Contrary to media headlines closely monitoring the lower- and mid-level federal courts as they opine on the individual insurance mandate, the United States Judiciary Branch may have little impact on the future of President Barack Obama’s 2010 Patient Protection and Affordable Care Act. As fascinating as the legal ramifications may be, the ways in which the Commerce Clause or the Necessary and Proper Clause impact the constitutionality of healthcare reform’s most notorious provision of late could have little meaning if the government fails to pay a few utility bills and the congressional lights go dark.

While the importance of judiciary participation in this historical debate should not be discounted, the U.S. healthcare system must first and foremost be concerned with self-sustainability, especially in light of recent issues concerning our credit rating as a nation.

To read the rest of the article, visit Becker’s Hospital Review.

This article first appeared on California Healthcare News.

California has always found its way into the public spotlight, and 1975 was no exception. That is the year in which Jerry Brown became the state’s 34^th governor, Nolan Ryan started the season for the California Angels, President Ford survived an assassination attempt in Sacramento, actors Jon Voight and Marcheline Bertrand gave birth to their daughter Angelina Jolie Voight in Los Angeles, and the state’s Medical Injury Compensation Reform Act of 1975 (MICRA) was passed.

At its core, MICRA was the end result of efforts to save California’s physicians from the fallout of a multitude of lawsuits, runaway jury verdicts, and draconian responses by insurance liability companies. With its $250,000 cap on non-economic damages in medical malpractice litigation, MICRA made history as its backers trumpeted the salvation of medicine in California. Controversial from the day Governor Brown first signed it into existence, MICRA continues to face challenges these 36 years later. For better or worse, however, MICRA addressed a critical issue and assuaged what were at the time very real fears that issues of liability and catastrophic jury verdicts would bring California’s medical system to a halt.

California’s hospitals are not alone in their need to proactively address situations involving unforeseen events. In this present era of health care reform, providers across the nation have an even greater abundance of legal issues on which they must focus their attention. For example, in the not too distant past a new concern appeared on the horizon some 2,700 miles from Sacramento. August 2005 saw Hurricane Katrina wreak havoc throughout southeastern Louisiana, with a death toll in excess of 1,800 and an $80 billion price tag, to say nothing of the sociological and environmental collateral damage that quickly followed.

Once the storm had passed and the dust had begun to settle, a frightening discovery at Memorial Medical Center in New Orleans captured the nation’s attention anew and resonated in the hearts and minds of every hospital administrator across the nation. Forty-five Memorial Medical Center patients died from the Hurricane, a number greater than any other New Orleans hospital, and blame was quickly directed to the hospital and its failure to provide for its community in an emergency situation. When questioned, the hospital’s clinical team maintained that its best efforts had been employed throughout the duration of this cataclysmic hurricane.

Six years later the hospital’s owner, Tenet Healthcare Corporation, settled the resulting class action lawsuit for $25 million, ensuring that this particular matter will never face a jury. What remains uncertain, however, is the degree to which hospitals will be held accountable in the future for the ways in which they react to natural disasters of any kind, anywhere, at any time.

Natural disasters can strike practically anywhere, and without much notice.  In response to the unknown, this fear of catastrophe sets a dangerous precedent, often misdirecting the focus of hospital leaders and staff, and at the same time funneling away precious financial resources from any health care institution in the wake of a theoretical disaster site. For years now California has been mindful of the impact a natural disaster may have on its infrastructure. Since the 1994 Northridge Earthquake, nearly every hospital across the state has embraced Senate Bill 1953 and taken steps to spend an estimated 90 to 120 billion dollars to meet state-mandated seismic safety requirements. While the 1994 disaster caused tremendous damage and the tragic loss of 72 lives, when broken down this natural disaster approached $1.7 billion per fatality.

Indeed, these regulations are so profound that state legislators have extended the mandatory deadlines on multiple occasions to ensure that California’s cash-strapped and overburdened hospitals will eventually be able to comply. But as each former deadline passes and California hospitals look toward the next one, the specter of a sizeable earthquake moves closer.  As the “when” and “where” remain unknown, hospital administrators in California as well as the rest of the nation must in good conscience ask themselves how appropriately the actions of California’s lawmakers comport with the Memorial Medical Center settlement.

