Debate over ‘hold room’ for mentally ill continues in Curry County

Curry County Pilot, December 11, 2015

Local law enforcement officials plan to keep their existing protocol when responding to calls concerning people with possible mental illnesses and take them to the emergency room in Gold Beach which will soon no longer have a “hold room” in which to stabilize them.

With the closure of the room, patients likely will be evaluated and released back into the community, officials noted at a meeting Friday. And that might not sit well with the community.

Representatives from the Sheriff’s Office, Gold Beach, Port Orford and Brookings police departments, and mental health officials from Curry Community Health and Aging and People with Disabilities hoped to talk with hospital officials, but no one from the hospital or its district board showed up

Instead, the group discussed problems they face and options — realistically and legally — they might pursue.

Curry Health Network CEO Ginny Razo could not be reached for comment Friday afternoon.

Hold room

The hold room at the hospital is a small room in which people suffering from dementia, mental illness or who are on drugs or alcohol are brought, stabilized and observed — sometimes for weeks — before staff can either release them or transfer them to another facility for more definitive care, said Ken Dukek, CEO of Curry Community Health.

“The most dangerous patient, nationwide, is a dementia patient,” he said. “Not someone on drugs, not someone who’s psychotic or has psychiatric problems. At the end of the day, we have to figure out what to do with these folks.”

Razo announced earlier this month that not only would the hold room close soon, but that the hospital doesn’t have a current license to even offer the service. She said earlier this week that Curry General Hospital is not set up to treat psychiatric patients, either.

Dukek said, however, that he found a license that indicates the hospital’s hold room is valid through October 7, 2017.

He noted that this is the third time in 18 months hospital officials have tried to close the hold room. Each of the other two times, Dukek was able to negotiate to keep it open.

Other options

Razo has also suggested the hospital might resort to transferring patients from its emergency room to those of other hospitals. But Dukek said no one will take them.

“Medford is full. Coos Bay is full. They won’t take a transfer because they are busting at the seams. There are not enough places for people to go for a hold room.”

According to Curry Community Health’s Behavioral Health Director Erin Porter, state statute gives hospitals 12 hours in which to find a facility to transfer mentally unstable patients.

“But if those 12 hours run out, they’re turned back out onto the street,” she said.

“It puts them and us right back in the same situation in a minute,” said Sheriff’s Lt. Mick Espinoza.

Hospitals without hold rooms can hold a mentally ill patient for 12 hours, Porter said, and an intoxicated person for 48 hours. She doesn’t know which protocol the new hospital in Gold Beach will follow.

Additionally, the receiving hospital has to offer a higher level of care than the hospital from which the patient is departing, and must agree to take the patient. With ERs overflowing, mentally unstable patients often remain in hold rooms, under surveillance, for days, if not weeks, awaiting proper mental health care.

“Sometimes we get lucky,” Dukek said of finding a hospital with space. “It’ll be two or three days. If we’re not so lucky, it might be five or 10 days. Other times — oh my goodness — it takes 17 to 20 days. What do you do when there’s nowhere to go?”

Then, there’s the cost of transporting them, which Dukek said can run as high as $2,500.

Additionally, said Colette Lafosse with the Aging and People with Disabilities agency, hospitals will not take patients with developmental disabilities, violent people, the elderly or people who present a high level of danger to themselves or others. There are only two hospitals in the state that accept elderly patients with mental problems, and two state mental hospitals, one in Salem and another in Junction City, Porter said.

Law and medicine

The standards under which law enforcement operate requires officers to transport mentally unstable patients to the closest facility with an emergency room — usually Curry General Hospital.

But mental health standards indicate patients should be taken to an “approved hospital” that specifically addresses mental issues. For Curry County, that’s either Coos Bay or Grants Pass.

“And then it’s whether or not we can get them in,” Porter said.

“Stabilize and release is not the best plan,” Dukek said. “And this isn’t a one-agency problem.”

Sometimes, family members cannot take the patient back home, noted Sheriff John Ward.

“They may not want to,” he said. “Sometimes they’re just taxed out. The person obviously needs help, and we end up putting them in jail.”

Gold Beach Police Sgt. Tracy Wood said he finds it ironic that his office often gets calls from the hospital to remove unruly mentally ill patients — and they end up in jail, as well. The city has considered billing the hospital for that, he said.

Because the Curry County jail is also experiencing fiscal challenges and can only detain the most egregious of criminals, many with mental disorders and who have committed minor crimes are released onto the streets of Gold Beach, bringing with that its own set of problems.

“They have to be in a safe place,” Espinoza said. “We don’t have medical. We have a young staff. We can’t monitor them. It’s a real risk.”

“We get people who are gacked out of their minds on drugs, or the drugs have burned them up until they’re mentally ill,” Ward said. “We have an inmate who takes off his clothes, he’s screaming, rattling the bars — he has no idea where he is. It takes a lot of staff time.”

Dukek does not know, but hopes, the new hospital will have a psychiatric room to stabilize such patients.

“It’s at the sole discretion of Curry Health Network at this point,” he said.

And while the entities affected could likely obtain grants to build such a facility of their own, granting agencies rarely offer funding for operations.

“That’s why you see hospitals with psychiatric units; they already have the medical staff,” Dukek said. “There’s a lot of property between here and Coos Bay that both Coos and Curry counties could use. There’s a lot of possibilities, support from the state. But if it’s the wrong bill for the coast, we’re just becoming part of the problem.”

The holidays

Espinoza noted that they need help now.

“There’s some irony in the timing here,” he said. “We’re at the height of the (holiday) season when people need these services.”

Ward said his office is already seeing an uptick in the number of contacts his office makes with people who are distraught.

“This is not good,” said Port Orford Police Chief Hank Hobart. “My mind is just ticking with the number of names we deal with. It’s just a matter of time.”

Dukek encouraged those in attendance to reach out to their city and county officials to let them know about the challenges they face.

“And we’ll cross our fingers and hope for the best over the next few weeks,” he said.