Topeka Problems in recent years at Osawatomie State Hospital have had a ripple effect in communities throughout Kansas, and particularly in Lawrence, as local hospitals and community mental health centers have been forced to pick up much of the slack.
But officials at Lawrence Memorial Hospital and the Bert Nash Community Mental Health Center in Lawrence said Thursday they are not yet convinced that a new proposal to privatize OSH is necessarily the right solution.
“My sense of it is that that isn’t going to really address the practical limitation of funding in behavioral and mental health, either at Osawatomie or more broadly,” said Russell Johnson, CEO at Lawrence Memorial. “So I don’t understand what that really solves, other than it moves the problem out from a governmental oversight and into a private oversight that’s going to be ultimately accountable to the stae anyway.”
Patrick Schmitz, the new CEO at Bert Nash, echoed that sentiment.
“I think it’s going to depend on a number of factors – the company they select; what that contract with the company might look like; and what the oversight for that, within that contract, to ensure that the level of care is going to appropriately meet the needs of the clients they are serving, which are the citizens of Kansas,” Schmitz said.
Osawatomie State Hospital is a 150-year-old institution, and one of the few psychiatric hospitals that the state kept open following a mental health “reform” initiative of the early 1990s.
That’s when the state closed a number of other institutions, notably a large state hospital in Topeka, with the idea that the bulk of all the mental health services provided by the state would be shifted to outpatient settings, through home and community-based services.
Both Johnson and Schmitz are relatively new to their jobs in Lawrence. Johnson came here in August 2016 from the Centura Health System in Englewood, Colo. Schmitz started his job at the Bert Nash center in June after 13 years as the CEO of the Plains Area Mental Health Center based in Le Mars, Iowa.
Both men, however, said the same mental health reform movement was sweeping through other states at the same time. And Kansas, like many other states, may have gone too far.
“With advances in care delivery, with advances in medication, we didn’t need that many beds,” Schmitz said. “But when they did the cuts, they cut too deep without moving the funding over to the community-based providers so they could effectively treat the individuals and keep them out of a hospital setting.”
“We still need some,” he said. “There will always be a need for some inpatient, acute care, crisis beds, because for some people the level of their mental illness at the time they are experiencing a need for hospitalization, it’s severe, and we have to have a place for them to be safe and get effective treatment.”
For the past few years, however, Osawatomie State Hospital has been unable to fill that need, and that has had a direct impact on both Lawrence Memorial Hospital and the Bert Nash Center.
Licensed as a 210-bed facility, OSH experienced severe overcrowding in recent years, forcing the state to limit admissions in 2014 only to those who were involuntarily committed there through a court order. People seeking voluntary admissions since that time have been referred elsewhere, either to non-state hospitals or community-based services.
That move reduced the hospital’s capacity to about 140 beds.
Problems became worse in December 2015 when the federal Centers for Medicare and Medicaid Services decertified the hospital, citing a number of deficiencies affecting patient care including staff shortages, lack of proper training, and physical issues with the facility itself that affected patient safety.
Since then, both Lawrence Memorial Hospital and the Bert Nash center have been directly affected by the decreased capacity at Osawatomie State Hospital.
“We do not have inpatient mental-behavioral health,” LMH’s Johnson said. “In responding to the reality of care delivery in our community, we are doing a lot of things. We have reached out and are building a much closer relationship with community mental health, and DCCCA, which is the addiction and alcohol treatment, with our Federally Qualified Health Center, with the county.”
Johnson said LMH has recently hired additional staff, including a psychiatrist, to help deal with the influx of mental health patients coming through its doors. But he said the hospital is frequently forced to house psychiatric patients for days or even weeks at a time when they come into the emergency room and there is no space available to transfer them to Osawatomie.
Schmitz said the Bert Nash center experiences similar issues. But he it’s the patients themselves who suffer the most from the delay in getting hospitalization.
“Thankfully, as long as we keep them in a safe environment, they are likely to not have a catastrophic event such as, let’s say we delay heart surgery or something like that,” he said. “But it does delay their recovery from that psychiatric condition, which then sometimes can result in an even longer time to recover because illness just gets worse and worse, and so it takes longer for them to get onto that path of recovery.”
Since CMS’s decision to decertify Osawatomie State, the Kansas Department for Aging and Disability Services, which is responsible for the hospital, has taken several steps in an effort to regain certification for at least part of the facility.
In effect, KDADS has divided OSH into two separate institutions: a 60-bed acute care facility that the state hopes will be recertified; and a 90-bed “licensed” facility that can accept other, non-Medicare or Medicaid patients.
KDADS announced recently that the 60-bed acute care facility recently passed an initial inspection by CMS, and the agency hopes it will be recertified before the end of this year.
But KDADS Secretary Tim Keck said this week that he is seeking a longer-term solution for the management of Osawatomie State Hospital, and he is proposing to contract out with an outside, for-profit company, Correct Care Solutions based in Nashville, Tenn., to manage the facility on an ongoing basis.
“I guess I don’t really understand,” Johnson said. “It sounds like we’ve got a problem, we’re not sure what we’re doing, we’re not sure how to deal with it, we’d rather just lay it off. But I don’t really see how the privatizing of it addresses the underlying challenges in mental health that are manifesting themselves at Osawatomie.”