Mandated by state and federal authorities and required by most accreditation entities, emergency preparedness is part of every hospital’s core curriculum. Even as disaster drills alternate from one horrific event to the next, the savviest of hospital safety officers is ever mindful that preparation must always focus on the unexpected in its most unimaginable form. To make trying times even tougher, the fact remains that when and where a disaster strikes may ultimately determine a hospital’s ability to respond in the ensuing hours or days, no matter how much attention has been given to preparedness.

Of the many roles a hospital may serve for its community, one of the most significant is the manner in which it can respond to an external disaster. But given the multitude of variables that come into play when disaster strikes, establishing criteria to assess liability beyond anything other than meaningful efforts to prepare in advance puts our nation’s entire medical system in jeopardy. While landmark legislation like MICRA may be premature at this juncture, it is something our nation’s leadership may wish to consider before it is too late.

– André Gide, French author

This article was first published on the PBS affiliated website This Emotional Life.

I have decided at last to forgo my search for instructions. Though it was nearly a decade ago that I first hoped to uncover an operational manual at work during my first tenuous days in an unfamiliar hospital environment, such guidance always escaped my discovery.

Seven months ago a new job of sorts presented itself to my wife and me, and not surprisingly, this owner’s manual also turned up missing. The resultant experiences brought about by new fatherhood have only served to reinforce my decision to trust my instincts from this point forward, as while there is an abundance of literature that purports to bridge such gaps in both professional and personal knowledge, I have yet to encounter any crisis brimming with patience, be it related to emergency department protocol or an unexpected and unexplainable late night tantrum.

In my professional role as health care attorney and consultant, I have come to grips with the fact that the federal government may not publish an “executive summary” covering all 2,700 pages of last year’s Patient Protection and Affordable Care Act (PPACA, more commonly referred to as health care reform) anytime soon.  Likewise, I do not expect to find an easy way to process the thousands of pages of topical regulatory addendums designed to supplement and clarify this landmark legislation for health care. Even so, as time allows President Obama’s fledgling program to mature, these once treacherous waters are becoming less disconcerting and have started to resemble instead a neighborhood pool that stays warm all year round. Passing months have a way of making any initially frightening scenario seem manageable.  The trick lies in allowing those first few months to pass with grace.

Let’s face it, we all enjoy a good challenge from time to time. A decade ago, when I was first introduced to the unexpected in the workplace, I never considered retreat as a viable option. Instead, I pushed forward with makeshift guidelines assembled largely by certain individuals with whom I later came to establish formidable bonds and lifelong connections. Last February, I had no inkling of my state of naivety when we took our first steps from the hospital as a family of three. A few short months later, I make it a point not to dwell upon how much I still need to learn, and instead I find joy in the many opportunities I have for improvement.

When it comes to my professional career and our nation’s health care system, I do not take lightly the absence of precedent concerning PPACA and its far-reaching implications for our country. In this particular context, I am mindful of the need to navigate with precision through a constantly shifting terrain. At the same time, I try to focus my attention on the specifics of this epic and fundamental reorganization of health care taking place in the United States today, rather than losing myself in the political ramifications or partisan rhetoric with which reform of any kind tends to be joined at the hip. And yet, it is with a sense of wonder that I beam with pride while watching an infant not much younger than the aforementioned legislation spend twenty minutes trying to master Newton’s first law of physics and break his wobbly-legged inertia, ready to celebrate as a team even if the end result is just a few inches of motion in a randomly selected direction.

A simple truth for me is that in life there are often no instructions to be found, and perhaps this notion alone provides sufficient understanding to address nearly any task at hand. To be sure, we would be remiss not to search for an accurate and appropriate map to guide us in matters relating to either hearth or health, for few find comfort in the assumption that such guidance is not forthcoming. Instead, we should spend more time being mindful of how uncertain times can affect the people around us, which in turn sheds light on the ways in which we can contribute toward a solution.

