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MDH budget highlights staffing crisis at state psychiatric hospitals; unions urge more hires
Summary
DLS testimony and MDH responses outline near‑capacity psychiatric hospitals, long court‑ordered placement waits (average 56 days in FY25), high overtime costs, and planned capital projects; union witnesses and staff urged more hiring, safer staffing ratios and investment in facilities.
Naomi Camaro, budget analyst with the Department of Legislative Services, told the subcommittee that the Maryland Department of Health (MDH) Administration’s fiscal 2027 allowance is $841,200,000, a slight decrease from the prior year, and includes funding for major IT projects, the 11 state hospital facilities and the opioid restitution fund.
Camaro said the department’s staff‑safety goal is fewer than one assault per 1,000 patient days, a standard most facilities did not meet in fiscal 2025. She reported that MDH had a 67% increase in court‑ordered commitment orders in FY25 compared with FY21 and that the department averaged 56 days to place patients in FY25 — well beyond the statutory 10‑day target. Camaro told the committee that the five adult psychiatric hospitals are operating at roughly 97% capacity, leaving little staffed bed space for new admissions.
"In fiscal 2025 it took the department an average of 56 days to place patients," Camaro said, summarizing DLS’s findings on court‑ordered placements.
Kate Wolf, MDH chief of staff, said several factors drive overtime and staffing pressures, including cost‑of‑living and step increases that raise overtime pay, 24‑hour specialized staffing needs, and many patients who require one‑to‑one or higher staffing ratios. Wolf said MDH is working to fill merit positions and to reclassify roles to better match therapeutic needs.
"We are working to fill vacant merit positions, especially those in our security and nursing classifications," Wolf said, adding that MDH is partnering with human resources and labor stakeholders to expedite hiring.
DLS and MDH discussed specific changes at Perkins and the JLG RICA campus. Camera and MDH officials said 15 merit positions at Perkins were abolished in the FY27 allowance; MDH stated those positions had been authorized in FY25 but never filled and that the budgeted savings are being used to reclassify and fund 26 other existing vacancies in therapeutic and administrative classifications.
Union witnesses and frontline staff told the committee those staffing changes have real safety and care consequences. Jenny Reese of AFSCME Council 3 said her union represents more than 5,000 MDH employees and reported hundreds of frontline vacancies across MDH facilities. Miriam Doyle, a social worker at Clifton T. Perkins, said she has seen patients wait months for risk assessments and linked understaffing to longer hospitalizations and higher state costs.
"We have a vacancy of 21.9% and 115 vacant positions," Doyle said, urging investment in recruitment and retention.
Morgan Harris, president of AFSCME Local 266 and a direct care associate at Spring Grove, described heavy workloads and on‑the‑job assaults.
"I have been left alone responsible for more than 20 patients on a two‑story unit by myself," Harris said, and urged safe staffing levels and additional positions.
On capital projects, MDH and DLS described renovations intended to expand capacity: a North Wing renovation at Perkins to add maximum‑security capacity and an expansion at the Bridal Baltimore campus to add 48 pediatric beds. MDH said it expects to open additional capacity at Springfield (adding one admissions unit and one subacute unit totaling 47 beds) and estimated operating costs for a proposed FFC at Noyes at about $5,700,000 annually.
Camaro also asked MDH to clarify discrepancies in major IT project accounting for the statewide electronic health record project; DLS questioned why remaining costs were listed at more than twice estimated completion amounts. MDH said the EHR project had spent roughly $15,000,000 to date, estimated completion at approximately $32,000,000, and did not expect costs to exceed the $40,000,000 figure listed in budget materials.
The committee asked MDH to provide timelines and additional detail on the renovations, the Perkins reclassifications and the use of opioid restitution fund dollars. MDH agreed to follow up with DLS on those requests. The subcommittee hearing concluded with requests for written follow‑up on staffing metrics, timelines for capital projects and the department’s plans to spend and draw down opioid settlement funds.
