DLS flags high vacancy rates, capacity constraints and assaults at state psychiatric facilities; MDH outlines recruitment and infrastructure steps

Naomi Camaro of the Department of Legislative Services told the Health and Social Services Subcommittee on Feb. 13 that the Maryland Department of Health (MDH) administration budget grows by roughly $31 million between fiscal 2025 and 2026, to about $847.1 million, and includes funding for administration, major IT projects and 11 state inpatient facilities.

DLS highlighted several performance and operational concerns: eight of 10 state inpatient facilities missed MDH's goal of no more than one assault per 1,000 patient days in fiscal 2024; the rate of assaults increased sharply at the Regional Institute for Children and Adolescents in Baltimore; patient-injury rates rose at some facilities; and the department failed to meet statutory placements for court-ordered patients within the 10-business-day requirement in fiscal 2022 and 2023. DLS said limited bed capacity — adult psychiatric hospitals are operating at about 95% or more capacity — and shortages in community placements challenge timely admissions.

MDH witnesses acknowledged the problems and described ongoing actions. The department said it is filling leadership roles at Clifton T. Perkins, including hiring Dr. Leah Jones as new CEO, has made CFO and other leadership hires, and is recruiting for a chief operating officer. MDH said it has implemented a revised incident-reporting triage system and is assessing training and training staff for security and clinical roles. MDH attributed some increases in reported incidents to improved reporting definitions, while also citing higher clinical acuity and more court-ordered patients than previously seen.

DLS also described fiscal items in the allowance: the governor's cost containment action reduced the fiscal 2025 appropriation by $2.5 million because of delays at the Thomas B. Finan hospital project and proposed a negative deficiency of $6.8 million for staffing those units; a $9.8 million addition in fiscal 2025 supports temporary HVAC systems at Perkins after permanent systems failed; and a proposed $13.3 million net addition to general fund appropriation for fiscal 2025 appears in the fiscal 2026 allowance as deficiencies. DLS recommended committee narrative requiring MDH to report on bed capacity and length of stay at Perkins; MDH concurred.

On audits and accounting, MDH said it is working with Deloitte to reconcile clearing accounts, MMIS and FAMIS reconciliations and to resolve findings from the Office of Legislative Audits; MDH reported no Medicaid shortfall as of June 30, 2024, and said some Schedule G accounts show a surplus that must be allocated. MDH described steps to prevent single-person operational dependencies by documenting standard operating procedures and automated tools.

MDH also described the newly moved Center for Firearm Violence Prevention and Intervention, which the department said has hired an executive director and will soon release a request for proposals to fund statewide violence-prevention programs; MDH said it is developing a firearm data dashboard and expanding epidemiology and data-analysis capacity.

Union testimony: Jenny Reese, president of AFSCME Local 539, testified that staffing shortages at Clifton T. Perkins and other MDH facilities lead to limited therapeutic activities for patients, frequent staff and patient assaults, insufficient security and nursing coverage, and dangerous working conditions. Reese urged alternatives to the proposed $6.8 million staffing reduction referenced in the allowance.

What the committee asked: Members pressed MDH for specifics on recruitment and retention plans. The department described targeted on-site job fairs, partnership with nursing schools, compensation improvements (using agency salary adjustments) and other multi-pronged recruitment to fill clinical and security roles. MDH and DLS also discussed data-quality concerns for the MFR performance reporting and a plan to place a secondary review of MFR submissions under MDH's chief data officer.

What DLS recommended: adopt committee narrative requiring a report on bed capacity and patient length of stay at Clifton T. Perkins; MDH concurred and provided a timeline for reconciliations and accounting fixes.

Speakers and roles listed in the hearing include Naomi Camaro (DLS budget analyst), the MDH secretary (identified in the record as the department secretary and as Doctor Herrera), Amalie Brandenburg (MDH chief financial officer), Dr. Leah Jones (incoming Clifton T. Perkins CEO — start date noted), and Jenny Reese (AFSCME Local 539 president).