Montana’s state-run psychiatric hospital lost federal funding this spring following staff complaints about lax COVID-19 protocols, which investigators suggested might have contributed to three patient deaths.
While housing about half as many patients, the Wyoming State Hospital also had three patients die from COVID-19, according to reports. Despite a higher COVID-19 death rate, Wyoming’s hospital has not drawn a similar level of criticism. State officials defend the facility’s pandemic protocols as sound.
Throughout the course of the pandemic, the Evanston facility has averaged 70-90 patients at any given time. All three deaths occurred during the surge of the Delta variant in fall 2021.
That total is higher than what’s been reported by other psychiatric hospitals in more populous Mountain West states. Skepticism about reporting practices in other states emerged after Colorado reported only one COVID-19-related patient death, while psychiatric hospitals in Utah, Idaho and New Mexico reported none, according to The Mountain West News Bureau.
Kim Deti, spokeswoman for the Wyoming Department of Health, told WyoFile in an email that “that trying to make direct comparisons and interpret those comparisons based on case counts or number of deaths is likely not simple or meaningful because all kinds of factors can vary greatly from location to location such as reporting and testing.”
“I know we have a very robust and continuing testing program,” she wrote. “I don’t know whether that’s true in other states.”
Andi Summerville, executive director of the Wyoming Association of Mental Health & Substance Abuse Centers, told WyoFile she’s heard nothing that would suggest WSH has had anything like the COVID-19 issues that plagued the Montana State Hospital.
WSH has in fact been “very cautious with their Covid (sic) protocol,” the director of one of Wyoming’s two patient advocacy organizations told WyoFile.
“We have had no issues,” Wyoming Guardian Corporation Executive Director Emily Smith wrote in an email.
Guidelines and funding
Federal law gives explicit authority and funding to groups like Wyoming Guardian Corporation to investigate cases of abuse and neglect at psychiatric facilities.
Wyoming’s other patient advocacy group, Protection & Advocacy System Inc., is currently suing WSH, alleging that phone contact with patients has been illegally hampered since the start of the pandemic. Representatives of P&A did not respond to emails requesting comment regarding the adequacy of WSH’s COVID-19 protocols. The organization has not made any allegations in its lawsuit regarding a lax approach to the pandemic.
The Centers for Medicare & Medicaid Services cut funding to the Montana State Hospital in April “due to their failure to meet Medicare’s basic health and safety requirements.”
“Involuntary termination of a provider agreement is generally a last resort after all other attempts to remedy the deficiencies at a facility have been exhausted,” according to a CMS notice.
Among other issues, a CMS investigation found that Montana State Hospital failed to implement a COVID-19 infection control plan, according to National Public Radio.
Meanwhile, state investigators have not found similar deficiencies at the WSH, according to public records.
Since the start of the pandemic, the Wyoming Department of Health’s Healthcare Licensing and Surveys division has investigated complaints at WSH three times: first in July 2021, and again this year in January and May.
In all three reports, state investigators indicated “no deficiencies were identified pertaining to the complaint investigation.” Investigators also found no deficiencies in its “focused COVID-19 infection control” surveys conducted last July and again in January.
In fact, WSH’s response to COVID-19 in Spring 2020 became the subject of a study by the Centers for Disease Control, which found the facility’s initial measures to prevent transmission appeared to be effective despite begin implemented “in the absence of specific guidance on prevention and management of COVID-19 in psychiatric facilities.”
COVID-19 protocols at WSH began in the early days of the pandemic, according to the CDC article. The facility began limited testing in March 2020 and, after two infected patients were transferred to the hospital the following month, WSH began testing all new patients and isolating them until receiving test results. Any patients who were symptomatic or tested positive were housed in a separate ward for two weeks or until they tested negative twice. All health care providers began wearing masks, as did all “compliant” patients, according to the CDC. The hospital’s pre-existing measures to prevent harm, like preventing patients’ access to metal and elastic, complicated the masking effort and WSH used other materials, namely socks, as face coverings for patients.
No transmission was detected in the three weeks after WSH discovered its first exposure to the infection in April 2020.
As with other psychiatric hospitals in the country, WSH has faced significant turnover in recent years and has employed a total of about 450 staff members since the start of the pandemic, Deti said.
Staff members have made up a significant proportion of reported COVID-19 infections, accounting for at least 53 of the 69 total cases in 2021 and at least 35 of the 42 cases in 2022.
Masks have been required “on and off” during the pandemic; they are currently required, Deti said.
WSH has promoted vaccination for all staff since the start of the pandemic, Deti said, and vaccination has been required for all staff since March, a deadline CMS set for all facilities it funds.
“Keep in mind that it’s an ongoing effort as new staff do come on board continually,” she wrote. “All offers of employment require proof of vaccination prior to the start date or, at a minimum, that they have submitted an exemption request.”
Staff who’ve received a religious or medical exemption for the vaccine are required to test once per week.
When asked for the vaccination rate, Deti simply asserted that the hospital is “at 100 percent compliance.” CMS has not done an inspection of WSH’s COVID-19 protocols and the federal agency’s last recertification survey took place in 2018, spokeswoman Carolina Fortin-Garcia wrote in an email. She noted that CMS’s requirement for staff at psychiatric hospitals to be vaccinated against COVID-19 includes “current staff, as well as any new staff who provide any care, treatment, or other services for the facility and/or its patients.”
WSH requires a negative COVID-19 test for all patients prior to admission, and patients are tested again when they’re brought into the facility. Patients are offered tests at least once per week, with testing increasing in frequency during an outbreak.
The three patients at WSH who died from COVID-19 were all “at high risk for severe illness,” Deti wrote.
“The staff at the hospital worked very hard to protect patients as much as possible at every step and, in fact, continue to do so,” she wrote. “But a pandemic with a virus such as COVID-19 is difficult to completely keep out of any location and it does have impacts. We’ve seen that all around the state, country and world.”
Correction: This story has been updated to correct the identity of the agency that conducted three investigations into complaints made at the Wyoming State Hospital. —Ed.
If Wyoming and Montana were lax, New York must be getting skewered by CMS.