Maryland's top health official told a Baltimore judge Tuesday that he should have asked for more money in this year's state budget to relieve a bed shortage that has prompted his department to turn away patients from state mental hospitals.
Van T. Mitchell, secretary of the Department of Health and Mental Hygiene, was summoned to court to explain why he and five other top department officials should not be held in civil contempt for failing to carry out court orders to admit criminal defendants in a timely manner.
Mitchell said he didn't get around to addressing the department's bed problem in time for this year's 90-day General Assembly session, which ended in April.
"I just made a mistake. I didn't do it," Mitchell told retired Circuit Judge Gale Rasin.
Mitchell told the judge that he learned early this year about the extent of the bed shortage at mental health facilities. He noted that he wrote a letter in April to leaders of the judicial branch, telling them the department was in "crisis" and couldn't admit patients as quickly as the courts were ordering them to be hospitalized.
The secretary said he recognized the department's legal responsibility to obey judicial orders promptly.
"That's why I wrote the letter, and that's why I'll get it fixed," he said. Mitchell said he has a work group of health officials, state and local corrections officials and judges seeking solutions.
Most of the court orders that have not been followed involve criminal defendants found either "not criminally responsible" for offenses they committed or "incompetent to stand trial." The former is similar to a finding of insanity. The latter means defendants are too ill to assist in their own defense.
In recent months, there has been a growing backlog of admissions to state mental facilities such as Clifton T. Perkins in Jessup, Spring Grove Hospital Center in Catonsville and Springfield State Hospital Center in Sykesville.
The hearing was part of a civil contempt case involving four city defendants who, in some cases, languished in jail for weeks after Rasin, chief of the city's Mental Health Court, ordered their immediate admission to state mental health facilities.
While the defendants have since been admitted as patients, Rasin has continued to require department officials to explain their actions.
It was the third time Mitchell, head of the state's largest executive department, was compelled to appear in court over the issue. Earlier this year, a Prince George's County judge ordered the secretary to testify in another contempt case. Last month, Mitchell appeared in Rasin's court but was not called after other officials' testimony went into late afternoon.
Last week, Rasin issued orders in three additional cases for department officials to explain why they should not be held in contempt. Unlike criminal contempt, civil contempt does not usually carry the threat of jail, but a judge can set conditions a person must meet to remedy a violation.
While Mitchell took responsibility for the failure to fix the problem, he attempted to deflect some of the blame to the previous administration of Gov. Martin O'Malley.
Mitchell said that when he took office in early 2015 after being appointed by Gov. Larry Hogan, he found many problems in the department that needed to be addressed. He said the bed shortage didn't find its way to his desk until this year.
"Quite honestly, I did not get a handle on it" until the contempt proceedings began this year. "We had so many issues. It's not an excuse."
Nevertheless, Mitchell said the department has made progress in cutting its waiting list at mental health facilities over the past two or three months.
The secretary said the bed shortage is not so much because of a lack of physical space but caused by difficulty attracting and retaining staff. He said the state doesn't pay enough to attract people for challenging jobs.
"The state has, in my opinion, an inherent problem with the salary and pay scale," he said. Mitchell added that he's been working with the Department of Budget and Management on ways to pay people more.
Hogan is standing squarely behind his health secretary.
"Secretary Mitchell has identified this issue as a crisis and has vowed to make improvements, in stark contrast to others in Annapolis who, over the past decade or more, have papered over the issue or just swept it under the rug," said Matthew A. Clark, the governor's spokesman.
Clark said the governor's office could not say how much money it might allocate to the department in next year's budget but is aware of the difficulty in attracting state workers.
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"A skilled, nimble and dedicated workforce could dramatically change the quality of service in the Department of Health and elsewhere," he said.
Pat Moran, who leads a union that represents many department employees, said he agrees that the pay is inadequate. However, he said the department has not done all it can to hire people for some dangerous jobs.
"Show us where they're making a coordinated and aggressive effort to hire staff," said Moran, president of American Federation of State, County and Municipal Employees Council 3. "People don't want jobs where they get beat up. ... People don't want jobs where urine and feces are thrown at them and supervisors say it's part of the job."
Mitchell was questioned after lawyers for the attorney general's office, which represented him, entered a motion asking Rasin, who has pursued the bed shortage issue aggressively, to disqualify herself because of a call she made to a department employee seeking information.
Rasin refused, saying the courts make a strong presumption of a judge's impartiality.