The budget slashing of human services during the Great Recession is coming back to bite Washington.
The $90 million cut from the state’s mental health system from 2009 to 2013 directly led to a state Supreme Court’s ruling in August banning very sick patients from being warehoused in hospitals, and probably will lead to a similar ruling next year regarding a lack of treatment in jails. A wavering financial commitment to court-ordered foster care reforms in the same era resulted in an extension of court oversight.
In a column tallying up the “flashing red lights” in state human services, I included a less-noticed new red light at Lakeland Village, an institution for people with developmental disabilities near Spokane. The problems there also flow directly from Great Recession budget cutting: as described in a Seattle Times story, a $1 million cut in 2011 forced dozens of patients into cheaper care that to me veers toward simple warehousing of patients.
But the response since then by the Department of Social and Health Services — to dispute and fight these red flashing lights — is exacerbating the problems. Federal auditors and disability advocates have now objected annually at least three years now, including an astonishing 41,231 separate violations of Medicaid rules in 2013, as described in a Seattle Times story. Patients who are in the most expensive type of care the state offers were parked in front of “The Jerry Springer Show” with the blinds folded.
In October, federal Medicaid auditors found yet more serious problems, this time with basic nursing care.
A letter from the watchdog group Disability Rights Washington summarizes violations, including a pressure sore untreated for five weeks and the spooky image of patients strapped to chairs or blank walls.
That six residents were observed “tied to a chair” with no activities other than watching television or facing a wall is intolerable, regardless of whether the tying mechanism was a “seatbelt” or any other type of restraint.
DSHS said last year the violations were just paperwork problems — that staff were merely failing to document rehabilitative services. But David Carlson, legal advocacy director of Disability Rights Washington, said the outside reviews — his group and federal auditors — dispute that interpretation, again and again. “It seems like once a year they’re getting this reminder,” he said.
What makes this even more aggravating is that it’s happening at a very expensive state institution. The annual cost at the state’s five institutions for the developmentally disabled is up to $200,000 per resident, while about 15,000 other people with developmental disabilities have lingered on a waiting list for services.
So far, Medicaid has not deployed the big hammer to fix the problems at Lakeland Village — withholding millions of federal dollars. And Disability Rights Washington hasn’t sued, although it could.
In a statement, DSHS said it sent federal auditors a corrective plan late last month, was reviewing care for patients identified in the most recent report, and was hiring eight new staff members at headquarters.
After three straight years of complaints, maybe DSHS is fixing this. Or I wonder if DSHS is waiting for yet another court order, forcing it to comply and turn off these flashing red lights. The agency fought demands to end psychiatric boarding, and lost. It fought an extension of oversight in the landmark foster-care Braam case, and lost.
The public may empathize with an agency that is trying to do tough, important work to help society’s vulnerable, even with budget cuts. But an agency that digs in its heels, that ignores the flashing red lights, smacks of bureaucratic arrogance.