, 2011: “The single most violent workplace in the state is at Western State Hospital …”
• And most recently, the headline from May 16, 2016: “Lakewood police investigating escape of Western State Hospital patient.”
Strange hopes a study by DOC prompted by the April escapes can help in boosting hospital security. But with some patients trying to flee and others allowed to leave for short periods as part of their planned re-entry into society, it isn’t an easy task.
With “that large a campus and that many patients, patients wander off the campus,” said Jamieson, who led the hospital between 2009 and 2012. “It’s just not a secure environment.”
Jamieson also relates to the staffing problems, adding that, “Getting good, talented people and retaining good talented people was a real challenge.”
DSHS is working to cut the time it takes to hire employees from 100 days to 50, according to Strange. She hopes to better target potential workers, and make scheduling more flexible to make the jobs more attractive.
Perhaps the biggest obstacle is the possible loss of federal certification and funding. DSHS and the federal Centers for Medicare & Medicaid Services (CMS) are working to put together an agreement.
The upside: It would likely include a full-time consultant at the hospital who could provide clarity on complying with federal regulations.
The downside: Under the agreement, DSHS would eventually either be found in compliance or have its certification ended. The agency wouldn’t be able to appeal.
“Without a dispute process, it’s very concerning to me,” Sen. Randi Becker, R-Eatonville, said last month at an oversight meeting for the hospital.
Strange acknowledges that with such an agreement, “we must be solid in our decision-making.” But she has faith in the work being done here.
“I walk these wards,” she says. “I watch the patients and the interaction and the humanity that I see on those floors, regardless of the chaos of the operating environment, (it) is really astounding.”