Emergency Department Boarding Bill Caught In Logjam

OHSU emergency room at Doernbecher Hospital kids children.jpg

SALEM – With just three weeks until the Oregon Legislature adjourns, advocates for a pilot project to address prolonged mental health patient stays in hospital emergency rooms are pushing for their bill to break through the logjam in the session's final month.

Proponents of Senate Bill 140 say that passing the emergency department boarding pilot project would be among the most concrete steps lawmakers can take this session to address Oregon's mental health crisis and its impact on the health care system.

But the fate of SB 140 and dozens of other health care bills are uncertain.

The Lund Report previously analyzed hospital data and found that Oregon State Hospital beds are increasingly being filled by homeless and mentally ill patients charged with low-level crimes, but unable to assist in their own defense. As a result, people with mental illness but not charged with a crime are increasingly turning up in hospital emergency departments that lack the services to care for them when they experience a crisis.

That includes suicidal and potential aggressive patients, doctors told The Lund Report, as the prevalence and severity of mental illness has worsened.

SB 140 would create a task force within the Oregon Health Authority to study the problem. It would also provide $3 million of taxpayer money to hospitals in the form of grants to study the issue themselves.

“Emergency departments are not set up to deliver mental health services. It’s a safe environment, but it’s not a therapeutic one,” Danielle Meyer, a policy director for the Oregon Association of Hospitals and Health Systems, which crafted the bill, said in a statement this week.

SB 140 is among the hundreds of bills in limbo in the session's final weeks. Bills that spend state funds must pass out of the Ways and Means committee before being voted on by the full House and Senate.

The pilot project bill passed unanimously out of the Senate Committee on Health Care in early April, and Senate President Peter Courtney referred it to Ways and Means a week later with the recommendation it be passed.

But the bill has sat in limbo awaiting a hearing ever since, as the committee's backlog has grown.

"We're still optimistic that this bill will get out of Ways and Means and hopefully be passed and signed" by the governor, David Northfield, spokesman for the Oregon Association of Hospitals and Health Systems, told The Lund Report this week. "It's an important step toward coming up with permanent community solutions to address a problem that affects both rural and urban hospitals and patients."

More than 17,800 mental health patients in Oregon stayed in an emergency department for two to five days in 2017, the hospitals and health systems association reported. Roughly 640 patients stayed between six and nine days and 302 patients stayed for 10 or more days.

Hospital systems reported mental health patient boarding in emergency departments equaling thousands of patient days per year, a growing problem advocates attribute to the deinstitutionalization of mental illness locally and across the country over decades.

The number of Oregon State Hospital beds for mentally ill patients has been slashed over the past half-century – according to some estimates, Oregon currently has just 10 percent of the state hospital beds it had in the 1950s.

Meanwhile, the demand for beds has grown, and the burden has shifted markedly to hospitals.

Legacy Emanuel’s emergency department boarded more than 250 psychiatric patients over the past year, with a median length of stay at about 26 hours, data provided by the hospital showed.

The emergency department at Legacy Good Samaritan Medical Center in Northwest Portland had about four mental health patients boarding each day, for an average of 40 hours.

Kaiser’s emergency departments in Clackamas and Hillsboro boarded at least 1,200 and 500 mental health patients last year, respectively, with an average stay of 24 hours.

The hospital association and a coalition of physicians' groups have lobbied the Legislature for SB 140's passage, along with the Oregon Nurses Association and the American Federation of State, County and Municipal Employees Council 75, AFSCME.

Many of the frontline workers that have seen the boarding up close say far greater reforms are needed than a task force and several million dollars to study the issue at a time when there is a growing consensus that major reforms to the behavioral health care and criminal justice system are needed.

"We do know that emergency department boarding is a huge issue, we know it's tremendously costly to the hospital systems and to all the people who are languishing in emergency departments," Multnomah County Commissioner Sharon Meieran, an emergency room doctor at Adventist Medical Center and Kaiser Permanente, told The Lund Report. "But we would do a much better job aligning the resources we have with the needs of those who have mental illness from a funding and resources standpoint if we address the elephant in the room."

The elephant is the other end of the problem – criminal defendants who are too mentally ill to understand their rights or court proceedings being housed in the Oregon State Hospital until they're deemed fit to stand trial. Hundreds of defendants each year are placed in the state hospital at a cost to taxpayers or more than $1,300 per patient per day, putting a massive strain on the state's general fund, Meieran said.

So $3 million for hospitals to study patient boarding in emergency departments, while useful, won't resolve the state's mental health and patient boarding crises in the way that larger systemic changes would.

"What we really need is a continuum of services," Meieran said. "Right now we have the crisis services at the most expensive institutions where we provide crisis care, and we have some of the lesser acuity services at the very other end of the spectrum. But we have virtually nothing in between, and that's where we're suffering."

Have a tip about the health-care industry or legislation? You can reach Elon Glucklich at [email protected].

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