Bill would grant legislators 'access' to Montana State Hospital; department warns of patient-privacy, CMS risks

Representative Donovan Hawk, R-Butte-Silver Bow, opened the hearing on House Bill 403 by describing the bill as a one-page measure to allow state legislators access to Montana State Hospital so they can oversee whether legislative policy is implemented, while accounting for safety and privacy concerns.

Proponents, including tribal representatives and advocacy groups, told the committee they support statutory access because they say legislators have been unable to schedule timely visits in the past and because oversight can help address alleged incidents of abuse, service shortfalls and discharge planning that can contribute to homelessness.

Patrick Yawake (representing Blackfeet Tribe, Fort Belknap Indian Community and Chippewa Cree Tribe of Rocky Boy) said legislative access would let lawmakers act as advocates and “first responders” when constituents in state hospitals face health-care problems; he cited an example of a hospital that lost Medicare/Medicaid funding after allegations of abuse and neglect that the witness said led to four deaths.

Representative Mary Caffaro described delays and restrictions the HB 29 transition commission experienced when scheduling a visit to the Montana State Hospital and said an access statute would ensure equal access for legislators regardless of assignment or party.

Opponents included Paula Stannard, chief legal counsel for the Department of Public Health and Human Services, who said the bill’s language — she quoted it as providing "immediate, unlimited access at all times to the Montana State Hospital" — would disrupt patient care and privacy, interfere with treatment plans, and could jeopardize the hospital’s ability to comply with federal law, including the Centers for Medicare and Medicaid Services (CMS) Conditions of Participation and HIPAA. Stannard also noted two statutorily authorized oversight bodies already have daily access and responsibilities: the Montana Mental Disabilities Board of Visitors and Disability Rights Montana (the state’s protection-and-advocacy organization).

Douglas Harrington (then interim Health Facilities Division executive director) and Dr. Kevin Flanagan, CEO of Montana State Hospital, said the hospital now has a permanent leadership team and daily access by the board of visitors and Disability Rights Montana. Flanagan told the committee the hospital has a visitation process that includes sign-in, confidentiality rules and patient choice; he said unfettered access as written could violate federal privacy and conditions-of-participation rules and jeopardize CMS certification.

Committee members asked whether existing law (for example, a statute providing access to state prisons) had language comparable to the bill; sponsor Donovan Hawk said HB 331 (the prison access measure) had similar wording and that the bill is meant to be adjusted by committee if necessary. Flanagan and others said they are willing to meet with the sponsor to work on language that preserves patient rights while improving timely access for legislators.

Key numbers and operational context: Dr. Flanagan testified the hospital is staffed for 174 beds (114 at the main hospital and 60 at the Sprat unit) and that the census earlier that day was 165. The department noted it must report allegations of abuse to Disability Rights Montana and the board of visitors within statutory deadlines and provided that process as the primary oversight route for abuse and neglect investigations.

Ending: The sponsor closed by saying he would work with other members and staff on potential amendments; the hearing was closed without a committee vote.