Montana State Hospital $17M over budget

New state health director does not plan to regain federal reimbursement
State Capitol
Posted at 5:08 PM, Aug 29, 2022

HELENA — The Montana State Hospital was $17 million over budget and elderly patients with dementia and severe mental illness are still sometimes held four to a room, according to testimony Friday from the new director of the state health department.

The Children, Families, Health and Human Services Interim Committee met for the last time before the 2023 Legislative Session to vote on what proposed bills it would introduce next year. The hearing was also the first time the committee heard testimony about the Montana State Hospital from Charlie Brereton, the new director of the Montana Department of Public Health and Human Services.

Lawmakers from both parties criticized what they saw as Brereton’s lack of action to correct conditions at the Montana State Hospital. State Rep. Danny Tenenbaum, D-Missoula, confirmed the hospital was still allowing the practice of holding multiple geriatric patients to a room in the Spratt Unit, where older patients with dementia and severe mental illness are placed.

Getting these patients into single rooms should be the number one priority for improving patient care at the state hospital, Tenenbaum said.

“Four dementia patients, in one room, is unacceptable,” Tenenbaum said. “It’s dangerous.”

Lawmakers also criticized Brereton for what they called his refusal to increase provider reimbursement rates for nursing homes in the state. Brereton said the department did not have the power to increase rates without the legislature.

Rep. Jennifer Carlson, R-Manhattan, said she disagreed with Brereton’s approach of the problem.

“Somehow we are finding a way to pay $855 a day at a state facility,” Carlson said. “And one of the reasons we have been told we need to put a patient with dementia in the Spratt Unit of the mental health facility is because they don’t have a placement at a nursing home in their community.”

The Montana State Hospital is the sole public psychiatric hospital in the state. After failing to meet basic health and safety standards for patients, contributing to at least four patient deaths, the U.S. Centers for Medicare and Medicaid Services pulled the hospital’s federal accreditation this Spring.

Without accreditation, the hospital cannot receive federal reimbursement funds, which means the hospital will miss out on about $25 million in funding over the next two years, according to committee Chairman Rep. Ed Stafman, D-Bozeman.

“Do I have those numbers right,” Stafman asked Brereton at the hearing. “Are Montana taxpayers really going to be on the line for an additional $25 million at a minimum before we seek recertification, if we even do that?”

Brereton confirmed the accuracy of the numbers and did not commit to seeking recertification. At minimum the process to regain certification would take at least two years to complete. Brereton denied rumors his department planned to privatize the hospital.

Hospital staffing was at about 45 percent, according to a July report by Alvarez and Marsal, a firm DPHHS hired to do a comprehensive assessment on the seven state-run health care facilities. However, Montana Federation of Public Employees Deputy Executive Director Quint Nyman said morale is improving among employees at the Montana State Hospital. Unionized hospital employees are under the Montana Federation of Public Employees.

Lawmakers also voted 6-4 to introduce a bill in next year’s session that would make significant changes to child abuse and neglect laws in Montana. Tenenbaum voted with Republican legislators to propose the bill in the next session.

If passed, the bill would require a warrant from a judge for most child removals and shorten timelines for initial court appearances after removals. In response to opposition to the bill, Tenenbaum pointed to a 9th Circuit Court of Appeals case, which said removal of a child without a warrant violated the Fourth Amendment.

Correction: This article was updated to better reflect DPHHS Director Brereton's comments on recertification of the Montana State Hospital.