State’s deadline for mentally ill patients extended until Monday

Friday, Aug. 6, 2004 | 10:46 a.m.

A day after area hospital administrators gave the state 24 hours to comment on a plan to force the mentally ill out of their emergency rooms, both sides backed off the tough talk and agreed on a Monday deadline.

But Karla Perez, president of the Clark County Health District's Facilities Advisory Board, which includes top-level administrators from the valley's hospitals, said the state needs to come up with something of substance -- not just a yes or no.

Jonna Triggs, director of Southern Nevada Adult Mental Health Services, said she believes "cooler heads have prevailed" in the wake of the advisory board's Wednesday meeting where the group gave written notice of its demands to Dr. David Rosin, medical director for the Nevada Division of Mental Health and Developmental Services.

Perez adopted a similar stance. The hospitals' "position paper" was "not an ultimatum; we just wanted a response from the state," she said.

"We're not going to say: 'Because you don't respond in 24 hours, we're going to drop all the patients on you,' " she said.

Still, Perez, who is also Spring Valley Hospital's chief executive officer, surprised Rosin with the board's position at the meeting. The paper said, "commencing immediately, the following changes must occur," referring to getting the mentally ill out of hospital emergency rooms and over to the state's psychiatric hospital.

Dan Musgrove, the county manager's intergovernmental liaison, said the hospitals had "thrown the gauntlet down" to the state. Musgrove was at the meeting to pitch a funding plan for the Crisis Triage Center at WestCare, a Las Vegas nonprofit organization. The center helps the mentally ill who seek treatment, as opposed to the mentally ill who may be harmful to themselves or others -- the patients filling up emergency rooms.

Jim Osti, former director of the center, said after the meeting that the apparent impasse showed "it's a scary time."

Osti said the problem of emergency room overcrowding, which led Clark County to declare a mental health emergency July 9, has often been divisive.

"Hospitals, local governments and the state have not always cooperated fully on this issue ... and the problem is, everybody has a different perspective on how it's going to be solved," he said.

The search for solutions next falls on the state's Interim Finance Committee, which meets Aug. 12 to consider freeing up $1.9 million for staffing a 28-bed state-run psychiatric facility that has been set up in recent weeks to try to alleviate the overcrowding in the emergency rooms.

But Perez has made clear that hospitals don't think that move will be enough, and she expects the state to come up with something else come Monday.

"We want to know: What is the next step? If everybody agrees something has to be done, what is it we can do?" she said.

Perez noted Thursday afternoon that 78 mentally ill patients were in the valley's emergency rooms, awaiting transfer to the state psychiatric hospital. That number meant four of 11 hospitals were in "code black" -- their emergency room beds were full, and the wait to get one was longer than an hour.

"We called a crisis and we're still on it," she said, referring to the county's July 9 announcement.

Triggs said Rosin e-mailed Perez on Wednesday to let her know that the state wouldn't be able to answer the hospitals until next week because the state's top official on mental health, Carlos Brandenburg, administrator of Rosin's division, is on vacation until then.

At the same time, she said, there's nothing else the state can do right now to stem the crisis.

"We sympathize with the hospitals' position, but ... we can only continue doing what we're capable of," Triggs said, referring to the Aug. 12 meeting.

Triggs also said that it was important for the state and the hospitals to come together on the issue in order to seek future funding for initiatives to help the mentally ill.

"I think they (the hospitals) understand that if there's any chance of the Legislature hearing us, we can't alienate each other," she said.

Perez countered, "I think we're a unified front -- what we want is a unified plan."

She said that the hospitals' position paper, which suggests that state psychiatric facilities should do physical and psychiatric treatment for the mentally ill instead of leaving the physical care to hospital emergency rooms, made clear their position.

If the state says Monday that this move can't come now, Perez wondered, "When can it be done?"