Valley Hospital security guard Genard Smith leaves a patient's bed Monday at the hospital's holding area, where mental patients are taken after they are seen in the emergency room. Photo by Ronda Churchill

CARSON CITY -- Despite the recent opening of a 190-bed mental hospital, the state's mental health administrator said Monday that another hospital must be built in the Las Vegas area unless private hospitals begin taking more mental patients.

Carlos Brandenburg, state mental health and development services administrator, told the Legislature's Interim Finance Committee that 62 mental health patients remained in emergency rooms of Las Vegas hospitals on Monday because there were no state or private mental hospital facilities available to help them.

Brandenburg said there will not be space to care for all mental health patients even after the state next week opens the last 40-bed pod at the new 190-bed Rawson-Neal Psychiatric Hospital in Las Vegas.

As long as the mentally ill crowd emergency rooms, Brandenburg said, other patients will have to wait longer for treatment.

"It is a tremendous burden on other folks who are having physical problems," he added. "The mentally ill are clogging up emergency rooms, and they (other patients) have trouble getting in."

Brandenburg said private hospitals in Clark County have closed 133 beds for mental patients since 2000. The hospitals now use these beds for surgical patients because the income they earn generally is twice what they make on mental patients, most of whom pay through Medicaid.

"There will continue to be a waiting period unless we offer private hospitals incentives to offer more beds," said Brandenburg, noting there are only 45 beds for mental patients in private hospitals in Clark County. "They got out of it because it wasn't lucrative enough."

Assembly Ways and Means Chairman Morse Arberry, D-Las Vegas, said the Legislature must take steps this session to end the waits for patients in emergency rooms, even if it means building another hospital.

"The hospitals are all backed up," Arberry said. "You can't get help. It gets worse at night and during the holiday season. We need to come up with answers during the next six months. We can't walk out of here without a hard-core decision.

Arberry added he is sure patients with physical problems have died because they could not get adequate help because of all the mentally ill patients in emergency rooms. He said he cannot imagine what happens to people who may be having heart attacks who cannot get prompt care.

"The population is growing," Arberry said. "Las Vegas is a more-senior type city and everybody doesn't have private insurance, so they have to go to UMC (University Medical Center)."

Brandenburg said not all mentally ill patients waiting for hospital beds to open up at mental facilities are homeless people. Some have been judged by police as being a danger to themselves or others, and they are taken to local hospitals because there is no other place for them.

Most of the waits occur at county-run UMC, but the 62 awaiting help Monday were in emergency rooms in most of 13 hospitals in the Las Vegas Valley, he added.

Once admitted to the state mental hospital, he said, these patients are examined by staff doctors and nurses who determine whether they should go to an observation unit or be placed in a regular bed. Those placed in regular beds stay an average of 17 days, according to Brandenburg.

He added the problem exists only in Clark County, noting there has not been a need to add mental health beds in hospitals in Reno and Carson City for more than four years.

Before construction of the new mental hospital, Brandenburg said the number of mentally ill people being seen at emergency rooms was about 100 per day.

He added the Department of Health and Human Services wants Gov. Jim Gibbons and the Legislature to reopen 22 mental health beds in portions of the old state mental hospital on West Charleston Boulevard that were closed when the Rawson-Neal hospital opened.

During the Interim Finance Committee meeting, several legislators expressed concern that the state has been able to hire only about half of the 99 psychiatric nurses to staff the Rawson-Neal hospital. Brandenburg blamed the problem on the national nursing shortage. He added nurses can pick and choose when and where they work that many do not want a full-time job.

The nursing vacancies at the Rawson-Neal hospital will be filled by part-time and contract nurses. In September, the committee approved a request by Brandenburg to use $1.1 million of the Division of Mental Health and Developmental Services' budget to fill some vacancies with contract employees. The committee also agreed to spend $3.6 million through June 30 to allow nonprofit WestCare to continue to provide care for 25 mental health patients a day in Southern Nevada. The organization's contract had expired Sept. 5 and was for 50 beds.

Brandenburg said state psychiatric nurses receive $51,000 to $67,000 per year, plus benefits. Psychiatrists are paid $156,000 a year. The state has not had as much difficulty in recruiting psychiatrists for the new hospital, he said.

In contrast, the state governor gets $140,000 per year.

Review-Journal writer Annette Wells contributed to this report.