The Faulty State of Fulton State

It’s no secret that Fulton State Hospital needs to be fixed.

The place is crumbling. An asbestos-infested gym sits above the dietary center where patients’ food is prepared. Emergency exits at the maximum-security Biggs Forensic Center literally hang off the side of the building, their addition caulked in place with super-strength safety sealant that patients can’t rip out of walls. After all, in 1937, when Biggs opened, there were no standards for emergency exits, says Marty Martin-Forman, a 34-year Fulton veteran who now serves as the hospital’s chief operating officer.

Biggs may have been state-of-the-art once, but standards for mental health facilities have evolved in the past 77 years. Now, its long narrow hallways and staircases take 188 security cameras to monitor; yet, there are still blind spots. If a patient or staff member needs assistance at the end of a hall, aid may be out of sight and far away.

The hospital, which at its 1851 opening was the first public mental health facility west of the Mississippi River, sprawls on more than 95 acres in Fulton, about a half hour’s drive from Columbia. The facility maintains 30 separate buildings, four of which house its 350 patients. The hospital has a 376-bed capacity, and the average client stays 2.7 years.

If funding comes through, many of Fulton’s current facilities could be demolished as early as next year. Biggs would be gone, as would the hospital’s administration building, dietary building and a number of unused buildings scattered across the campus. In their place would be a new one-story maximum and intermediate security complex that embraces modern technology and consolidates patient and administrative services, recreational and vocational space and staff training rooms.

Lawmakers from both sides of the Statehouse aisle agree that the hospital needs to be rebuilt. Legislators are considering different bonding proposals to fund the $211 million project. Although a recent Missouri House proposal, HB2020, suggests a five-year debt repayment plan that would cost the state less in interest than Gov. Jay Nixon’s proposed 25-year bond issue, all proposals have the potential to add professional jobs to Columbia and also save Missouri millions.

Crunching the numbers

“There’s no doubt; it’s a big construction project,” says Sen. Kurt Schaefer, R-Columbia, who chairs the Senate Appropriations Committee and has been pushing for funding for years. “The need for a new facility is really the chief driver for the project, but it’s great that it also generates jobs, and I’m not going to discount that.”

The Missouri Economic Research and Information Center, the research branch of Missouri’s Department of Economic Development, estimates that a $211 million construction project has the potential to create 2,532 new jobs. The new jobs would almost exclusively benefit the area around Columbia and Fulton: 1,477 jobs would deal directly with construction, and about 1,055 would be related to the supply chain and other businesses that benefit from construction workers’ spending.

Construction jobs also pay more than Missouri’s average private-sector salary. Department of Economic Development spokeswoman Amy Susan says that 2012 construction pay averaged more than $50,000 annually, ahead of the state average of just more than $43,000.

The construction jobs, however lucrative, are only expected to last through the hospital’s tentative 2019 completion date, according to a December 2013 estimate of hospital rebuild plans. What could last longer, however, are jobs for registered nurses.

“There’s another kind of business, and that’s the ongoing permanent professionals who will work there,” says Rep. Chris Kelly, D-Columbia, another longtime supporter of Fulton’s funding.

The new hospital plans don’t substantially alter the hospital’s number of beds or 1,184 employees, but a new facility could help Fulton address its chronic shortage of registered nurses.

“RNs are kind of at the center of treatment,” Martin-Forman says. Although RNs play an integral role in the hospital, Fulton almost always has vacancies.

Martin-Forman says recent pay raises helped lower the RN vacancy rate to 18 percent. But vacancies hovered between 25 and 30 percent last year, and one December 2013 hospital estimate put the rate as high as 40 percent. Reports say better facilities could help keep professional staff positions full.

“That’s something else, too,” Kelly says. “Those are very good and very permanent jobs.”

Columbia-area RNs averaged annual salaries of nearly $57,000 in 2012, according to Department of Economic Development research. Schaefer says there is a definite connection between the Fulton and Columbia economies, driven in part by hospital workers living in Columbia and choosing to send their children to Columbia’s schools. The University of Missouri School of Medicine sends psychiatric residents to Fulton, and hospital materials advertise Columbia as a popular living choice for professional staff.

Statewide savings

Beyond Columbia, a new hospital would also come with substantial savings for the state.

Poor hospital construction leads to high rates of workers’ compensation claims. Patients can behave dangerously, and Biggs’ narrow hallways and corners put workers at a disadvantage.

“You can’t catch all the blind spots where people might wait behind the corner,” Department of Mental Health spokeswoman Debra Walker says.

Workers’ compensation costs the hospital $4 million annually, by far the highest cost at any state facility. One in three workers at this hospital will file for workers’ compensation during their careers, which makes the hospital statistically a more dangerous place to work than the Missouri Department of Corrections. Reports say the state expects workers’ compensation claims to decrease in a new facility.

Serious injuries to staff members are down 33 percent in recent years, though Martin-Forman says the hospital still struggles with high rates of moderate injuries, such as soft tissue damage. Some injuries can be blamed not on patients but rather on outdated facilities.

Due to the hospital kitchen’s impractical location down the road from Biggs, dietary workers have to load patients’ meals onto box trucks before every meal. Even routine activities such as food transport can be risky for staff members.

Martin-Freeman recalls one dietary worker who broke his arm loading food into the truck on a windy day. He wasn’t at fault. A gust of wind blew the heavy truck door into his arm, which resulted in a workers’ compensation claim for the hospital and several months of missed work for the man. Martin-Freeman says even seemingly small changes, such as combining the dietary center with Biggs, would cut down on costs and improve worker safety, which could affect retention rates.

“I don’t want you to expect to be hurt here,” Martin-Forman says. “That’s not OK.”

Moving forward

Expecting a hospital rebuild, the Department of Mental Health and the Missouri Office of Accountability’s Facilities Management, Design and Construction division have deferred $73 million in hospital maintenance costs. The maintenance might have to be funded if rebuild funds aren’t available soon.

“We are at the end of what we can do with what we have,” Martin-Foreman says.

As the Statehouse works to come to a funding agreement, Kelly says the rebuild makes economic sense, but his underlying support for the project lies in patient and worker quality of life. Kelly says he’s seen the hospital’s dark hallways and cramped quarters during legislative tours and that he feels the outdated facilities’ upgrade is 25 years overdue.

“The hospital is a disaster,” Kelly says. “It’s bad for patients, it’s bad for employees, it’s bad for the state of Missouri, and it’s bad for treatment.”

Schaefer says the fact that hospital space is simply too antiquated to help patients recover motivates him to find funding.

“The importance really is that we need the facility,” he says.