Oregon State Hospital: Budget and opponents throw up obstacles

From the Eugene Register Guard, March 20, 2011

Junction City mayor David Brunscheon stands next to the site of the proposed state prison and mental hospital.

Junction City mayor David Brunscheon stands next to the site of the proposed state prison and mental hospital.

Plans to build a long-promised state psychiatric hospital in Junction City are facing more opposition than ever in the Legislature.

The state budget shortfall, human rights concerns and scrutiny by the U.S. Department of Justice are among the reasons opponents want the state to cancel the project.

The hospital still has many powerful backers in the Capitol, including Senate President Peter Courtney, D-Salem, and House Co-Speaker Bruce Hanna, R-Roseburg.

Gov. John Kitzhaber continues to support it, his press secretary Christine Miles said, but he also is involved in discussions about the future of the state’s mental health care system as a whole.

“We’re evaluating all options statewide to find what is the best solution,” Miles said.

In 2007, after controversies surrounding Oregon’s treatment of the mentally ill, lawmakers approved a $458 million plan to build two new hospitals — a 620-bed facility in Salem and a 360-bed facility in Junction City — to replace the dilapidated Oregon State Hospital in Salem.

The new Salem psychiatric hospital will be completed this year. Work to prepare the state-owned site in Junction City for both the hospital and its proposed sister facility, a state prison, began in 2008.

By July, the state will have spent $24.8 million on infrastructure in Junction City, and by October, the state’s tab for design and other preliminary work for the hospital will hit $24.1 million, project administrator Linda Hammond said.

Last month, the governor’s proposed 2011-2013 budget cut the Junction City facility to 174 beds, based on a revised forecast of bed need by the Department of Human Services.

Kitzhaber’s 2011-2013 budget originally covered all of the remaining construction for the smaller Junction City facility — $83 million — which would have allowed the hospital to be built and open by the fall of 2013.

But in the past few weeks, the governor has proposed shifting $50 million of those construction costs to the 2013-15 biennium, the legislative fiscal office says. That translates into a construction delay.

But it doesn’t mean the governor is wavering, Miles insisted. “We are simply adjusting the timing,” she said.

A debate over cost, care

Opponents this session want to halt construction completely and protect future state budgets against the estimated $101 million per biennium costs of staffing and operating the 174-bed Junction City facility.

Rep. Carolyn Tomei, D-Milwaukie, said that given state government’s gloomy revenue forecasts, Oregon won’t be able to afford a second big psychiatric hospital. “My concern is that we would have a new hospital but never have the money to staff it,” she said.

Even legislators who still favor constructing the Junction City hospital admit they are concerned about fitting the operational costs into future state budgets. Each patient treated in an institutional psychiatric setting costs the state more than $200,000 a year, the Oregon Health Authority says.

“We don’t want to pass off funding of an empty institution to the next Legislature,” Hanna said.

“We don’t have endless amounts of money to throw at this,” said Rep. Tina Kotek, D-Portland.

But Rep. Val Hoyle, a Eugene Democrat who represents Junction City, argues that the operating costs of the 174-bed Junction City hospital would only represent a relatively slight increase in net state spending if the state carries through on its plans to close its two satellite psychiatric hospitals, OSH Portland and Blue Mountain in Pendleton.

Both need upgrades and increased staffing to meet federal standards, the DHS says. Factoring in the savings of not making the upgrades to both facilities and closing them, the forecast estimated that the additional costs incurred by the Junction City facility for the state would be $11 million per biennium.

But some legislators argue that Oregon needs to move away from the institutional model of care for mentally ill patients regardless.

“If we build a second state hospital in Junction City, we will be indentured to the institutional style of care for mental illness in our state for as long as we can foresee,” said Rep. Sara Gelser, D-Corvallis. “We will have taken a clear position. There will be no reverse course.”

The National Alliance on Mental Illness and Mental Health America are lobbying for a shift toward community-based care, where they say patients are treated more humanely in smaller facilities and given more independence.

