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Tri-City board delays psych ward closure until Oct. 2 but rebuffs pleas for longer stay

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Tri-City Medical Center directors acted Tuesday night to delay the indefinite suspension of the hospital’s psychiatric ward by more than one month but rejected pleas from a wide range of constituents to keep the vital resource open through the end of the year.

On a 5-2 vote after hours of testimony from the public, law enforcement, elected officials and medical staff, the board adopted a proposal from the county’s behavioral health services department to shutter the unit on Oct. 2 rather than Aug. 26 as originally planned. Tri-City officials said the unit will stop admitting new patients on Sept. 22, the earliest date that such an action could take place, according to the county.

Pressed on all sides to reconsider after deciding on June 26 to shutter its 12-person crisis stabilization unit and 18-bed behavioral health units in late August, the Tri-City board announced last week that it would provide a fresh opportunity for the public to make a case for why its plans should not go forward.

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The board’s meeting room in the basement of the Oceanside hospital was packed Tuesday night with people who did just that. Law enforcement officers and local politicians argued that, with Tri-City’s capacity offline, deputies and police officers would be forced to transport those undergoing psychiatric emergencies to Escondido or San Diego for hospitalization, taking police and deputy sheriffs off their beats for extra hours every day. Coastal North County residents tearfully highlighted the extra burden of potentially having to travel so far to visit hospitalized loved ones.

Many said that Tri-City’s previously-expressed concerns over finances, regulations and staffing problems are surmountable. They hinted that the county is willing to provide enough cash for Tri-City to make nearly $8 million in needed repairs to its psych units They also felt federal regulators would surely grant a temporary reprieve on new requirements to reduce hanging risks. They also suggested that other companies are available to help address staffing shortages.

Though board members visibly agonized over their decision, they said they saw no firm solutions to the issues that caused the unit’s closure.

Talks with the county have not so far, they said, produced written solutions to any of the problems they have cited, and the public district hospital is expecting a triennial licensing survey this fall.

Board members worried that if that survey found that the psychiatric unit does not meet new federal guidelines, the hospital’s ability to receive federal reimbursement could be put in jeopardy. Likewise, they worried that the hospital could face additional legal liability if psychiatric patients harmed themselves while being treated in units that federal guidelines say are unsafe.

Tri-City board member and registered nurse Laura Mitchell proposed that Tri-City postpone suspension until Jan. 31, 2019, to provide the county more time to come up with a solution,. She got no support on the idea from her fellow directors nor did the notion of delaying until the end of the year as proposed in a last-minute letter from Kristin Gaspar, chair of the San Diego County Board of Supervisors.

In the end, Tri-City board member Julie Nygaard said that it is important to make a stand and demand a solution from the county which is legally responsible for arranging hospitalization services for all Medi-Cal patients brought in on “5150” psychiatric holds if they’re thought to be a danger to themselves or others.

Promises of a solution, Nygaard said, are no longer going to cut it. Those promises, she noted, have staved off the unit’s closure several times in the past, but no more.

“If they come up with something in October that’s concrete, we’ll be here ready do do whatever needs to be done. But we can’t continue to put our patients at risk,” Nygaard said.

The county has said it is working on a plan to replace the capacity lost by Tri-City’s suspension, but no plan has yet been released. The county board of supervisors is set to discuss the current state of emergency psychiatric services across the region during a special meeting on Oct. 30.

The vote — with Mitchell and RoseMarie Reno both in opposition — elicited boos from an audience that accused the board of abdicating its responsibilities to the community it serves as a public district hospital with an elected governing board.

North County resident Sandy Murphy, who said her son who lives in Oceanside and has made multiple trips to Tri-City’s psychiatric unit, was among those who tried unsuccessfully to appeal to the hospital’s sense of mission.

“He has attempted suicide five times and you have helped him,” Murphy said, adding that driving to Escondido or San Diego is not an option for those who live in coastal North County.

“I need the fastest closest hospital, which is your hospital,” Murphy said.

She, like many in the audience, said Tri-City should find a way to tap growing public support for addressing the ever-growing demand for mental health services.

