Spencer State Hospital

Times Record/Roane County Reporter
July 20, 1989

The struggle is won... and lost

With the recent closure of Spencer State Hospital, an important chapter in the history of Roane County came to an end. This three-part series examines that history. This final segment reviews the 96-year-old hospital's final years.

By Katherine A. Kean

Spencer State Hospital's final years saw the citizens of Roane County united in a battle to save the institution, much as they united to bring the hospital to Roane County nearly a hundred years ago. Under a new state Department of Health director, debate focussed [sic] on whether the hospital would be converted to a geriatric center, continue as a training center for the mentally retarded or close, in keeping with new methods of treating mental illness in less restrictive settings than the large institutions of the past. But each gain in the struggle brought a corresponding loss until it seemed there was little left to fight for. In the end, the closure of Spencer State Hospital, was effected quietly.

Dr. George Pickett left in November 1980 to accept a position at the University of Alabama. He was replaced by Dr. L. Clark Hansbarger, who visited Spencer in April and said he had no plans to close the hospital.

Governor Jay Rockefeller also visited the hospital during the institution's 88th anniversary celebration in July 1981, telling the assembled crowd that Spencer State Hospital was "here to stay."

But six months later, the governor broke that promise, announcing in his State of the State address that the hospital would be closed as part of 10 percent budget cuts being imposed on all state agencies. Rockefeller said he chose to shut down the hospital because it was not Medicare/Medicaid certified and "has little prospect of being certified unless it's almost completely rebuilt."

Hospital employees and citizens of the county were shocked by the news, as they believed the fate of the hospital had finally been decided. Administrator Desmond Byrne had announced in June that the hospital would become a treatment center for elderly patients with psychiatric problems. Admission of elderly patients was increasing, he said, and many had serious psychiatric problems which precluded nursing home placements. The hospital's resident population was also getting older and its staff had developed great expertise in the area of geriatric care. A psychiatric-geriatric facility seemed the best overall solution. The hospital's third floor, closed the previous year when elderly patients were transferred to nursing homes, would be re-opened to accommodate psychiatric-geriatric patients, Byrne said.

Byrne, who learned of the impending closure only shortly before the speech, was given until February 15 to remove all 315 patients from the facility. Many hospital employees said they would continue to work without pay to care for patients until homes could be found for them.

The threatened closure in 1983 presaged the events occurring when the hospital finally closed last month, since the announcement coincided with lay-offs at a local factory.

At that time 336 workers were employed at the hospital, which pumped about $3 million a year into the economies of Roane and the surrounding counties. Funding for a new water system just installed by the city of Spencer and also serving the hospital was to some degree dependent on the facility. Approximately 1/12 of Roane General Hospital's revenue came from the treatment of Spencer State Hospital patients.

Jim Mylott, administrator for the Roane County Commission and treasurer for the Mid-Ohio Valley Regional Board of Health, estimated closure of the hospital would reduce local tax revenues by 50 percent. Approximately 120 students would be pulled from the county school system, resulting in a loss of $174,000 in state aid. Mylott set the loss in buying power at $3.8 million.

The Save Spencer Hospital committee, headed by Mylott, was formed and the struggle to save the hospital began.

A suit was filed by a group of Roane County attorneys challenging the closure of the hospital on the grounds that the institution had been created by an act of the state Legislature in 1893 and could not be closed without legislative approval. The suit also claimed that the order forcing the rapid closure did not allow patients and their families time to adjust and was damaging to their health and well-being and that other state hospitals were not prepared to accommodate Spencer's patients.

State Senator Orton Jones accused the governor of sacrificing the hospital to make up for an unexpected $91 million shortage in state taxes. A resolution was pushed through both houses to delay the closing of the hospital until alternatives to such a radical action could be examined.

Travelling to Charleston on chartered busses, Roane County residents filled three galleries of the state senate during the initial hearing on the hospital, held January 17,1983.

But the issue was taken out of the legislature's hands two days later when State Supreme Court Justices, ruling on the suit, voted unanimously to keep the hospital open and ordered that no patients be transferred except for medical reasons.

A rally in Spencer the following week was attended by 1,300 local residents. Congressman Bob Wise addressed the group, praising improved conditions at the hospital. "We fought too hard to make Spencer State Hospital an adequate care center to lose it now," he said.

The Save Spencer Hospital committee engaged Dr. George Zitnay, former Health Commissioner for the state of Maine, to evaluate West Virginia's mental health system and determine if there was a need for the Spencer facility. Zitnay's report indicated the hospital should be converted to a psychiatric-geriatric facility, as had been originally planned. As soon as the institution could be Medicare/Medicaid certified, federal funds for its support would be forthcoming, he said.

Near the end of January, the Senate appropriated $1.9 million to keep the hospital open until the end of the fiscal year in July. The Senate action was initially blocked by the House of Delegates, which wanted the facility closed as did Hansbarger, who called the concept of a geriatric center "foolish." According to Hansbarger, upgrading Spencer to meet certification requirements would cost $5-6 million.

