State considers own ER for mental health patients

Monday, Aug. 30, 2004 | 9:45 a.m.

CARSON CITY -- The state is looking at a new alternative as a possible solution to the crisis caused by mental health patients filling the beds of emergency rooms in the Las Vegas Valley.

The idea is for the state to start its own emergency room to examine these patients to determine if they need medical treatment, rather than psychiatric care. Carlos Brandenburg, director of the state Division of Mental Health and Developmental Disabilities, is trying to calculate what it would cost.

Brandenburg was before the state Board of Health Friday where he was questioned about the problems associated with the increasing number of mental health patients in Southern Nevada.

He told the board that the recent approval to open 28 additional beds for mental health patients was "only a small finger in a large dike."

He said the state hopes to break ground in January for a 150-bed psychiatric hospital in Las Vegas and is asking the state Public Works Board to include on its priority list $5 million to add another wing of 40 beds to the proposed hospital. That recommendation, if approved, would go to the 2005 Legislature.

The director is also going to ask the Legislative Interim Finance Committee at its Sept. 15 meeting for permission to use $1.2 million in savings. He said the rising price of steel may mean that the 150-bed hospital may be short of money. Or if that's not the case, he would use the $1.2 million to construct a shell on the 40-bed addition.

The finance committee already turned him down once.

But the finance committee, in an emergency meeting earlier this month, gave Brandenburg $500,000 to open 28 beds for mental health patients in an unused building at the Southern Nevada Mental Health Center.

Brandenburg was asked Friday by health board members Dr. Jerry Reeves and Frances Sponer both of Las Vegas whether the state was doing enough to solve the problem. Even with the opening of the 28 beds, there are still 60 patients in emergency rooms waiting for admission to the state mental health center.

The health board agreed to approve a license to use the 28-bed facility on the mental health campus in Las Vegas as a residential facility. It could not be designated as a hospital because it was built of wood, said Brandenburg. So it had to seek residential facility designation.

Reeves was critical of leaving people with mental health problems in hospital emergency room beds while others with medical problems don't have access. Reeves said he didn't understand why such patients are taken to the emergency room when only 1 percent have a medical ailment.

Brandenburg explained that the patients have to be "medically cleared" because they may have some physical ailment, like a brain tumor, that is causing their erratic behavior.

Reeves suggested the use of a brain tumor as an example was an exaggeration.

Reeves questioned how much it would cost the state to start its own emergency room to care for the medical needs of the patients, saying it would be $26 million. Brandenburg replied it is "no where near that," but he said he does not have an estimate yet.

Such an operation would need to to have doctors and nurses on duty 24 hours a day.

Brandenburg said when the new hospital is complete in May 2006, the division would still retain some of the beds in the present 103-bed hospital to treat mental health patients in case of an overflow.

Sponer asked what it would take to solve the problem. Brandenburg said he could build 300 new beds and they would all be filled, and that more money needs to be spent in community programs, such as providing housing, medication and rehabilitation programs for the mentally ill.

Reeves suggested the mental health patients be transported to Northern Nevada where there are 40 vacant beds but no staff. He suggested that's a better solution than leaving the beds in the emergency rooms in Las Vegas filled.

But Brandenburg said that would not be "good psychiatric care or medical care." He said he was opposed to putting the patients in a car or van and then driving them 450 miles to Sparks.

Reeves countered that it would allow those with medical emergencies in Southern Nevada to have a hospital bed available.