Las Vegas mental clinic to close under federal pressure

An outpatient clinic inside Rawson-Neal Psychiatric Hospital that federal officials found fell short of standards set by the Emergency Medical Treatment and Labor Act will close its doors at 5 p.m. Friday.

The clinic opened in July to help decrease the number of mentally ill patients seeking treatment at local emergency rooms.

Nevada officials continue to disagree with the federal Centers for Medicare and Medicaid Services’ interpretation of the standards and its insistence that the outpatient clinic falls under the act, referred to as EMTALA, since the clinic was never intended to operate as a medical emergency room.

State officials say the federal agency lacks separate regulations for psychiatric hospitals and doesn’t recognize interim-type facilities, such as the clinic.

“In essence, for CMS you are an ER or you’re not,” Dr. Tracey Green, the state’s chief medical officer, said on Thursday. “We are very saddened by the fact that we are going to close the clinic. The intent was to provide early intervention for clients who were in crisis and did not have to go to an emergency room.”

However, federal officials said on Thursday the statutes they are enforcing at the facility do apply to such clinics. It’s up to Nevada officials to comply or to close the clinic.

There was an EMTALA complaint investigation, which state officials said was confidential. However, federal documents show the complaint alleged lack of emergency assessment and documentation.

The EMTALA violations included problems with maintaining the emergency room log, medical screening exams and appropriate transfers.

In addition, the Southern Nevada Adult Mental Health Services agency also went through a recertification inspection on Nov. 8. The inspection found the agency, which oversees Rawson-Neal, remains out of compliance with standards on oversight, quality assurance, performance improvement, and nursing services, according to federal documents.

The agency submitted a plan of correction on Wednesday.

The definition of an emergency department can be subjective, said Rufus Arther, CMS survey and certification branch manager for the western division. The regulation defines “dedicated emergency department” as any department or facility of the hospital that either is licensed by the state as an emergency department; is held out to the public as providing treatment for emergency medical conditions; or, in one-third of visits to the department, provides treatment for emergency medical conditions on an urgent basis.

Any one of those three triggers would make a facility subject to EMTALA requirements.

EMTALA applies to a number of psychiatric hospitals across the nation with emergency services and those facilities are in compliance, Arther said.

“It’s really erroneous to say that there’s not a CMS model for psychiatric hospitals,” he said.

If they want to modify their clinic or close it, it’s completely up to Nevada officials, Arther said. They just need to make sure that they are in compliance with the statutes that are applicable to the facility.

“Certainly, we understand their perspective, but at the same time, we are applying the regulations that are applicable to the hospital, and again, it’s an operational decision on the hospital on what they want to do,” he said.

Officials at the federal agency are concerned with the continued noncompliance at Rawson-Neal and of the agency that oversees the hospital, Arther said. Officials are reviewing the corrective action plans submitted by Nevada officials.

If accepted, the hospital will receive an unannounced inspection to make sure the problems have been fixed.

Green said there are other alternatives that state officials may use to continue to provide the services that were offered by the clinic. One of the alternatives could be crisis intervention centers.

The 18-member council appointed by Gov. Brian Sandoval to recommend improvements for the state’s mental health system is meeting on Jan. 29. Final recommendations will be made by the council.

State officials are taking the easy way out, said Dr. Dale Carrison, chief of staff and head of emergency services at University Medical Center, which is often faced with treating patients with mental illness that the hospital is ill-equipped to serve. He said EMTALA also applies to the quick-care clinic inside UMC and they are in compliance.

“It’s extremely disappointing,” he said. “Anytime we take services away, we hurt the system. I just can’t imagine how anybody thinks this isn’t going to make things more difficult. That’s easier for them. They always do things that are easier for them.”

Erik Pappa, spokesman for Clark County, said the decision to close the clinic it’s disappointing. The number of patients taking up emergency room beds across the valley is up to 183. That number was at 164 in July.

“We’re concerned,” he said. “Something has to be done to get the mentally ill the services they need while keeping our emergency rooms clear for true emergencies.”

Green said a number of improvements have been made at the hospital.

“I don’t want the negative light to overshadow the fact that our hospital has come a long way in making significant improvements,” she said.

Contact reporter Yesenia Amaro at yamaro@reviewjournal.com or 702-383-0440.