by Steve Ahnen, New Hampshire Bulletin
Three weeks ago, the federal district court ruled that the state is failing its responsibility to care for our most vulnerable citizens and must finally to take action to cease its illegal practice of boarding patients experiencing a psychiatric crisis in hospital emergency departments. In response, the governor inserted into his budget bill provisions that enshrine this broken system in place. We are disappointed the administration has chosen to point fingers and target hospitals rather than do what the court has ordered and solve the problem.
For more than a decade, New Hampshire’s mental health system has been unable to meet the growing demand from patients experiencing a mental health crisis. When an individual is suffering from an acute psychiatric crisis and is deemed to be a danger to themselves or others, New Hampshire law is very clear: If an involuntary emergency admission (IEA) is certified by a qualified clinician, that patient becomes part of the state’s mental health system and is to be transferred immediately to a specialized location known as a designated receiving facility (DRF) where they can receive the care and due process that they need and deserve. Unfortunately, due to an inadequate number of available DRF beds in the state for both adults and children, these patients are required to wait days, sometimes weeks, in hospital emergency departments until they are transferred to the appropriate setting for care.
Multiple rulings in federal and state court over the past several years have confirmed that the state is failing its obligations to these patients by not transferring them immediately to a specialized setting. In response to the most recent federal court ruling, the governor inserted language in his budget trailer bill that seeks to abdicate the state’s responsibility in caring for these patients and lock in place a broken system. But most troubling is the language that changes the requirement that patients in an acute psychiatric crisis would no longer have to be transported immediately to receive the care and due process they deserve, essentially telling them that they can just wait.
Despite recent comments by the governor suggesting that hospitals have not been willing to resolve this issue, hospitals have been at the forefront and will continue to be. For the past decade, hospitals have worked to serve patients suffering an acute psychiatric crisis until they can be transferred to the appropriate setting to receive care. Hospitals have renovated facilities and partnered with mental health care providers to provide safe, dedicated space to serve these patients while they wait. Hospitals have added outpatient behavioral health services, voluntary psychiatric beds, and additional DRF beds, and continue to expand on these efforts.
In addition, hospitals have sought to resolve this matter with the state so that patients get the care they need in accordance with the law. We understand it will take time to create that additional capacity, but there must be an end to the practice of emergency department (ED) boarding. The state has never proposed a solution that would end this practice. This is what forced hospitals to go back to court to resolve this matter in support of these patients.
Over the past year, the state has closed two 24-bed units at the state’s psychiatric inpatient facility due to staffing vacancies. Those closures have only served to exacerbate the ED wait list, not relieve it, while hospitals have stepped up to meet the overwhelming demand for care by spending millions of additional dollars monthly to bring in temporary staff. The state’s proposal to require every acute care hospital to add specialized inpatient psychiatric services is not a practical solution. No other state requires hospitals to offer these services as a condition of their license. The state’s proposal assumes that these practitioners and support resources are available or could be made available in every community hospital. We do not take this approach in any other specialty service by requiring every community hospital to offer open heart surgery or neonatal intensive care programs, and we should not be doing so here.
The state’s failure to respond to the court rulings and work with hospitals to end the ED boarding crisis, while instead implementing rules that enshrine a broken system, suggests there is no end in sight to the ED boarding crisis. New Hampshire hospitals have been eager to negotiate a binding solution with the state, with no response. Patients deserve more than finger pointing and inaction. It’s time to invest the resources necessary to better serve patients and families in need.
This story was written by Steve Ahnen, president of the New Hampshire Hospital Association and contributor to the New Hampshire Bulletin, where this story first appeared.
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