Hospitals to state: ‘It’s your problem’

By Timothy Pratt

Thursday, Aug. 5, 2004 | 11:09 a.m.

In a move that one official described as, "We keep them in our hallways, now you can keep them in yours," a board of Las Vegas Valley hospital administrators on Wednesday gave the state 24 hours to accept or reject a proposal to stop "warehousing" the mentally ill in their emergency rooms.

The proposal was outlined in a two-page document titled "Southern Nevada Hospitals' Position" that the Clark County Health District's Facilities Advisory Board gave to Dr. David Rosin, state medical director for the Nevada Division of Mental Health and Developmental Services.

Its immediate effect -- surprise and discord -- showed the intensity of the debate over how to stem the county's mental health emergency declared July 9 by Clark County.

Rosin, together with JoAnn Lujan, director of the Crisis Triage Center at WestCare, a nonprofit organization, was at the meeting to report on how the state and the center were facing the emergency.

Lujan's agency got a reprieve from the board, as the members agreed to meet again in 10 days and come up with a way to fund a third of the triage center for the next nine months, which will cost about $1 million. Funding the triage center will help with those mental health patients who voluntarily seek treatment, but most of those who are stuck in hospital emergency rooms are there because they are a threat to themselves or others.

Rosin told the board that the only plan currently afoot to help those patients was to open up 28 more beds in a state building at 1300 Jones Blvd.

Funding for staffing that new mental health unit will be discussed at the Aug. 12 legislative Interim Finance Committee meeting, Rosin said.

"Other than that ... I don't have anything else but hope and prayer," Rosin said.

Karla Perez, president of the board, then told Rosin that the board had a "new plan," based in part on how "all hospitals feel strongly that emergency rooms should be for medical crises -- and psychiatric patients should be held in your (the state's) facility."

The board said it would give the state 24 hours to respond to the document.

"It's a shame we've gotten this far together and that things would have to come to this," Rosin said, before excusing himself to consult with the state's legal counsel about the implications of the plan.

"I was shocked," Lujan said of the board's move.

Perez, who is Spring Valley Hospital's chief executive officer, said after the meeting the board was "raising the pressure on the state" by delivering the document.

She also admitted that the board "doesn't have the authority to dictate policy" to the state, and said the intention behind the controversial "white paper," as she called the document, was to push the state into doing as much as possible to solve the problem as soon as possible.

According to Perez, Rosin "has said before, 'We sympathize with your problem.' But this isn't a hospital emergency department problem, it's a community problem, and we want them to do their part."

Perez said she hopes the state goes beyond seeking funding for 28 beds and seeks funding from the interim finance committee for doing medical evaluations of mentally ill patients at psychiatric hospitals and for holding such patients at those same hospitals, instead of doing both in area hospital emergency rooms.

But Jonna Triggs, director of Southern Nevada Adult Mental Health Services, said none of that can be done because "we don't have the funding or the permission."

Additionally, Triggs said, Carlos Brandenburg, administrator for the division of mental health and developmental services, would not be able to evaluate the board's proposal until next week, as he is currently on vacation.

At the same time, Triggs said she also wanted to move towards what the board was seeking, but that it would take more time -- at least through the next legislative session, which doesn't even begin until February 2005.

"We agree with the board," Triggs said. "In an ideal world, we would have enough money to deal with this instantly."

Rosin said it would be impossible to immediately begin accepting more patients at the state mental health hospital.

"I think there would be some eyebrows raised if we just dumped these people on our lawn," he said.

Board member Suzanne Cram, chief operating officer at Sunrise Hospital, said she hoped that the issue of taking care of the mentally ill would be treated with as much urgency as possible in the coming months.

"We're trying to move the crisis out today to where people can see it instead of hiding it in emergency rooms," she said.