Crowded ERs filling needlessly

Stacy J. Willis

Thursday, Feb. 8, 2001 | 11:31 a.m.

An apparent glitch in communication may be responsible for a significant portion of overcrowding in local emergency rooms, hospital administrators found out Wednesday.

Emergency room employees have been holding mentally ill patients because they were told that the only Southern Nevada state mental hospital was full. But in their first meeting with state mental health officials, frustrated doctors and nurses learned otherwise.

"We have only been on divert (at full capacity) once this year," Jim Northrop, director of Southern Nevada Adult Mental Health facility, said in a meeting at the Clark County Health District. "On June 17 I maxed out, once."

"What?" asked Joe Calise, emergency room nursing manager at Summerlin Hospital. "We've got people who are medically cleared sitting in our emergency rooms with no psychiatric care for up to 72 hours because we are told they can't get into your facility."

Many local emergency rooms have been on "divert" status for six months, meaning ambulances are asked to take patients to other hospitals. The overcrowding is caused by circumstances ranging from the region's rapid population growth and a change in doctor-patient relationships because of the rise in managed care insurance.

There are 210 hospital emergency room beds in Southern Nevada, serving a population of 1.6 million people. About 6 percent of adults have serious mental illnesses, while 23 percent suffer from a diagnosable mental disorder in any given year, according to the National Alliance for the Mentally Ill.

Northrop and his boss, Carlos Brandenburg, director of the Nevada Division of Mental Health, said they had no idea that doctors and nurses were being told the adult mental health facility was full by its employees.

"This is outrageous to me. I've never heard of such a thing," Northrop said, shaking his head in disbelief.

Brandenburg added, "Somehow our staff is maybe not doing what it is supposed to be doing."

All eight of the county's hospitals have reported holding as many as 20 psychiatric patients per week in their emergency rooms during the last year, taking up much-needed bed space because they believed there was nowhere to send the patients for appropriate care.

The state mental facility has a bed capacity of 86. On Wednesday only 51 of those beds were full. The state also has a 10-bed observational unit at the same location, 6161 W. Charleston Blvd.

Northrop said he would investigate the matter with his staff. He also gave emergency room personnel his home telephone number and asked to be contacted if they were ever told by the mental health facility's staff that the hospital was full. Mental health advocates said that being held in an emergency room could exacerbate a mentally ill patient's psychotic episode, or cause them to give up and not seek help for potentially life-threatening problems.

"It's not good for psychiatric patients because we don't have the ability to help them," Calise said.

Mental health advocates and ambulance service representatives also went toe-to-toe with state mental health officials about transportation between the mental health site and the hospitals.

By state law, psychiatric patients must be "medically cleared" before being admitted into the the state's mental health system to assure that the problem is not something other than mental illness. But the process of medical clearance can be expensive and redundant.

If a psychiatric patient walks in to the state mental hospital, he likely will be sent by ambulance to University Medical Center to be medically cleared, and then sent by ambulance back to the mental hospital, and charged for both rides at a cost of about $400 per ride.

If the patient walked in to UMC, was medically cleared, and sent via ambulance to the psychiatric hospital, UMC would be forced to pick up the cost of the ride for indigent patients.

Representatives of UMC suggested that the state provide a mobile medical clearance unit, or a staff position at the emergency rooms to assist with psychiatric patients.

But Brandenburg said the state does not bear the sole responsibility for medical clearance nor transportation.

"As you know, there has not been a lot of support for mental health issues in this state," Brandenburg said. "Don't expect me to go in there and fund 100 percent of a physician in your facility ...

"Let me give you some political reality. The governor's budget does not include a mobile health care unit, and I support the governor's budget."