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Overspent: Pueblo Mental Health Hospital goes $13M over budget on temp employees

Staffing shortages are impacting industries across the country in a post-pandemic world
Posted at 6:29 PM, Jul 13, 2023
and last updated 2023-07-13 20:43:03-04

PUEBLO — Staffing shortages are impacting industries across the country in a post-pandemic world. The shortages at the Colorado Mental Health Hospital in Pueblo (CMHHIP) are costing taxpayers millions of dollars, as the hospital relies on contracted, temporary workers for jobs.

“With the national staffing, nursing shortage, we have had to utilize quite a few contract staff,” Jill Marshall, the hospital’s CEO said.

In June, the Department of Human Services, which the hospital is under, made a supplemental budget request to the General Assembly’s “Joint Budget Committee”, asking for more than $13 million to offset the costs for temporary workers.

“While it’s a lot of money to spend on the nursing services we are working within the framework right now to bring nurses in at market value with other hospitals in the country and throughout Colorado,” Marshall said.

This was a part of the hospital’s 2022-2023 fiscal year budget, which ended in June.

Without approving the supplemental request, it would require an automatic budget cut of that amount next year.

The Department of Human Services brought up the concerns during the budget-making process in 2023.

“It’s something that we would never want to reduce our staffing ratios, so we do have to rely on the contract staffing, in addition to our regular state employees,” Marshall said.

Graph 2 Nursing Staff.jpeg
Data from Joint Budget Committee report.

According to the budget request, as of April 2023, the hospital was relying on 232 contract nursing staff compared to 322 state-employed staff.

In July 2021, the hospital had 55 contract nursing staff. To fully staff the hospital, 675 nurses would be needed.

Money was pulled from other places in the department to cover the cost, but it wasn’t enough.

“We really want to make sure that we have a good balance of consistent staff that work for us and work for the hospital and our employees versus having solely having contract staff so we want to make sure that there is that good balance,” Marshall said.

The budget request also details a trend in the increasing costs for temporary workers: it costs the state more money than state employees. In some cases, more than double.

The request showed the hospital pays about $120 an hour, compared to $50 an hour (including benefits) for state employees. Marshall did not say why that’s the case.

“The temp workers are paid by their agency and we pay a rate to the agency, I’m not exactly sure how much the workers are being paid from their agency but I know what we pay the agency for the temp workers,” Marshall said.

When pressed for how much that is, Marshall said it depends on the agency and would have to get back to News5 on those numbers.

Days later, a spokesperson for the Department of Human Services sent News5 data on how much money has been paid out to each staffing agency.

In fiscal year 2023, which ended in June, more than $57,332,319.49 was paid out to more than a dozen staffing agencies.

Graph 1 FTE v Contract.jpeg
Data showing costs of state employees versus temporary workers.

Marshall said some of the contract employees are former state employees. Meaning they’re leaving jobs, waiting out about six months, and returning on a contract.

Data provided to News5 by the Department of Human Services showed only three employees have left and returned as contract employees in the past five years, it is not common.

Marshall said there’s an agreement for state workers they will not work for a contract for a certain period of time after working for the state.

In March, the state began offering $14,000 sign-on bonuses for nurses at the hospital, as well as for the psychiatric hospital at Fort Logan. It was an increase from $7,000, which the hospital said was not competitive with what nearby hospitals were offering.

Since the hospital began offering the bonus, Marshall said it’s hired 18 staff, 17 of which are nurses.

Last month, ten state employees left the hospital, six of those were nurses.

“I think we’re competing with the contract agencies, we’re competing with other hospitals, we’re competing with other health care organizations and then we’re competing with the work-from-home environment that was sort of created during COVID,” Marshall said.

There are other impacts to the hospital with the staffing shortage. The state has a backlog of 456 patients waiting for restoration treatment services ordered by a judge.

The U.S. District Court of Colorado fines the hospital $500 a day per patient if those treatment services aren’t performed in a timely manner under a “Consent Decree”.

Fines are capped at $11.1 million dollars, the department has budgeted $12 million dollars for the fines in both the current and most recent fiscal years.

Without the cap, the Department of Human Services estimates it would owe $62.8 million.

“We’re budgeting in order to get enough staff in so we can make sure that we can open up beds and have more bed capacity for those who are on the waitlist make so that will help certainly get them into the hospital and get them the treatment that they need,” Marshall said.

When it comes to retention, workers say there are other issues in the hospital.

“The state is not a place where you can be a gig worker, like you can’t you show up and you can do this work,” Hilary Glasgow, Executive Director of Colorado WINS, the union for state employees said.

Last month, nursing staff employed by the state were put through a “schedule re-bid" process at the hospital which upset many workers. It required them to bid to stay on their schedules or ask for new shifts.

“My concern and all of our concern is we know we're understaffed, and we know that they're doing things to try to bring stuff in, but keeping workers in constant turmoil does not make people stay,” Glasgow said.

“It appears that CMHHIP is at a crossroads- they can either continue to spend millions of taxpayer dollars on temp nurses to cover the holes they’ve had a hand in creating or they can start working more directly with their employees to retain talented staff and keep the hospital running,” Glasgow said in a statement response to the department going $13 million over budget.

Marshall said she hopes the hospital is able to work through the staffing issues by next year.

State employees at the hospital were recently given salary increases and Marshall said mandatory overtime has been reduced. Those raise are five percent across the board and about eight percent for all nurses, which is about $41.00-$45.00 an hour in base pay.

The department said it's also negotiated lower rates with some agencies, the average contract rate for nurses at the hospital for this current fiscal year is $109 an hour.

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