Officials scramble to resolve emergency room closures spurred by the mentally ill
Hospitals throughout the valley will continue to temporarily close their emergency rooms to ambulances as officials form a plan to handle the growing number of mentally ill patients who occupy beds meant for those with acute medical conditions.
During a Thursday meeting, Gov. Brian Sandoval’s Behavioral Health and Wellness Council directed Mike Willden, director of the Nevada Department of Health and Human Services, to find ways to handle the crisis faced by Las Vegas Valley hospitals.
“The need continues to outpace the available resources, especially for the underserved,” said Brendan Bussman, vice president of strategic development and marketing for Sunrise Hospital and Medical Center, in a statement issued Thursday.
“We are appreciative for the continued efforts by the Nevada Department of Health and Human Services … and the Governor’s Office to seek our input into trying to find solutions in addressing the behavioral health needs in our community.”
On Tuesday night, four valley hospitals declared “an internal disaster,” meaning ambulances had to be turned away because the facilities had reached capacity.
“I don’t know yet,” Willden told the Review-Journal when asked what will be done to alleviate the problem. “It’s not an easy answer. We are working every day.”
Emergency rooms throughout the valley sometimes hold up to 200 mentally ill patients. That is markedly worse than in 2004, when Clark County declared a state of emergency as hospitals routinely held about 120 mentally ill patients.
The issue is more complicated than it seems, Willden said. Officials will have to find new resources and identify places the mentally ill can go to for services instead of emergency rooms.
An option for an alternative to emergency rooms could be to open more community triage centers. There is one in Las Vegas that has 36 beds and is full every day, Willden said.
Building a triage center could take about six months, Willden said, and it still would need to be staffed. Another option is deploying more mobile crisis teams and adding more beds to existing facilities.
Southern Nevada Adult Mental Health Services has a mobile crisis team that rotates among area emergency rooms to help triage patients. The team has psychologists, but a doctor or a psychiatrist would be needed to medically clear patients so they don’t linger in the emergency rooms, Willden said.
Only a doctor or a psychiatrist can determine whether someone needs inpatient services or can be discharged with outpatient treatment. The psychologists on the mobile crisis team are only able to make recommendations to a doctor, Willden said.
One option the Behavioral Health and Wellness Council could consider is specifying who has the authority to medically clear patients on Legal 2000s. A Legal 2000 is issued when a person is in danger of hurting himself or others and allows the patient to be held for up to 72 hours.
Financial resources are also an issue. Willden can access about $2 million to help with the crisis. That funding is from a $4 million contingency account set aside after issues of patient dumping emerged at the Rawson-Neal Psychiatric Hospital in Las Vegas. Half that fund already has been earmarked for improvements.
If more money is needed, the council would have to go to the Legislature’s Interim Finance Committee.
Some relief will be provided to area emergency rooms with the creation of 21 additional beds at Rawson-Neal by April 1, Willden said.
State officials also are working with private hospitals to take mentally ill patients. Officials are working on what an acceptable Medicaid reimbursement rate would be for that. Willden said the current daily reimbursement rate is about $460 for a psychiatric bed, but hospitals are asking for a rate of about $1,400 a day.
Willden said a few private hospitals are willing to step up but said he couldn’t disclose them.
“The most immediate issue is the ER,” said state Sen. Debbie Smith, D-Sparks and member of the council. “That’s a crisis to everyone that needs to be addressed sooner (rather) than later.”
Reporter Yesenia Amaro can be reached at yamaro@reviewjournal.com or 702-383-0440.
