MountainView turns away ambulances

By Timothy Pratt

Tuesday, Sept. 14, 2004 | 11:14 a.m.

MountainView Hospital declared an "internal disaster" Monday afternoon, meaning its emergency room was closed to ambulances and their patients until further notice.

Hospital Chief Operating Officer Tad Morley said the action was taken because "there was no room at the inn." And there was no room, in part, because seven of the 22 available beds were taken up by psychiatric patients.

University Medical Center almost reached the same decision Monday, with 15 of about 50 beds taken up by the mentally ill, said Rory Chetelat, EMS manager for the Clark County Health District.

That, and the total number of 97 such patients crowding emergency rooms throughout the valley on Monday, led hospital executives and state and county officials to speculate at a meeting that day that the mental health emergency declared by Clark County Manager Thom Reilly July 9 may be worse than ever.

And with winter around the corner, they said, the dire situation will worsen.

Morley said his hospital's situation "punctuates the level of crisis we have in this community -- every day, at every hospital."

When Reilly declared the emergency in July -- making Clark County the only known municipality in the nation to do so -- 103 psychiatric patients filled emergency rooms.

Since then a fast-track effort resulted in the state opening up 28 additional beds. But they don't seem to have made a dent, officials said Monday.

"We're right back there again," Chetelat said.

"We're going to be at 120 easily by the end of the year," said Sam Kaufman, chief operating officer for Desert Springs Hospital.

The situation was debated Monday at a meeting of the Clark County Health District's facilities advisory board, a group of hospital executives and county and state medical personnel.

Officials at the meeting showed their frustration with the ongoing crisis, and warned that winter, with the flu and other health problems, would make for an untenable situation.

Hospital officials aimed some of their criticism at state official Jonna Triggs, director of Southern Nevada Adult Mental Health Services. The state is responsible for caring for the mentally ill and has plans to create additional beds -- possibly as much 190 -- by 2006.

Karla Perez, chief executive officer of Spring Valley Hospital and chairwoman of the advisory board, said, "I guess what I have a problem with is there is no other plan."

Triggs said the only immediate plan the state was evaluating involved sending patients from the Las Vegas Valley to Reno, where more beds are available.

Morley said some solution was needed, and fast.

"I heard three months ago you were looking at facilities up north," he groused.

"You've got to get beyond 'looking at,"' he said.

Morley's hospital had declared its "internal disaster" only an hour before the 3 p.m. meeting.

The term is a recent one, created April 1 as a way of raising the bar for hospitals, since a tactic in which they closed emergency rooms for an hour at a time to relieve overcrowding was not working.

The former approach was meant to allow a hospital facing overcrowding an hour's breather while patients were sent to other hospitals. But it only served "to pass the buck," Chetelat said.

After April 1 hospitals took on an experiment whereby hospitals couldn't close their emergency rooms unless they declared an "internal disaster."

Since then five hospitals have used the declaration, but Mountain View has been the only one to do so because of a lack of room and personnel. The other cases involved a fire, power outages, and a hazardous substance, Chetelat said.

"They're stuck by themselves in the northwest, a fast-growing area, without much support," Chetelat said. Mountain View is located by Cheyenne Avenue and U.S. 95.

The board decided Monday to continue using the "internal disaster" system for six more months, to see if it works as a mechanism for keeping emergency room doors open as long as possible.

The board also tried to reach an equitable way of spreading out mentally ill patients brought by ambulance to the different hospitals, approving a plan whereby ambulances would go the hospital with the least amount of such patients in a given area.

Chetelat will be "taking a look at that plan" in the coming days to see if it is workable, he said.

But meanwhile, he said, Monday's events were "very scary."

"The issue becomes when one hospital declares an internal disaster, then patients have to be taken to another and then it fills up," he said.

"I'm very concerned about this being ... a domino effect that we can't stop."