With this in mind, my personal and professional worlds collide yet again as I offer concurrent instruction in the mystic arts of crawling as well as how best to navigate through the newly constructed labyrinth known as health care reform. In each instance, the stakes are both powerful and personal, and I watch closely as the frustration builds for all involved. While I may not know how either story will unfold, I am more confident in my son’s success, especially since I have a strong suspicion he will not be satisfied until he accomplishes a certain degree of mobility that is presently all too imaginable but not yet feasible. I hope that our nation’s approach to health care reform shares some commonality with the perseverance I see in my newborn, especially since we will all be forced to accept some risk and exercise a certain degree of faith before we learn how the story of PPACA is to end.  For my part, I am grateful to be ensconced in the middle of both, and I can only hope that my expectations for the future of health care will be as gratifying as the role I now play in assisting my son as he takes his first steps on his way to self-sufficiency.

The article was first published August 26, 2011 on Becker’s Hospital Review (written by Molly Gamble).

Healthcare executives might remember time moving a bit more slowly before March 23, 2010. That was the day President Obama penned his signature, supposedly letter by letter, onto the Patient Protection and Affordable Care Act. The average workday for healthcare or hospital CEOs was probably filled with slightly different concerns or agendas before that moment. Since then, though, the industry has been flung into fast motion to accommodate the policy changes mandated in that 2,700 page bill along with its larger overarching themes that are shaping modern-day healthcare.

For the rest of the article, visit the Becker’s Hospital Review Website.

This article first appeared in the August 25, 2011 edition of Payers and Providers.

As President Obama’s Patient Protection and Affordable Care Act (PPACA) continues to evolve, the structure of health care in the United States grows ever more complicated, and California is no exception to the rule. One of the nation’s most expensive states when it comes to treating an average hospital patient, California makes up more than 10% of what the U.S. spends on health care annually.  Therefore, it is not surprising that state legislation has designated certain opportunities for its hospitals to benefit from special programs designed to fortify their financial stability in the short term.

However, with these conditional programs come additional regulations, making an already complex system even more difficult to navigate.  Leapfrogging over the myriad requirements relating to authorizations, categorization of in- and out-of-network providers, and the other combinations of factors that exist as a condition precedent to accessing non-emergency care, many of California’s hospital administrators have recently found themselves in the eye of health care’s hurricane, temporarily lulled into submission by the peace of mind granted by such programs and their promised funding, even as the chaos surrounding the nation’s health care reform is presented daily in the press.  Following are a few examples:

Medi-Cal Disproportionate Share Program

In just under 31,000 words, California’s Welfare and Institutions Code codifies the Medi-Cal disproportionate share program (DSH). It ensures that hospitals serving a large number of Medi-Cal patients, as well as low-income patients, receive additional support as a means to balance out Medi-Cal’s low reimbursement rates. In 2009 alone, this figure weighed in at more than $2.2 billion. With its origins in the Omnibus Budget Reconciliation Act of 1981 (P.L. 97-35), DSH funds have over the years provided a lifeline for struggling hospitals that may have otherwise shut their doors long ago.

California Medical Assistance Commission

The California Medical Assistance Commission (CMAC) oversees the Private Hospital Supplemental Fund for hospitals meeting certain criteria relating to emergency services, teaching hospitals, children’s hospital medical education, and small and rural hospital programs. For fiscal year 2010, hospitals received close to $242 million under this fund.

CMAC is also responsible for administering a state program to compensate a handful of hospitals with “distressed hospital funds” based upon criteria relating to their commitment to the Medi-Cal population in the state (although not tied to DSH payments) and the degree to which each hospital has experienced financial hardship. CMAC continues to work with the California Department of Health Care Services to coordinate the Construction and Renovation Reimbursement Program, having paid an estimated $90 million during fiscal year 2010-2011 for contracting hospitals that meet certain new construction criteria for plans submitted to California’s Office of Statewide Health Planning and Development (OSHPD) between 1988 and 1994.

