State hospital leaders tell lawmakers patient mixes, forensic caseloads and staffing drive operational costs

Superintendent Aaron Wilson and medical director Ed Yabot briefed the Senate Appropriations Committee’s Human Resources Division on operations, staffing and program flows at the North Dakota State Hospital in Jamestown.

Why it matters: committee members weighing capital funding also asked detailed budget questions about the current hospital’s workforce, turnover and per‑patient operating costs. Committee members sought clarity on how inpatient care, geriatric psychiatric services and a long‑stay forensic population affect the hospital’s budget and statewide behavioral‑health capacity.

Who spoke and the headline points Aaron Wilson, superintendent of the North Dakota State Hospital, said staffing metrics have improved and the hospital has about 275 employees. Wilson told the committee “our turnover rate has improved… we are at about 16% for turnover when we were at about 23% back in 2023.” The hospital reported multiple vacant FTEs supplemented by temporary positions and travel‑staffing contracts.

Ed Yabot, medical director for the state hospital, gave clinicians’ perspectives on populations and length of stay. Yabot said average acute stays are “anywhere between 7 to 14 days,” but forensic and some specialty populations have much longer trajectories — notably the sexually dangerous/offender residential program, where he reported average lengths of stay of roughly 10–11 years for that cohort and said those patients often cannot be placed into nursing homes because facilities decline them.

Program mix and pressures Yabot and the hospital’s testimony emphasized three operational realities: (1) the hospital provides acute psychiatric stabilization; (2) it delivers longer‑term psychosocial rehabilitation and specialized forensic services; and (3) substantial medical comorbidity exists among the inpatient population, increasing care complexity. The hospital reported an increase in court‑ordered restoration referrals and a heavy evaluation caseload: the forensic evaluation team completed hundreds of competency and criminal‑responsibility evaluations over the prior biennium.

Rates, reimbursements and comparisons Committee members asked about per‑day operational cost figures. The hospital’s cost accounting team described a unit cost methodology for rate setting and cited a roughly $900 per‑day figure for the geropsychiatric unit derived from actual cost allocations; the department said that is an average unit cost and that Medicaid billing depends on patient eligibility (IMD rules apply) and requires state matching for federal funds. Officials cautioned that state hospital unit costs are not directly comparable to skilled‑nursing facility rates because the state hospital delivers higher levels of psychiatric and clinical services.

Staffing, travel labor and vacancies The hospital reported continuing reliance on contracted/travel staff when positions could not be filled locally. Testimony to the committee put the contracted staffing (travel nurses and other temporary labor) line at about $5 million for contract staffing needs; presenters said the goal is to reduce that reliance as permanent staffing improves. The hospital also detailed FTE accounting complexities — staff sometimes appear in temporary dual positions to pay overtime or cover clinical shifts.

Discharges, placements and community connections Presenters said roughly 45% of discharges return patients to home settings and a substantial share return to secure settings or jails when criminal processes remain unresolved. Yabot emphasized the hospital’s role in preparing patients for community reentry and described arrangements to link discharged patients with regional behavioral‑health clinics and wraparound services.

Education, teaching and clinical scope Hospital leaders described the state hospital’s role as a training site: medical students, nursing students, counseling, social‑work and allied‑health trainees rotate through the facility as part of academic partnerships; the hospital reported hundreds of training hours and dozens of students in recent years.

Committee concerns and next steps Senators asked the hospital for further documentation: line‑by‑line explanations of budget variances; details about temporary staffing versus filled FTEs; and comparisons of state hospital per‑day costs to skilled‑nursing daily rates. Hospital staff agreed to provide more granular cost breakout information and to continue assessment work for staffing models tied to the proposed new facility.

Quotes used in this article were taken from testimony by the speakers listed below.