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Osawatomie admissions cap forcing patients to wait in hospital emergency departments

Lawrence Memorial Hospital reports increased wait times for patients in mental health crises

By Meg Wingerter | January 11, 2016

Osawatomie admissions cap forcing patients to wait in hospital emergency departments
Photo by Susie Fagan Lawrence Memorial Hospital has increased staffing and security at its emergency department as some patients in mental health crises face waits of several days for an open bed at Osawatomie State Hospital.

People experiencing a mental health crisis who are a danger to themselves or others sometimes are having to stay for days in emergency departments while waiting for a bed to open at Osawatomie State Hospital. That has prompted at least one Kansas hospital to increase staffing and security in its emergency department.

Janice Early, vice president of marketing and communications at Lawrence Memorial Hospital, said the emergency department director confirmed to her that patients requiring an involuntary mental health commitment have waited an average of 17 hours for a placement in the last year, but recently those times at LMH have ranged from 24 hours to 140 hours, or just short of six days.

“The biggest challenge we’re facing is how long we hold our patients in our emergency department,” she said.

Angela de Rocha, spokeswoman for the Kansas Department for Aging and Disability Services, said she wasn’t aware that people were waiting five days or longer for admission to Osawatomie.

The average wait time since KDADS limited admissions at Osawatomie in June has been about 23 hours, she said, although the average for the most recent week was 29.8 hours. Wait times tend to rise in the summer and around holidays, de Rocha said.

Osawatomie is one of two state-run inpatient treatment facilities for Kansans with severe and persistent mental illness. The other is in Larned. The Osawatomie facility is usually equipped for 206 patients but is allowed only 146 now, while renovations are under way to correct deficiencies found by federal surveyors

Recently, federal inspectors decertified the hospital, making it ineligible for Medicare reimbursements until certain safety and security deficiencies are corrected. State officials haven't decided whether to pursue recertification, saying that the renovations required to fix the problems would be expensive and would force the hospital to continue to limit admissions.

Delays in the process

The process of admitting someone to Osawatomie involves a representative from a community mental health center assessing a patient’s mental health needs and then having a conference with Osawatomie staff about what placement would be appropriate, de Rocha said. Patients who can be treated in a less-secure setting are diverted from Osawatomie to shorten wait times for those who need more intensive care, she said.

“Osawatomie is limited to people everyone agrees are a danger to themselves or others,” de Rocha said.

Sometimes placement can be delayed if a community mental health worker isn’t immediately available or if patients have other medical problems that need to be treated before they leave the emergency department, de Rocha said.

LMH has a crisis stabilization unit with private rooms, which are separate from the rest of the emergency department, Early said. The rooms have less equipment than a typical trauma room and are set up to be safe for mental health patients, but they aren’t intended for long stays and don’t have features like private bathrooms, she said.

“They’re not getting the treatment they need. We’re not a (mental health) treatment facility.”

- Janice Early, vice president of marketing and communications at Lawrence Memorial Hospital

Most patients who come to the LMH emergency department with mental health issues don’t need to be sent to Osawatomie, Early said. The process of determining placement involves first taking care of any medical emergencies, then assessing the patient for mental health needs, she said. Those who are deemed to represent a danger to themselves or others are committed involuntarily to Osawatomie or another secure facility when a bed becomes available.

“It’s a challenge finding a bed,” she said.

LMH assigns one employee to each person in the crisis stabilization unit, which requires increased staffing, Early said. LMH also has decided to increase its emergency department security at times.

More worrisome, Early said, is that patients aren’t getting the level of treatment they need while waiting in the emergency department. LMH can take care of any non-mental health problems the patient has and keep him or her safe, but it isn’t equipped to begin offering psychiatric care, she said.

“They’re not getting the treatment they need. We’re not a treatment facility,” she said.

‘Often at capacity’

Susan Burchill, marketing and public relations manager for Wesley Healthcare in Wichita, said she couldn’t provide specific numbers for Wesley Medical Center. But she said the hospital also was seeing more people needing mental health treatment. 

“My understanding is that our local hospital resources for mental health patients is often at capacity and that we often look for other options statewide to find these patients ongoing care,” she said.

Jill Hagel, nursing director for case management and the in-patient adult psychiatric unit at University of Kansas Hospital, said the Kansas City, Kan., hospital has seen an increase in patients with mental health needs since admissions to Osawatomie were limited. It isn’t clear whether that is related to the moratorium at Osawatomie or growth in patient numbers across departments due to KU’s reputation, she said.

KU Hospital does have a psychiatric unit, Hagel said, but it specializes in stabilizing people relatively quickly and setting them up with outpatient mental health resources. People who need a long-term involuntary stay have to go to Osawatomie or to KVC or Cottonwood Springs in Olathe, she said, adding she hoped Osawatomie will be successful going forward.

“You’ve got to have hospitals like Osawatomie for that,” she said.