The Hospital Fee Program

Signed into law last year, California’s Hospital Fee Program has already brought an infusion of $2.6 billion in Quality Assurance Fee monies to the state’s medical facilities, as well as providing Stabilization Act supplemental payments to eligible hospitals. With the help of matching federal funds, the program was initially designed to help offset the estimated $4.6 billion in Medi-Cal losses suffered by these same hospitals the previous year.  Considered a boon by many, the Hospital Fee Program has been extended through 2012, with its second round already nearing completion. Successful in large part due to the Herculean efforts of the California Hospital Association, the Hospital Fee Program has accomplished the unimaginable: it has forced hospitals to work together for a greater good.

California’s Medicaid Waiver

Last year the federal government approved California’s $10 billion Medicaid waiver.  This allowed the state Medicaid program to customize coverage under Medi-Cal and deviate from certain federal requirements. The inherent flexibility in this waiver was designed to improve the Medi-Cal program and reduce expenses between now and 2014, when the state health insurance exchanges under the Patient Protection and Affordable Care Act are scheduled to begin.

While by no means an exhaustive list, the programs referred to above provide an important glimpse into the complex nature of health care funding in California. Without these programs, it is hard to imagine what the state’s health care system would resemble today. Unfortunately, immediate improvements in our nation’s health care system do not appear to be forthcoming, and more specifically, ordinary reimbursements are expected to decline. California’s efforts to keep its health care system alive are both admirable and necessary in the short term.  What remains to be seen is how well its hospitals will be able to navigate the impending health care storm without such help.

Today’s headlines contend that our system is failing, and health care’s inability to sustain itself may ultimately prove its demise. This is in part due to the fact that the industry must straddle an unenviable fence, protecting its rights as both a public service and a sustainable business. It is remiss for those in authority to focus primarily on impermanent programs at the expense of rectifying flaws inherent in the current system, for they then run the risk of viewing such programs as commonplace crutches to assist them on a regular basis. A one-time infusion of unexpected yet substantial capital may top the list of “good days” for any hospital administrator, and should this occur a second time, so much the better.  But how many times will it take for an isolated event to become an annual expectation? And when the expected becomes necessary, what will be the impact on the state of our health care if or when such programs disappear?

This article first appeared in the Daily Journal on August 17, 2011.

When President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA) last year, he effectively gave the United States a map to describe the route of American health care for the foreseeable future. And if its initial robust 2,700 pages were not enough, additional regulations proved quickly forthcoming. As necessary and expected as these supplements may be in the grand scheme, pouring through their merits can be daunting.  To make matters worse, the frequency with which the federal government updates health care reform through regulatory addendums is not only confusing to the general public and health care professionals alike, but it provides opportunities to infuse partisan politics on either side, which detract from the gravitas of the situation at hand.

The last few months have seen clarifications to some key components within PPACA. For example, in April the federal government released the long awaited and much anticipated details defining Accountable Care Organizations (ACOs). Although ACOs are not set to take effect until 2012, these proposed regulations may have unexpectedly stalled the fervent collaboration between private payers, physicians, and health system leaders previously occurring nationwide.

On the surface, ACOs may trigger well-established violations of law without the benefit of a new, expected safe harbor provision or other comparable exceptions, especially in California where the corporate practice of medicine is prohibited. Moreover, proper formation of ACOs under the regulations will necessitate a significant capital commitment, a commodity that has been depleted in a state like California with serious financial burdens separate and apart from an underfunded health care system, which is in the process of entering the electronic health records age with physical structures that must meet state mandated seismic safety standards.

Perhaps as a way to provide some assurance that the fledgling ACO-collaborations stay on track, the federal government subsequently offered details on its Pioneer ACO Model. The Pioneer Model caters to health care alignments with preexisting experience in coordinating patient services, thus creating a “fast track” from the shared savings model to a population-based model. Similar in structure to the Medicare Shared Savings Program, the federal government hopes that its Pioneer Model will set the gold standard for ACOs in the future as these new entities scramble to align payers, providers, and patients.

Last month the federal government released approximately 300 pages of guidelines addressing the ways in which states must implement new ”affordable insurance exchanges” by the Jan. 1, 2014 deadline, although California was the first state to pass legislation in this regard. Last week, the government directed another $185 million in “establishment grants” to assist the individual states with their health exchange endeavors. The exchanges intend to provide consumers with a variety of private health insurance options displayed in such a way as to allow an easy comparison of covered services, premiums, co-pays and deductibles.  This is indeed the quintessential harbinger of health care’s future under PPACA.