“If we need money, I would be more than happy to help you raise money. Let’s do it,” Murphy said.

Though Tri-City has struggled to get the public’s support for needed upgrades in the past, with three failed bond referendums in the early 2000s, the crowd in the room Tuesday night did seem ready to help drum up public support. However, board members and hospital staff made it clear that the challenges facing Tri-City’s psychiatric units are urgent now and cannot wait for solutions that could take a long time to materialize.

Board chair James Dagostino said that the state’s seismic upgrade laws — which require the hosptial’s central and south towers to be repaired, replaced or taken out of service by 2030 — add urgency to the situation. Tri-City, he said, needs to show a $10 million operating profit per year in order to borrow the millions it needs to pay for repairs in time to avoid shutdowns in 2030.

That budget pressure, he said, forces Tri-City to pare back services that lose money. He said Tri-City’s behavioral health unit and crisis stabilization unit lose between $4 million and $5 million per year.

Meanwhile, the condition of services for psychiatric patients in Tri-City’s emergency room have changed since the hospital sidelined its crisis-stabilization unit on Aug. 3.

Dr. Karl Jacobs, a psychiatrist who works in Tri-City’s emergency room but is part of a medical group at UC San Diego, told the gathered public about the hospital’s “fast track” unit where psychiatric patients are held. The area consists of an L-shaped hallway, he said, with two exam rooms converted to makeshift dormitories with chairs instead of beds, one shared bathroom and no showers.

“The absence of showers and beds is significant, because patients may languish under these circumstances for four or five days while waiting to be admitted to a psychiatric hospital bed or to resolve sufficiently to be discharged to a less restrictive level of care,” Jacobs said.

Psychiatric evaluations are conducted, he said, in a linen closet.

“I am frequently interrupted by hospital linen or kitchen staff who are looking for the linen closet and who are understandably surprised to find patients and me in there,” Jacobs said.

Hospital staff did not directly refute Jacobs’ statements during the meeting, but Aaron Byzak, a Tri-City spokesman, said Thursday evening that Jacobs’ portrayal is inaccurate.

“We do absolutely refute the account,” Byzak said, adding that patients are offered showers, three meals per day and stay for multiple days only under the recommendations of psychiatrists.

Tri-City’s medical staff has generally been supportive of its move to suspend the units. Dr. Cary Mells, director of the hospital’s emergency department, did say that “100 percent” of the medical staff supports the board’s suspension decision.

“I know in my heart it’s the right decision, and I support it,” Mells said.

Board members and administrators also touched on difficulties that Tri-City has had hiring and retaining enough psychiatrists to staff its units. They said UC San Diego — which has a contract with the hospital to provide coverage from 8 a.m. to 5 p.m. Mondays through Fridays and 24 hours per day on the weekends — was not living up to its commitments.

Reached Wednesday afternoon, Patty Maysent, UC San Diego Health’s chief executive, said there was a little trouble hiring the four psychiatrists that the contract required, but added that the university was eventually able to provide full coverage for the behavioral health unit.

“At the point where they were making their decision to shut down we were fully ramped up,” Maysent said, adding that UCSD was not contracted to staff the hospital’s crisis stabilization unit.

Several Tri-City executives were chagrined during Tuesday’s meeting that many in the public have said the hospital is closing its units, noting that the board voted on June 26 for suspension, not closure.

However, many, including the Service Employees International Union, have noted that the state Employment Development Department’s official layoff notice report listed the reason for 80 worker layoffs in Tri-City’s behavioral units as permanent closure. That listing was changed to “closure unknown at this time” on July 30 after Tri-City requested a correction, a department spokesman said in an email Wednesday morning.

Tri-City’s initial layoff notice, the employee added, said that the the hospital’s intention was to “suspend operations indefinitely” however staff processing the form interpreted those three words to mean that the units would be permanently closed. The Union-Tribune has changed its reporting from “closure” to “suspension” to reflect the change in the state’s changed listing.

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paul.sisson@sduniontribune.com

(619) 293-1850

Twitter: @paulsisson

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