Mental health services for poor face cutbacks

Monday, Sept. 10, 2001 | 10:51 a.m.

RENO -- Mental health services to the poor will be curtailed in Clark County for at least several months by the state because of a declining number of psychiatrists.

Dr. David Rosin, medical director of the state division of Mental Health and Development Services, said he will meet with staff today to examine where the cutbacks will be made.

The state is committed to maintaining the 24-hour-a-day acute mental health hospital, he said.

Rosin and Cynthia Pyzel, chief deputy attorney general for the state Human Resources Department, appeared before the Nevada State Medical Examiners Board Saturday to seek help.

The mental health program has relied on out-of-state psychiatrists to come in temporarily because of the shortage, which is being felt nationwide. A new law that became effective July 1 required out-of-state psychiatrists to pass a competency test if they had not taken one in the past 10 years.

Rosin said that out-of-state doctors who could come to Nevada are instead going to other states that don't have that requirement. Of seven potential out-of-state temporary doctors, only one was willing to take the examination, he said.

But the examiners board said there was nothing it could do. Board President Dr. Cheryl Hug-English said the board has two legal opinions that it cannot grant any waivers of the examination under the new law.

"Our hands are tied," Hug-English told Rosin and Pyzel. She suggested the state might try to rely on psychiatric assistants and advanced nurse practitioners for temporary help.

Assemblywoman Shelia Leslie, D-Reno, who attended the meeting, said she would see if there was anything that could be done during the legislative interim, noting the consequences of cutting outpatient clinics in Southern Nevada. "If they close clinics, that's a potential disaster," she said.

Leslie, who said she had signed up to testify but was never called, said she was disappointed that the examiners board did not offer more suggestions on how to improve the situation. "They could have worked with us even more," she said.

Hug-English said the examiners board faced a "rough situation. We have a law. We don't have any discretion."

The state has 18 available psychiatrist slots in Las Vegas, but only six are filled, Rosin said. Another three doctors are out on sick leave. Three of the current temporary psychiatrists are leaving in the next two months, and only one temporary one, who passed the test, is scheduled to come to Southern Nevada.

The state has recruited nationally, and Rosin said he may have five or six permanent physicians coming to Southern Nevada in the future. But he added, "It's tight" in the next several months.

"It's not a simple matter to fill a slot," Pyzel told the examiners board. "We have to rely on temporary help."

Larry Lessly, executive director of the medical examiners board, said the 1985 law allowed temporary physicians to come into Nevada without taking the examination to help the rural counties. The law was stretched, he said, to aid the mental health division.

The board has issued 44 temporary licenses since 1987 for the mental health program. The licenses, usually good for six months, were not to be renewed under the law. But Leslie said the board extended the licenses to keep the psychiatrists working in the mental health program.

It wasn't the new law requiring the examination that has caused the problem, Lessly said. The division has had nine resignations of psychiatrists in the past two years. The board, he said, has "bent over backwards" to help the mental health program.

Rosin said psychiatrists who start their practice with the mental health division, "get experience and move on."

The required examination, Lessly said, "does nothing more than weed out the purely incompetent." He said it should not be a burden on any psychiatrist. He argued that Nevada's poor mentally ill should have the benefit of the same level of competence as the state requires for private physicians.

Board member Dr. Joel Lubritz suggested Rosin approach the governor to get more money to pay psychiatrists, who make, Rosin noted later, $130,000 to $140,000 a year.

Money is not the issue, Rosin said. "The Legislature was quite generous."

Rosin, who took over in January, said the program was at a "crisis point" and he has been trying to contract with private Nevada physicians for services.

Board member Donald Baepler suggested the state division continue to work with the board to see if there is "any wiggle room" in the law that might help alleviate the shortage.