At least one article reporting on the new regulations last month (Los Angeles Times, July 12, 2011) commented that the exchanges are designed to make the purchase of health insurance much like employing the Internet to purchase airline tickets and hotel reservations.  Whether accurate or not, such an analogy is frightening and evokes images of innocent hospital patients shopping for coverage just prior to an appendectomy, and ending up on standby for gallbladder surgery with a layover in the ICU.

One of the primary objectives of the exchanges is simplification. Necessary or not, these new regulations do very little to ease the minds of most health care consumers. Instead, this outpouring of information strikes fear in the hearts of hospital patients. Both fan and foe of PPACA can agree that there is plenty of information to process at present, and even more assembling on the horizon.

And if that was not enough information to digest, last week the 11th U.S. Circuit Court of Appeals held that the individual insurance mandate is unconstitutional, thus creating a split amongst the circuit courts. In ruling against this component of health care reform, the court argued:  “The uninsured have made a decision, either consciously or by default, to direct their financial resources to some other time or need than health insurance.” (Florida v. United States Dept. of Health and Human Srvs.,(11th Cir., Aug. 12, 2011.)

But have the 50 million uninsured really made a decision, or is their inaction simply a reaction to the confusion inherent in our current health care system? Making sense of the situation will take time, and any rush to judge these developments will result in a disservice to all those involved. As lengthy as it is, the original text of PPACA did little more than outline a new way of delivering health care to a nation in need of support.  In fact, a majority of PPACA’s initial draft relates to pilot programs, preventative care measures, and other studies that focus on the future of medicine, rather than the delivery of health care.

And while the fight to repeal PPACA moves closer to the U.S. Supreme Court, as well as into the hands of the debt ceiling legislation’s “Super Committee,” it is important to remember that from a practical standpoint, PPACA’s legacy remains difficult to quantify until it has been given the chance to mature into a definable entity.

This article was first published on Becker’s Hospital Review.

Well into its second year, President Obama’s Patient Protection and Affordable Care Act continues to exhibit a series of growing pains as it struggles to flex its muscles and mature. As with any rapidly evolving entity, our nation’s healthcare system has been reshuffling a number of core options lately, and though only a select few draw national attention, the recent vote to keep Oak Forest Hospital up and running in Illinois’ Cook County sheds new light on an escalating problem within the American healthcare structure. Namely, who pays the greatest price when a hospital is not allowed to shut its doors?

As the fledgling PPACA gains momentum, change is certainly afoot. Earlier this year the federal government placed strict requirements on those insurance companies who intend to raise plan premiums in excess of 10 percent. Last month, the same federal government announced that hospitals could no longer ignore patient satisfaction if they wanted to maintain their Medicare reimbursements without additional cuts. Prior to that, the Centers for Medicare & Medicaid Services released a set of much anticipated proposed regulations for accountable care organizations, which will arguably become the blueprints for the future of American healthcare. The draft requirements, however, make it clear to any but the largest health care providers that the future of medicine is both cost prohibitive and fraught with even more regulatory minefields than the existing system.

This is not good news for smaller, independently owned hospitals struggling to stay afloat in the current economic climate. It also emphasizes the frightening fact that each year fewer emergency departments are available nationwide, in urban neighborhoods in particular. A recent study by a doctor at University of California at San Francisco states that one out of every four hospital emergency departments has shut down in the past 20 years, even as ED visits have increased by 35%. The strain of regulatory pressures on today’s medical facilities is causing significant cracks in the foundation of America’s healthcare structure as a whole, and if not rectified in the short term, it will ultimately be the patient who is forced to do without.

When the Emergency Medical Treatment and Active Labor Act (EMTALA) was passed in 1986, requiring hospitals to provide medical care to anyone needing emergency treatment, regardless of citizenship, insurance, or ability to pay, hospital administrators across the country clamored that such a mandate would be the death knell of many of the nation’s hospitals. Imagine their surprise to hear that we as a nation have progressed so far this past quarter century as to not allow a failing hospital to close when it can no longer afford to provide for its community.

