Chairman Collins, Ranking Member Leiberman, members of the Senate Committee on Governmental Affairs, I am Marti Knisley, the Director of the District of Columbia Department of Mental Health and I thank you for inviting me to testify before you on a subject of great importance to myself, my department, and the citizens of our nation’s capitol  -- the past, present, and future of the West Campus of Saint Elizabeths Hospital.

            Allow me to preface my remarks with a brief explanation of the Department and its current interest in the subject of this hearing.   As you no doubt know, in 2001, the Mayor and the District of Columbia Council, with the approval of Congress, abolished the old Commission on Mental Health Services and established the Department of Mental Health as a new District of Columbia cabinet-level agency.  The establishment of the Department as a cabinet-level agency, with independent personnel and contracting authority, attests to the District government’s resolve to finally create a fully-functioning community-based system of mental health services delivery for the citizens of the District, thereby meeting the goals set out in the Court-Ordered Plan in Dixon v. Williams and ending the class action litigation first brought almost thirty years ago, when the Hospital was owned and operated by the predecessor agency to the Department of Health and Human Services (HHS).  The cornerstone of this effort involves moving away from the District’s long-standing Hospital-centered system of care, where community programs perform only those services that the Hospital cannot, to a community-based system, where the Hospital provides a service of last resort, and constitutes one alternative among several hospitals.  To meet this challenge, the Department dedicated itself to making every effort to shift as many resources as possible away from the Hospital and into community-based services.  We identified as an immediate priority the reduction of Hospital-associated costs by vacating the West Campus, consolidating patient-care-related functions on the East Campus, and moving non-patient care functions off the Campus.  We have completed these moves and are currently making arrangements for the removal of personal property from West Campus buildings and the cleaning of those buildings so that they may be stabilized and mothballed.

            Chairman Collins has asked me to comment specifically on how the West Campus arrived in its present state of deterioration?  Let me first say that I possess no first-hand knowledge of events from 1987 until my appointment in April 2001 and, from my staff’s efforts to compile answers to questions previously posed by Committee staff, it appears that very little institutional memory carried over to the Department from its predecessor agency.  Nevertheless, I can offer the following comments.

It is important to keep in mind that the Hospital Campus was already in a deteriorated state in 1987, when ownership of the East Campus and five buildings on the West Campus was transferred to the District pursuant to the “Saint Elizabeths Hospital and District of Columbia Mental Health Services Act’, also known as the “Transfer Act”.  The West Campus is the site of the 148 year-old original hospital building, as well as a number of other buildings of comparable vintage.  Under the original version of the Transfer Act, the federal government was charged with the responsibility of repairing and renovating  those buildings and support systems that the District indicated it intended to use in its Final System Implementation Plan.  Pursuant to the Act, HHS contracted for a physical plant audit which was conducted by an architectural and engineering firm, AEPA Architects Engineers.  This audit concluded that it would cost 55.8 million dollars to bring up to code those portions of the campus that the District intended to use.  Of that amount, 25.8 million dollars was attributable to renovation of West Campus facilities.

            Unfortunately, the story only goes downhill from there.  In general, I believe the Government Accounting Office (GAO) hit the nail on the head when it commented in its April 2001 report (at p. 2) that “lack of funding and the absence of a clear direction for the future of the west campus over the years have left it in a badly deteriorated condition.”   In hindsight, it appears to me that the District did what it could to keep up with maintenance of the West Campus.  However, its efforts seemed to be hamstrung by a number of factors.

First, the effort to bring the property up to code was never adequately funded.  At some point, it was determined that, rather than carry out the renovations identified in the AEPA audit, the federal government would transfer the funds identified in the audit to the District, which would then be responsible for performing the renovations.  However, The Department of Health and Human Services (HHS) transferred only 20.7 million of the 55.8 million dollars identified in the audit.  The District brought suit against the United States over these discrepancies in 1993 and to date the litigation remains unresolved.

            Second, the rapidly deteriorating buildings and crumbling infrastructure have required the District to devote its operating and capital funds to remedying immediate functionality, safety, and environmental issues to the detriment of strategic and preventive maintenance.  Infrastructure compromises have produced the greatest cost burdens.  For instance, in the past year alone, a crack in an aging water tower on the campus, left us no choice but to spend a quarter of a million dollars to replace it, even though the Washington Area Sanitation Authority (WASA) plans to put a new tower on the campus in the near future.  We are currently replacing aged fuel oil tanks and cleaning up oil that has leaked from them, at a cost of 300,000 dollars.  Steam line leaks and faults are a common occurrence, as are water main breaks, which require major digging at great expense.  The ubiquitous slate roofs are vulnerable to high winds and rain and are very expensive to replace.  Maintenance of the lawns, trees, roadways, and parking lots is an immense and costly task.  Hurricane Isabel just knocked down some thirty trees, which will have to be removed.  The list goes on and on.  

