County Lacks Beds for Mental Patients

Los Angeles County’s four public psychiatric emergency rooms have been overwhelmed in recent months by a surge of patients, causing doctors and nurses to frequently recommend that patients be taken elsewhere.

The psychiatric ERs have seen 16% more patients in the last year. Some officials believe the increase was caused in part by the closure of seven private hospitals in the past 18 months, reducing the number of beds reserved for psychiatric patients.

“There are fewer options out in the community with the closure of over 200 beds in the private sector,” said Paula Packwood, chief of staff to the director of the county Department of Health Services. “What happens is, when the beds are full, then it gridlocks emergency rooms.”

The overcrowding became so severe that in May officials created a diversion system that allowed doctors and nurses to recommend that patients go to other hospitals when their units were too jammed.

Health department figures show that since then, County-USC Medical Center, Harbor-UCLA Medical Center, Martin Luther King Jr./Drew Medical Center and Olive View Medical Center in Sylmar have requested diversion about 67% of the time. County-USC near downtown Los Angeles was the busiest, asking for diversion 82% of the time.

“There’s pressure on the system and we need to proceed with care,” Packwood said.

Some county officials pointed to the suicide of a patient a few weeks ago at Harbor-UCLA’s psychiatric emergency room as a sign of the dangers of overcrowding. The patient had to wait several days for care in the hospital, said Dr. Roderick Shaner, medical director for the county Department of Mental Health.

“When incidents occur in crowded emergency rooms, it’s difficult to imagine the crowding was helpful,” he said.

After the death, county Supervisor Zev Yaroslavsky called for a plan to ease the crunch.

“We have a supply and demand problem,” Yaroslavsky said. “There’s no financial excuse now not to deal with this,” he added, referring to voters’ passage this month of Proposition 63, a tax for mental health services levied on people who earn more than $1 million a year.

The Health Services and Mental Health departments plan to present a strategy to the Board of Supervisors on Tuesday.

The county has several ideas for keeping psychiatric patients from overloading or revisiting emergency rooms, said Jim Allen, deputy director for adult systems of care at the Department of Mental Health.

One would be separating out psychiatric patients who do not require longer-term care and sending them to a new “crisis stabilization service,” where nurses, psychologists and others could take care of them for up to 24 hours.

Allen said the county plans to base the new service at Augustus Hawkins Medical Clinic, a psychiatric facility at King/Drew in Willowbrook, south of Watts. Patients could also receive up to a year of follow-up care.

Also, Proposition 63 could help fund services that would send therapists and other psychiatric professionals out to patients to help them stabilize their lives in the community and assign each case manager a fewer number of patients, officials said.

The money could also go toward contracting more in-patient beds for psychiatric patients in private facilities.

Officials said they are not sure how many patients were actually diverted from the emergency rooms over the last six months. In some cases, doctors and ambulance companies were able to find patients care elsewhere, while at other times, the patients were brought to the facilities anyway.

Jim Lott, a spokesman for the Hospital Assn. of Southern California, said that acute psychiatric services are generally not a profitable part of hospitals. Such units often lose money, but not as much as emergency rooms, which deal with large numbers of uninsured patients.

“In an era when revenues are tightening, hospitals are looking for where to cut expenditures,” he said. “Any service not profitable and not required is on the chopping block. And psychiatric services are not a required service for an acute hospital.”

Cedars-Sinai Medical Center suspended use of some of its psychiatric beds because it didn’t have enough nurses to staff them, county mental health officials said.

Part of the financial problems that prompted Northridge Hospital Medical Center’s Sherman Way Campus to close last week stemmed from the 44-bed behavioral health unit, said Vice President Tracey Veal.

“There were a significant number of low-income, transient and homeless people, which are typical of those having psychiatric issues,” she said. “A certain number of those are also uninsured and underinsured, but we had to take everybody that came in.”

Some officials with the Department of Mental Health disagree that the closure of psychiatric beds in the private sector has a great effect on the overcrowding of psychiatric ERs in the public sector.

“There has always been and continues to be a shortage for persons who don’t have” insurance, said Dr. Marvin Southerd, the director of the Department of Mental Health. “It’s a rare day in which all of the acute beds are filled for people who have Medi-Cal.”

Southerd said his biggest concern with psychiatric services is for children.

“There are some children’s facilities that have been having business difficulties apart from the general hospital business,” he said.

“It’s probably related to the costs that are necessary to run a quality children’s program -- child psychiatrists, nurses specialized in children’s issues. Those are expensive.”