Tuesday, July 13, 2004 | 11:15 a.m.
What local officials are calling a public health crisis has, officials say, a political root, and if it is to be solved, a political solution.
Getting to that solution, however, may be a long, crooked road.
The county and state governments responded to a flood of psychiatric patients to area hospitals with a Friday declaration of a state of emergency, which provided up to $100,000 in state funds for 10 days -- a period that ends Sunday. A more permanent fix could require action by the same Legislature that last summer did not fund a triage center for the mentally ill.
The Legislature's Interim Finance Committee is not scheduled to meet until Sept. 15, more than two months from now. In the meantime, the emergency situation is not expected to dramatically improve.
According to Brenda Erdoes, legislative counsel, Gov. Kenny Guinn's administration has the legal authority to fund stopgap measures to respond to the crisis until Sept. 15 if Guinn deems the situation is a "threat to life and property."
Guinn could redirect money within the state's Division of Mental Health and Developmental Services.
With response plans still under consideration, it is not clear how much money would be needed. Guinn and his administration are taking the issue very seriously, said Carlos Brandenburg, division administrator.
"After either the $100,000 is spent, or the 10 days are up, we need to basically take a look at what we're going to do," Brandenburg said. "The state has both a moral and a legal obligation to look at some plan that will go beyond the 10 days.
"We're tossing around options right now. We're exploring options and hope to have something for the governor to consider within two or three days."
While the governor can shuffle money over the next eight weeks, the Interim Finance Committee will have to make a decision on any longer term program when it meets. By then, the worst of the crisis may be past, Brandenburg said.
"Historically, during the early fall the numbers go down," he said. While about 700 psychiatric patients, defined as a danger to themselves or others, need treatment during cooler months, that number swells to 1,200 each month during the summer, Brandenburg said.
About 90 percent of those seeking treatment are indigent, most of them homeless, he said.
State Sen. Ray Rawson, R-Las Vegas, an Interim Finance Committee member, said he believes the committee will find a way to fund the beds needed.
"This is a real crisis," Rawson said. "We have seen it growing worse month after month. It needs to be dealt with. This is one of those issues that is critical enough that we bite the bullet and do it."
The problem is not confined to the emergency rooms of area hospitals, although patients there may have to wait for beds because of the influx of psychiatric patients. Rawson said the crisis has led to half-hour waits for ambulances, almost three times the expected 12-minute response goal.
"The ambulances are waiting in parking lots because they can't discharge their patients," he said.
Rawson sponsored the bill last year that would have fully funded the WestCare Community Triage Center, providing about 40 more beds for psychiatric patients than existed before the emergency was declared. The bill would have provided about $670,000 more for the center, which now is mostly funded by the local government and area hospitals -- although Nevada law gives the state government the responsibility for mental health care.
Rawson said the bill was the victim of the acrimonious session last summer.
"It got caught up in a very complicated session where people postured anti-taxes and anti-spending, and this was one of the things that was chopped, because it had some Republican backing," he said.
The bill died in the Senate without a vote, and never made it to the Assembly. The Senate has a Republican majority, while the Democrats rule the lower house.
Assemblywoman Chris Giunchigliani, D-Las Vegas, is also an Interim Finance member. She said the ball wasn't dropped -- it never came up as an important proposal.
"I want to dispel anybody's thought that the Legislature didn't move on it, because none of us knew about it," she said. "It was never brought up. It was never discussed.
"If something was that important and laid out this plan, why was that not communicated to us?"
She said she would support diverting money to fund a response to the crisis.
State Sen. Bill Raggio, R-Reno, the Interim Finance chairman, said that he supported funding for the WestCare program when it came back to Interim Finance last year. Raggio said those Southern Nevada officials who say the state failed to contribute "its fair share" to the WestCare program are wrong, however.
"This was never funded by the state," Raggio said. "The triage center was created by WestCare and was funded by local government. It was not in the state budget."
Raggio, a lawyer, said he is not sure the state has a legal obligation to fund mental health programs, although he is investigating the issue.
"If there is a state obligation, I would support some payment," he said. "I will ask our (Legislative Counsel Bureau) fiscal division to do any proposal that legally can be done.
"I need to find about a little bit about what the needs are and what the responsibility the state has, and what responsibility the local governments have."
Assemblyman Lynn Hettrick, R-Gardnerville, an Interim Finance member, said he doesn't know if the money can be found for funding new mental health programs in Southern Nevada. Hettrick represents an area which is not far from Carson City and Reno, where there's a surplus of beds available in the state's mental health hospitals.
"I don't know, frankly, how much money the state has," he said. "We filled a whole lot of requests last time. You're looking at three more months this year, five more months next year that would have to be funded. If that's the case, I don't think we have the money in the IFC."
The state's contingency fund has more than $3 million in it, but the money could quickly be used if Nevada is hit by bad forest fires, Hettrick noted.
Clark County Manager Thom Reilly, who has been the go-between for local hospitals with emergency rooms choked with psychiatric patients and the state government, said he doesn't believe the state will refuse to fund a solution to the issue.
"I'm pretty confident that the state will come up with the funding because it is their responsibility," Reilly said. "I don't think they can say that because the money was not appropriated (in the last session) that they're going to allow a public health crisis to occur. They can't jeopardize the lives of Clark County citizens."
He said Michael Willden, the state's director of Human Resources, which oversees the mental health division, is visiting Las Vegas today to help formulate a response.
"I believe they are doing everything they can to develop a short-term plan and a longer-term plan," Reilly said.
He said the legislators, too, will have to respond.
"The fact remains that mental health is a state responsibility and ultimately the Legislature will have to deal with this issue."
Reilly and Dale Carrison, medical director of University Medical Center's emergency department, said the state has done a good job of responding to the immediate crisis. Carrison said the state, however, has to do more.
He said one-third of the area's emergency room beds were filled with psychiatric patients last Friday, and that constitutes an unprecedented public health hazard.
"They (state officials) need to step up to the plate," Carrison said. "They're opening this, doing that, and that is all fine and good, but who is going to pay for it? The state's lack of response to the issue is what precipitated the problem in the first place."
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