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State hospital budgets in trouble

By Dave Ranney | April 07, 2008

By Dave Ranney
KHI News Service

TOPEKA, April 7 The state"s hospitals for the mentally ill are running out of money.

"Being over census has taken its toll on our budget," said Greg Valentine, superintendent at Osawatomie State Hospital. "Our outside medical costs are up, our pharmaceutical costs are up, our food costs are skyrocketing. Those are things you cannot avoid you have to feed people, you have to medicate people."

"I"ve been here seven years and this is my toughest year yet," said Larned State Hospital Superintendent Mark Schutter.

"We"ve had to go to a hiring freeze because there just isn"t any money in the budget," he said. "We have 100 full-time positions being held vacant; that"s the most we"ve ever had and we"re projecting another 13 vacancies a month between now and July 1."

The hospitals care for seriously mentally ill adults who are considered a danger to themselves or others.

In recent months, the hospitals have been operating at or over their licensed capacities: 465 beds at Larned, 176 beds at Osawatomie.

"We"re at 195 this morning," at Osawatomie, Valentine said Monday. "We had 32 admissions over the weekend. If that"s not a record, it"s close to one."

Valentine also oversees Rainbow Mental Health Facility, a 50-bed unit in Kansas City, Kan.

The 79-bed adult psychiatric unit at Larned had 90 patients Monday. The hospital also houses a youth and adolescent facility, a security hospital, and a sex predator unit.

Patients are referred to the hospitals by community mental health centers throughout the state; some are court-ordered referrals.

"Osawatomie had 18 admissions yesterday," Valentine said. "Our average is 6.5 admissions a day. We"re reeling."

When the hospitals are at or over capacity, employees often are expected to work 16-hour shifts.

Late last week, because of the budget pressure, Valentine notified Osawatomie"s 429 full-time employees that effective next week they would not be paid overtime; instead, they would receive "comp time."

"If I keep paying overtime, I"m going to blow my budget," he said. "We"re just out of money, basically."

Schutter said Larned workers have been on "comp time" since October.

"The bad thing about comp time is that it"s so temporary," Schutter said. "When somebody puts in eight hours of overtime, you have to give them 12 hours off at some other time. So you"re robbing Peter to pay Paul to get to you to the end of the fiscal year."

Employee morale, too, has suffered.

"It takes a lot of patience to work with mentally ill people all day," said Kristy Paden, a direct care worker at Osawatomie. "At the end of a 16-hour shift, that patience isn"t always there. There"s a fatigue, a kind of irritability that sets in."

In the current fiscal year, which ends June 30, Larned is expected to spend $54.7 million; Osawatomie, $25.5 million.

In her proposed budget for fiscal 2009, Gov. Kathleen Sebelius included no additional staffing for either hospital though both were expected to incur slight increases in their average daily censuses.

As it turns out, the recent increases in cases have not been slight.

"Our average daily census is around 165," Valentine said. "So far this fiscal year, it"s right at 171. But that"s not the problem the problem is the spikes in admissions. Right now, between Osawatomie and Rainbow, we"re projecting 2,900 admissions; last year, that number was 2,641. That"s about a 10 percent increase. It"s unreal."

Larned, too, is experiencing a 10 percent increase in admissions.

"What"s killing us is outside medical costs," Schutter said. "We have a fair number of long-term patients and for whatever reason a number of them have had to go outside the hospital for things like cancer and heart disease to the tune of hundreds of thousands of dollars a year. We have no way to control that."

Neither superintendent could explain why they"re receiving more patients.

"I have no idea," Valentine said. "I wish I did."

Legislators aren"t expected to vote on the hospitals" budgets until omnibus, the major spending bill that usually isn"t finished until the wrap-up session"s final hours.

"We"re looking at more money to address the staffing issues at Larned and Osawatomie," said Senate Ways and Means Committee Chairman Dwayne Umbarger, R-Thayer. "We keep asking more and more from the facilities and more and more individuals are receiving services, so we need to the provide the FTEs to provide those services."

Department of Social and Rehabilitation Services Secretary Don Jordan said he was monitoring the hospitals" budgets.

House and Senate budget committees last week added about $900,000 to the Larned hospital"s budget and put up $1.5 million needed to staff a 30-bed unit at Osawatomie that"s due to open by Jan.1, 2009.

"We"re assessing the situation in light of the conference committee"s action," Jordan said.

The Legislature"s first adjournment was Friday. House and Senate budget committees return April 21 and April 23, respectively. The Legislature reconvenes April 30.

Raw nerve

Mental health advocates have spent much of the session trying to call legislators" attention to the growing need for additional hospital beds.

For them, the hospitals" budget woes come as no surprise.

"The overcapacity and understaffing issues really expose a raw nerve when it comes to the inadequacies of the services that are so sorely needed," said Rick Cagan, executive director for the National Alliance on Mental Illness-Kansas.

"I have to wonder what this is leading to," he said. "When you"re short-staffed and your people are pulling double shifts, that"s not good for morale and at some point that"s going to have an impact on the quality of services you"re providing.

"I can"t help thinking some subtle pressures are taking place to get people out the back door, back into the community, sooner than they"re ready," Cagan said. "That"s not good."

-Dave Ranney is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at dranney@khi.org or at 785-233-5443, ext. 128.