Lawmakers seek changes at Western State Hospital

Some lawmakers want to change how money flows to the state’s psychiatric hospitals and who is allowed to treat patients there.

A proposal set to be introduced Wednesday in the Legislature comes as federal inspectors are paying a visit to Western State Hospital this week to check on safety problems they found last year. More than $60 million per year in funding is at risk of disappearing March 1 if the problems haven’t been fixed.

At the root of the problems is staffing. Western State has struggled to hire and keep staff, leaving hundreds of vacant jobs, including about one in four psychiatrists’ positions.

Sen. Andy Hill wants the state hospitals to fill some of the gap by hiring psychiatric nurses with advanced degrees. Psychiatrists at the hospitals oppose the idea, but nurses’ groups have pushed for it.

By not employing psychiatric nurse practitioners in clinical roles, Western State is an outlier within the state, said David Guidry of the Association of Advanced Practice Psychiatric Nurses.

“I already know three colleagues that would love to work there,” said Guidry, whose practice provides medical care for state prison inmates.

Glenn Morrison, president of the doctors’ union at the state hospitals, said patients there require complicated care. Those cases require specialized training, he said, and psychiatric nurse practitioners don’t have enough of it.

“They don’t have medical degrees. They haven’t spent four years in medical school, four years in supervised training and residency,” Morrison said.

Hill said lawmakers would work with doctors on the plan.

“It’s not like we’re turning psychiatrists away for jobs. We can’t find them,” he said. “There’s a straight-up shortage, a terrible shortage. If I were them, I’d be looking for some help.”

Democratic Gov. Jay Inslee, though often at odds with Redmond Republican Hill, voiced openness to the idea when speaking to a recent gathering of nurses.

Three Democrats and four fellow Republicans signed on to Hill’s plan in the Senate. In the House, Rep. Laurie Jinkins, a Tacoma Democrat, supports many of the bill’s concepts including the use of advanced nurses.

Hill’s measure would use financial incentives to try to reduce the use of the state hospitals.

Instead of receiving a set number of slots at the hospitals, regional behavioral-health organizations would receive money and could use it for a variety of treatment — at the hospitals, alternative locations or outpatient programs.

The regional organizations have sought to manage the funding in the past.

“The more we can do in the community, the better for the patient, the better for the family, the better for recovery,” said Mark Freedman, administrator for the organization covering Thurston and Mason counties.

Jinkins said strings attached to federal hospital funding complicate the issue.

“That’s a good concept to look into. The question is, where is the money going to come from?” she said.

Another part of the proposed legislation calls for Western State Hospital to find somewhere else to house at least 30 geriatric or long-term-care patients.

The state has tried for years to find places outside the state hospitals to take patients who might not benefit from staying at the hospitals, but still have complex needs and may pose dangers. Hill said stepped-up efforts to find a facility to take the 30 patients would allow Western State to reduce the size of patient wards, easing pressure on staff.

Inslee has proposed adding staff, including more than 50 nurses at Western State. Hill, the lead budget writer in the Senate, said he would be more open to requests for money if the hospitals’ practices are reformed.

Some practices should have changed without the Legislature getting involved, Hill said.

“The fact that (lawmakers need to propose) a major reform bill makes me question management,” he said.

The hospital made a host of improvements to safety, said Carla Reyes, assistant secretary for behavioral health at the Department of Social and Health Services. In the longer term, her agency wants funding to hire consultants to analyze how to improve deployment of staff.

“We want better quality of care. This isn’t just about satisfying” federal regulators, Reyes said. “We want a safe hospital.”

This story was originally published February 9, 2016 at 7:21 PM with the headline "Lawmakers seek changes at Western State Hospital."