The federal government has pulled $53 million a year and certification from Western State Hospital after the state-run psychiatric facility in Lakewood failed a recent inspection.
The loss of funding comes two years after Western State promised federal regulators it would make enough safety and quality of care improvements to meet their standards.
"Despite improvements, Western had not achieved substantial compliance," according to a letter to state officials from the federal Centers for Medicare and Medicaid Services.
It is not immediately clear which specific parts of the federal inspection Western State failed. The letter states the hospital was not compliant in general areas such as "nursing service" and "physical environment."
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The 857-bed hospital has struggled for years to upgrade aging facilities and reduce assaults on patients and staff, long wait times for admission and discharge, patient escapes and staffing shortages. The problems were exacerbated in the wake of budget cuts during the Great Recession.
Over the last five years, the state has dumped hundreds of millions of dollars into revamping Western State and Washington's mental health system, and leaders have pushed for even greater reform at the hospital. But there has been little progress on the key part of that reform: Moving hundreds of civil, or noncriminal, patients out of the hospital and into community settings.
Starting July 9, Washington will be forced to pick up the extra $53 million a year after losing certification, which makes up roughly 19 percent of the hospital's budget, according to the Department of Social and Health Services.
"The Legislature has invested millions and millions of dollars and poured it into Western State Hospital to try to help that facility to be able to be a safe place for workers and for patients," said state Rep. Laurie Jinkins, a Tacoma Democrat heavily involved in mental health reform. "And the feds just told us today we have not achieved that."
Kelly Stowe, a spokeswoman for DSHS, said the agency can reapply for certification, but won't do so until the state addresses concerns raised by federal regulators. Jaime Smith, a spokeswoman for Gov. Jay Inslee, said the state should be able to foot the bill for the lost money until lawmakers return to Olympia in January.
Faced with significant issues at Western State, legislators have been pushing to move most patients who are not involved in the criminal justice system to community settings around Washington. The hospital currently has beds for about 580 civil patients at a time and about 270 for forensic patients getting treatment as part of the criminal justice system.
State officials contend that civil patients are better served closer to home and that the change will free up space to ease enormous wait times faced by forensic patients. The state has been slapped with millions in fines for not giving timely mental health services to criminal defendants.
Inslee recently set a five-year deadline to complete this push, which lawmakers have angled for since at least 2017.
Despite bipartisan support for the concept, progress has been sluggish. Few beds have opened up to serve patients who would ordinarily get treatment at Western State, and community hospitals have been slow to take those patients.
[Do you have a loved one at Western State Hospital? We'd like to hear from you: https://goo.gl/QCKV71]
State Rep. Eileen Cody, a Seattle Democrat who chairs the House Health Care and Wellness Committee, said it takes a while for hospitals to complete necessary renovations to treat psychiatric patients and added there is a shortage of mental health workers.
Cody said she hoped the new Behavioral Health Hospital being built by CHI Franciscan and MultiCare in Tacoma would serve some civil patients who need the long-term treatment. Efforts to reach a spokeswoman for the hospital project were not immediately successful.
Inslee has proposed building some state-run facilities to take psychiatric patients, which could also take years to get up-and-running. He has not offered concrete plans for how to pay for the transition at Western State, but first argued for the transition in 2016.
In the meantime, many civil patients have been languishing — stuck waiting to get into the hospital and stuck waiting to get out of the hospital.
Civil patients typically wait about 100 days to get into Western State. Roughly 40 percent of civil patients actually in the hospital are ready to be discharged, but can't leave since there is a lack of proper places to discharge patients who often need some level of ongoing treatment.
Jinkins said the CMS ruling creates more urgency for the the Legislature to move quickly. While she said lawmakers have been "interested" in building community placements for patients who are involuntarily committed as part of the civil mental health system, "we just don't end up seeing the beds in as timely a fashion as we'd like to."
"With the news from the federal government, that’s something that’s going to be unacceptable in the future," she said.
Inslee also said the federal sanctions represent an opportunity to push forward on creating community beds for civil patients outside of Western State. Explaining why Inslee's plan has not yet been realized, Smith said while there has been a "sustained push" and a chunk of money going toward Western, there have been other priorities, such as court-ordered education funding that the state has needed to address.
"It’s a very heavy lift," she said. "Just like education, sometimes the progress is a lot more incremental than you want it to be or than it should be. But we have made progress."
State Sen. John Braun, a Republican from Centralia, said in a statement the CMS decision also reflects managerial problems at Western State and in the governor's office. Inslee was in Iowa this weekend campaigning with Democrats since he is the chairman of the Democratic Governor's Association.
Last session, Braun pushed for a public vote on $500 million in bonds to pay for mental health construction. It was not approved by the Legislature.
"While the loss of federal funding is incredibly problematic, today’s announcement should come as no surprise given the years of warnings and failure of the hospital’s leadership to correct a host of problems," he said.
On top of its woes with the federal government, Western State is currently without a permanent CEO. The hospital's acting CEO, Marylouise Jones, announced her departure on June 8. Jones replaced Cheryl Strange, who was promoted to lead DSHS.
Strange took over from Ron Adler, who was fired in 2016 when two men, one accused of murder, escaped from the hospital.
"We need real results for our most vulnerable friends and neighbors, not empty promises," Braun said.