Though the basic tenets of the PPACA are laudable in their attempts to provide a broader range of coverage, in the final analysis healthcare is a business, and as such must be allowed to follow the traditional rules of commerce if it is to be expected to successfully provide an acceptable quality of service. By forcing hospitals to stay open when they are financially unable or unwilling to do so, the system effectively creates a smoke screen, tricking patients into thinking they have access to reasonable medical care when in fact the facility is scraping bottom.

While federally mandated health care does its best to ensure that no one slips through the cracks, such blanket coverage comes at a price. And that price just might be your local hospital.

Medicare and hospitals go hand in hand. Hospital payments account for the greatest share of the federal program’s spending, and Medicare is the largest payor for hospital services, comprising a significant portion of most hospitals’ revenue. As of Oct. 1, though, hospitals will operate under a revised inpatient prospective payment system — one that could put many hospitals at risk.

The proposed changes to IPPS for fiscal year 2012
Imagine if the method of assessing individual taxes changed and the government scrapped its traditional, income-based approach for a model that taxed Americans based upon their personal caliber.

This may sound far-fetched, but healthcare leaders might share a strange yet familiar connection with the scenario — particularly in light of the Centers for Medicare & Medicaid Services’ proposed changes to IPPS. These rules, unveiled in April 2011 for fiscal year 2012 (thus going into effect Oct. 1), contain payment rate changes, coding adjustments, and the quality reporting program which mandates hospitals to report on 55 measures for FY 2012. 

More than 60 percent of hospitals already lose money on Medicare, according to the American Hospital Association. Section 3401 of the Patient Protection and Affordable Care Act detailed across-the-board Medicare payment reductions for hospitals. These cuts are estimated to reduce reimbursements by $155 billion from 2010-2019, a strategy hospitals agreed to accept in 2009 to help fund healthcare reform. While good news for CMS, these additional Medicare cuts could prove devastating to hospitals, particularly when paired with extensive performance-based healthcare delivery reforms, such as value-based purchasing, which is set to begin in Oct. 2012.

Putting IPPS into context
From an academic and legal standpoint, Craig B. Garner, a professor of law at Pepperdine University in Malibu, Calif., says the proposed changes are fascinating. “Throughout its history, Medicare has employed variations of cost-based reimbursement, originally factoring in the actual cost to a provider and then transitioning to a predetermined rate based upon a patient’s particular diagnosis. Soon it may not matter anymore,” says Mr. Garner. “The new regulations are changing a very complex system and steering it in a totally new and equally complicated direction, only this time based on performance.  This will include what people think of a hospital, the patient experience during a hospital stay, and ultimately the reliability of a hospital in its delivery of patient care,” says Mr. Garner.

The complete article can be viewed HERE.

By the 1920s, the sanatorium expanded its mission to include the full spectrum of tuberculosis cases, and continued in that regard until the middle of the twentieth century when medication became the prevailing treatment. In 1950 the facility expanded its scope of services to include all chest diseases, and the name was changed to the New Jersey Hospital for Chest Diseases. Indeed, throughout the 1960s, many former tuberculosis hospitals transitioned to a broader range of treatment.

In 1977, the hospital changed its name again to the Senator Garret W. Hagedorn Gero-Psychiatric Hospital as it focused on its new calling as a state nursing home and eventually a 288-bed psychiatric hospital. The hospital’s premier location high up on a mountaintop with 600 acres of provided inpatient, comprehensive psychiatric treatment for adult patients. The hospital stated as its mission “to provide quality interdisciplinary psychiatric services that maximize potential and community reintegration within a safe and caring environment.”

In 2011, New Jersey decided to close the smallest of New Jersey’s four public mental hospitals.  In the words of psychiatrist David Nathan: “Finally, a good state hospital, and they want to close it.  It is rare to see even a private mental hospital that gives good care to the severely mentally ill. Hagedorn is a public hospital.   .  .   .   .   and it comes across as top notch.”

