S-3265.4          _______________________________________________


                                 SENATE BILL 6319



State of Washington              52nd Legislature             1992 Regular Session


By Senators Niemi, West, Wojahn and Bailey


Read first time 01/24/92.  Referred to Committee on Health & Long‑Term Care.Modifying placement responsibilities for persons in the state mental health system.

     AN ACT Relating to the placement of people with disabilities; amending RCW 72.23.025; adding a new section to chapter 72.23 RCW; and declaring an emergency.




     Sec. 1.  RCW 72.23.025 and 1989 c 205 s 21 are each amended to read as follows:

     (1) It is the intent of the legislature to improve the quality of service at state hospitals, eliminate overcrowding, and more specifically define the role of the state hospitals.  The legislature intends that eastern and western state hospitals shall become clinical centers for handling the most complicated long-term care needs of patients with a primary diagnosis of mental illness.  Over the next six years, their involvement in providing short-term ((and)), acute care, and less complicated long-term care shall be diminished in accordance with the revised responsibilities for mental health care under chapter 71.24 RCW.  To this end, the legislature intends that funds appropriated for mental health programs, including funds for regional support networks and the state hospitals be used for persons with primary diagnosis of mental illness.  To the extent that persons with developmental disabilities, head injury, AIDS, dementia, or other disorders are treated by state hospitals, the legislature intends that the secretary allocate funds from separate appropriations to help support their care.  The legislature finds that establishment of the eastern state hospital board, the western state hospital board, and institutes for the study and treatment of mental disorders at both eastern state hospital and western state hospital will be instrumental in implementing the legislative intent.

     (2)(a) The eastern state hospital board and the western state hospital board are each established.  Members of the boards shall be appointed by the governor with the consent of the senate.  Each board shall include:

     (i) The director of the institute for the study and treatment of mental disorders established at the hospital;

     (ii) One family member of a current or recent hospital resident;

     (iii) One consumer of services;

     (iv) One community mental health service provider;

     (v) Two citizens with no financial or professional interest in mental health services;

     (vi) One representative of the regional support network in which the hospital is located;

     (vii) One representative from the staff who is a physician;

     (viii) One representative from the nursing staff;

     (ix) One representative from the other professional staff;

     (x) One representative from the nonprofessional staff; and

     (xi) One representative of a minority community.

     (b) At least one representative listed in (a) (viii), (ix), or (x) of this subsection shall be a union member.

     (c) Members shall serve four-year terms.  Members of the board shall be reimbursed for travel expenses as provided in RCW 43.03.050 and 43.03.060 and shall receive compensation as provided in RCW 43.03.240.

     (3) The boards established under this section shall:

     (a) Monitor the operation and activities of the hospital;

     (b) Review and advise on the hospital budget;

     (c) Make recommendations to the governor and the legislature for improving the quality of service provided by the hospital;

     (d) Monitor and review the activities of the hospital in implementing the intent of the legislature set forth in this section;

     (e) Report periodically to the governor and the legislature on the implementation of the legislative intent set forth in this section; ((and))

     (f) Consult with the secretary regarding persons the secretary may select as the superintendent of the hospital whenever a vacancy occurs; and

     (g) Approve applications for and the receipt of federal funds or private funds by the institutes established under subsection (4) of this section.  Such approvals shall be granted if the boards find that the application or receipt of funds by the institute will directly impact the state hospitals or community service providers in providing better care and support of those who are acutely mentally ill, chronically mentally ill, or emotionally disturbed as defined in chapter 71.24 RCW.

     (4)(a) There is established at eastern state hospital and western state hospital, institutes for the study and treatment of mental disorders.  The institutes shall be operated by joint operating agreements between state colleges and universities and  the department of social and health services.  Until July 1, 1995, the institutes ((are intended to)) primary mission is to assist with the training of community service providers and state hospital staffs, and to help develop clinical treatment programs to support implementation of regional support networks and the changing role of the state hospitals.  After that time the institutes are intended to conduct training, research, and clinical program development activities that will directly benefit mentally ill persons receiving treatment in Washington state by performing the following activities:

     (i) Promote recruitment and retention of highly qualified professionals at the state hospitals and community mental health programs;

     (ii) Improve clinical care by exploring new, innovative, and scientifically based treatment models for persons presenting particularly difficult and complicated clinical syndromes;

     (iii) Provide expanded training opportunities for existing staff at the state hospitals and community mental health programs;

     (iv) Promote bilateral understanding of treatment orientation, possibilities, and challenges between state hospital professionals and community mental health professionals.

     (b) To accomplish these purposes the institutes may, within funds appropriated for this purpose:

     (i) Enter joint operating agreements with state universities or other institutions of higher education to accomplish the placement and training of students and faculty in psychiatry, psychology, social work, occupational therapy, nursing, and other relevant professions at the state hospitals and community mental health programs;

     (ii) Design and implement clinical research projects to improve the quality and effectiveness of state hospital services and operations;

     (iii) Enter into agreements with community mental health service providers to accomplish the exchange of professional staff between the state hospitals and community mental health service providers;

     (iv) Establish a student loan forgiveness and conditional scholarship program to retain qualified professionals at the state hospitals and community mental health providers when the ((superintendent)) secretary has determined a shortage of such professionals exists.

     (c) Notwithstanding any other provisions of law to the contrary, the institutes may enter into agreements with the department or the state hospitals which may involve changes in staffing necessary to implement improved patient care programs contemplated by this section.

     (d) The institutes are authorized to seek and accept public or private gifts, grants, contracts, or donations to accomplish their purposes under this section, subject to the approval of the boards as provided in this section.

     (5) The department shall review the diagnoses and treatment history of hospital patients and create a plan to locate inappropriately placed persons into medicaid reimbursable nursing homes or other nonhospital settings.  The plan shall be submitted to the legislature by June 30, 1990.


     NEW SECTION.  Sec. 2.  A new section is added to chapter 72.23 RCW to read as follows:

     The secretary shall develop a system of payments or other incentives to discourage the inappropriate placement of the developmentally disabled, those with head injury, dementia, AIDS, those suffering the effects of substance abuse, or those with similar ailments at the state hospitals, whether or not a mental disorder is associated with their illness, and to encourage their care in community settings or on state hospital or residential habilitation center grounds.  The system shall be similar to that used in contracts with regional support networks to limit their use of the state hospitals.

     Under the system, state, local, or community agencies shall be given financial or other incentives to develop appropriate community care arrangements.  However, if it is determined that care on state hospital grounds is appropriate, the secretary shall condition such care on payments from appropriate nonmental health program budgets within the department.  The payments shall be adequate to support additional care that the superintendents may determine are needed for these persons, after consultation with experts and the boards.

     The secretary may establish specialized care programs for persons described in this section on the grounds of the state hospitals.  Such programs may operate according to professional standards that do not conform to existing federal or private hospital accreditation standards.


     NEW SECTION.  Sec. 3.      This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and shall take effect immediately.