“It’s not good policy to build ‘big box’ hospitals,” said Chris Bonueff, executive director of NAMI Oregon.

A few small, typically 16-bed, state-funded psychiatric facilities exist in Oregon cities for patients who do not pose a threat to the safety of others or themselves. But those facilities face possible severe budget cuts this session.

Tomei favors shifting funding away from the Junction City project and into small facilities and preventative care, particularly as dollars spent by the state on community-based care receive a federal match.

The small facilities represent “a different mindset from what we’ve had before, and now is the time to do it,” she said.

But Courtney warns that institutionalized and community-based care serve two very different populations.

“The Junction City facility has nothing to do with community mental health care,” he said. “People have no business comparing the two. … It’s reckless and unconscionable. … Everyone is forgetting the statements of law enforcement officials and mental health experts that say we need more institutional beds.”

Under federal scrutiny

DHS’s 2010 report estimates that Oregon will need 960 psychiatric hospital beds by 2030: 620 in Salem, 166 beds in community-based settings, and 174 beds in Junction City.

“There continues to be a need for hospital-level care and transitional care at the proposed Junction City campus,” it states.

Hoyle said the report confirms her belief that the population needing institutional care is too large for the state hospital in Salem alone.

“I’m not in favor of building (the Junction City hospital) just to build it,” Hoyle said. “But after looking at all the facts, I have no doubt that we absolutely need it.”

But Gelser and Tomei said that if the state used its Salem beds more efficiently — through reforms to the state’s Psychiatric Security Review Board, for example — it could handle all the patients who need 24-hour supervision.

“We must avoid the danger of institutionalizing those who would thrive in a different setting,” Tomei said.

Last November, the U.S. Department of Justice — which has had Oregon on its radar since the controversies at the old OSH Salem — notified the state that it was expanding its investigation into the state’s treatment of the mentally ill.

The federal agency is particularly worried that Oregon may be spending money to increase institutional capacity while cutting community mental health, its letter reads.

Opponents of the Junction City hospital believe that letter shows that the federal government is serious about implementing community-based mental health care as the national norm and would not look kindly on completion of the Junction City project.

Gelser said that, in a worst-case scenario, the federal government could try to take control of Oregon’s psychiatric hospitals.

Others are less certain that federal officials are specifically critical of the Junction City project.

“I don’t think we’d be sending the wrong message (by building the Junction City hospital). But at the same time, we can’t take money away from community-based care to build it,” Kotek said.

Hanna agreed: “The federal pressure is more about whether we have the capacity, employment and training to treat the people we need to help.”

A Justice Department representative declined to elaborate on the letter.

Location a concern

Some opponents also fault the Junction City location.

“The site choice was problematic from the start,” said Bonueff, the NAMI executive. “Institutions need to be close to people being served. Shipping patients to a location hours from where they live, without public transportation access, is counterproductive.”

Nearly 70 percent of Oregonians who need institutional care live in Northwest Oregon, mostly in Portland, Bonueff said.

If the state mental hospital in Portland is closed as part of the plan to build the one in Junction City, Portland would be left with zero state psychiatric hospital beds, he said.

“People say Salem is close enough,” Bonueff said. “Well it’s not.”

Legislators found no optimal Portland locations for a new hospital when they began the planning, Courtney said. So they decided “Salem would serve the northern part of the state, and Junction City would serve the southern part,” he said.

Despite the taxpayer dollars already spent, the Legislature could still shelve the Junction City project this session.

Bonds to finish the construction have not yet been approved by the Legislature or sold, said Jack Kenny of the Department of Administrative Services.

Prison still up in air

Construction on the Junction City state mental hospital’s sister building, a state prison, has been put on hold for two years by the governor’s proposed 2011-2013 budget.

Gov. Kitzhaber has said he would like to see that project permanently canceled.

Unless there’s unexpected interest by lawmakers in pushing ahead with the project, the state won’t revisit the matter until 2012 at the earliest.