JAY INSLEE 

Governor
STATE OF WASHINGTON
Office of the Governor

 

September 11, 2019

John Wiesman, MPH

Secretary

Washington State Department of Health
101 Israel Road SE

Tumwater, WA 98504

Dear Secretary Wiesman:

The integration of our behavioral health systems has been a tremendous undertaking this past
year by the Department of Health (D OH), Health Care Authority (HCA), Department of Social
and Health Services (DSHS), as well as numerous other agencies, local partners, providers, and
stakeholders. The shift from large mental institutions to smaller, community-based facilities is
central to this transformation. It requires us to build up an entire new system of public and
private facilities throughout the state.

I have been reading the Seattle Times series, ?Public Crisis, Private all, with great concern. It
is clear to me that our existing regulatory structures are inadequate for ensuring that new,
privately?run facilities are meeting the levels of transparency, safety and quality that patients and
their families deserve, and that state government has every right to expect. While DOH has
provided sound oversight of medical hospitals for many years, the agency needs additional tools
for the increasing number of behavioral health facilities that, by their nature, operate very
differently from a medical facility and serve a very different population of patients.

I know your staff has been talking with my of?ce about several potential improvements and
reforms that could strengthen enforcement capabilities, improve reporting requirements
and transparency, and strengthen the Certi?cate of Need (CON) application process. Our
ultimate goal is to make sure that every patient in need of mental health services is able to ?nd a
quality provider Whose top priority is the patient?s health, safety, and recovery.

As your team considers what more DOH can do and what we may take forward to legislators,
there are two items I hope you can move quickly on:

0 Strengthening the CON application process to ensure a more thorough review of an
applicant?s previous record and history, especially if they have been with out-of?state
facilities.

~12 P.O. Box 40002 - Olympia, Washington 98504-0002 - (360) 902-4111 0 Q.)

Secretary John Wiesman
September 11, 2019
Page 2

- Speeding up the process for posting inspection reports so they are easily accessible to the'
public.

I would also be interested to hear if there are additional reporting requirements that would
bene?t patients and their families as well as providers. I know you and your staff are looking at
what additional enforcement measures would allow your agency to bring facilities into
compliance more quickly. I look forward to hearing your recommendation on those issues.

There is also a bigger question about how to ensure private, for-profit providers, such as Acadia
Healthcare and US HealthVest, are not prioritizing pro?t over patient and staff well-being. As
we continue building up our network of community?based providers, we should evaluate whether
our current proposed mix of public and private facilities is correct and consider whether we
should update or modify the way we consider the roles of a for-profit versus a non-pro?t entity. I
look forward to discussing this in further detail with you, DSHS Secretary Strange, and HCA
Director Birch in the near future.

I know that some of these policy conversations predate the news stories, and I appreciate that
you and your team have been taking this transformation effort so seriously. The Legislature has
supported our efforts to build new facilities, expand workforce-training opportunities, increase
staf?ng at state facilities, and more, on a bipartisan basis. Like us, legislators understand the
urgency of expanding access to behavioral health care. However, I am deeply troubled at the
prospect of corporations exploiting gaps in our oversight systems to profit from vulnerable
Washingtonians and hard?working hospital staff. Anyone who has experience in our mental
health system either as a patient or as an involved loved one should likewise be troubled. We
have a responsibility to hold all our providers, public and private, accountable. I look forward to
our further discussion.

Very truly yours,

Jay Ins ee
Governor