Junction City site support may be lacking

From the Eugene Register-Guard, June 26, 2010

The proposed facility in Junction City faces declining support from lawmakers who are worried about the cost

Opponents of a proposed psychiatric hospital in Junction City are gaining traction in their push to scrap it, because of a flagging state budget outlook that calls into question Oregon’s ability to pay the cost of staffing and running the big facility.

Advocates of community-based mental health services have for years been critical of the state’s planned hospital, the smaller of two such institutions that are part of a master plan to replace the 127-year-old Oregon State Hospital in Salem.

A consulting firm hired by the state recommended the two-hospital plan in 2006 to replace the Oregon State Hospital. A majority of legislators voted in 2007 to authorize the state to borrow money for construction of both the 620-bed Salem facility, which is being built and is to open next year, and a 360-bed hospital in Junction City, which is in the planning stage and is to begin operating in fall 2013. The state has since scaled back the Junction City hospital’s size to 270 beds, with a construction cost of $186 million.

Now, with a decade’s worth of state budget shortfalls on the horizon, some lawmakers are increasingly attuned to the arguments from longtime critics of institutionalized mental health care.

“Everybody acknowledges the fiscal reality has changed since the concept of the proposal was first put forward,” said House Speaker Dave Hunt, D-Gladstone.

The operating costs of the Junction City hospital are estimated at $214 million per biennium.

The proposed hospital, with a staff of 1,000 or more, would be good economic news for a county badly bruised by the recession. Lane County area job seekers have swamped the state with inquiries about positions at the Junction City facility.

But the groups Mental Health America of Oregon, National Alliance on Mental Illness (NAMI) and Disability Rights Oregon, along with community-based providers of mental health services, have been meeting with Hunt and other House members, seeking to convince them to reconsider plans for the hospital.

Chris Bounoff, the NAMI Oregon executive director, said the strategy — raising the issue of tight budgets as a reason to stop a facility his group has long opposed — appears to be paying off.

“People are realizing we can’t afford it, so I suspect we’ll be having more conversations about that,” he said.

Advocates, including the two legislators who represent Junction City, say the increased scrutiny is important. Even so, said Rep. Val Hoyle, D-Eugene, it still makes sense to proceed with the facility.

“If this wasn’t needed, I wouldn’t support it,” said Hoyle, whose district includes the future hospital’s site. “There’s no way around the fact that we need the beds and since we need them, Junction City is the right place to build it.”

For now, the hospital continues to have the support of many powerful officials. Senate President Peter Courtney, D-Salem, has been a champion from the start. Gov. Ted Kulongoski maintains his support for the Junction City hospital as part of the state’s comprehensive approach to mental health care, said spokeswoman Anna Richter Taylor.

But Beckie Child, board president of Mental Health America of Oregon, said Hunt and other House members have been receptive to the push to cancel the Junction City facility.

She said a meeting with Hunt gave her the impression that “he gets it.”

“He said if we had a good plan, he’d be willing to take Courtney on,” Child said. “The Senate has taken the lead on this for so long. It’s time for the House to stand up and do something.”

Hunt didn’t dispute Child’s characterization. “There are a large group of House members who have been more interested in getting more engaged in this issue, and they are. Appropriately so.”

Project needed, official says

No one is questioning the need for the new 620-bed hospital in Salem to replace the decrepit Oregon State Hospital. The new facility has roughly the same capacity as the existing one.

But Dr. Bruce Goldberg, head of the Oregon Department of Human Services, said it would be problematic to cancel the Junction City hospital plans. Oregon leases 90 psychiatric care beds in Portland and runs a facility in Pendleton with residential care for 60 mental patients. Both are scheduled to shut down by the time the Junction City hospital opens in the fall of 2013.

The new hospital in Salem won’t be able to accommodate the Portland/Pendleton patients once those 150 beds are eliminated, so the state needs the Junction City hospital, Goldberg said.

He also said the net state cost of operating the Junction City facility will be less than the $214 million projection. The $56 million Oregon currently spends biennially to house and care for those patients in Portland and Pendleton would no longer be spent, so the Junction City facility would only represent a net spending increase to the state of $158 million, he said.

Many of those skeptical about the Junction City hospital say they worry its increased operating dollars will drain money from Oregon’s community-based system of caring for people with mental illnesses.

“I don’t see how, given our budget situation, we can open a new hospital,” said Rep. Sarah Gelser, D-Corvallis. “It does not make any sense to me to fund more institutional settings when we have not adequately funded our community-based system of support.”

Kevin Campbell, CEO of Greater Oregon Behavioral Health, said the state should move away from institutions to more community-based services, such as those his company provides in Eastern Oregon and in Douglas and Clatsop counties.

“Let’s reconsider the Junction City necessity and let’s look at what a right-sized state hospital and care system would look like and ultimately put those dollars into community-based treatment operations, instead of simply sticking them in a state hospital,” he said.

Mental Health America of Oregon’s Child said ongoing problems at the Oregon State Hospital underscore the importance of moving away from the institutional model.

The U.S. Department of Justice is expanding its four-year investigation of patient care at the Oregon State Hospital and the lengthy patient stays there. This month, the state disclosed that five hospital employees were reprimanded for providing inadequate care for a patient who died there last fall.

Forensic patients an issue

Over time, Oregon State Hospital has become the destination primarily for “forensic” patients — those who committed crimes and were either unable to assist in their trial because of mental illness or were found guilty except for insanity.

The movement of these forensic patients from the state hospital into community-based treatment has been slow, limiting the space that is then freed up at the hospital for new civilly committed as well as forensic patients.

The state Psychiatric Safety Review Board holds jurisdiction over these “guilty-but-for-insanity” patients. Because the board’s statutory mission explicitly prohibits it from releasing patients who pose a danger to themselves or others, many of these patients are committed for the full length of their sentences — decades or the remainder of their lives.

That worries both critics of the state’s system and those who run it.

Goldberg said a state panel is examining the possibility of changing the statutory mandate in order to reduce the housing of forensic patients at the Salem and Junction City facilities.

Even if that happens, he said, both hospitals are needed and should not be paid for at the expense of community-based mental health budgets.

Goldberg noted that the master plan drawn up by consultants and being pursued by the state called for both components of Oregon’s system of mental health care to be improved.

“We’ve got to fund both parts of the system,” he said. “We can’t be pitting mental health in one place against the other.”

Goldberg questioned how realistic it would be to create the 16-bed community-based facilities that some hospital critics have called for in place of a large institution. He said neighborhood opposition would be fierce if the state were to site one or two dozen such facilities.

So far, the state has spent or committed about $1.5 million to $2 million for planning, design and other costs related to building the Junction City hospital on a 240-acre state-owned parcel that’s also the planned location for a prison complex.

Junction City’s city administrator, David Clyne, said the state committed to paying $30 million of the city’s $34 million cost for the first phase of adding infrastructure to serve both the hospital/prison site and nearby land the city has for years sought to develop as an industrial park.

When the cost of the wastewater treatment facility is factored in, he expects the state’s overall infrastructure cost to be as much as $50 million, with about $20 million in expenses falling to the city.

Clyne said Junction City was prepared for the possibility that both the hospital and the prison fail to materialize. He cited language in the intergovernmental contract assuring that Junction City’s costs would be shifted to the state if it decides against building its planned institutions.

“We would walk away not happy about losing the two facilities and all those jobs,” Clyne said. “But at least we won’t be responsible for any of the infrastructure development if they don’t come.”