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Legislative committee looking to transfer dementia patients out of State Hospital – Daily Montanan

['Keith Schubert', 'More From Author', '- March']

Date: 2022-03-04 00:00:00

An interim legislative committee proposed two bills on Friday seeking to address chronic problems at the Montana State Hospital that would transfer some patients and enhance third-party oversight of the hospital.

At the conclusion of a more than 5-hour meeting, the Children, Families, Health and Human Services Interim Committee came to a consensus on two separate pieces of legislation, one that would transfer patients with dementia assigned to the hospital by court orders out of the hospital and into community care facilities, and another that would give an outside group oversight of the hospital’s functions.

The votes come following cascading revelations of death and the death of Kathy Toavs, a dementia patient who suffered a fatal fall at the hospital.

“To make sure that people like Kathy Toavs don’t die avoidable deaths in the state hospital … we can avoid that by taking action now to begin drafting a bill to find community-based placements for the existing population of the Spratt (unit),” said Rep. Danny Tenenbaum, D-Missoula. “But then also make sure that people living with dementia are not sent there anymore, and to make sure they’re given placements where they’re close to their community where they can receive appropriate medical care, where they can maintain support networks, whether it’s family or friends.”

Rep. Jennifer Carlson, R-Manhattan, echoed Tenenbaum’s message.

“I think that taking care of marginalized people, actually, is our job. And we need to do a good job of it. It needs to be a priority,” she said.

Transferring care of dementia patients from the state hospital in Warm Springs to facilities across the state will also increase oversight, Tenenbaum said.

“The importance of family and family visitation … it’s a set of eyes that we don’t really have at the state hospital because if you’re living in Billings, getting to Warm Springs is a big deal,” he said.

The bill will be closely modeled after legislation passed in 2015 that gradually transferred patients out of the Montana Developmental Center, now known as the Intensive Behavior Center in Boulder.

At the same time, both Tenenbaum and Carlson recognized the bill proposal is a long-term solution and does not directly deal with shortcomings identified in the hospital after an impromptu investigation by the Centers for Medicare and Medicaid Services on Feb. 8.

“When we took people with developmental disabilities out of Boulder and moved them to community-based care that wasn’t easy, or popular or fast. But if we don’t start now … you never get to that end,” Carlson said.

The second bill would increase the oversight role for Disability Rights Montana, a non-profit advocacy group, and would require the hospital to hand over reports of significant events and deaths at the state hospital to the disability rights organization.

“This is an independent way of providing some transparency. We’re not attached to the state; we’re not attached to the federal government,” said Bernadette Franks-Ongoy, executive director of Disability Rights Montana.

Upon completion of the Feb. 8 investigation, CMS said the hospital failed to prevent falls and did not have an adequate COVID-19 plan in place during an outbreak in the facility, which contributed to the deaths of four patients between Oct. 4, 2021, and Feb. 4, 2022, and led to the hospital being put on “Immediate Jeopardy” status, as first reported by the Helena Independent Record.

Among the most startling findings in the report were that Toavs, who was admitted to the hospital as a dementia patient, fell 13 times, with the last fall being fatal. The hospital additionally did not have a COVID-19 infection plan in place, which resulted in COVID-19 positive and COVID-19 negative patients being lodged together and hospital staff simultaneously working in COVID-19 and non-COVID-19 units within the hospital.

According to the report, between Jan. 4 and Feb. 8, 87 of the hospital’s 107 patients at the time — including three who died — and 95 staff members tested positive for COVID-19.

Another hospital failure came to light for the first time on Friday, with a report from Department of Public Health and Human Services Director Adam Meier showing the hospital failed to “demonstrate facility-wide education had occurred specific to the definition of ‘what a chemical restraint is.” But the same report showed that the issue had been resolved by Feb. 25 and was no longer impacting the hospital’s immediate jeopardy status.

The hospital has until March 13 to bring the hospital into compliance with federal guidelines; if it fails, it could lose more than $30 million in federal aid.

Department of Public Health and Human Services Director Adam Meier addressed pitfalls identified by CMS at Friday’s meeting and presented the committee with a corrective plan. The plan included things like tweaking the hospital’s fall risk reporting policies and developing a COVID-19 infection control plan.

“We are looking at this problem, and not just looking to make some sort of invisible high profile move, based on information on, we’re really trying to be strategic about fixing the problem,” Meier told the committee.

DPHHS is also offering $2.2 million for a private contractor to review operations at the hospital and other state-run health facilities. And Meier said within six months of starting the contract, the department will have a “very good strategic path” to address the problems at the state hospital.

But Democratic lawmakers on the committee said they would like to see more urgency from DPHHS in addressing problems at the hospital, like the 50% vacancy rate among staff, the increased use of travel nurses and the lack of adequately trained staff.

“I appreciate everything that’s been talked about so far … but we have an emergency today,” said Rep. Mary Caferro, D-Helena. “If we leave this meeting without doing anything about the emergency today, I think that we’re neglecting our responsibilities of oversight over the Department of Health and Human Services.”

Caferro proposed writing a letter to DPHHS requesting the agency send the national guard to the hospital to help alleviate staffing issues and put in a COVID-19 differential pay, which would the pay for state hospital employees working during the COVID-19 pandemic.

Both proposals were implemented under former Democratic Gov. Steve Bullock’s administration but ended during the administration of Gov. Greg Gianforte, and stakeholders suggested that the measures be put in place at Friday’s meeting again.

“As those COVID-19 differentials expired, employees across the state, not just in Warm Springs, found themselves in a situation where they were making, for example, $4 less per hour than they had previously. But they were actually working under riskier conditions,” said Amanda Curtis, president of the Montana Federation of Public Employees, which represents about 200 state hospital employees. The proposal failed on a 5-5 party-line vote.

The committee will meet again on March 15.

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