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The North Dakota State Hospital has operated since 1883 and been part of the North Dakota Constitution since 1889. A resolution to remove the reference from the constitution will be considered in the upcoming legislative session. John M. Steiner/The Sun

State Hospital faces cuts

JAMESTOWN, N.D. — The budget for the North Dakota Department of Human Services is being considered in the Senate Appropriations Committee, but a high decrease of funds in some areas of the budget could negatively impact behavioral health services in the state, according to a department official.

Dr. Rosalie Etherington, North Dakota State Hospital superintendent and chief clinics officer for the Department of Human Services, testified in favor of the department’s executive budget to the Senate Appropriations Committee on Wednesday.

House Bill 1012 proposes an overall increase to the Department of Human Services budget but additional cuts to the State Hospital and human service centers’ budgets than those included in the department’s executive budget.

“It would reduce behavioral health services across the state when there is already a shortage,” Etherington said. “People would go without care or be undertreated.”

The bill also proposes cutting 51 full-time equivalents (FTEs) in the department, including 11 from the State Hospital and Sex Offender Treatment and Assessment Program, Etherington said. The hospital’s staffing formula determined that the cuts would require the hospital to close an eight- to 10-bed patient care unit, she said.

According to Etherington’s testimony, it takes the State Hospital, on average, 142 days to hire a nurse, 545 days to hire a psychologist and 905 or more days to hire a psychiatrist. The hospital has psychologist and psychiatrist vacancies at 50 percent and registered nurse vacancies at 17 percent. Vacancies have required contracting with out-of-state specialists, Etherington’s testimony said.

The forensic psychologist shortage is most critical, with three long-term vacancies, according to Etherington’s testimony. The positions are necessary for court-ordered criminal responsibility, criminal competency and sex offender evaluations, she said.

Rep. Chet Pollert, R-Carrington, is the chairman of the House Appropriations Human Resources Division Committee, which considered and amended the budget in the House.

Pollert said as a whole, the Department of Human Services received an increase to its total budget due to increases in the baseline budget to long-term care facilities, such as nursing homes, and also the Developmental Disabilities Division of the department. But there are cuts to the human service centers and State Hospital.  

“North Dakota is in a tight budget crunch because of the drops in revenues from oil and agricultural commodity prices, so we are forced to make some very tough decisions,” Pollert said.

The DHS has the ability to transfer dollars in its $3.5 billion budget between all of its divisions, so the department can address shortfalls in different areas, Pollert said. Some services will probably be reduced, but a 4 percent reduction and some transfer authority amongst divisions can make the reductions minimal, he said.

Rep. Jim Grueneich, R-Jamestown, said in an email that the budget is a work in progress and until the Legislature knows what the final budgets will be it is premature to comment.

Sen. John Grabinger, D-Jamestown, a member of the Senate Appropriations Committee, said he is still going through the budget information provided by the department. Grabinger said nothing stuck out as a drastic cut, but something may come up as he analyzes the information.

There is “absolutely” a shortage of behavioral health care services in the state, but the department’s focus has been on aging and long-term care services, Grabinger said.

Budget breakdowns

The human service centers combined budget decreases by $5.6 million, from $201.4 million in 2015-2017 to $195.8 million for the 2017-2019 budget in the House’s proposal.

The department-wide FTE allocation proposed by the House would result in a 21-FTE reduction through the human service centers, including the South Central Human Service Center in Jamestown, but a loss of behavioral health employees would reduce client services and delay child services, Etherington said in her testimony.

The State Hospital budget decreases by $3 million, from $70.6 million in 2015-2017 to $67.6 million in the 2017-2019 budget proposal from the House.

The State Hospital’s proposed executive budget includes the loss of one FTE security officer because of the closing of one sex offender unit. There was also a decrease in temporary salaries and overtime because with more FTEs being hired there was less overtime and temporary staff costs at the hospital.

The department-wide FTE allocation results in the reduction of nine nine FTEs from the State Hospital, which could lead to the closure of an inpatient unit, reducing the psychiatric hospital bed shortage and further burdening community treatment providers and private psychiatric hospitals, Etherington’s testimony said.

A decrease in the hospital’s operating expenses would require eliminating the University of North Dakota psychiatry residency program and reduce preventative maintenance of infrastructure, she said.

The Sex Offender Treatment and Assessment Program budget decreases by $900,000 from $13.1 million in 2015-17 to $12.2 million in the 2017-2019 budget proposal, Etherington said.

There was already a decrease of 10 FTEs in the program because of increased community discharges and placement to the hospital community transition center, allowing closure of one of the program’s units, according to Etherington’s testimony.

The department FTE allocation would result in two additional FTEs reductions for the program, which would result in reduced nursing care hours for medically fragile sex offenders and community readiness services for the Community Transition Center at the State Hospital.

Across the board, removing the Fair Labor Standards Act overtime funding would cause problems, according to Etherington’s testimony.

Removing the overtime funding from the human service centers would limit staff hours, resulting in service reductions and loss of revenue, according to Etherington’s testimony.

A decrease in overtime pay at the State Hospital would limit the hospital from paying staff from picking up additional shifts when the minimum staffing levels are struggling to be met, she said.

In the Sex Offender Treatment and Assessment Program, a decrease in overtime funding could lead to inability to pay staff for working additional shifts, an inability to meet minimum staffing requirements and put accreditation in jeopardy, Etherington said.

Etherington said in the department’s opinion, it brought forward a sound budget. However, she said she understands that lawmakers have a difficult job to balance needs.

Overall, too strict cuts to the budgets of the State Hospital and human service centers would have a negative impact for behavioral health services across the state, Etherington said.

Etherington said she can’t know for sure what would happen, but high budget cuts to behavioral health services in other states have caused rates of higher hospitalization, higher incarceration, higher homelessness and illnesses left untreated.