Staffing and leadership problems continue at Montana State Hospital

Nearly two years after losing federal certification, the state’s adult psychiatric hospital in Warm Springs is facing leadership shakeups and turnover of medical providers and key staff. That’s according to new reporting from the Montana Free Press. Employees there are raising concerns about patient care, shifting standards and hostility from administrators.

Austin Amestoy So, MTPR listeners have heard about safety issues and staffing shortages at the Montana State Hospital since it lost certification from federal regulators back in 2022. What have you been hearing from employees about the current working environment there?

Mara Silvers So we spoke with more than a dozen current and former hospital staff for this story, including many medical providers, and what they described is basically turnover among top staff. So the hospital's long time chief medical officer and forensic psychiatrist, Doctor Thomas Gray, was put on administrative leave in December for unknown reasons. And the state health department told us on Wednesday that he is no longer a state employee. But they wouldn't say why. Other psychiatrists and advanced practice nurses have put in their resignation in the last three months, along with other key staff members. And what we've heard is that the Gianforte administration's push for regaining federal certification has created mandates from administrators and consultants in Helena that the staff feel are impossible to fulfill and in some cases, not good for patient care.

Austin Amestoy Hmhm let's unpack those mandates for a second. What are some examples of policies that have changed under the hospital's interim CEO, Jennifer Savage? And why are providers alarmed?

Mara Silvers The biggest thing we heard about consistently was that doctors and nurses are being strongly discouraged from ordering 1 to 1 staffing for patients, and that's just a fancy term for direct supervision. So providers say that even though it is a drain on resources, it's an essential tool for patients who are at risk of hurting themselves, falling or hurting other people. Providers are also now restricted from reviewing security footage after patient incidents, and they've been required to dramatically increase how often they write notes about patient progress. And because of the technology troubles at the hospital, that documentation is often handwritten and done without the help of dictation or transcription services that are pretty common in other health care facilities. Providers have brought up those concerns and plenty others. During April, staffing meetings with administrators and recordings of those meetings were obtained and reviewed by the Montana Free Press for this reporting.

Austin Amestoy Mara, you mentioned earlier the Gianforte administration's objective with a lot of these changes is regaining federal certification from the centers for Medicare and Medicaid as soon as possible. Remind us what exactly has to change for that certification to be regained at the hospital?

Mara Silvers Yeah, the state has put some things in place that are required for certification. They've created a governing board for the hospital medical committees and a more formal grievance process, among other things. But above all, CMS needs to see that patients at the hospital are safe, that they're being adequately attended to and cared for. Documentation needs to be solid. Providers should only be using seclusion or restraints as as a very last resort, that type of thing. The Gianforte administration has said that it wants to apply for certification by January of 2025, and if their application is approved, the hospital would also need to go through a probationary period and then would be periodically reviewed for compliance every year after that.

Austin Amestoy How has the state health department responded to the concerns from staff you're highlighting in your reporting?

Mara Silvers Yeah. State Health Department Director Charlie Burton held a pretty firm line in the statement that he gave us. He defended Jennifer Savage, the interim CEO, as an important change agent for the hospital, and he said that the facility was undergoing a significant cultural, clinical and operational transformation after decades of neglect from previous administrations, in his words. And he ended by saying that difficult decisions are being made and new found. Accountability isn't always popular, but the state really values patient safety and care and puts it above all else.

Austin Amestoy Well, we always appreciate having you on to share your reporting, Mara. Thanks for being here today.

Mara Silvers Thank you, Austin. Thanks for having me.