Wichita's leading mental health center has informed state officials that it expects to refer an additional 1,250 people to Osawatomie State Hospital next year, which would mean a large influx of patients at a facility that already is frequently overcrowded.
COMCARE officials said they must begin diverting more patients to Osawatomie because recurring state budget cuts have left the center no longer able to afford the costs of providing inpatient care in Wichita.
Executive Director Marilyn Cook said COMCARE was on course to lose $3.2 million this year and $3.6 million in 2012.
“I’m afraid we’ve reached the point where we have to do something and this is a service that we’re not mandated to provide,” Cook said. “It’s outside the scope of what most mental health centers do."
Cook said COMCARE in Wichita is the only one of 27 community mental health centers in Kansas that has provided local hospitalization for the mentally ill.
Osawatomie is the largest of the three state-run hospitals for people with serious and persistent mental illness. The others are Larned State Hospital and Rainbow Mental Health Facility in Kansas City.
COMCARE is in the Osawatomie hospital's 46-county catchment area.
It’s unclear how many additional patients Osawatomie State Hospital would be able to accommodate.
According to the Kansas Department of Social and Rehabilitation Services, the agency that oversees the state hospitals, the 176-bed facility exceeded its licensed capacity four of every 10 days in the fiscal year that ended June 30. In recent months, the hospital has averaged 173 patients a day.
Also, SRS last week announced that on Nov. 9 it would begin moving 30 Rainbow Mental Health Facility patients to Osawatomie while Rainbow is renovated to meet fire and safety codes. The remodeling is expected to take six to eight months.
COMCARE and Via Christi officials are scheduled to meet with SRS officials on Thursday to discuss the planned diversions, according to spokepersons for COMCARE, Via Christi and SRS.
“SRS is aware of the situation and takes it very seriously,” Angela de Rocha, a spokeswoman for the department, wrote in an email to KHI News Service. “We are examining our options.”
Gov. Sam Brownback toured Osawatomie State Hospital this morning, though the visit was not related to the COMCARE decision, according to the governor's staff.<a name="continued"></a>
For more than 20 years, Cook said, COMCARE has had an arrangement with Via Christi Health System that allows COMCARE's medical staff to care for Sedgwick County residents who need inpatient care and who agree to be admitted to Via Christi’s 80-bed psychiatric unit in Wichita.
Only those who resist admission to Via Christi or whose behaviors are considered too disruptive have been sent to Osawatomie State Hospital.
But after Dec. 31, Cook said, all would-be Via Christi referrals will be sent to Osawatomie.
“On any given day, COMCARE has between 18 and 20 patients at Via Christi,” she said. "But that's an average. It's not uncommon for that number to be considerably higher."
Cook said with the diversions, COMCARE expects to cut costs by about $400,000 a year.
Most of the patients COMCARE treats are either uninsured or on Medicaid or Medicare.
The state-funded portion of COMCARE’s budget, Cook said, has been cut 65 percent since 2005.
“We just can’t take that kind of cut and keep doing what we’re doing,” she said.
De Rocha said SRS officials weren't ready to discuss what options might exist for the agency. But sources with close knowledge of state hospital operations and SRS said the options likely include:
- Imposing a cap on Osawatomie State Hosptial admissions;
- Referring patients to Larned State Hospital, if or when beds are available there;
- Once Rainbow renovations are complete, reopening 14 beds that were closed at Rainbow earlier this year when federal surveyors cited the facility for being understaffed;
- Keeping open a newly remodeled 30-bed unit at Osawatomie State Hospital, staffing for which earlier this year lawmakers opted not to fund. SRS recently announced it would staff the unit while it is used to temporarily house Rainbow patients.
- Paying private psychiatric hosptials to take COMCARE referrals;
- Paying Via Christi to provide the medical staff now paid by COMCARE to treat COMCARE patients;
- Using University of Kansas Medical School-Wichita residents to offset some of the staffing costs.
- Increasing payments to COMCARE so it could maintain the status quo.
Meanwhile, those who deal with the mentally ill in Wichita said they were concerned about the potential consequences, if COMCARE goes through with its plan to divert patients to Osawatomie.
“If this goes through, there will be a lot of people who are voluntary admissions now who just won’t go to Osawatomie,” predicted Douglas Winkley, interim executive director at Breakthrough, a walk-in program for the mentally ill in Wichita.
“It’s because of the stigma that comes with being sent to Osawatomie; Via Christi is seen as a much better place to be,” Winkley said. “People would rather go to (the emergency room) and see what happens.”
Many Breakthrough members are former Osawatomie State Hospital residents, he said.
All of the patients referred to inpatient care are considered a danger to themselves or others and have a serious and persistent mental illness. Many have mutiple diagnoses.
Stephen Feinstein, a former superintendent at Osawatomie State Hospital, said the hospital already was strained due to persistent overcrowding and growing new demands.
“It’s pretty clear what’s going to happen,” he said. “There will either be shorter stays, delayed admissions or closed admissions. There isn’t room for 25 more patients a day. It’s too crowded, too dangerous. SRS needs to get on top of this, because when things like this go south, they go south in a hurry.”
Feinstein is a past president of both the National Alliance on Mental Illness and NAMI-Kansas.