In this May 2018 photo, Dr. Hughes Melton, state commissioner of Behavioral Health, right, shakes hands with Dr. Faizur Rahman, one of the doctors on the forensic unit at Central State Hospital in Dinwiddie County.

Gov. Ralph Northam might have to propose a new approach for replacing Central State Hospital after General Assembly budget negotiators removed funding to plan a project that would cost more than $385 million and require at least seven years to complete.

Northam had proposed $16 million in planning money for the project, which has more than doubled in cost and scope under a study completed Dec. 1.

Budget negotiators cut the planning money from the two-year spending compromise reached shortly before the legislature adjourned last month. They say they are open to funding a different approach if the governor proposes one before the assembly reconvenes on April 3 for its veto session.

Central State was founded after the Civil War as one of the nation’s first psychiatric institutions solely for African-Americans; it became racially integrated in 1967, three years after passage of the Civil Rights Act. The hospital, made up of almost two dozen old buildings on 543 acres in Dinwiddie County outside of Petersburg, is considered crucial to rebuilding Virginia’s mental health system.

But legislative leaders said the proposal to replace the hospital requires clearer focus and quicker results.

“It just didn’t seem like they had thought the thing through,” said Senate Finance Co-Chairman Emmett Hanger, R-Augusta. “I wanted them to expedite it.”

Hanger, Finance Co-Chairman Tommy Norment, R-James City, and House Appropriations Chairman Chris Jones, R-Suffolk, made the decision to drop the capital planning money late in negotiations by the conference committee that reconciled differences between the Senate and House of Delegates on revisions to the two-year budget.

“That, by far, was the largest project,” Jones said. “If the governor feels that passionately about it, he can send something down at the reconvened session.”

Northam spokeswoman Ofirah Yheskel said, “The governor is disappointed to see the critical need that was reflected in his proposed budget is not being addressed and he will evaluate options moving forward.”

‘Indispensable institution’

Secretary of Finance Aubrey Layne said he has been warning the assembly money committees since early fall that replacing Central State is one of the state’s biggest looming financial obligations.

“Right now, probably one of the most critical needs in the commonwealth is not being addressed,” Layne said.

Central State is “an indispensable institution” because it contains the only maximum-security mental hospital unit in the state, said Sen. Creigh Deeds, D-Bath, leader of a joint subcommittee that has been working for years to restructure Virginia’s troubled mental health system. The hospital also serves a central part of Virginia, including the Richmond area.

However, state officials say the sprawling hospital campus is old — the average building age is 65 years — inefficient and unsafe, undermining treatment of some of the most difficult patients in the state system.

“I don’t understand how people can get well in that facility the way it’s laid out now,” Deeds said. “It’s more reminiscent of ‘One Flew Over the Cuckoo’s Nest.’”

The revised budget includes language that directs the Department of Behavioral Health and Developmental Services to study how to fit Central State within a larger study of how to “right-size” the state’s increasingly overcrowded mental hospitals.

Dr. Hughes Melton, who became behavioral health commissioner last spring, thinks the hospital’s role won’t change.

“I don’t see a possible future where we don’t need a replacement hospital for Central State,” Melton said Tuesday. “I think the need for the facility is very clear.”

What’s less clear is the feasibility of the plan developed by the behavioral health department and the Department of General Services, which oversees real estate and construction projects for state government.

Doubled in scope, cost

The agencies produced a 403-page report on Dec. 1 that provided a detailed analysis of a project that has more than doubled in scope and cost in less than a year.

Last summer, the state was considering a $169.1 million project that would replace eight outdated buildings — including the maximum-security forensic unit — with one building. The new report instead recommended a project that would replace 23 buildings with one consolidated facility at a cost of $385.1 million.

The costs would go up and the construction schedule would slip if the state split the project into two or three phases. Layne said that is why the new study recommended a comprehensive approach instead of an incremental one that would put pressure on hospital staff and clinical treatment. “Operationally, we’ll be spending a lot of money,” he said of the preliminary study, completed in 2015.

State mental health officials say the earlier study did not include a full site analysis or consider all necessary clinical, medical and support services.

The new study, updated for inflation, “was more thorough and was done by an independent contractor,” said Maria Reppas, spokeswoman for the behavioral health department. “It included plans and cost estimates for a site analysis, additional treatment space, a pharmacy and the clinical and medical services that are needed for a free-standing hospital.”

“It included changes for the old hospital design that no longer meet federal standards of care required for treatment facilities like Central State, such as individual bathrooms in the maximum-security unit,” she added. “It also included the support services needed to run the hospital, such as the physical plant, laundry, warehouse and the food service kitchen.”

At least seven years

Melton said the new plan would require at least seven years to complete because it would require “detailed drawings for a really sophisticated facility that would have two facilities under one roof” — the maximum-security forensic unit and units for civil patients and forensic patients requiring a lower level of security while they are evaluated.

Legislators also are concerned about the reliability, efficiency and safety of the current Central State complex, which is why they want the state to move faster with a replacement hospital that is modeled on the modern facilities built at Western State Hospital in Staunton and Eastern State Hospital near Williamsburg.

“My hope is we can work this out prior to the veto session,” said Sen. Rosalyn Dance, D-Petersburg. “It should not take them seven years to do this project.”

Layne acknowledges the concerns, but he says the state cannot afford to wait any longer for money to plan the project.

“The message from us is we can’t go another year without any action,” he said.

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