RD512 - Commonwealth of Virginia, Department of Behavioral Health and Developmental Services Forensics Unit Preplanning Study – August 2, 2019
The purpose of this study is to fulfill the requirements of the 2019 Virginia Acts of Assembly, Chapter 854, Item 310 CC.4 stating: “Also as part of the plan in paragraph CC.2., DBHDS, in consultation with the Department of General Services, shall address the feasibility of relocating forensic beds to state-owned property other than the current Central State Hospital location authorized in C-48.10. The analysis shall at a minimum address the issue of cost and timeline for construction." Our team investigated five DBHDS designated test fit sites within the state and determined the original site identified in the “Preplanning Study – Central State Hospital Full Replacement 2018" report remains the best location for the new facility.
DBHDS, working in concert with the Department of Real Estate and Facilities Management (DREFM), evaluated 17 sites within the Commonwealth for a new forensic unit. Site evaluation included key features such as centrality of location, proximity to regional medical and education facilities, site availability and adaptation, proximity to current DBHDS facility for shared services, and regional employment availability. Based on this evaluation criteria, the following five sites, in addition to the Central State Hospital site, were recommended for test fit evaluation:
• Western State Hospital, Staunton, Virginia
The “New Central State Hospital" site evaluation matrix is located in Section 4 - Site Evaluation and Test Fits. It provides further supporting evaluation selection criteria. The “New Central State Hospital" site evaluation matrix provides a summary review and recommendation of the key site features, but it does not represent a ranking or preference for the site.
Test Fit Site Selection Program:
The basis for this “Forensic Unit Test Fit – Five Sites" study is the information provided in the “Preplanning Study – Central State Hospital Full Replacement 2018," prepared by HDR for the Virginia Department of Behavioral Health and Developmental Service.
A Conceptual Space Program was developed using the HDR 2018 Preplanning Study program for the Central State Hospital replacement. Several departments in the program are clearly identified as “Forensic" departments (Forensic Living Units, Forensic Mall, etc.). However, to create a freestanding Maximum Secure Forensic Hospital, several support departments are required. This includes departments such as Dietary, Administration, Admitting, etc. To determine the approximate sizes for the support departments, a percentage of the total area of the HDR program was applied to each department and that square footage was used to create the Conceptual Space Program
Using the Conceptual Space Program, a “Generic Hospital Model" was created that met the planning principals outlined in the HDR 2018 Preplanning Study. This hospital model was non-site specific.
All five of the identified campuses were visited and assessed. The most favorable site location on each campus was identified for the location of the freestanding Forensic Hospital. The Generic Hospital Model was site adapted to fit each of the preferred sites identified for the five campuses. In addition to the conceptual hospital plan, the site adaptations included: vehicular entries and circulation, parking for 200 cars, a maximum secure perimeter (double layered secure fencing), and a perimeter loop road.
Using the site test fits and site analysis, a Conceptual Cost Estimate was developed for each site and contains the following elements: building construction estimate using the information identified in the HDR 2018 Preplanning study and test fit, site-specific elements like length of roads and utilities required, secure perimeter fencing, and other features unique to the site.
Each of the sites were ranked according to cost and the aforementioned criteria. This ranking confirms that locating the secure forensic unit in Petersburg, VA, is the recommended option.
Operation and Staffing Evaluation:
The current maximum security forensic facility at Central State Hospital has evolved into a comprehensive and fundamental therapeutic treatment program that supports individuals with severe mental illness from across Virginia. Patient care and support staff with knowledge and experience of the complexities for managing recovery programs for maximum security forensic patients are vital to the overall safety and success of its treatment program. Given the complexities of the Central State Hospital forensic program, operational and staffing considerations are critical to location and program development, which are essential evaluation criterion.
Financial data for Fiscal Year 2019 provided by DBHDS for the Central State Hospital secure forensic unit identifies an annual operating cost of $20,515,625. This amount includes direct care and security cost, physicians cost, all non-direct operating costs (buildings and grounds, pharmacy, laundry, food services, etc.) and specialized medical care costs. For site evaluation comparisons, the first year annual operating cost if the forensic unit is located at Western State Hospital and Catawba Hospital would increase approximately 256 percent. If located at CVTC, Powhatan Correctional Center, or James River Correctional Center the annual operating costs would increase approximately 308 percent. Over a five-year period, this equates to an operating cost for the Commonwealth of Virginia of $134,629,077 if located at Western State or Catawba Hospital, and $187,638,478 if located at CVTC, Powhatan Correctional Center or James River Correctional Center. If the program remains at the Petersburg campus, the operating cost for a five-year period would be $102,578,125.
After careful consideration of the options to find the optimal location for the secure forensic hospital within the Commonwealth of Virginia, it is the conclusion that the Central State Hospital campus in Petersburg, VA, remains the ideal location for the new hospital. This conclusion is based on the findings in first evaluating 17 proposed state-owned sites that was narrowed to six campuses including the Central State Hospital for careful analysis and consideration.
The ability of each campus to support the new 111-bed forensic behavioral healthcare hospital was evaluated. This analysis included such factors described within this report including: the ability to staff the facility, centrality to clients and their families and homes, the support of academic medicine and medical services within proximity, and the ease of fitting the ideal new facility on the campus. The outcome of this analysis indicated that the Central State Hospital campus in Petersburg, VA, was the best campus for this new facility scoring the highest of all the sites investigated.
The economic analysis of each campus provides the most conclusive criteria for the suitability of the Central State Hospital campus to provide the best value to Virginia residents.
This analysis evaluated the cost to build the new hospital building on the campuses, the site adaptations and improvement construction costs that would be required to support the new hospital, and the operational costs required to open and operate the new hospital. The accompanying chart summarizes these costs for each campus.
It is the conclusion of this study that the Central State Hospital campus remains the best suited campus to locate the new secure forensic behavioral healthcare hospital.