After much deliberation, the legislature voted to include the hospital in the budget for the coming fiscal year at a cost of $3.75 million. Both legislative bodies also voted for conversion of the Spencer facility to a psychiatric- geriatric center, setting July 1984 as a goal for certification.

Governor Rockefeller cut this amount back to $1.5 million, saying he planned to use the savings accrued from closing the hospital to start a jobs program. Senator Oshel Craigo commented that keeping Spencer Hospital open and converting it to a geriatric facility would "be the equivalent of an immediate jobs program - one that's already in place." Suits were again filed contesting the governor's action and the state was petitioned to allow experts to examine Spencer, Weston and Huntington hospitals to determine the cost of upgrading each facility to meet certification standards. The study revealed Spencer State Hospital required less work than the other two institutions. It could be renovated by the end of the year to accommodate 270 patients.

The State Supreme Court of Appeals voted to overturn Rockefeller's veto of the budget and awarded Spencer State Hospital $3.75 million to continue in operation. But it was a hollow victory, for a month later Byrne was ordered to lay off 95 hospital workers, nearly 1/3 of the institution's staff. Several registered nurses and other specialists would be hired when these aides were dismissed as part of the move toward certification.

In the midst of these plans and preparations, Hansbarger announced on July 6 that Spencer State Hospital would become a training center for the developmentally disabled. This transitional program to prepare mentally retarded adults to live in community settings would, he said, phase out the Spencer facility over a longer period of time, probably three to five years.

The change in Spencer Hospital's mission came about as part of the Hartley Plan. In 1981 the state health department was mandated by the state Supreme Court to provide individualized treatment programs for all residents of state hospitals within 90 days. The order came as the result of a suit filed on behalf of four unnamed patients at Huntington State Hospital. The court found treatment of patients in state institutions to be "woefully inadequate" and "conditions of their hospitals are such as to shock the conscience of any civilized society." While the Supreme Court ruled that the state's mental health system required revamping, it did not state how this was to be accomplished, but simply returned the case to Kanawha Circuit Judge Andrew MacQueen. The details of the order, which came to be called the Hartley Plan, were worked out over the next two years and implementation began in 1983.

The hospital began its new role under new leadership. Hansbarger announced that he had appointed Byrne Director of Health Planning and Evaluation. He would work with Zitnay, appointed by the Kanawha Circuit court to oversee the program leading to the certification of the three state hospitals, on the state-wide implementation of the Hartley Plan. Barbara Martin would become the director of Spencer State Hospital on September 1, 1983. Three months later, Joseph Carrier arrived to serve as program director.

Though Martin was filled with hope for the future of the Spencer facility, where she had also been employed in the early 1970's, conversion of the hospital to its new mission was plagued by difficulties.

Three of the hospital's four physicians resigned. Dr. Precella Famularcano said she believed the hospital was operating under a plan more "idealistic than realistic with the majority of patients". Another physician, Dr. Ching Pang Kao, said he feared to work in an environment beset by injuries to patients and staff alike. There were also allegations that the doctors' authority in treatment of patients, especially in the area of prescribing medication, was being undermined by the new regime.

During its conversion to a training center, the hospital began to employ behavior modification techniques to change patients' behavior rather than the tranquillizing drugs used in the past. Reduction of medication levels caused some patients to react violently. At the same time, an open door policy was implemented, similar to one in existence during the early years of the facility. This meant that patients with violent tendencies, once separated from their fellows, were free to roam the halls and attack both patients and staff. Some also walked away from the institution and entered homes, exhibiting, in some cases, aggressive behavior.

Martin and Carrier responded that after many years of confinement and sedation, some emotional outbursts were to be expected when the patients suddenly gained their freedom. The behavior modification program now in use at the hospital employed medication only as a last resort.

On a weekend in February 1984 five workers required hospital treatment for injuries received from patients. Following what came to be known as "Black Weekend," patients with violent tendencies were transferred to a separate unit and seven aides were recalled to work. Ninety employees completed a self-defense program, yet injuries continued to soar from 23 in April to 140 in July. In August, employees filed 40 grievances against the hospital, all citing a level of staffing inadequate for patient cars.

In November, 19 grievances by Spencer State Hospital employees were presented at a Civil Service hearing. In her closing statement, employee spokesperson Paula Moore reiterated the complaint that there was not enough staff at Spencer to give practical protection to employees or patients or to implement adequate programming, No action was taken to rectify the situation.

Later that month Ronald Beto, age 39, died of complications arising from injuries he received during an altercation with three other patients on his ward. Though he complained of pain in his hip after the struggle, a nurse found he still had a full range of motion in his leg. Beto was still in pain the following morning and was taken to Roane General Hospital, where it was discovered he had sustained a fracture of the right femur. Surgery was performed on November 26, but Beto developed pneumonia and died on December 3. His death was ruled a homicide.

The incident was investigated by state police and a Roane County Grand Jury. They found Beto sustained the fracture when he was "kicked in the leg with steel-toed shoes in a great and severe manner" and that he also "was struck about the head and face and thrown to the floor of the ward with force." Their report also stated that the safety of both patients and staff were endangered by inadequate staffing, "particularly in the light of wholesale abandonment of medication as a means of controlling violent aggression demonstrated by some of the patients."

