26 January 2009

The Psych Bed Crisis in Denver

While the recent financial crisis has largely held the health care industry harmless, not all classes have providers have managed to capture a piece of double digit health insurance price increases year ater year.

Denver's psychiatric hospitals have been catastrophically cut in the past two decades, despite a growing metropolitan area population and no sign that the mental health of our region's people is getting any better. "About 40,000 mentally ill people show up in Colorado emergency rooms each year, statistics show. Of those, about 40 percent need hospitalization."

While there as a major deinstitutionalization of the mentally ill in the 1960s, most agree that while there were too many institutionalized mentally ill people in 1955 (about 340 bed per 100,000 people), that deinstitutionalization went too far. Now, many people who should be receiving institutionalized mental health treatment homeless, in jails and prisons, and cycling through expensive emergency rooms.

Metropolitan Denver has 700 psychiatric hospital beds in 1990. Now it has 230. Colorado is 50th among the 50 states and District of Columbia, in psychiastric hospital beds per capita.

Psychiatric hospital beds aren't cheap. The University of Colorado, which recently shut down its twenty-one bed psychiatric hospital spent $80,000 a year per bed to operate its facility.

Colorado has 11.8 psychiatric beds for every 100,000 people, while nationwide the average was 30.

The shortage of beds is bad enough that in November the state hospital at Pueblo had to turn away patients for nearly a week.

The hospital, which has eliminated more than 60 percent of its beds since 1990 because of budget cuts, had no choice, said Liz McDonough, spokeswoman for the state Department of Human Services, which oversees state hospitals. . . .

CU is hardly the first hospital to close its psychiatric unit. Heather Cameron, director of the Triage project, said the group found at least eight hospitals that had closed units in the past decade or so, including Presbyterian/St. Luke's and St. Anthony Central.

St. Anthony's closed in 2005; that year, the unit lost $3 million, said David Thompson, who became the hospital's chief financial officer after the closure.

The loss didn't come because the unit's 29 beds sat empty. On the contrary, "It stayed full. There definitely was a demand," Thompson said.

What was missing was payment for the care.

"The majority of patients did not have insurance," Thompson said.

At Denver Health Medical Center, 960 adults were admitted for inpatient treatment in 2007. Of those, 55 had private insurance, said Dr. Robert House, behavioral health director at Denver Health.

In November, Dr. Patricia Gabow, Denver Health's chief executive, warned that the number of uninsured patients might force the hospital to cut services — including mental- health care — in the coming year.

With University and St. Anthony hospitals shuttering their units, Gabow worries that the strain of psychiatric care, especially for indigent patients, could stretch their resources to the breaking point.

The hospital recently added a 10-bed psychiatric emergency unit, and it operates a 44-bed adult inpatient psychiatric unit.

Even when patients have insurance, there is no guarantee against losing money taking care of them.

At St. Anthony, insurance "reimbursement rates just weren't up to par. They just didn't cover the cost," Thompson said.

Many insurers require hospitals to provide almost daily justification for continuing treatment, and even then limit what they will cover, Most said.

"We have to beg sometimes every day to keep a patient in the hospital," Most said. "We have staff dedicated to just that."


Sometimes the insurers win and the results can be tragic. In one sad wrongful death case where I represented a mental health patient's survivors, the patient didn't want to leave, didn't have a good discharge plan, and committed suicide within 48 hours of being discharged.

While all areas of the health care system have deep seeded and intactable problems with patients who can't afford health insurance or pay for care out of pocket, there a few places where the problem is more accute than psychiatric hospital care. A system based upon employer provided health insurance, and on individual policies that often provide little or no mental health care coverage, simply does not serve this need well.

Even if a system of near universal health insurance through employers, supplemented with means tested subsidies, can work passably well for much of the nation's health care needs, this may not be a system that works to meet the needs of those requiring in patient mental health treatment. Given the grave costs of denying health care in this circumstances to patients, to their families and to the larger public handling this part of the health care system on a single payer basis may make sense.

