Officials agree on psychiatric hold policy

Curry Pilot – by Jane Stebbins

Patients being assessed for their mental health can be held up to five days — not 30 — in Curry General Hospital’s “hold room,” but must be transported somewhere else when that time is up.

The consensus isn’t the greatest, but it’s a start, agreed law enforcement, hospital officials, mental health and addiction advocates at a meeting last week in Gold Beach.  

The hold room has been a problem for all involved for months, with patients endlessly waiting for space to become available in a psychiatric hospital; interfering with work, doctors and patients in the adjacent emergency room operations; being released just to be rearrested for petty crimes and causing havoc for citizens and law enforcement while they’re out.

“I don’t want anyone in there for five days,” said Curry Health Network CEO Ginny Razo. “It’s not humane. It’s not appropriate. It’s just too long for someone to sit and get no services. And we’re not set up to do that.”

Razo initially thought the certification for the room had expired, but later learned it is valid through July 2017.

But with no windows, no door and no restroom, it’s not just a bad situation for the person being evaluated and stabilized, she said. They had three such patients in the small room on a recent Friday, Razo reported.

Hold room patients have attacked hospital personnel. They’ve demanded to be set free. Many are released, creating problems for Gold Beach, or requiring the police to arrest them and place them in jail.

And psychiatric beds — the nearest is in Coos Bay — are usually unavailable. Family members of the patient are often at their wits’ end, having tried everything to take care of the patient and are no longer able.

Curry Community Health has hired one full time psychiatric counselor and a tele-psychiatrist.

“Psychiatrists are the most expensive guys on the planet,” said Ken Dukek, CEO of the nonprofit organization. He noted that those needing mental health services often need help during off-hours.

‘Patients can’t get rest’

“In the hospital right now, patients can’t get rest,” Razo said. “They’ve got these people being disruptive. We can’t have patients not getting any sleep because we’re wrestling someone to the ground.”

The hospital has no security guards, either.

“If a violent patients wants to leave, we let them,” Razo said. “It’s come to that. I can’t put my employees in that position. They’re not security. It’s easier for the staff to say, ‘Let him go.’ He’s going to harm somebody.”

Sometimes, officers or deputies can calm such a patient and convince them to return to the hospital, said Gold Beach Police Chief Dixon Andrews.

Other times, the problem is passed on to the jail.

When in jail, the mentally ill usually don’t get the treatment or counseling they need. They disturb other inmates, and often must be held in a private cell for their own protection and the safety of others. They too, are often released early, as constraints at the jail allow officials there to hold only the most egregious offenders — and often times, those suffering with mental issues are arrested for petty crimes, such as disorderly conduct or trespassing.

“Without a five-day hold, we’ll be turning those people right back around and dealing with the same situation and putting them in harm’s way,” said Sheriff Lt. Mick Espinoza.

“As deplorable as the conditions might be in the hold room, those people certainly don’t need to be in our jail,” said County Commissioner David Brock Smith, who serves as the county liaison to the hospital. “In jail or in that hold room, we’re not meeting the needs of that patient. There comes a point and time we’ve got to put the patient first.”

The new hospital will have a true hold room within its emergency room, Razo said.

Other elements the group agreed to work on to make their professional lives easier include alerting hospital personnel, CEO Ginny Razo and a counselor when a patient with mental problems is likely to be en route to the hospital; and obtaining crisis intervention training for medical personnel and law enforcement to learn how to defuse volatile situations involving those with mental illnesses.

Medical costs

Another challenge facing the emergency room in Gold Beach is that while a person is in the hold room, there is no way for the hospital to bill Medicare for any treatment they do receive, Razo said.

“It’s still considered an ER (admission), but for those five days, there are no billing codes,” she said. “They’ll produce a code if you get bitten by an alligator in a hotel, but there are no ER codes for psychiatric patients. We can’t even drop a bill for most of these patients. We’re in a terrible Catch-22.”

A problem facing the jail is that a state administrative rule dictates that anyone booked into the jail loses their medical coverage, be it private coverage, state or federal aid — even veteran’s benefits. Insurance is reinstated after trial.

And transporting a patient to a psychiatric hospital can run up to $3,000 — and it falls to the county, Dukek said. If anybody is lodged in jail and needs extensive medical procedures — for example, dialysis — the bill falls to the county.

“That will break our budget right there,” Espinoza said. “Some people would say they don’t deserve medical care. We’re tasked with keeping someone alive and healthy. And when we get them, they’re at their worst.”

Many of those booked into the jail have lifelong health problems.

“Right now we’re just putting a Band-aid on a gaping wound and hoping to solve the bleeding,” Espinoza said. “It’s an example of how deep this thing can get.”

Jail Sgt. Joel Hensley said it used to be a patient could be stabilized and released into the general population of inmates.

“Not any more,” he said. “And unfortunately (they’d be in jail with) our higher levels of criminals.”

Paying for it

Insurance, psychiatric treatment, medicine, counseling, training — it all costs money.

“And none of us have the money,” said Gold Beach City Administrator Jodi Fritts. “We have to determine what are our priorities for our community. I don’t know what the answer is.”

People with psychiatric problems are often released from the hospital or jail and end up on the streets of her city.

“They don’t need to be in the jail or the hospital,” Fritts said. “People in the hospitals are people with heart attacks or strokes. They don’t need Mr. Freak-out in the room next door.”

All agreed that an outpatient facility, similar to the Clubhouse in Gold Beach that provides housing and counseling for some individuals, would be “utopia.”

“And we can’t afford the services we have now,” Smith said.

“The reality is, people are here,” Fritts said. “They’re costing us money. One incident at the jail can wipe out your budget. We’re all just one lawsuit away from bankruptcy.”

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