For the next few days at least, the private nonprofit group WestCare will continue to accept mentally ill patients overflowing from local emergency rooms. But private sector and government health officials said Monday they don't know what will happen when the $100,000 in state emergency funds run out, which is expected to happen soon.
A meeting of public and private sector health officials Monday ended with more questions than answers regarding how the problem of mental patients overcrowding emergency rooms will be dealt with in the coming weeks and months.
State Department of Human Resources Director Mike Willden was expected in Las Vegas today to survey the situation as state health officials considered their options, including opening beds for the mentally ill at the Desert Regional Center, a partially empty state facility for the developmentally disabled.
"Anything we do we will have to have the support of the administration," Dr. David Rosin, medical director with the Nevada Division of Mental health and Development Services, said.
The long-evolving problem reached a crisis point Friday, when Clark County hospitals said too many -- about one-third -- of their emergency room beds were filled with mental-health patients. Hospital officials feared there were not enough emergency room beds left to deal with a sudden influx of patients if there were mass casualties and asked County Manager Thom Reilly to declare a local emergency.
Gov. Kenny Guinn then released $100,000 in emergency funding, which went to WestCare to open 36 temporary beds in a building at its facility near Martin Luther King Boulevard and Charleston Boulevard.
With time and WestCare's help the number of psychiatric patients in the 11 local emergency rooms has gone from a high of 108 down to 60, officials said.
As of late Monday afternoon, WestCare had received 46 patients from local emergency rooms, and another five were on the way. Eighteen of the patients that had gone to WestCare since Saturday had been released to other facilities or on their own, WestCare President Richard Steinberg said.
But the $100,000 from the state isn't expected to last long. Steinberg said the money could run out in a few days, but added he really didn't know how long it would last until he started seeing all of the bills.
Rosin said the money would likely run out before Sunday, and where additional funds could come from is unclear.
"It's a decision for the governor whether to call for an emergency IFC meeting," Rosin said referring to the state Legislature's Interim Finance Committee. "Or maybe there's another source of emergency funding."
Rosin said state officials are looking at the Desert Regional Center, which is at about two-thirds of its capacity, as a possible place to open additional beds, but it's unclear when they would be available, how much it would cost to prepare the building for the patients and where that money would come from. Government licensing and fire marshals have been in the building, and Rosin said he is hoping to hear their reports on the building soon.
Steinberg, who toured that building Sunday, said it would probably take about 30 days to turn the building, which was used for the developmentally disabled, into a place for psychiatric patients.
Rosin said the veterans home in Boulder City and Summit View Youth facility have also been mentioned as possible sites for additional psychiatric beds, but he said officials at those sites haven't even been approached about that possibility at this time. He said there is no talk of using the prison camp in Jean.
The problem of mentally ill patients crowding emergency rooms is caused by the fact that the worst mental patients are brought to the emergency rooms first.
In Clark County, patients who are a danger to themselves or others -- "homicidal or suicidal," as one official put it -- are taken to hospital emergency rooms to be checked for physical problems. Those patients are only allowed to leave after they are checked out by a doctor who gives them a "medical clearance," Davette Shea, emergency department director at Southern Hills Hospital & Medical Center, said.
After receiving a medical clearance, the patient could be discharged to another care facility or in some cases allowed to go home, she said.
But another part of the problem is that even after receiving medical clearance, sometimes there is no place to move those patients who still need care. This is the problem that was addressed, at least in part, by the opening of the temporary beds at WestCare this weekend.
Shea said that roughly three-fourths of these severely mentally ill patients are men between 25 and 50 who are homeless and have no health insurance or family able to help them.
Shea said even when the numbers of psychiatric patients in hospital emergency rooms doesn't reach the level it was on Friday, the number of psychiatric patients in emergency rooms is a primary cause of long waits for other patients.
Those mentally ill patients not considered dangerous enough to have to go to emergency rooms are brought to a triage center on North Fourth Street run by WestCare. Steinberg said about 8,500 patients a year are treated there.
Officials said that without the triage center the area hospitals would see even more psychiatric patients, and another potential problem looms because that facility only has funding for two more months.
Steinberg and Rosin said the long-term solution to the emergency room problem is to establish a triage center that would also handle the worst cases.
A plan to establish such a center, which Rosin said could go at the state's mental health hospital in Las Vegas, has been discussed for years, they said.
But when it would be built and where the money would come from are unknown.
Steinberg said such a one-stop, all encompassing triage center for mentally ill patients would cost about $8.4 million a year. The existing mental health triage center costs about $3.8 million annually.
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