            Challenges such as these confronted the District from the first day it assumed responsibility for the West Campus.  The Hospital power plant, located on the West Campus, became an immediate and especially significant drain on the District’s resources.  After being cited by the Environmental Protection Agency (EPA) for Clean Air Act violations, the federal government sued the District in 1991 in an effort to force it to essentially “pick up the tab” for years of neglect and mismanagement of the power plant prior to 1987.  Affidavits filed in that case by the Hospital’s Mechanical Engineer substantiate that the District spent 5.3 million dollars in fiscal years 1988 through 1994 on repairing the power plant to achieve Clean Air Act compliance and projected it would have to spend 18.3 million dollars overall.  The court dismissed the federal government’s claims in that case and consolidated parts of a counterclaim raised by the District with the other lawsuit I mentioned earlier.

            In fiscal years 1988 through 1991, the District spent 10.1 million dollars to preserve, maintain, and repair all the vacant buildings on the West Campus. Of that amount, 4.35 million was attributable to buildings that the District had notified HHS it had vacated; and therefore, under paragraph 13 of the 1987 Use Permit agreement, HHS was to reimburse the District up to 1.3 million dollars.  HHS ultimately transferred only 1.1 million and the difference of $200,000 is the subject of the ongoing litigation I mentioned earlier.

            Records we have been able to locate for five of the years since 1991, establish that the District spent an annual average of 10.7 million dollars out of its capital budget each year for maintenance and repairs on the Hospital campus.  The records do not parse these costs out as between east and west campus, but a pro rata distribution based on relative square footage would attribute 4.4 million of those dollars to annual maintenance and repair of the West Campus.  My staff developed a current estimate that, even after decommissioning the West Campus buildings, maintenance costs could amount to 3.6 million dollars annually.  This high figure is due in large part to the fact that the deteriorated condition of the campus infrastructure, especially the water distribution systems, makes it impossible to cut off utilities to decommissioned buildings without risking substantial damage.

You have asked me to address the responsibility for this state of affairs.  The responsibility ultimately rests with HHS as the holding agency of the property.  The 1987 Use Permit stated that HHS “has holding agency responsibility and accountability” and paragraph six of the associated agreement assigns to the Public Health Service the responsibility for administering the agreement and supervising the District’s use of the property.  The extension agreement executed in 1997 substituted SAMHSA for PHS as the supervising office.

Beyond the information I have already shared, which is gleaned in large part from the record of the ongoing litigation, my Department cannot shed much light on HHS’ level of effort over the years to supervise the use permit.  We have not been able to locate records of visits or other enforcement activity, nor does anyone currently employed by the Department recall visits or inspections related to the use permit.  I can say that, since the federal government’s decision to surplus the property, which roughly coincided with my appointment and our decision to vacate the West Campus entirely, we have enjoyed a collaborative relationship with HHS.  They have participated with the District’s Office of Planning in the process of planning for development of both the East and West campuses.  They took responsibility for mothballing and stabilizing the Center Building, the oldest and largest building on the West Campus.  And currently, they are working with us and GSA on a three-way agreement for cleaning out the remaining West Campus buildings in preparation for mothballing. 

            In fairness, HHS’ task has not been made any easier by the transformation that has taken place over the years in the District’s plans for use of the West Campus.  Once the District decided to vacate the West Campus altogether, the GAO was correct to point out that “it would likely have little reason to continue its maintenance and protection responsibilities.”  (2001 Report, at 13).  Also, we can no longer sacrifice fiscal resources needed for the long-overdue development of a delivery system for community-based mental health services.

            You have also asked me to comment on the extent of the deterioration and the financial loss associated with the deterioration.  There is no way to give a comprehensive answer to this question without expending precious financial resources for a full-scale assessment.  For instance, we commissioned an assessment of just one West Campus Building, Hitchcock Hall.  The assessment, which concluded it would take 5.8 million dollars to restore the hall to a useable state, cost 14,000 dollars to obtain.  Other available figures provide rough measures of financial loss.  For instance, the District’s Master Plan,  submitted to Congress in 1993, estimated costs ranging from 116 to 128 million dollars to renovate the West Campus for a mix of mental health services, other institutional uses and retail uses.

Finally regarding plans for future use of the site, it is too soon to answer this question with any specificity.  Of course, the immediate plans are for HHS and GSA to mothball and stabilize the property pending its disposition as excess federal property.  In the meantime, the District’s Office of Planning has begun the process of planning for redevelopment of both the East and West Campuses, involving the federal government, the local citizenry, and other stakeholding entities, and taking into account the continued consolidation of hospital functions into a small number of buildings on the East Campus and the planned construction of a replacement hospital there.

I thank you for the opportunity to address the Committee today and I will strive to answer any questions you may have of me.