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SLO County Behavioral Health responds to grand jury report on psychiatric care issues

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A top San Luis Obispo County health official challenged some of the core findings of a recent SLO County grand jury report that highlighted an array of deficiencies in the county's system of emergency psychiatric health care.

ON HOLD IN THE ER A recent SLO County grand jury report highlighted the prolonged wait times that mentally ill patients face in local emergency rooms when they're in psychiatric crises. - FILE PHOTO BY JAYSON MELLOM
  • File Photo By Jayson Mellom
  • ON HOLD IN THE ER A recent SLO County grand jury report highlighted the prolonged wait times that mentally ill patients face in local emergency rooms when they're in psychiatric crises.

The grand jury report—"San Luis Obispo County Mental Health Services: a safe harbor or a perilous journey for those in need?"—investigated how residents with severe mental illnesses spend prolonged periods in hospital emergency rooms awaiting transfer to proper care facilities, which are often out-of-county.

"Finding a facility that will take them is often a long, convoluted, and arduous proposition," the report read. "In the meantime, the held person waits."

Among the findings of the report, the grand jury said that SLO County "has failed to create and maintain a safe, orderly, effective, and efficient means for ensuring the persons experiencing mental health issues receive the care they need, when they need it."

But in a formal response to the report filed with the Board of Supervisors on Sept. 13, SLO County Behavioral Health Director Anne Robin flipped the narrative, writing that many of the problems with emergency psychiatric care reside with the private hospital systems, not the county.

"It is not accurate to report that the county has created this situation," Robin wrote. "Currently, local hospitals are not fully complying with their federal and state legal responsibilities in this area."

Robin said that "an ever-growing number of individuals" are presenting to San Luis Obispo County hospitals with psychiatric emergencies, and that the county health agency has gone "above and beyond its legal obligation" to try to help hospitals manage the crisis.

SLO County runs a 16-bed inpatient psychiatric health facility for low-income patients on Medi-Cal. For those with private insurance, it's the hospitals' legal responsibility "to screen, stabilize, and transfer all individuals who present to their campuses," Robin said.

But the onus for managing psychiatric emergencies has instead fallen onto the county, she said. The county now has a 24-hour team that "receives all requests from emergency departments to seek out-of-county (or local) inpatient placements, arranges for transportation, and assists with follow-up."

"There is virtually no reimbursement to the county for the transportation services to individuals with private insurances, causing a use of public funds for services that should be covered by private insurance," Robin wrote. "The hospitals have contracts with placement and transportation companies for all medical diagnoses, except for psychiatric conditions.

"In summary," she said, "the hospitals depend on the county to provide care for individuals in psychiatric distress, not the inverse."

Robin added that the county's efforts have helped keep local wait times for the transfer of patients with psychiatric emergencies in line or below the statewide average of about 30 hours.

In a statement to New Times about the county's response, Dignity Health Central Coast, which owns French and Arroyo Grande hospitals, wrote that their facilities "undoubtedly meet all state and federal requirements for patient care, including patients in psychiatric crisis."

"We struggle with lack of resources, as do care providers from all local facilities," the statement read. "Finding the appropriate transportation for transfer patients is certainly an ongoing challenge; more so these days due to the increase of patients in SLO County being seen for psychiatric crises. We don't consider it productive to place blame or displace accountability for patient care, and prefer a collaborative approach."

Representatives with Tenet Health Central Coast, owner of Sierra Vista and Twin Cities hospitals, did not comment before press time. Δ

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