ISSAQUAH, Wash. (AP) — As coronavirus cases top 200 at Washington state’s largest psychiatric hospital, officials are implementing new procedures to try to get it under control.

Making matters worse, the economic downturn that resulted from the pandemic, and the loss of revenues needed to run state government, is forcing the Department of Social and Health Services to make budget cuts, including layoffs at Western State Hospital.

COVID-19 has hit at least 158 hospital workers since March, which takes them off the schedule and means a lot of overtime for the workers left on the wards. At least 64 patients have tested positive and one has died.

Hospital CEO Dave Holt placed a dozen wards “on hold” this week, meaning there was some sort of COVID-19 exposure on the ward and no transfers or staff movement is allowed until the end of the month, at least.

Holt also ordered all staff to start wearing face shields in addition to masks. Another recent order said patients should wear masks, too.

Western State Hospital was struggling with staff shortages and other problems long before the pandemic hit.

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The 857-bed facility in Lakewood, Washington, has been operating without its accreditation since 2018, when the Centers for Medicare and Medicaid Services stripped its federal certification for continually failing safety inspections. It also lost about $53 million in federal funds.

Not long before that happened, Western State Hospital drew a national spotlight after two dangerous psychiatric patients escaped, including one who had been charged with torturing a woman to death.

Violence at the hospital continues to be a problem with assaults both on staff and patients.

Before the accreditation cutoff, the hospital was working under a “system improvement agreement” with CMS and officials recruited people to serve as “ward administrators.” They were tasked with overseeing what happened on the wards in order to satisfy federal safety standards and try to secure accreditation.

Since they were non-clinical workers, they were not welcomed by medical staff.

“Their intent was to take over all direct care without answering to licensed care providers, in essence “yes persons” for administrators who were tired of all the complaints made by doctors and nurses,” said Paul Vilja, a nursing supervisor.

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Officials defend their decision to appoint people to these new positions.

“Although the hospital was not successful in maintaining its certification, the Ward Administrators quickly proved themselves as invaluable to hospital operations,” Holt said.

But last week, Holt announced that all 12 ward administrators were being laid off and he was eliminating their positions due to a shortfall in state funding for all DSHS programs, including the hospital.

“We recognize the difficulty of identifying operational efficiencies to achieve the approximate $3 million dollar budgetary savings that is needed,” Holt told staff in an email. “We will work collaboratively across all disciplines and areas of operation to determine where operational efficiencies can be found while minimizing impacts on direct patient care.”

Vilja, the nursing supervisor, said the solution to improving conditions at the facility is to increase the medical staff and cut administrative personnel. Medical workers need to be more involved in the hospitals daily operations instead of being dictated to by non-clinical officials, he said.

He said most of the people who work directly with the patients “have never interacted directly with our nursing director or medical director,” he said.

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In a letter to hospital officials, Vilja said they should draw upon the experience of the hospital personnel who were around when the facility was fully accredited.

“We have solutions for what WSH is facing now, all you have to do is listen to us rather than ridicule or retaliate for having differences of opinion based on our direct experiences at WSH,” he said.

Sean Murphy, assistant secretary of behavioral health, one of the hospitals greatest challenges is working in an aging building. And staffing problems have been magnified by the pandemic.

Despite those issues, “the care right now is solid,” he said. “We are performing to standards and our staff is doing an amazing job.”

“We serve very complex patients that are very sick and we do so very well,” he said. “The work that’s happening is nothing short of amazing.”