Budget woes jeopardize Oregon State Hospital reform

From the Salem Statesman Journal, March 19 2009

Adequate staffing — as many as 1,000 new workers — is seen as crucial to success

The chronically overcrowded and understaffed Oregon State Hospital has added 300 new employees in the past year, spurring notable improvements in patient care at the much-criticized psychiatric facility, OSH Superintendent Roy Orr said.

Oregon State Hospital

Oregon State Hospital

Now, the 2009 Legislature faces a thorny question: Can the financially-strapped state afford to add hundreds more workers in the coming 2009-11 budget period, which begins July 1?

And if a massive staffing infusion doesn’t materialize, will that cripple ongoing reform-minded efforts at the existing 126-year-old facility, as well as a planned $280 million replacement facility? The new 620-bed complex, described by state leaders as a world-class facility, is scheduled to open next year and become fully operational in late 2011.

By all accounts, adequate staffing looms as crucial for the hospital’s success. But stark budget realities will make it difficult for legislators to come up with enough money to pay for the kind of staffing infusion — anywhere from more than 500 to nearly 1,000 new employees — deemed necessary by Orr and other officials.

The issue will start to draw sharper focus today when Orr gives testimony before legislative budget writers.

As it stands now, the state hospital employs about 1,300 workers at its campuses in Salem and Portland.

Gov. Ted Kulongoski’s recommended 2009-11 budget earmarked $43 million for state hospital staffing, far below the $124 million outlined last November in a proposed budget package unveiled by Orr and the state Department of Human Resources.

If legislators go along with the scaled-down staffing level recommended by the governor, Orr said the hospital would be able to hire about 540 new employees in the upcoming two-year budget period. That’s far below the nearly 1,000 positions Orr previously deemed necessary to provide the kind of patient care demanded by the federal Department of Justice, which harshly criticized hospital care and conditions in January 2008.

“It was reduced given the condition of the economy and the state budget,” Orr said, referring to the governor’s proposed funding level. “We’re certainly not isolated from those things.

“We still don’t know what the Legislature will approve. I don’t want to jump to any conclusions. I just feel at this point that it will be a challenge for this organization to deal with the opening of the new hospital with a reduced number (of staff) as exists in the governor’s recommended budget. But it all depends on what the Legislature ultimately approves.”

Senate President Peter Courtney, D-Salem, said hospital staffing remains a high priority but he can’t make any promises about specific increases for 2009-11.

“We are in a heck of a crisis,” he said. “I’m scared to death because of what’s coming in May with the new (revenue) forecast. I’m frightened. I’m worried.”

Where does that leave state hospital staffing?

“I can’t give you the numbers or the exact way we’re going to do it, but I know we’re committed to keep trying to make progress,” Courtney said. “I’ve just seen the beautiful drawings of what they hope the new hospital is going to look like. But if you don’t have enough staff, then we probably won’t be any better off out there than we’ve been before.”

The Legislature previously agreed to spend $458 million to replace the dilapidated hospital in Salem and build a second hospital in Junction City. The state will use bonds to finance construction of a 620-bed hospital in Salem and a 360-bed hospital in Junction City, which is scheduled to open in 2013.

State funding for additional hospital staffing in the 2009-11 budget period, which starts July 1, would come from the general fund budget.

Concerns about potential costs for state hospital staffing have been simmering since Orr told legislative budget writers in November that the Department of Human Services intended to request $124 million to hire nearly 1,000 new employees in 2009-11.

At the time, legislators used words such as staggering and sobering to express their reservations.

Since then, the deepening economic recession and its toll on the state’s finances have intensified doubts about the state’s ability to pay for hundreds of additional therapists, nurses and support staffers.

In recent talks, state officials have discussed the possibility of taking a longer-term funding approach to state hospital staffing. Under one scenario, the kind of staffing envisioned by Orr would occur in phases, with partial funding in the 2009-11 budget, followed by another round in the 2011-13 budget.

Courtney estimated that it could take multiple two-year budget cycles to reach the staffing levels sought by the hospital.

Orr said it’s too early to say how staggered infusions of extra staffing might effect operations, patient care and safety at the new psychiatric hospital.

Orr said the hospital sorely needs more workers before the new hospital opens.

Large staffing increases are necessary to reduce the hospital’s enormous reliance on employee overtime — voluntary and mandatory, Orr said. The hospital currently is on track to spend about $25 million in overtime pay during the 2007-09 budget period, which ends June 30.

Without adequate staffing, he said, “we’ll just forever rely on overtime, and we know how expensive and in some cases how dangerous that can be.”