Legislature approves staffing boost at Western State Hospital

A state budget deal contains enough money to add 51 nurses at Western State Hospital, where thin staffing has factored into unsafe conditions.

It’s one of several steps the Legislature took to grapple with problems in the mental health system just before adjourning its work 19 days late.

The Democratic House and Republican Senate approved an operating budget with money for staff and a capital budget that would fund construction of facilities, plus a package of policy changes at state hospitals.

Lawmakers sent each of the measures to Gov. Jay Inslee on Tuesday.

“There was a ton of attention paid particularly to Western State and the problems at Western State,” said Sen. Bruce Dammeier, R-Puyallup. “We are in a situation of crisis out there and the Legislature has to weigh in to help that ship get righted.”

Investigators looking into patient deaths and an assault on a restrained patient put the Lakewood psychiatric hospital on notice last year that it was violating regulations, but have repeatedly extended the deadlines to meet standards or lose federal funding.

On Tuesday came another reprieve, pushing the deadline to May 3.

Western State has struggled to hire and keep employees, with vacancies in hundreds of positions.

To lure professionals, Inslee’s administration provided bonuses of $2,100 for certain nurses and pay raises of 10 to 15 percent for doctors, psychologists and social workers.

The Legislature agreed to provide $10 million for those raises and bonuses and another $6.8 million for Democrat Inslee’s proposal for 51 extra nurses, who would work on day and evening shifts.

As many as 99 staff positions could be added at the two state psychiatric hospitals through an “innovation fund” lawmakers created and filled with money to be awarded by the governor’s budget office, but that money could be put to other uses.

In addition to adding staff, lawmakers agreed to require Western State to move 30 patients with dementia and brain injuries into long-term care facilities.

Together, the changes could leave more employees handling fewer patients.

A staffing report shows Western State has fewer nurses and nursing assistants working on a typical shift in a ward than does Eastern State Hospital near Spokane, though a ward at Western State has more patients.

The Legislature called for both hospitals to use the same staffing model, one that takes into account the severity of patients’ mental illness.

“They need to develop that model because one of the challenges for we legislators ... it’s unclear to us if 51 nurses is the answer, or 150, or 24,” said Rep. Laurie Jinkins, D-Tacoma. “I don’t disagree that we’re understaffed, but I have no idea really by what magnitude.”

The staffing model would have to include a role in treatment for nurse practitioners with advanced degrees, who could do some of the same work psychiatrists do now.

Doctors have opposed that idea, saying the nurses don’t have enough specialized training.

As they hammered out a supplemental budget for the next year, lawmakers didn’t increase the total amount of operating money to be spent on mental health. They kept it about the same as in the two-year budget they wrote last year.

But they moved around money that had gone unspent after safety problems scuttled a Western State expansion meant to satisfy court orders for speedier treatment.

They also scooped up money from reserves freed up because of changes at a Southwest Washington mental health agency. Clark County lawmakers largely opposed the budget and Rep. Sharon Wylie, D-Vancouver, criticized it on the House floor for “shortchanging our community systems.”

Other budget items or policy changes on mental health approved Tuesday include:

▪ A committee and consultants to recommend improvements at the state hospitals.

▪ A requirement for a plan on how mental-health agencies might be allowed to spend money now used for hospitalization on alternative treatment.

▪ Mobile crisis teams and housing teams.

▪ More than $3 million worth of construction projects at Western State.

▪ Design of an 18-bed addition to the children’s treatment center that shares a campus with Western State.

▪ $2 million for renovation that is wrapping up to build a treatment center for criminal defendants in Grand Mound.

▪ More than $12 million in grants for construction of community facilities.

▪ $6 million for housing for people with severe mental illness, including $1.5 million that Pierce County could tap only if it joins other large urban counties in imposing a sales tax of one-tenth of 1 percent for local mental health services.

This story was originally published March 29, 2016 at 6:07 PM with the headline "Legislature approves staffing boost at Western State Hospital."