Lawmakers told mentally ill, drunks crowd LV hospitals

By Emily Richmond

Wednesday, Jan. 9, 2002 | 10:06 a.m.

Mentally ill patients and public drunks are overburdening Southern Nevada emergency rooms, and the problem has reached crisis proportions, community advocates told members of the Legislative Committee on Health Care Tuesday.

Public drunks cost area hospitals an estimated $4.4 million to care for last year, said Davette Shea, director of Emergency Trauma and Transport at University Medical Center. Psychiatric patients cost area emergency departments $3.9 million in 1999, the latest year for which figures were available.

"We have no detox programs, no drug treatment and no crisis intervention," Shea said.

Once the patients are brought in to the ER, there's little a hospital can do for them other than provide a place to sober up or wait for a psychiatric bed, hospital workers said.

"The emergency room's resources are greatly outpaced by the supply of patients who want to access those resources," said Dr. Jeff Davidson, a member of Clark County's Medical Advisory Board. "If we could access other programs for the public inebriates and the mentally ill, it would lessen the burden on the ERs tremendously."

One solution proposed to the committee Tuesday would be a separate facility devoted to caring for the mentally ill and chronic drunks. That would free up emergency room staff and also ensure that mentally ill and inebriated patients received specialized help more quickly, advocates said.

Dr. Dale Carrison, director of UMC's emergency department, said within the past two weeks he had two chronic inebriates in the ER for more than 90 hours. When a mentally ill patient comes to the ER, the on-duty doctors must wait for a psychiatric consultation, Carrison said.

"It's frustrating for everyone," Carrison said. "Our doctors do an excellent job of diagnosing medical problems, but we're not psychiatrists. That's where the system falls through."

Some drunks wind up at detox centers operated by the Westcare Foundation, a private, nonprofit organization that provides social services throughout the state. But Westcare's bed space is limited, and the ER is often the only resort for these patients who lack the insurance for private treatment.

Some patients picked up by Metro Police end up waiting hours in the back of a police cruiser for a bed to open up, Sheriff Jerry Keller said.

"We are so overburdened, I end up having five-, six-hour ride-alongs because we have no place to take (the patients)," Keller said during his testimony Tuesday.

Keller said while he welcomed steps to address the short-term aspects of the crisis, the long-term problems will likely require new laws.

"We will be bringing a solution to the Legislature," Keller said. "We don't believe this can be solved by simple rule changes. We are 75 percent of the Nevada tax base, and we need some of those resources directed back at the community for people who don't have a voice."

Vic Davis, president of the Alliance for the Mentally Ill, said the crisis is compounded by a shortage of psychiatrists. There are 18 slots available with the state's mental health division but less than half are filled, Davis said. There's also a shortage of case managers and people to provide follow-up care after hospitalization, Davis said.

One solution may be to bypass the state and instead contract out the county's mental health services to a private agency such as Westcare or the Salvation Army, Davis said.

Sen. Ray Rawson, R-Las Vegas, the health care committee's chairman, said Tuesday he intended to make the mental health crisis a top priority both during the interim and in the 2003 legislative session.