Center that alleviates hospitals threatened

By Ed Koch

Monday, June 28, 2004 | 11:06 a.m.

A center created 18 months ago to relieve the overcrowding of local hospital emergency rooms caused in part by chronically intoxicated people and the mentally ill may close next week because of a nearly $677,000 shortfall in state funding, the center's operator says.

WestCare, the operator of the Community Triage Center at 930 N. 4th St., says it will be forced to close the center Wednesday if Clark County and local municipalities don't come through with funding agreements for the new fiscal year that begins Thursday. WestCare says it needs enough local funding to offset the loss of the state money.

The $3.81 million project has been funded by $1.27 million from Clark County and local municipalities, $1.27 million from area hospitals and $1.27 million from the state.

To date, the state has provided only about half of its share, mostly in federal funds from the Bureau of Drug and Alcohol Abuse that are funneled through the state. The state failed to fund the rest through an appropriations bill before the 2003 Legislature and later before the Interim Finance Committee.

While the county and cities have budgeted their shares -- $544,000 from the county, $434,000 from Las Vegas, $170,000 from Henderson, $110,000 from North Las Vegas and $13,000 from Boulder City -- there are concerns they will pull those funds in the wake of the state's shortfall.

The prospect of the center closing has state and county health officials -- as well as Las Vegas and Clark County government leaders -- concerned because the project has saved taxpayers more than $11 million, based on what it would cost to treat drunks and mentally ill elsewhere, WestCare officials have estimated.

"If the CTC is not (fully) funded we will have more mentally ill people tying up emergency room beds, delaying access for all of us," said Dr. Jonna Triggs, chief executive officer of Southern Nevada Adult Mental Health Services.

She noted that a record was set June 23 when there were 73 uninsured psychiatric patients in local hospital emergency rooms waiting for beds to become available in the crowded state mental health system.

"The impact of the closure of this program will mean that record will be exceeded," she said. "Between March 2003 and March of this year, there were on average 30 people a day waiting in local emergency rooms for one of our 103 beds. Each waited an average of 43 hours in an emergency room."

The center helps alleviate those problems because it provides an alternative. Patients who are not in need of emergency room evaluation, which is required for potential admission to the state mental hospital, can be taken to the center by police and ambulance crews.

The center also takes patients in from hospitals, for mental health treatment, thus relieving emergency room workloads.

The center sees about 750 patients per month who are suffering from mental health or substance abuse crises. If the center closes, those same numbers of people can be expected to once again fill emergency rooms, Triggs said.

Richard Steinberg, president and chief executive officer of WestCare, a nonprofit organization, said in a letter Wednesday to local elected officials that this year the triage center was on pace to assist 8,500 to 9,000 people, including 7,225 to 7,650 of whom are homeless or indigent.

"Without commitments from all of the cities that originally committed to solving this community-wide program, WestCare ... does not have the resources to continue operating this project," Steinberg wrote, noting that transports from hospital emergency rooms also would cease.

"The fact that we, as a community of this size, could not adequately support the CTC is unfortunate. Those of us who envisioned the project believed it could succeed and we still believe it can."

Rory Chetelat, emergency medical services manager for the Clark County Health District, says closing the center would "significantly impact emergency medical services if they (the intoxicated and mentally ill) have no better alternative. It will be a burden, with increasing off-load times (for paramedics and police) at the hospitals and the adding of congestion to emergency departments."

The Clark County Board of Health on Thursday was told that discussions between the county and WestCare were ongoing, to try to resolve the issue.

Clark County Manager Thom Reilly said it is not fair to put the entire funding burden on the shoulders of the local governments.

"We are in full support of the triage center but mental health is a state responsibility," Reilly said. "The municipalities and the hospitals stepped up to the plate with two-thirds of the funding for this facility. The state has not got its (full share of funding) through the Legislature."

Reilly said that despite the threat of closure, the county does not plan to pull funding from the triage center.

"Another option for the center could be to reduce its level of efforts," he said. "It should not be all or nothing."

Reilly is concerned that hospitals and other municipalities might pull their funding in the wake of the state not meeting its burden.

"It has been a fragile alliance," he said. "If others do pull out, the program is sunk. We're open to other options but they depend on the willingness of hospitals and municipalities to continue."

Las Vegas Deputy City Manager Betsy Fretwell said the Las Vegas City Council will take up the matter at its July 7 meeting and will consider providing additional funding to keep the center open for a couple months to give the state further opportunity to restore its funding.

"There are three legs to this stool and the state is one of them," she said. "We've met with legislators over the last month to address this (funding). All parties benefit from this triage center, from decreasing the impact on time paramedics have to sit in ambulance bays to not putting people in jail."

In some cases, police have the chance to determine whether a mentally ill or drunk person has committed a crime -- disturbing the peace or public nuisance, for example -- or just needs mental health services provided by the triage center.

Officials acknowledged that if there were no triage center and police would have to choose between baby-sitting people for eight hours or more in a crowded emergency room or spending less than an hour booking them into a jail, the jails are likely to become filled.

Fretwell said that while there may be options for a leaner version of the center to remain open until the funding issue is resolved, she said she knows that WestCare has certain overhead costs that can't be trimmed, including paying for sufficient numbers of medical personnel.

Last fall, WestCare officials cut back about a third of the trauma center's original staff of 60 and reduced the number of ambulances it uses from three to one in the wake of the state not fully funding the project.

Rick Plummer, spokesman for MountainView Hospital, said local hospitals have agreed to continue to fund the triage center that opened in January 2003 after a study by the Chronic Public Inebriate Task Force found that intoxicated people and the mentally ill were contributing to the overcrowding of emergency rooms.

Triggs said the triage center has reduced emergency room workloads even though mentally ill people are being stacked up in those facilities at record levels.

"We (state mental health) are rapidly stabilizing patients, but we have not been able to keep up," she said, noting the state mental health facility on West Charleston Boulevard has just 26 observation beds to monitor new arrivals.

She said about 50 percent of patients are treated and released from those beds in a few days and that the other half goes to a 70-bed facility on the same campus for short-term care. The average stay there is 19 days, Triggs said.

The national average of publicly-funded beds for the mentally ill is 33 per 100,000 people. In Nevada, there are only 4.5 beds per 100,000 people, health officials said.

"There are only 500 emergency room beds in the valley," Triggs said. "If 15 percent or more of them continue to be tied up daily (by the mentally ill) we've all got a problem."