Official sees no relief soon to ER overcrowding

By Timothy Pratt (contact)

Thursday, Aug. 12, 2004 | 9:27 a.m.

A high-ranking state official told hospital administrators Wednesday that he shared their sense of urgency about psychiatric patients crowding emergency rooms, but that nothing could be done to fix the problem immediately.

At the same time, Mike Willden, the state's Human Resources Department director, said the state would be looking into ways to encourage private hospitals to develop psychiatric wings.

This is the first time a representative from the state, which is charged with treating mental illness, has mentioned that possibility in the weeks since Clark County Manager Thom Reilly declared a mental health emergency.

"Most cities have hospitals with small pyschiatric units," said Dr. David Rosin, state medical director for the Nevada Division of Mental Health and Developmental Services. Willden's department oversees Rosin's division.

"We're unusual in that way," Rosin said.

He also said that up to four years ago there were 166 beds in private hospitals valley-wide for the general population with mental illness. Only 36 remain, at Montevista Hospital near Flamingo Road at Jones Boulevard.

Rosin was the state's representative at the Aug. 4 meeting of the Facilities Advisory Board, which includes top-level administrators from the valley's 11 hospitals, where the hospitals delivered their "white paper" telling the state to get psychiatric patients out of their emergency rooms.

Karla Perez, president of the board and chief executive officer of Spring Valley Hospital, could not be reached for comment Tuesday afternoon.

Rosin was with Willden after the administrator met with the hospitals Wednesday in response to the board's paper.

The two looked over a 28-bed addition to the state's battery of services for the mentally ill, located on the same campus as the main psychiatric hospital at 6161 W. Charleston Blvd.

That addition is the state's next move in stemming the mental health crisis; the legislative interim finance committee is expected to vote today on allocating $1.9 million to staff the additional beds.

"I don't think we disagree with anything," Willden said, referring to the position the hospitals took in the Aug. 4 meeting. The position paper said, "commencing immediately, the following changes must occur" -- and then laid out how psychiatric patients should be moved out of emergency rooms as quickly as possible.

"The only issue is resources for beds and staffing," Willden said.

He also said there was the "clinical issue of medical clearance." The hospitals say in their paper that psychiatric patients should be physically evaluated elsewhere, such as the state psychiatric hospital, but state officials have repeatedly said in recent days that the psychiatric hospital is not equipped to perform that service.

Willden also said the state would be looking into how much the state reimburses hospitals for Medicaid patients, to see if those amounts can be raised enough to make it financially attractive for hospitals to create psychiatric wings.

"We need to look at other states' rates," Willden said. Nevada pays about $390 a day for psychiatric patients using Medicaid, he said.

Willden said recuperating any of the care for pyschiatric patients lost in the past four years would be a valuable additional step to turning down the crisis in mental health care facing the valley.

"We talk a lot about what the state can do," he said.

"(But) how do we encourage the expansion of private hospital psychiatric care?"