Mentally ill patients overloading hospitals

Local emergency rooms remain in “crisis mode” as mentally ill patients seeking care continue to overload hospitals ill-equipped to meet their needs, despite Gov. Brian Sandoval taking action in June to mitigate the problem.

Within the last 30 days, at least three hospitals have been forced to close their emergency departments to new patients because they were holding 140 mentally ill patients waiting for beds at Rawson-Neal Psychiatric Hospital, said Dr. Dale Carrison, chief of staff and head of emergency services at University Medical Center. UMC’s emergency department was one of the three. Two St. Rose Dominican Hospital campuses also had to close temporarily.

Over the last 30 days, the emergency department at the St. Rose de Lima campus has closed to new patients four times for a total of 54 hours because it had reached capacity. The St. Rose Siena campus closed its emergency room 10 times for a total of 73.75 hours, according to Kathleen Ryan, spokeswoman for the hospitals. Officials only make that decision when it affects patient safety.

“The crisis is not over at all,” Carrison said. “The crisis is still there. …We are still in a crisis mode.”

Carrison spoke Wednesday during Sandoval’s Behavioral Health and Wellness Council meeting. The ripples of the crisis almost had an impact on UMC’s rating from the Joint Commission, which accredits hospitals and conducted a recent inspection there, Carrison said.

“They couldn’t understand why we had mental health patients waiting in the ER when we are not certified as a mental health facility, ” he said. The problem was resolved after Carrison, with help from Sandoval’s office and state officials, was able to give Joint Commission officials a presentation about the efforts that are underway to solve the problem.

In June, Sandoval ordered immediate action on five short-term recommendations to improve Nevada’s struggling mental health system. The cost of implementing the recommendations was estimated at $3.5 million, which was paid for with the state’s tobacco settlement money.

But some of those recommendations have been slow to materialize.

“The state did what it could do, very fast,” Council Chairman Joel Dvoskin said after the meeting. “Unfortunately, the ERs aren’t seeing the results yet because the big things take a few months.”

The state allocated $255,500 as the state’s share of funding to expand the number of triage beds at the Las Vegas WestCare triage center from 36 to 50. The state, the local hospitals and the local jurisdictions each pay a portion of the cost for the WestCare triage center.

“The state’s portion (of the funding) is there,” Mike Willden, chief of staff for Sandoval’s office said. But the other two parties involved — the local hospitals and the local jurisdictions — haven’t finalized their part of the funding.

Parties involved are still meeting on the issue. Willden said there’s an active discussion to see if the funding portion from the local hospitals and the local jurisdictions can be reduced by billing Medicaid for some of the services.

Fourteen hospitals in Southern Nevada currently contribute $622,000 a year toward the cost of the triage center beds, and the hospitals were being asked to contribute an additional $248,000 a year to support the additional beds, Bill Welch, president and chief executive officer of the Nevada Hospital Association said in June.

Another recommendation was to increase the daily psychiatric reimbursement rate for hospitals with a psychiatric unit from $460 a day to $944 a day. But Willden said state officials are still involved in negotiations with officials at the federal Centers for Medicare and Medicaid Services, which has to approve the increase.

“They are going to have a critical eye to our request,” Willden said.

However, he believes the federal agency will approve an increase, but it might not be at the amount requested.

That could be problematic.

“We are getting to a very critical stage … since we haven’t had approval,” said Karla Perez, vice president of the acute division for Universal Health Services, which owns the Valley Health System.

Valley Hospital Medical Center hopes to open an inpatient psychiatric unit with about 50 beds, but if no approval from the federal agency is granted, the beds could be used for general medical surgical care, Perez said.

Construction for the unit is expected to be completed by Nov. 1, with an opening date of Dec. 1, she said.

If the federal agency approves an increase less than the $944 per day rate requested by the state, establishing the psychiatric unit at Valley Hospital would still be in question.

“Without that rate, we would have to reevaluate,” Perez said outside the meeting.

Meanwhile, other hospitals are still burdened with large numbers of mentally ill patients.

“I don’t believe things have really changed,” Ryan said on behalf of St. Rose. “The short-term fixes are just now being implemented.”

Sunrise Hospital and Medical Center is “committed to addressing this important and challenging issue while maintaining our commitment to keep our emergency department open,” Brendan Bussmann, vice president for strategic development and marketing for the hospital, said in a statement Tuesday. “Behavioral health remains a major issue and we appreciate the governor’s continued commitment to find solutions with key stakeholders.”

The Clark County Department of Social Services will begin to hire staff for a mobile outreach safety team, which state officials hope will be up in running by October, said Dr. Tracey Green, the state’s chief medical officer. State officials had previously hoped to have the mobile outreach safety team, which was also a recommendation, out in the community by this month.

The council on Wednesday also began discussing long-term fixes to improve the state’s mental health system, such as establishing regionalized mental health systems to have more local control and accountability.

Contact Yesenia Amaro at yamaro@reviewjournal.com or 702-383-0440. Find her on Twitter: @YeseniaAmaro.