The Denver Post offers as a public service, and I repeat, a list of the Denver area psychiatric hospitals with their respective capacities:

Where to find hospital care:
Key metro-area hospitals licensed to provide adult inpatient psychiatric treatment, including patients involuntarily committed:

• Boulder Community Hospital: 10 beds

• Centennial Peaks Hospital, Louisville: 30 beds

• Colorado Mental Health Institute at Fort Logan, Denver: 153 adult beds*

• Denver Health Medical Center: 44 beds

• Exempla West Pines, Lutheran Medical Center, Wheat Ridge: 38 beds

• Highlands Behavioral Health System, Littleton: 56 beds

• Porter Adventist Hospital, Denver: 35 beds

*Does not include beds for those committed through the criminal justice system

2 comments:

Sean L. Harrington said...

Well, here's another strategy that one could avail himself to get long-term, throw-away-the-key mental health care. I personally vouch that it works:

(1) Get yourself an unskilled job at the Jefferson Center for Mental Health (or whichever county mental facility where the person you believe is in need of psychiatric services lives). Perhaps volunteer at the facility. Get to know the Clinical Director (e.g., of JCMH, it's Tom Olbrich). If the director is male, it probably wouldn't hurt if you're female.

(2) Over a span of a couple of weeks, get to know the cops in the neighborhood of the person you believe is in need of mental health treatment. Tell them the person is mentally ill, not taking his/her medications, and is likely engaging in bizarre behaviors, like smearing blood and feces on the interior walls of his or her home. Mention that you work at a mental health facility and know the person well. Mention one or more diagnosis (it is likely that one or more of the officers will be familiar with the alleged ailment, so memorize the symptoms and provide descriptions that are corroborative).

(3) After a few weeks have passed, go file a Mental Health Hold under C.R.S. § 27-10-106. Make up some fantastic, outrageous allegations concerning the person you care about that are consistent, in part, with what you told the police. Make certain that you allege that the person is an imminent danger to herself and/or the community. It helps to have an unethical attorney aid in the preparation of the petition.

(4) Once the petition is granted (it will be), ask your boss, the clinical director of the county-affiliated facility where you work (and where the treatment will be assigned by the court) to specify that the person should not be taken to one of the HMO facilities that Andy mentioned above (like, e.g., Lutheran / West Pines) and, instead, that he or she should be taken "to a more secure facility" like the Colorado Mental Health Institute at Ft. Logan (CMHIFL) or at Peublo. Olbrich will adopt the information you alleged to the court (or alternatively can give directly to him) and prepare a medical referral for CMHIFL that contains diagnostic information that you alleged, even `though the clinic never treated the person and never had access to his or her records. The CMHIFL will regard the referral as an officious, authoritative medical document and will not question the origin of the diagnostic statements. These will be recorded into the CMHIFL doctors' notes and orders as assumed facts.

(5) Once the person has been transported to CMHIFL, he or she will be placed into solitary confinement with no windows, a bed pan and stainless steel bed bolted to the floor. This "safe room" will be located in the "violent offenders' ward," as a proximate and actual result of your fraudulent petition & affidavit.

(6) Ask your unethical attorney to place numerous calls, faxes and personal meetings with the treatment staff of the facility claiming to be in fear of her life (it helps if the attorney is a woman and can feign fearfulness). The attorney should request a duty-to-warn for herself and you, so as to give the act credibility. The CMHIFL staff understand this to mean that, if they don't err on the side of caution, they may have certain legal liabilities. By this point, the rights of the patient and the "truth" are inconsequential.

The result of this strategy is that, under the "short term certification" statute, the person you believe is in need of critical psychiatric care will receive at least three (3) months of free, intensive psychiatric medicating, sedation, confinement and traumatization by placement in proximity with pedophiles and murderers. During this time, the person will valiantly attempt to prove his or her sanity, while the doctors note in their logs, "PT denies homicidal ideology. . . staff is concerned that he may be faking high functioning & coherency."

Under C.R.S. § 27-10-108, the 3 month certification may be extended another 3 mos. Under C.R.S. § 27-10-109, a long-term certification of 6 mos. or longer may be ordered by the court.

For those who doubt the veracity of this strategy, I've seen it successfully employed in Case No. 00MH243 (district court, Jefferson County) and a variation was employed in 95MH155 (District Court, Boulder County).

The foregoing is not legal advice and you should not act or refrain from acting based on anything suggested herein. There are numerous unethical attorneys in the Denver metropolitan area that would be happy to assist you with this scheme.

Jaz said...

Outpatient drug treatment is a lower intensity alternative to programs such as long-term inpatient treatment, and it offers the flexibility and structure necessary to begin recovery.