By Kevin Rector, email@example.com
4:34 PM EDT, August 24, 2011
After years of non-committal posturing from state health officials on the fate of Spring Grove Hospital Center campus, a recent surge of attention promises to spark new feedback.
Two studies currently pending at the state level — one on the future redevelopment of the 189-acre hospital campus and one on the future outlook for psychiatric patient populations across Maryland — should be completed within the next four months, according to health officials and Del. Adrienne Jones, who represents District 10, which includes parts of Catonsville.
"It won't be something, 'OK, we're doing this report. We'll put it on the shelf.' No," said Jones, who was instrumental in drafting the studies' requirements. "To me, it's a culmination of years of talk."
Talk on the future of the sprawling campus has been occuring for years, even decades — often provoking the ire of residents, politicians, institutional leaders and developers, who have all expressed their own ideas for future use of the land.
The hospital, which dates to the Civil War and was known as the Maryland Hospital for the Insane until 1912, is based on an outdated model for psychiatric care from that time.
Some residents noted there have been plenty of studies of Spring Grove in the past, none of which forced much change, and expressed doubts that the pending studies will be any different.
But officials said direct involvement this time from the Department of Health and Mental Hygiene and the state legislature distinguishes these studies from those past.
Until 2009, the conversation surrounding Spring Grove's future was largely shaped, and tamped down, by the health department, which owns the land and long held the stance that it had no plans to name any of the property as excess to its needs — a necessary step before it can be named surplus by the state's Board of Public Works and sold.
But following a nudge from Gov.Martin O'Malley, who in 2009 asked the state's Department of Business and Economic Development to get involved, health officials began to talk among themselves about evolving that stance. Shortly after, they announced a partnership with the Maryland Economic Development Corp. to assess the financial benefits of retreating to a portion of the property within a modern hospital facility, and excessing the remaining acreage.
Plans for parcels
Today, the results of that assessment, conducted by the Sparks-based SC&H Group, are out. They show the state would recoup the proposed $180 million cost of building a new facility within 18 years of its completion through operational savings from the condensed footprint of a modern facility and the end of expensive deferred maintenance costs piling up at the current, deteriorating campus.
The assessment does not include the potential economic benefit to the state from selling portions of the property not used for the new hospital facility.
The two studies now pending will further inform health officials on what a transition to a smaller facility would look like, Jones said.
The first study calls for the health department to again partner with MEDCO, using $50,000 of Spring Grove's general funding, to produce a "Redevelopment Plan" for the hospital campus that specifically considers parceling land for a new hospital facility; for use by the University of Maryland, Baltimore County; for recreation space for Baltimore County; and for mixed-use development.
That language, which not only concedes but highlights the potential viability of the four most publicly talked-about plans for the land, undercuts the circumspect approach to the property that has long sidelined progress — an encouraging fact for those whose plans were given a nod.
"It certainly is gratifying and encouraging to see that language there," said Lynne Schaefer, UMBC's vice president of administration and finance, echoing the thoughts of others.
Though the study, required in the last legislative session, is currently due Sept. 1, officials from the health department and MEDCO said they will need more time.
"It was a very short timeline, and I think to get a good product, it's reasonable to expect that it's going to take a little bit longer," said Betsy Barnard, director of the health department's office of capital planning, budgeting and engineering services. "We're hoping that it will provide us with some useful information moving forward in terms of a parcel that we would need for a replacement hospital and what would happen around it, or what could happen around it."
Delays on studies required by the legislature are not uncommon, and Jones said she expects the report will be ready by the middle of December.
"There's the old expression, 'Good things come to those who wait,'" Jones said. "I know that it can be frustrating, but they want to make sure that it's done thoroughly."
The second study, due Dec. 1, calls for the health department to use $200,000 in general funding from its five psychiatric hospitals, including $78,000 from Spring Grove, to produce an "analysis of short- and long-term population and placement trends to determine potential demand for state-run psychiatric hospital capacity," with community-based alternatives to state placement considered as well.
The study also requires the health department to determine "best practices for facility operations, including building size and configuration," as well as "appropriate site locations based on future demand."
In-patient vs. out in community
The requirements speak to long-developing societal changes and more recent policy changes that have reshaped the landscape for psychiatric care in Maryland, according to Brian Hepburn, executive director of the Maryland Hygiene Administration, an agency within DHMH responsible for delivering mental health services.
At a societal level, there are more community-based alternatives for psychiatric care, and more drug options for patients, than ever before. At the same time, there has been a shift in the understanding of care for those who remain in state institutions, Hepburn said.
"The idea of the older hospital was really one of having somebody go away for a prolonged period of time and having a calming, rural environment," Hepburn said. "Now, the idea of a hospital is to get a person stabilized and out to the community as fast as possible."
Over the years, these changes have contributed to a dramatic decrease in the number of psychiatric patients in state institutions, a number that peaked in the 1950s, when Spring Grove's population was close to 3,000, compared to its population of less than 500 patients today. But, they aren't the only — or even the greatest — cause of that reduction recently, Hepburn said.
Since 2002, that decrease has been driven by policy changes to, and increased enforcement of, the specific care requirements for uninsured psychiatric patients under the federal Emergency Medical Treatment and Active Labor Act (EMTALA), Hepburn said.
Until 2002, uninsured psychiatric patients who showed up at the emergency rooms of local general hospitals needing in-patient care were often sent directly to state institutions once they were stabilized. Now, those hospitals are required under EMTALA to not only stabilize such patients, but also work to provide or find them with a bed in an acute general psychiatric unit or private institution, Hepburn said.
In the last few years, enforcement of those requirements has also been ramped up, putting hospitals that don't comply in jeopardy of losing future Medicare claims payments, Hepburn said.
"As a result, hospitals now have to take individuals regardless of their ability to pay," Hepburn said, and the impact on state institutions has been profound.
"As of last year, there was hardly anybody going from an emergency room to a state (psychiatric) hospital because they were uninsured," Hepburn said. "At this point, the majority of individuals who are going into our state hospitals are either being referred from the courts or they are going from detention centers."
Felony offenders are all sent to the maximum security Clifton T. Perkins Hospital Center in Jessup. Misdemeanor offenders are sent around the state.
The two studies combined will provide a massive amount of information directly relevant to the discussion of Spring Grove's future, officials said — a positive step in the eyes of many, including Baltimore County Executive Kevin Kamenetz.
"The county executive is a big believer that you can't do anything intelligently unless you do a good amount of planning and study on the front end," said Don Mohler, Kamenetz's chief of staff.
"We've got to be innovative, we've got to consolidate where possible, and we've got to be efficient, and I think that's what the state is looking to do here."