Some doubt benefits of psychiatric ER plan

Hearing set for March 20

By: Richard Craver | JOURNAL REPORTER
Published: February 23, 2009

The potential for a 24-hour psychiatric emergency department in Forsyth County is being pitched as a time-and-resources saver by its proponents.

But there is some doubt as to whether it could be an assistance or hindrance to local health-care providers and law-enforcement agencies.

Old Vineyard Behavioral Health Services said Friday that it has applied for a certificate of need for the department as part of a $14 million expansion that would include the transfer of 50 beds from Broughton Hospital in Morganton. The plan is to build a two-story, 48,000-square-foot building at 3637 Old Vineyard Road. The cost is about $14 million.

There will be a public hearing at 1 p.m. March 20 at the Forsyth County Public Library, 660 W. Fifth St., in Winston-Salem. The state agency is expected to make its decision by May 1.

CenterPoint Human Services is participating in the request. Although the focus is on serving the needs of local residents, the beds would be accessible to patients statewide.

Old Vineyard's application to the N.C. Division of Health Service Regulation is in response to the state's emphasis on moving more beds dedicated to psychiatric care from state hospitals to local community operations.

The goal is to reduce the volume of hospital emergency-room visits -- and time spent there -- by sending people with a behavioral problem to Old Vineyard, particularly if they also don't have a physical ailment or wound.

Another goal is to provide a more efficient approach to where law-enforcement officers, particularly area sheriff's deputies, take people in need of mental-health assistance.

"These initiatives are the culmination of efforts spanning years of stakeholder work and input defining the critical needs of consumers, families, hospitals, magistrates and law enforcement," said Betty Taylor, the chief executive of CenterPoint. Taylor has been the target of criticism by advocates over the recent health-care and financial performances of CenterPoint.

Andy Hagler, the executive director of the Mental Health Association of Forsyth County, said that the Old Vineyard proposal "will help fill in one gap in our community" for law-enforcement agencies.

"It will provide a 24/7 emergency facility for law enforcement to take/transport a person with a mental illness in crisis, as an alternative to jail or as an alternative for waiting in a hospital emergency department for hours or days on end," Hagler said.

Laurie Coker, a board member of local mental-health groups, said she's concerned that the plans for the 50 additional beds or the psychiatric emergency department is not enough to provide timely service to people having a behavioral episode.

Coker, along with other local advocates, are concerned that adults ages 21 to 64, who are dependent on Medicaid to pay their bills, will continue to be turned away at Old Vineyard because it is limited on how many such patients it can admit at any given time.

"The problem is that we should be preventing unnecessary hospitalizations by placing persons appropriately in community-based treatment settings," Coker said.

Coker said that in recent years, almost half of the local people transported by Forsyth County sheriff's deputies to state hospitals were returned to hospitals here after they were evaluated.

"For by the time they arrived at John Umstead Hospital, the crisis had largely passed and it was determined by the clinicians there that these people did not need to be hospitalized," Coker said. "Hospitalization is traumatic and costly, and often not effective when someone has a chronic condition. They need to be appropriately linked to a service provider out in the community."

Jo Haubenreiser, the vice president of Behavioral Health Services at Forsyth Medical Center, said that the hospital supports the CON application because it "anticipates fewer patients waiting for hours in local emergency departments to be transported and admitted to a state hospital."

"This collaboration will assure patients are proactively managed throughout their stay in the local hospital, and then are re-connected to a broader pool of resources in the local community.

"In addition, the process prioritizes transfers to the state hospital in the event the patient is found to need a longer, more intensive hospital stay."

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