Montana State Hospital

The entrance to the campus of the Montana State Hospital at Warm Springs.

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A federal agency has given the Montana State Hospital 23 days to correct noncompliance issues so severe that the agency determined patients’ health and safety are in immediate danger, or else the state’s only psychiatric hospital will lose its federal funding.

The violations that spurred the Centers for Medicare and Medicaid Services to potentially strike its federal funding agreement with the Warm Springs facility: patients rights and infection prevention control.

In a Feb. 18 letter to Montana State Hospital administrator Kyle Fouts, CMS said it intends to terminate the hospital’s Medicare provider agreement on March 13. Termination of that agreement can only be averted by correction of the hospital’s actions by that date.

According to the letter, CMS inspectors pored over the facility from Feb. 8 through 10. By the end of the survey on Feb. 10, the state hospital was in an immediate jeopardy situation, although the Montana Department of Public Health and Human Services, which operates the facility, has denied it was under that status when inspectors left the facility.

“Information was provided regarding the failures that were identified during the survey and the need for a written plan of action to remove or abate this serious situation,” Friday’s letter states. “The hospital at that time was unable to provide a written plan of action and was unable to implement sufficient corrective actions to remove the (immediate jeopardy) situation by the end of the survey.”

Earlier this week a DPHHS spokesperson said that although the hospital had not been officially placed on immediate jeopardy status and was awaiting the report, the agency was moving forward with a corrective action plan as if it had.

Immediate jeopardy is a specific designation that comes with potential sanctions and fines by the day for noncompliance. In order to reach such a finding, inspectors must conclude that the facility is out of compliance with federal health and safety regulations, that serious injury or death could arise from that noncompliance, and that the threat is so dire that the facility must take immediate action to prevent it.

Disability Rights Montana, an advocacy group that monitors health care facilities in Montana that work with people with disabilities, raised the alarm Friday about the immediate jeopardy status. Bernie Franks-Ongoy, the organization’s executive director, said in an interview Friday it’s important that families with loved ones at the state hospital be aware of the situation at the state hospital.

“We are really concerned about the conditions in the hospital and we are particularly concerned because we’re talking about immediate jeopardy,” Franks-Ongoy said Friday. “We’re talking about the threat to health and safety and when the state takes people into their care and removes them from their community, they need to be able to do it in appropriate way.

“This isn’t about a ‘gotcha’ for the state hospital,” she added. “This is about ‘Let’s all roll up our sleeves and do the right thing,’ and the right thing is to make sure that people are getting the appropriate care in the facility.”

The letter does not bear details of what patient rights and infection control violations were uncovered at the facility; DPHHS likewise did not return an email asking to provide those details, or to comment on the CMS notice issued Friday.

In January, two weeks before the recent inspection, DPHHS confirmed the hospital was experiencing a COVID-19 outbreak. Subsequent interviews with current and former staff indicated employees have been given work assignments that transferred them from COVID-positive units to units without infected patients.

“They do it constantly,” one traveling nurse, who requested anonymity for fear of retaliation, told the Montana State News Bureau. “They say they’re doing safe practices, but they’re not. They’re not even trying.”

CMS had initially approved an inspection of the facility in September that found staffing numbers were below the level needed to prevent patients from falling. Inspectors then found patients had fallen 113 times between June and August 2021, and employees told inspectors staffing documentation had been altered to not list patients whose needs required one-on-one attention from staff. After the Montana State News Bureau asked the agency how it approved that inspection, CMS said it would revisit the situation in Warm Springs, although it is yet to answer how the September inspection was approved.

Montana State Hospital

One of the older buildings on the campus of the Montana State Hospital in Warm Springs.

The Montana State News Bureau has interviewed more than 20 current and former staff since October who illustrated untenable working conditions and an unresponsive administration led by Fouts. The state health department has declined to make Fouts available for an interview, although November figures from DPHHS showed 40% of positions are vacant at the hospital; many of those functions are being carried out by traveling nurses at a much more expensive rate. Employees say long-term staff continue to leave the facility, which in turn has grown more reliant on traveling nurses.

Employees also raised their concerns with state lawmakers like Sen. Mark Sweeney, a Democrat whose district includes the state hospital, and at a committee hearing in January. Rep. Ed Stafman, a Bozeman Democrat who chairs the interim committee that heard from those employees, on Friday criticized the state’s response to employees pleading for relief in Warm Springs.

In order to stabilize the work force, DPHHS last year put out a request for proposals from potential contractors to temporarily take over management of all its health care facilities, not just the state hospital. Gov. Greg Gianforte, similarly hoping to pad the low staffing numbers in Montana’s health care facilities, offered signing bonuses for health care workers to come to Montana. Neither proposal directed additional funding to retain permanent staff in Warm Springs.

“Our committee held a hearing several weeks ago where we made clear that ‘the house is on fire,’ so we can’t afford to wait months for a consultant’s report,” Stafman said in an email Friday evening. “Still, no action was taken. Our hearts go out to the patients and their families whose health and safety have suffered and will suffer from this neglect, and our thanks go out to the dedicated MSH employees who have stuck it out, despite having to work under deplorable conditions. We will do everything within our power to compel DPHHS to appropriately address patient safety and working conditions.”

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