Even with a one-year reprieve by New Jersey’s legislature, Governor Chris Christie has targeted Hagedorn as the one to close.  According to Robert Davison, chair of the Governor’s Task Force on Mental Health, the decision is “fundamentally flawed.” Davison continued: “It is irresponsible to close a state hospital in a year or less.”

Governor Christie explained that by closing Hagedorn New Jersey would save $9 million annually.  It would also result in the closure of Freedom House (a center for treating addiction on the Hagedorn campus). Local residents expressed concern about the future of the 600-acre property.

Critics of the decision expressed disappointment that Hagedorn was selected over Trenton Psychiatric Hospital. One critic, Hunterdon County Freeholder Ron Sworen, stated: “Where are these people going to go?  Just putting them out into the public and halfway houses isn’t the answer, the way some of these people are.  It’s an important facility in our area, it’s the only one that really deals with geriatric care, that goes away and where do all these people go?”

With the closing also comes the relocation of 623 employees in the summer 2012.

To make the situation even more complicated, in July 2011 the Joint Commission found numerous deficiencies at Trenton Psychiatric Hospital and may recommend its closure.  When both hospitals were considered for closure, the task force identified physical deficiencies with Trenton. According to one task force member said task force member Gilbert Honigfeld: “We made a big point that Trenton Psychiatric is basically dealing with an infrastructure and a superstructure that is upwards of 150 years old. These are old, decaying buildings with all the environmental hazards associated with that and it looks like a warehouse, which everyone is trying to avoid.”

By the 1920s, the sanatorium expanded its mission to include the full spectrum of tuberculosis cases, and continued in that regard until the middle of the twentieth century when medication became the prevailing treatment. In 1950 the facility expanded its scope of services to include all chest diseases, and the name was changed to the New Jersey Hospital for Chest Diseases. Indeed, throughout the 1960s, many former tuberculosis hospitals transitioned to a broader range of treatment.

In 1977, the hospital changed its name again to the Senator Garret W. Hagedorn Gero-Psychiatric Hospital as it focused on its new calling as a state nursing home and eventually a 288-bed psychiatric hospital. The hospital’s premier location high up on a mountaintop with 600 acres of provided inpatient, comprehensive psychiatric treatment for adult patients. The hospital stated as its mission “to provide quality interdisciplinary psychiatric services that maximize potential and community reintegration within a safe and caring environment.”

In 2011, New Jersey decided to close the smallest of New Jersey’s four public mental hospitals.  In the words of psychiatrist David Nathan: “Finally, a good state hospital, and they want to close it.  It is rare to see even a private mental hospital that gives good care to the severely mentally ill. Hagedorn is a public hospital.   .  .   .   .   and it comes across as top notch.”

Even with a one-year reprieve by New Jersey’s legislature, Governor Chris Christie has targeted Hagedorn as the one to close.  According to Robert Davison, chair of the Governor’s Task Force on Mental Health, the decision is “fundamentally flawed.” Davison continued: “It is irresponsible to close a state hospital in a year or less.”

Governor Christie explained that by closing Hagedorn New Jersey would save $9 million annually.  It would also result in the closure of Freedom House (a center for treating addiction on the Hagedorn campus). Local residents expressed concern about the future of the 600-acre property.

Critics of the decision expressed disappointment that Hagedorn was selected over Trenton Psychiatric Hospital. One critic, Hunterdon County Freeholder Ron Sworen, stated: “Where are these people going to go?  Just putting them out into the public and halfway houses isn’t the answer, the way some of these people are.  It’s an important facility in our area, it’s the only one that really deals with geriatric care, that goes away and where do all these people go?”

With the closing also comes the relocation of 623 employees in the summer 2012.

To make the situation even more complicated, in July 2011 the Joint Commission found numerous deficiencies at Trenton Psychiatric Hospital and may recommend its closure.  When both hospitals were considered for closure, the task force identified physical deficiencies with Trenton. According to one task force member said task force member Gilbert Honigfeld: “We made a big point that Trenton Psychiatric is basically dealing with an infrastructure and a superstructure that is upwards of 150 years old. These are old, decaying buildings with all the environmental hazards associated with that and it looks like a warehouse, which everyone is trying to avoid.”