The state health department has more than doubled the funding and extended the deadline for a contract proposal to get new management to run its health care facilities.
While the department acknowledged last year part of the reason for the contract was to have someone address problematic staffing shortages at facilities like the state psychiatric hospital, it also said the contract was meant to find someone to oversee the consolidation of all its health facilities under one division within the department.
The Montana Department of Public Health and Human Services initially put out a request for bids in late November, offering a third party a $1 million contract. Now that's up to $2.2 million, with an extended deadline to apply until Jan. 26. The department posted the increased amount online two days after the initial proposal period closed.
The contracted management would be in place for 16 months, from Feb. 15 through June 30, 2023, when the department expects to hire someone into the new position full time.
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Spokesperson Jon Ebelt said the department extended the timeline "due to several rounds of vendor questions." The department increased the funding, he said, to allow the bidder additional flexibility to bring on human resources and support staff.
Because the period for submissions is still open, Ebelt declined to provide any further information on the applicants, or whether any applied.
Montana State Hospital is among the most plagued of the department's facilities, with 40% of its 524-person staff currently vacant. One potential contractor asked the department on Dec. 6 through the state contract procurement website if the 210 vacant positions are, in fact, fully funded. They are, however, "many of these functions are being performed by contracted staff at a more expensive rate," the department responded.
In December, staff told the Montana State News Bureau the exodus from the state hospital was due to an unresponsive and inadequately trained administration. Staff shortages, they said, have put employees and patients at risk.
Ebelt previously told the Montana State News Bureau the state hospital had been found to be in compliance after a survey conducted in September, and that no correction plan was required of the facility. But the September survey, which became public last week, found four deficiencies, one of which the report said could have been tied to a patient's death in August.
The September inspection of the facility found:
- An in-house investigation failed to determine whether neglect played a role in a patient's death in August. The in-house investigator, identified as "staff member B" did not interview staff about the death, failed to maintain their records of the investigation and video footage from the building on the date of the patient's death was no longer available because it had been "accidentally recorded over by other video footage."
- Staffing was below the levels needed to prevent patients from falling. A review of the facility's log showed patients fell 113 times between June and August. Staff failed to notify a medical provider of a patient who had fallen; a medical provider later found he had broken his hip.
- Employees reported staffing documentation was "not accurate," and did not list patients whose needs required one-on-one attention from staff. That alleged alteration to the records "made the schedule look pretty," an employee told inspectors.
- A patient's family or representative had not been notified of several incidents in which the patient had fallen.
- Staff failed to revise care plans for a patient who had fallen several times.
Sen. Mark Sweeney, a Democrat whose district includes the state hospital, has been hearing from hospital staff for months about the festering work conditions there. He said the report that became public last week was not surprising.
"Everything that was in that report has been expressed to me," he said in a phone interview Friday. He also rejected any notion that the workforce issues are a symptom of the pandemic era in health care settings.
"The problems have been there long before COVID," Sweeney said. "And I believe it's management-related and it's been exacerbated by COVID. … It's beyond a shame, it's been a travesty that we have lost that many long-term employees."
Ebelt has not yet responded to questions about how the hospital could both be in compliance and found to have deficiencies in the CMS report, but the survey lists no corrective plans for the deficiencies found by inspectors. The Montana State News Bureau emailed the Centers for Medicare and Medicaid Services asking why such deficiencies would be allowed without a plan to correct them; a return email said responses would not be available until next week.
The state legislative health and human services committee has set aside time during its Jan. 21 hearing to hear from Sweeney, as well as Jeremy Hoscheid, the Mental Disabilities Board of Visitors executive director, which represents patients of the state hospital; and Robin Haux, labor program director at the Montana Nurses Association, the largest nurses' union in the state. Following the panel on the state hospital "staffing and patient care concerns," the committee will question DPHHS Director Adam Meier. The committee has oversight over the department. Rep. Ed Stafman, who chairs the committee, previously told the Montana State News Bureau he had asked Meier to look into the concerns from staff elevated to the committee by Sweeney.