Report on state hospital cuts beds

From the Eugene Register Guard, January 19, 2011

Planners say a smaller psychiatric facility in Junction City is needed

A new forecast Tuesday said a psychiatric hospital is still needed in Junction City, but it should serve fewer than half the number of patients called for in the original plan.

The report, issued by the state Department of Human Services, comes as critics of institutionalized care are trying to persuade the Legislature to kill plans for the hospital in favor of more residential treatment facilities dispersed throughout the state.

The report said the hospital should be built to accommodate 174 patients, down from the original recommendation of 360 beds.

The state recently opened a 620-bed replacement for the Oregon State Hospital in Salem. It is preparing the Junction City site for construction next year and completion in 2013. State hospital administrators last year estimated the Junction City hospital would create about 1,200 jobs, including about 705 nursing positions. The new forecast calls for 522 full-time-equivalent employees to serve a smaller patient population.

Last year, state hospital planners said they would reduce the Junction City facility’s capacity to 270 beds. But then, as now, they said it wasn’t feasible to scratch it altogether because of the continued need for a secure, institutional setting for some patients, as well as the need to replace facilities going off line in the near future in Portland and Pendleton.

“It’s a smaller hospital than was originally anticipated. It has some case load growth built into it, but it’s mainly replacing existing facilities,” said Richard Harris, administrator for the state’s Addictions and Mental Health Division.

Critics of the hospital have said the state won’t be able to afford to operate it. Oregon’s general fund revenue is in free-fall and projected to be 20 percent, or $3.5 billion, short of meeting 2009 service levels in 2011-13.

Harris said the Junction City facility wouldn’t operate until the next biennial spending cycle and noted that its operating costs don’t drastically exceed what the state already spends for a smaller number of patients. The state’s lease of hospital space in Portland for 92 patients expires in 2015 and it is planning to stop using the Blue Mountain Recovery Center in Pendleton for 60 beds because that facility requires extensive rehabilitation to continue operating.

According to Tuesday’s report, the $101 million biennial cost of operating a scaled-back hospital in Junction City is $11 million beyond the cost of continuing with those two facilities after increasing staffing levels to meet U.S. Justice Department standards.

The Junction City facility’s patient numbers would fall for three reasons:

The overall number of beds forecast to serve people with mental illnesses through 2030 is down by 52, from the 1,012 forecast using an older methodology in 2005 to 960 using what officials consider a more accurate approach of projecting the number of patients requiring residential treatment.

The state thinks it could serve 70 older patients in community-based facilities, rather than at the Junction City hospital.

Officials expect to have bed space in secure treatment facilities for 64 patients who committed crimes but were either found “guilty but for insanity” by the courts or did not stand trial because they were unable to assist in their defense.

The new study examined alternatives to a scaled-down Junction City facility, but said they were not feasible. One alternative included building multiple 16-bed hospital and secure residential facilities — the 16 beds would allow each facility to qualify for federal Medicare and Medicaid dollars — but the added expense of separate administration would fail to provide cost-effective services, the report said.

Chris Bouneff, Oregon director of the National Alliance on Mental Illness, said Oregon should not be planning a second hospital in the southern Willamette Valley, in part because the larger Salem hospital it supported already is too far from the state’s population center in and around Portland.

“It seems like this is driven by politics rather than clinical care and clinical outcomes,” said Bouneff, noting that originally officials did not describe the Junction City facility as a replacement hospital as they are now in pressing their case.

Rep. Sara Gelser, a Corvallis Democrat and one of the Legislature’s leading skeptics of a Junction City psychiatric hospital, said she is “still not on the Junction City bandwagon, but this demonstrates a real thoughtfulness and a move in the right direction.”

Rep. Val Hoyle, a Eugene Democrat with Junction City in her district, said the report won’t end the debate about the planned hospital, but does underscore her point of view.

“This makes it clear that this facility is badly needed,” Hoyle said. “And since we do need it and it’s going to be built, I want it built in Junction City where these much-needed jobs will help my communities.”