Injuries to staff in the early months of 1985 included a male aide, bitten to the bone under treatment for an infection lodged in the bone; a nurse in danger of losing a finger because a patient kicked a door shut on her hand; and an aide who had most of her hair pulled out by a female patient before help could be summoned.

Health department officials placed the blame for injury rates on untrained staff, rather than numbers. A study conducted by union officials showed Spencer as having the highest injury rate of all state institutions. Between May and October 1985 1,411 injuries were reported at the hospital.

In early January, 1986 a new governor unveiled yet another plan for the future of Spencer. Arch A. Moore, Jr. presented a $23 million plan to restructure the state's mental health system, including $3 million designated to build a new psychiatric-geriatric facility in Spencer. The Medicare/Medicaid certified intermediate care facility was scheduled to be completed by June 30, 1989, the same date set for the transfer of the hospital's population of mentally retarded adults to group homes. But the pattern of gain offset by loss held, for Moore also reduced the hospital's operating budget by $2 million, resulting in additional layoffs.

Ground-breaking ceremonies, attended by the governor, were held in February 1988 and architects' plans for the new facility were made public.

But questions began to arise regarding where the $23 million was to come from. The plan's success also depended on downscaling the role of the state's institutions and placing their patients into community settings, but the group homes necessary to accommodate them remained unbuilt.

Inroads, Inc. directed by Joe Carrier, investigated the possibility of locating some of the proposed group homes in Roane County. To Carrier, this seemed a happy solution, as it would provide about 75 patients with homes and keep some hospital workers employed.

Public announcement of the plan brought over 50 citizens to a City Council meeting on March 3 to protest moving patients into the community. Recent walkaway incidents and the policy of housing a criminal element in the minimum security hospital may have sparked the protest.

Placing persons accused of committing crimes in Spencer Hospital had again come to public attention the previous year. Former Roane County Prosecuting Attorney, T. C. Evans III learned that a man accused of robbing and raping an 83-year-old woman was housed in Spencer Hospital and given a pass to visit the town. Evans informed the community of his discovery.

Martin defended the man's presence in Spencer's training program for the mentally retarded, saying persons accused of crimes but adjudged incompetent to stand trial might spend their lives in "limbo" in institutions. Margin also said that patients allowed to go to Spencer by themselves had to complete "a rigorous independent travel program" to earn a pass, which the man in question had held for four months without incident. With the coming of the training center, she concluded, the community of Spencer had become a larger school in which learning and growing occurs for those who are having these experiences for the first time."

Citizens attending the council meeting, however, declined to allow their community to fulfill that role, even when it was explained that patients to be placed in the proposed local group homes would not be those exhibiting extreme anti-social behavior. Following citizens' protests. Governor Moore announced no group homes would be located in Roane County.

Then in August 1988 came the court order to halt construction of the proposed geriatric facility, based on a report by E. Gail Falk, one of the two court-appointed monitors of the Hartley Plan. The legislature had authorized expenditures of $34 million from the health services revenue account, which contained only $24 million. Falk praised the progress that had been made toward overhauling the state's mental health system, but feared some of the new programs would lose funding if plans for construction went forward.

Judge MacQueen ordered Falk to prepare a report of feasibility and need for the hospital, which she submitted to the court on September 28, 1988. She recommended that the Spencer project be abandoned or, if it was to be continued, another institution should be closed. Falk noted that while there was no hospital in West Virginia providing both psychiatric and nursing care, there were 94 vacancies in existing institutions. A new long-term care facility would create even more vacancies as patients were transferred to Spencer. She recommended space in an existing institution be converted to serve psychiatric-geriatric patients. Transfer of developmentally disabled patients at Spencer was to proceed on schedule to meet a deadline of June 30.

Though several rallies were staged at the hospital as the deadline approached, little support was forthcoming from the community, still reeling from the loss of another major employer. Workers took their complaints to Charleston, but both Governor Caperton and Heydinger refused to hear them. Employees also saw that alleged that patients being transferred out of the hospital were going to other over-crowded facilities unable to provide treatment, rather than the group homes mandated by the Hartley Plan, but their efforts to stop the process were blocked by Falk. As the last patients were bussed away and Spencer State Hospital closed its doors after 96 years of service, Falk resigned as court monitor.

And there was a great silence on the hillside across from the town, where the state flag flew at half mast.

State officials now claim a 36- bed facility for adults dually diagnosed as mentally retarded and mentally ill is still a possibility for Spencer in two or three years' time. But a facility of this sort would restore few of the jobs county residents have lost, as treatment of these patients would require the services of specialists. And most former employees of the hospital will have left the area to seek work long before construction of the new hospital even begins.

It is a very suspenseful time for Spencer - a time of change. Two established cornerstones of the community's economy are gone and what might take their place remains unknown. But if we stand on the verge of repeating the 100-year- cycle begun in the 1890's, new economic developments will return a measure of prosperity to Roane County.

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