Mental health crisis called county’s worst

Monday, July 12, 2004 | 10:31 a.m.

A state of emergency continues for Clark County, dealing with what county government and health care officials are calling the worst mental-health crisis in the region's history.

Though a short-term fix is in place, local officials warn that an emergency situation could return within days if no permanent solution to accommodate mentally ill patients can be found. Affected are both the patients, many of them homeless and addicted to drugs or alcohol, and the public, which lost access to emergency rooms Friday.

Forty-two mentally ill patients were treated at a temporary facility that was opened over the weekend after local emergency rooms found themselves on Friday with one-third of their beds filled by mental-health patients. Top-level hospital administrators asked Clark County Manager Thom Reilly to declare a local emergency.

The crisis grew over the course of the summer, with all available beds for psychiatric patients full at area hospitals and mental health centers, forcing the overflow to take up beds in the emergency rooms throughout the Las Vegas Valley.

By Friday more than 100 patients with serious mental health problems -- some requiring drug therapies, restraints and observation -- were in the emergency rooms, and emergency room directors and hospital administrators pushed the panic button.

With nearly one-third of all Clark County's emergency room beds in 11 local hospitals were taken by patients with mental health issues, the hospital chiefs were concerned that they would not have beds or staff to deal with a "mass casualty" incident requiring traditional emergency medical assistance.

"We do have an emergency," Dale Carrison, emergency-room director for the University Medical Center, said on Friday. "We have the potential for a huge medical disaster.

"If you close down 108 emergency beds, you essentially close down three emergency wards in Las Vegas," he said.

Once the emergency was declared, the state contracted with local nonprofit WestCare, which already operates a mental-health intervention service, to open and staff the temporary facility with 31 beds. About a dozen beds at the state-run Southern Nevada Adult Mental Health Services hospital were freed up.

Gov. Kenny Guinn released emergency funding for up to $100,000 to cover costs for the next 10 days and hospitals provided volunteer doctors and nurses. By Sunday the number of mentally ill patients in emergency room beds had dropped to fewer than 60, although the number fluctuated throughout the day.

Local officials praised a combination of state and local efforts to defuse the situation Friday and over the weekend, but warned that the problem is far from solved.

"Clearly this just alleviated the emergency situation, so we got past the public health crisis," Reilly said Sunday. "It's a pretty precarious situation. We're jeopardizing the entire community."

Davette Shea, emergency services director for Southern Hills Hospital and the ad-hoc spokeswoman for the private hospitals in the county, said the county, Clark County Health District, WestCare, hospitals and state planned to meet today and throughout the week to discuss a more permanent solution.

"We're all concerned about that," Shea said. "This is going to be a very hot topic for the governor.

"It's not fixed, but the positive thing is that we have found it can be improved," she said. "We were desperate. We had to go to the officials and say 'Help!' That's when everybody stepped up to the plate."

Potential solutions that the officials are scheduled to discuss today include opening up an unoccupied state building at the Southern Nevada Adult Mental Health Services center on West Charleston Boulevard or keeping the WestCare stopgap facility open, both measures that would take state funding.

Keeping the WestCare facility on Alta Drive and Martin Luther King Boulevard permanently open could create a stir in the neighborhood, arousing fears of patient escapes.

"Some people get paranoid and crazy over this kind of thing," said Adam Swope, who lives less than a mile away in an apartment complex. "I wouldn't care -- but I know some people would raise hell over it."

For the most part, though, having area hospitals free to handle emergencies and the mentally ill cared for seem to be the primary concern.

"Better they're there (WestCare) than crowding all the ERs or wandering the streets," said Jon DeCaro, 49, also a neighbor. "It's wrong there's no place for them to go in the first place. It isn't fair to anyone. It shouldn't have to get to this point for them to do something."

Now that the situation has escalated to emergency status, much has to be done to find a permanent solution to a long-growing problem.

David Rosin, state medical director for mental health, said he toured the former developmental disabilities service building on West Charleston to determine what it would need to open on an emergency basis.

He said today that state and local officials would "look at what could be done, how much it would cost, to inhabit and staff."'

"Obviously, we are still in an emergency situation," Rosin said. "We are in ongoing consultation (with local officials)."

Another solution discussed Friday by the local and state officials was opening up the closed state prison in Jean, although that scenario was scotched, at least for now.

Reilly said the Legislature will almost certainly have to find some money to help out with the long-term solution, a solution that until now the Interim Finance Committee has been unwilling to fund.

Reilly and others noted that without the WestCare triage center, the mental health emergency would have been much worse. The survival of the triage center, however, is in doubt.

The center received a two-month reprieve from closure last week when Clark County and Las Vegas agreed to give WestCare $163,000, but funding from other regional governments has not been promised. Clark County, Las Vegas, Henderson, North Las Vegas and Boulder City officials are to meet this month to discuss a funding formula for the center.

The biggest problem for the $3.8 million annual program is that the state government, expected to fund a third of the program, has not contributed $680,000. In response WestCare scaled back the program, but local officials and the governor's office have asked the Legislature's Interim Finance Committee to fully fund the state's share.

Reilly and Richard Steinberg, WestCare president, said the weekend crisis was not manufactured to boost WestCare's funding. Reilly said he responded to a call from the chief executives of Clark County's 11 hospitals to declare an emergency.

Steinberg said WestCare's funding issues exacerbated the emergency, but did not cause it.

"It's kind of weird," he said, noting that the issue came to a head a day after he testified before local government officials in a Regional Planning Coalition meeting. "It was almost like it was orchestrated. But it's not about WestCare."

Carrison, with UMC, said the number of psychiatric patients has grown consistently in the past year, from a regular daily influx of about 50 a day that needed treatment in the region's emergency rooms to more than 100 on Friday.

"It's never been anywhere near as bad as today," he said. "It's not going to get better before October. This has the potential to be an absolute disaster.

"This is just a snowball that has been going down the hill and it's finally hitting the tree."

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