Eight Comcare patients from Sedgwick County were refused admission to the Osawatomie State Hospital from Friday to Sunday as the psychiatric facility works to reduce overcrowding.
The state recently announced it was suspending voluntary admissions until the hospital’s census reaches 185 patients. The hospital is licensed for 206 beds. Its patient population reached 250 several times during the late summer and fall, Angela de Rocha, communications director for the Kansas Department for Aging and Disability Services, said Tuesday.
A Dec. 2 memo said the state also was implementing an “aggressive” triage system for involuntary admissions. The eight patients from Sedgwick County would have been involuntary admissions.
Marilyn Cook, executive director of Comcare, the county’s mental health agency, said in an e-mail Monday to county leaders that the Centers for Medicaid and Medicare Services (CMS) visited Osawatomie in October. The visit was “due to a complaint they received about the crowding there. … CMS gave the state until this morning to get the census down to the 206 level or jeopardize the $10 million that CMS pays the state for these admissions.”
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De Rocha said Tuesday that the state presented Medicaid and Medicare with a plan to fix overcrowding.
“They accepted the plan of correction,” she said.
“We’ve experienced a lot of pressure on the census,” de Rocha added.
“We’ve been over census more often than not since April.
“It spikes. It’s been spiking. To put this in context, this has happened before.”
Cook told Sedgwick County commissioners about the problem Tuesday, warning them to expect a “ripple effect in our community.”
Comcare does not send voluntary patients to Osawatomie, Cook explained. So the patients turned away over the weekend were involuntary, she said. She told commissioners she wasn’t sure whether to say the patients were “denied” or “delayed” services.
When patients with mental illnesses such as schizophrenia, severe bipolar disorder and major depression need treatment but refuse it, the county sends them involuntarily to Osawatomie, which is about three hours from Wichita.
“Interestingly enough, we had three more involuntary petitions yesterday, and they were allowed into the state hospital,” Cook said Tuesday.
The crowding problem at Osawatomie will put more pressure on Comcare and other community mental health centers, she told commissioners.
The centers are looking for treatment options other than hospitalization, she said.
Cook said overcrowding has been “especially bad this year, since maybe the spring. We all ask why. Why is it so bad now?”
She offered some guesses.
“The economic situation has caused more stress for people,” Cook told The Eagle. “We do see consequences of the economic environment. We’re seeing families struggling.”
De Rocha offered another possible cause for the spike in the number of patients. About half of patients at Osawatomie are what’s called “dual diagnosis,” which means they have a mental illness and a substance abuse problem.
“One could reasonably infer that the level of drug abuse in our state is driving at least a part of this,” she said.
Cook noted that “a lot of communities are losing their local inpatient facilities. Some of that has to do with insurance companies cutting their rates.”
Wichita has 80 beds for psychiatric patients at Via Christi Behavior Health Center and at 20 beds for elderly mental health patients at Via Christi Hospital St. Joseph.
“So many local inpatient units have closed across the state,” Cook said. “You have less local beds for people to go to. Even in Sedgwick County, when I came over here in 1993, we had almost 300 inpatient beds.”
De Rocha said in an e-mail that smaller hospitals in rural areas across the state do not usually have many, or any, psychiatric beds, which are licensed separately from regular medical beds.
“People experiencing a mental health crisis in such hospitals are usually treated and stabilized in an emergency room setting, and then either directed to community treatment resources or to one of the state hospitals,” she said.
Hospitals in medium and larger cities have psychiatric beds, “but federal Medicaid policy has reduced the number of those beds they can afford to maintain, and as a result, many of those beds have been closed,” de Rocha said.
“The state hospitals are currently carrying the lion’s share of the burden imposed by the closure of private, inpatient beds,” de Rocha said.
The memo from the state last week outlined changes being made to reduce the hospital’s patient population.
“Involuntary admissions will be aggressively triaged following the procedure outline below,” the memo from the state says. “Immediately, and whenever the (hospital) census reaches 185, the hospital will implement the intensive triage system.”
The state asked community mental health center screeners to consult with the hospital’s admissions officer and, if necessary, an on-duty physician from the hospital “regarding the diagnostic criteria related to each patient before admission. Both admissions officers and physicians will be on duty 24 hours a day at the hospital to provide these consultations.”
The memo said the consultations would take place by phone and “must occur before a patient is transported to Osawatomie.”
Sending the patient’s screening documents to the hospital by fax or other means “without first discussing that patient with a hospital admissions officer will not be allowed.”
In September, the state awarded a $1 million grant to the South Central Mental Health Counseling Center/Regional Recovery Support Center to fund behavioral health crisis intervention services in Butler, Sedgwick and Sumner counties.
The grant aims to stabilize people “before they suffer a full-blown mental health or substance use crisis requiring their admission to an inpatient facility,” de Rocha said.
The state also has worked with a group of professionals and advocates in the Kansas City metro area to create Rainbow Services Inc., “a multi-purpose crisis and triage center that is having tremendous success, serving people in the metro area effectively and efficiently,” de Rocha said.
Osawatomie admissions from the Kansas City area have been “substantively reduced” since Rainbow Services Inc. opened, de Rocha said.