The buildings, though elegantly designed, have suffered from decades of neglect and in one case a few too many grenade explosions.
One of the vacant buildings used to be a school. Another served as lodging for nurses. It’s been empty for years. Kansas lawmakers surveyed the disrepair in horror as they toured the grounds in April. They’re the landlords.
This is Osawatomie State Hospital, where Kansas treats those who have been found to be a danger to themselves or to others — “the sickest of the sick,” in the words of Tim Keck, the Kansas secretary for Aging and Disability Services.
Founded more than 150 years ago as a self-sustaining farm and hospital for the mentally ill, Osawatomie lost its federal Medicare certification more than a year ago after a patient allegedly raped a staff member in late 2015.
Federal inspectors pointed to gaps in safety that had put patients and staff at risk and to the hospital’s outdated facilities.
“I think getting decertified sort of opened our eyes wide to where we are,” Keck said.
The current facility can house 206 patients, but the number of patients has been capped at 146 since June 2015 because of short staffing. Community mental health centers and county jails have had to house patients on a waiting list during that stretch, which has put a strain on their resources. The agency plans to add back another 12 patient beds in July.
Keck took the reins of the agency that oversees the state’s psychiatric hospitals in January 2016, a month after Osawatomie lost its certification, which costs the state $1 million a month in federal aid. The state’s other psychiatric hospital in Larned has retained its certification but has also struggled with low staffing.
Federal inspectors conducted a preliminary review of the Osawatomie facility in May after the state spent $2.9 million upgrading its acute care unit. The physical changes range from new ceilings meant to prevent suicide attempts to new chairs that are too heavy to pick up and throw.
Keck and other state officials are optimistic they’ll regain certification for that 60-bed unit — though not the whole hospital — and recapture a portion of the monthly federal payments.
But even if that happens, the state faces long-term questions about what to do with the hospital, which is about 50 miles southwest of Kansas City and serves the eastern half of the state. The most recent buildings where patients are treated were built when John F. Kennedy was president.
Gov. Sam Brownback would like to partner with a private company to build a new hospital and hand over its daily operations, a move he believes will save dollars and enable improvements to treatment. But lawmakers fear this will reduce oversight of the already troubled facility.
“The most important thing is to provide an environment that’s the most therapeutic for our patients,” Keck said. “We’re doing a very good job of that right now, but we can do better. And we can do better if we build a new facility and come up with a better model to provide care to those patients.”
The architecture contributes to that, Keck said. The current buildings are “closed-in and cramped and outdated and just not very therapeutic for a patient with mental health issues.”
The only company to bid on building and managing a new facility was Tennessee-based Correct Care Solutions, a company that oversees psychiatric facilities and medical care in correctional facilities in 38 states.
The company provides medical care at the Jackson County Detention Center in Kansas City, where an inmate died earlier this year of a burst aorta. Family members and two heart specialists contacted by The Star said the inmate might have lived if the nurses on duty had recognized her symptoms and gotten her to a hospital.
Keck visited several of their facilities in Florida in April and provided The Star with outlines of what a new facility in Osawatomie could look like with a “more open, airy, more inviting, comfortable therapeutic setting” that would include more green space for patients.
But lawmakers and mental health advocates are wary about handing over the facility to a private company — especially given the ongoing questions about the effectiveness of the state’s privatized foster care and Medicaid systems.
“You’ve got to get that profit somewhere, and it’s going to have to impact patient care,” said Rocky Nichols, executive director of the Disability Rights Center of Kansas. “That’s a serious concern of ours.”
Correct Care is a defendant in multiple lawsuits based on accusations of improper care. An investigation into Florida’s mental health system by the Tampa Bay Times and Sarasota Herald-Tribune identified six patient deaths over a five-year period at facilities run by Correct Care that could have been avoided, including a case in 2011 where a patient was left in a boiling hot tub long enough that he developed second-degree burns all over his body.
A spokesman for the company declined to comment on questions about patient care other than saying that Correct Care is “excited about the possibility of partnering with the leadership of Osawatomie to serve their health care needs.”
Keck said he has discussed the Florida investigation with the company, but that he “doesn’t know a lot about those particular instances.”
Cate Graziani, a Texas-based mental health advocate who successfully fought mental health privatization in that state, said the quality of treatment in the company’s facilities is questionable.
“In a lot of cases, they’re just warehousing folks,” said Graziani, who authored a 2016 report titled “Incorrect Care: A Prison Profiteer Turns Care into Confinement” for the progressive group Grassroots Leadership.
“I think one of the main concerns for us is though they’ve rebranded themselves as a treatment provider, the company is still very much a private prison contractor,” she said, contending that patients in the facilities get limited time with psychiatrists.
Graziani said privatizing mental health facilities has become an attractive option to “cash-strapped governments” and that Correct Care has been adept at lobbying for that.
Their registered lobbyists in Kansas are George Stafford and Riley Scott, both of whom worked for Brownback during his time in the U.S. Senate. Scott is also Kansas Senate President Susan Wagle’s son-in-law. Neither man would comment on the Osawatomie bid.
Keck said the state can either build a new facility, or it can spend an estimated $5 million remodeling the current buildings that house patients to get another five years of use.
The third option is to “keep doing what we’ve been doing for a long time and led us to where we are now. And I’m not a fan of that,” he said.
Many of the buildings on the campus are no longer safe for staff or patient use and have been vacated. Some of them have been empty since the 1990s.
“It seems like a waste of good resources that these buildings have fallen into such disrepair,” said Rep. Kathy Wolfe Moore, a Democrat from Kansas City, Kan. “This has not been recent disrepair. This has happened over many administrations, I have to admit.”
One empty building, a 115-year-old structure that once housed the hospital’s library, has been used for SWAT training for local law enforcement in recent years, John Worley, the hospital’s superintendent, told lawmakers during an oversight visit a month ago.
“The interior of the building looks quite interesting with lots of little grenade explosions,” Worley said. “But for functionality, absolutely not.”
Despite the dilapidation, the buildings remain standing because razing them would be too costly. Restoring the structures would be even more expensive.
“A lot of buildings there just need to come down,” said Rep. Jan Kessinger, a freshman Republican from Overland Park who participated in the oversight visit. “What we don’t want to do is just get them recertified again and perpetuate an outdated facility.”
Sen. Carolyn McGinn, a Sedgwick Republican who chairs the Senate budget committee, has pushed for studies on the cost of tearing down the unused buildings and for the cost of building a new 100-bed unit at Osawatomie. McGinn has said she worries privatization will reduce lawmakers’ ability to intervene if there are problems with the facility.
Nichols, with the Disability Rights Center of Kansas, called Osawatomie the “last port of call” for people in the mental health system and called on state leaders to invest the money to fix it without a private partner.
“You’ve broken the state hospital,” Nichols said. “You need to fix it. But you can’t fix it with duct tape and bubble gum. You can’t fix it by bringing in a for-profit company and have them take their cut.
“The state of Kansas can issue bonds. They can get a much better bond rate than a private company could. … So if your argument is we can build new, OK, build new. That argument lends itself to the state of Kansas building it.”