Montana lawmakers are grappling with what they can do to improve patient care and operations at the state’s psychiatric hospital since realizing that the efforts underway to restore the troubled facility’s good standing could take more time.
The nearly 150-year-old Montana State Hospital has recently struggled to care for patients and retain staff. The problems came to a head in 2022, when federal investigators yanked the hospital’s federal certification — and funding — from the Centers for Medicare & Medicaid Services because of a pattern of patient deaths found to be preventable, as well as injuries and falls.
Since then, Republican Gov. Greg Gianforte’s administration has launched a complex and expensive overhaul of the Montana State Hospital’s operations with the goal of regaining certification. That outcome may require years more work and tens of millions in additional funding from the Republican-majority legislature.
At least some lawmakers begrudgingly acknowledge the protracted scenario, reflecting on the time spent trying to pressure the state health department to move at a faster pace.
“I think it’s going to be done when it’s done,” said Sen. Dennis Lenz (R-Billings), a longtime lawmaker who sits on the state health department’s budget committee in the legislature. “It's like telling your teenager, ‘Come on, get your act together. Come on, put your clothes away.’”
Lawmakers in this session have the power to add or restrict money for Gianforte’s health department and write laws related to state hospital oversight, admissions, and discharge processes.
Health officials in the Gianforte administration are neck-deep in efforts to renovate the facility, slow its revolving door of leaders, and increase staff retention. Lawmakers are instead turning their attention toward ways to strengthen mental health services outside the hospital — an effort urged on by other mental health care advocates.
“I think the future of the hospital, and whether or not it will improve enough to be considered meeting the minimum federal standards for a hospital, rests on whether or not Montana can build up its community-based services,” said David Carlson, executive director of Disability Rights Montana, a federally appointed watchdog group that advocates for patients in state facilities. “They’re so interlinked. And we’re putting too much pressure on a singular hospital in Warm Springs.”
The state hospital’s campus, located in southwestern Montana near Butte, treats criminally and civilly committed patients. Inspectors decided to decertify the hospital after identifying numerous violations of patient care standards, including deaths, infection control issues related to covid-19, repeated falls, and medication mismanagement that amounted to “chemical restraints.” In the wake of that loss, the hospital’s top-level leadership has rotated through five administrators. Medical staffers have strongly criticized new mandates and changing protocols. The facility relies on expensive contracted health professionals, and, until this month, a consulting firm to oversee the hospital’s operations. Waitlists for the unit of criminally charged patients are persistently long, bogging down court cases and leaving suspects incarcerated in jails throughout the state.
In mid-January presentations to lawmakers, state health officials gave mixed reviews about how the hospital is improving.
The facility has discontinued the use of chemical restraints entirely, officials said, and recently hired a permanent CEO and chief medical officer. Doug Harrington, Montana’s state medical officer, said the facility is also seeing more interest from prospective employees applying for open positions.
“The short answer is yes, things are changing. And it will take time; it's not going to happen overnight. But the seeds have already been planted, and we're seeing some of the fruit growing up,” Harrington told lawmakers on the health department’s budget subcommittee.
Harrington also acknowledged that the timeline for regaining certification from CMS was pushed back to 2026 due to physical repairs at the central hospital.
“When you start tearing the wall out, you frequently find fungus, black mold, infectious agents in the water of the cooling systems,” he said. “We need to shut down an entire wing and move those patients somewhere else so that that can be sealed off and worked on.”
Last fall, the state began moving patients to a 20-bed space in Helena leased from Shodair Children’s Hospital to allow for the renovation of one of the hospital’s wings.
In total, the Gianforte administration has requested that the legislature greenlight a one-time allocation of almost $61.5 million to continue to cover the cost of contracting clinical and nursing staff at the state hospital. The facility’s two-year budget, including that request, is more than $167 million.
Another high-priority upgrade for the hospital is the creation of a comprehensive electronic health records system.
Funding for that project — approximately $27.6 million to cover all state facilities — was originally approved by the legislature in 2023. But state officials have yet to ink a contract for the electronic system, and they say the cost could change during negotiations with a future vendor.
The state estimated in January that the electronic records project, from development to implementation, would take three years. A spokesperson for the hospital said the department expects to have a contract signed and to begin that timeline in March.
Previous efforts to legislate change at the hospital are still in motion. Lawmakers passed a bill with bipartisan support in 2023 that directed the state to move patients with a primary diagnosis of dementia, such as Alzheimer’s disease, or a traumatic brain injury out of the hospital and into community-based facilities better equipped to care for patients with memory issues and other cognitive disabilities.
The bill set a deadline for those patients to be moved by the end of this June. Jennifer Carlson, a former Republican lawmaker who chairs a committee to oversee that transition, said the department still has patients in residence who are subject to the legislation, but she’s feeling optimistic about meeting that target.
Another bill from 2023 required the state health department to share unredacted abuse and neglect reports with Disability Rights Montana, the designated federal civil rights inspector. But since the law took effect, staff turnover and changing protocols at the hospital made for inconsistent application of the law, officials with the advocacy group said.
David Carlson of Disability Rights Montana, who is not related to Jennifer Carlson, said lawmakers’ and advocates’ time may be better spent this session on trying to reduce the number of patients that hospital staffers are struggling to care for. One strategy is to finalize the transfer of memory-care patients targeted by the 2023 law to community-based facilities, he said, and help grow local mental health crisis services.
Even with those changes, he added, the responsibility for high-quality patient care rests with the Gianforte administration and the hospital’s leadership team.
Ultimately, if medical standards and internal protocols don’t improve, David Carlson said, the last branch of government that can put a check on the hospital’s operations is the judiciary. Disability Rights Montana has previously represented patients suing state institutions over civil rights violations and errors in patient care.
“That's not a threat. That's just a description of how this all works,” Carlson said. “Accountability will come from some branch of government. The administration can embrace it themselves and get ahead of it. The legislature can lay it on there, or we can have the courts do it.”
KFF Health Newsis a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
