Governor’s council focuses on emergency room crowding

Southern Nevada emergency rooms inundated by the mentally ill seeking services the facilities are ill-equipped to provide need help now, say those charged with finding solutions.

“We can’t keep waiting,” said Nancy Harpin, a registered nurse and clinical manager at University Medical Center’s pediatric emergency department.

The crisis, which caused several emergency rooms to close to ambulances in February, is being tackled by multiple groups working on solutions. Gov. Brian Sandoval’s Behavioral Health and Wellness Council will meet Monday and Tuesday in Las Vegas and hear reports from some of those groups.

The council is an advisory group that will make recommendations to Sandoval to take to the Legislature next session, said Joel Dvoskin, council chairman. Any proposal that requires state funding will need legislative approval. The council has to submit recommendations by May 31.

“The entire council believes the emergency room problem is a very high priority,” Dvoskin said Friday. “I can almost promise you that there’s such a strong feeling among the entire council that this problem needs a solution sooner than later, that by May 31, we are going to agree on recommendations that will be targeted specifically to that problem.”

Solutions that could relieve emergency rooms sooner may be workable within the existing budget, but the council will wait to learn more about the problem at its meeting, Dvoskin said. It’s possible that the council could act on a recommendation next week, but Dvoskin said he favors waiting to vote on recommendations until the council’s meetings in April and May.

“I don’t want to jump to making a recommendation just for the sake of making a recommendation,” he said. “These are complicated issues and the solutions are not always snap-your-fingers kind of solutions.”

Harpin is involved with a pediatric multi-disciplinary task force that includes hospital officials, providers and judges. Harpin and an official with the Clark County School District formed the group to find solutions to the pediatric side of the mental health services issue faced by emergency rooms.

The group met Feb. 26 with Assemblyman Andy Eisen, D-Las Vegas. The focus was on developing alternatives to taking mentally ill children to emergency rooms, Harpin said. Mentally ill children and adults can only be stabilized and medically cleared at emergency rooms. Emergency department personnel cannot treat their mental disorders.

On Thursday afternoon, a separate group pondered the problem for two hours. But this group, which also has broad representation, focused on adults.

A legislative subcommittee on health care has identified mental health as a priority, said Eisen, who is on the subcommittee.

The increasing number of people being placed on mental health holds is contributing to emergency room crowding. The holds, called Legal 2000s, are issued when people are considered a possible danger to themselves or others. They can be held for up to 72 hours for evaluation.

Last summer, Rawson-Neal Psychiatric Hospital in Las Vegas opened an outpatient clinic to decrease the number of people seeking mental health care at emergency rooms. However, state officials closed the clinic in January because of federal licensing issues.

The subcommittee on health care is looking at programs for the mentally ill across the country that could be replicated in Southern Nevada, Eisen said. An Arizona program in Tucson has a crisis response center for the mentally ill who would otherwise go to an emergency room.

A San Diego program that allows mental health clinicians to ride along with law enforcement and work with the mentally ill in the field is being examined. The partnership allows mental health workers to help people in crisis, decreasing the need to place someone on a 5150 hold, California’s equivalent of a Legal 2000. The Southern California program decreases the need for hospitalization and incarceration.

Another idea is for emergency medical services personnel to take patients directly to a psychiatric facility or community triage center.

The subcommittee will present its findings on possible solutions to the governor’s council on Tuesday morning.

“They all realize we have a tremendous, difficult problem to fix,” said George Ross, director of legislative and government affairs at Snell &Wilmer Law Offices. Ross heads the subcommittee.

The cost of the potential solutions to emergency room crowding caused by a demand for mental health services will be discussed by the subcommittee and the council on Tuesday. The meeting begins at 9 a.m. in room 4401 of the Sawyer Building, 555 E. Washington Ave.

In the meantime, the state is implementing short-term measures. The mobile crisis team that the state deployed last summer to help hospitals handle the mentally ill is helping, Sandoval said.

“If there’s more to do, that’s a priority to me,” he said on Thursday afternoon at a Review-Journal editorial board meeting. “I don’t know how much that’s going to cost.”

The mobile crisis team is now in 10 valley emergency departments, said Dr. Tracey Green, the state’s chief medical officer. State officials made modifications to send the team to more emergency rooms, which has helped lower the numbers of mentally ill waiting at the emergency departments, she said.

At the beginning of this week, there were 148 mentally ill at valley emergency departments waiting to be transported to a psychiatric facility. On Thursday, that number had gone down to 101.

“We are looking at how we can get seven-day coverage with the same team,” she said.

Northern Nevada has a mobile outreach team, which is similar to the program in San Diego. Green said that’s something officials are looking at for Southern Nevada, but it would require a lot of staff, given the large geographic area covered by the Metropolitan Police Department.

“We are going to start looking at realistic options,” said Dr. Dale Carrison, University Medical Center’s chief of staff and head of emergency services. He also is on the Behavioral Health and Wellness Council. “I think now we need to come up with a road map.”

Reporter Yesenia Amaro can be reached at yamaro@reviewjournal.com or 702-383-0440.