Inundated by the mentally ill, valley emergency rooms close to ambulances

Hospital emergency rooms throughout the valley are closing their doors to ambulances because the mentally ill are now occupying available beds at a rate higher than in 2004, when the problem prompted then Gov. Kenny Guinn to release emergency funds after Clark County declared a state of emergency.

In 2004, hospitals geared for treating those with physical ailments were routinely holding about 120 mentally ill patients. Emergency departments now sometimes hold up to 200 such patients, said Dr. Dale Carrison, chief of staff and head of emergency services at University Medical Center, which temporarily closed its emergency room to ambulances on Friday.

As of 8 p.m. Tuesday night, at least four hospitals had declared “an internal disaster,” meaning they were telling ambulances not to bring any more patients to them because they were at capacity, said Scott White, Nevada general manager for American Medical Response, which provides ambulance services. Those hospitals were UMC, Valley Hospital Medical Center and the Siena and de Lima campuses of St. Rose Dominican Hospital, he said.

“Hospitals are seeing an increase in Legal 2000s (people who are at risk of hurting themselves or others) and they are giving us that feedback,” White said. “They are just inundated with these patients.”

Such closures typically last for a short period of time, he added, and have been increasing in frequency since December. In January, Rawson-Neal Psychiatric Hospital in Las Vegas closed its outpatient clinic, which was intended to help reduce the number of mentally ill patients going to area emergency rooms. It had opened in summer 2013.

Carrison said the closure of the Rawson-Neal clinic has contributed to the burden UMC now faces.

Gov. Brian Sandoval’s Behavioral Health and Wellness Council met Wednesday and will meet again Thursday. During Wednesday’s meeting, the council heard a presentation on the issue of mentally ill patients showing up at emergency departments. White was not part of the presentation, but Carrison was one of the presenters.

The 18-member council has been tasked with looking at the state’s troubled mental health system and finding solutions to fix it.

During his presentation, Carrison said an efficient emergency department will usually turn over a bed at least every four hours. If a mentally ill patient is taking up a bed for 24 hours, anywhere between 4 to 6 patients with acute medical conditions are not being seen.

But mentally ill patients don’t usually stay for just 24 hours. Such stays can last from three to five days, slowing down the whole system and blocking the availability of beds for those with acute medical problems, such as heart attacks and abdominal pain, Carrison said.

“Those are true emergencies and true emergencies are being delayed in care,” he said.

When hospitals declare an internal disaster, the ambulance provider has to take the patient to the next closest hospital, White said. That puts the ambulance itself out of service for a longer period of time, which could result in response delays.

Responding to a call and taking a patient to an emergency department usually takes an average of 60 minutes to 80 minutes, but if the hospital is at capacity and the patient needs to be transported to the next closest hospital, the process can take an average of 90 minutes to an hour and 45 minutes, White explained.

“We have plenty of resources to meet that demand, it’s just a juggling act,” he said.

Mentally ill patients show up at emergency departments by walking in, arriving by ambulance or being escorted there by law enforcement, Carrison said. Most of them are Legal 2000 holds, which can last up to 72 hours.

Sherry Harney, an officer with the Metropolitan Police Department, said by the end of an officer’s day, they are supposed to report the number of “Legal 2000” holds they had.

So far this year, Las Vegas police have had 868 Legal 2000 holds. There were 6,727 in 2013, 6,185 in 2012 and 5,989 in 2011.

Harney, who coordinates the Police Department’s Crisis Intervention Team, said not all Legal 2000 cases are related to crisis intervention calls.

The Crisis Intervention Team was implemented in 2003 and was designed to help educate officers on how to handle a person who is having a mental health crisis.

There have been 2,763 crisis intervention calls so far in 2014. In 2013, there were 18,707.

The crisis intervention calls for 2014 could exceed 20,000, Harney said.

A concern is the repetition, or responding to multiple calls involving the same person, said A.J. Delap, government liaison for the Metropolitan Police Department. The department has about 15 cases a month involving those who’ve been previously referred for Legal 2000s.

“We take them into custody, we book them into jail, if necessary, we Legal 2000, if that’s appropriate,” he said. “Or in some (cases) we do nothing because they don’t meet the threshold for a Legal 2000 and they don’t meet the threshold for a crime.”

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