Care in ER a top issue

Determining who has responsibility for mental-health patients in local emergency rooms has gotten the attention of more than law-enforcement and health-care providers.

Yesterday's 2½-hour meeting also attracted three local legislators who are concerned about the inefficiencies in the current system.

Reps. Dale Folwell, R-Forsyth, Earline Parmon, D-Forsyth, and Larry Womble, D-Forsyth, said they wanted to hear the presentation by Angel Gray, an assistant state attorney general. It served as a training session on the law related to the transportation of the mentally ill to hospitals, and law enforcement's role in this process.

Parmon, a member of the House mental-health reform committee, said that the presentation reinforced her concerns about the ambiguities in the statutes regarding involuntary commitments.

"Particularly regarding when does law-enforcement responsibility end and health-care provider responsibility begins," Parmon said.

"As a policy-maker, those are things perhaps we can address locally that will have statewide application in resolving the gaps in the current system."

The issue has vexed local law-enforcement, health-care and mental-health officials for years -- financially, logistically and in terms of security. Advocates say they worry that long waits are becoming more common because of a lack of beds in local and state hospitals and psychiatric facilities.

In late May, for example, the lack of beds for psychiatric patients meant that a local man who was having a mental-health crisis spent more than eight days in the emergency department of Forsyth Medical Center -- at times in handcuffs -- before being admitted to the hospital.

The meeting was the second to address the emergency-department topic in six weeks.

There were about 40 officials in attendance yesterday, including those in health care, mental-health care and law enforcement, and elected officials from Davie, Forsyth and Stokes counties.

Like the first meeting in July, local mental-health advocates and the media were not allowed to attend. A PowerPoint presentation was provided to the Winston-Salem Journal after the meeting.

Some of the key points from Gray's presentation were:

□ A first evaluator has 24 hours to assess the patient after they have been brought into a health-care facility by a law-enforcement officer.

□ The officer should stay with the patient until it is determined that a doctor or eligible psychologist is available to conduct the examination. It is also recommended that the officer ensure that the patient is left under appropriate supervision.

"Factors for appropriate supervision include whether respondent appears violent, or has a history of violence, type of facility --secure? -- and personnel available to supervise," according to the presentation." The officer does not have to stay with the patient at a 24-hour psychiatric center.

Folwell said that having emergency rooms seen as the first option for treating a mental-health case "is just one more way that the collapse of the mental-health system in the past 15 years is bubbling to the surface."

"One reason for my interest is that I'm a big believer in getting a higher return on investments we've already made in society," Folwell said. "The current system acts as a drain on law enforcement, on health-care providers, on taxpayers and on patients and their families."

Scott Cunningham, the police chief of Winston-Salem, said that the meeting helped law-enforcement and health-care providers "try to achieve better clarification of transport and custody/supervision issues."

Jo Haubenreiser, a vice president for post-acute services at Forsyth Medical Center, said she found the information "very helpful in the continuing discussion on how best to manage behavioral-health patients."

Another meeting, involving Davie and Forsyth sheriffs' officials, Winston-Salem police and Forsyth Medical officials, has been scheduled for Friday at CenterPoint Human Services.

Many advocates are frustrat­ed by being excluded from the meetings, as well as what they perceive as a "closed-door policy" by some CenterPoint officials. The advocates help provide training to Winston-Salem police and Forsyth deputies on how to deal with a mental-health crisis.

Betty Taylor, the director of CenterPoint, said that the presentation was helpful to provide more clarity on the issue.

"We need a clear-cut, black-and-white law to cover this situation for the patient," Taylor said.

"Our job is to help support law enforcement and health providers as they come up with a plan they can agree with."

■ Richard Craver can be reached at 727-7376 or at rcraver@wsjournal.com.