Tri-City Medical Center closes crisis-Stabilization unit

August 15, 2018
The San Diego Union-Tribune
By Paul Sisson
August 8, 2018






Tri-City Medical Center in Oceanside has closed its 12-person crisis-stabilization unit, a move that precedes plans to shut down the hospital’s 18-bed behavioral health unit later this month.

In a short statement made Wednesday afternoon, Tri-City management confirmed that it closed the unit on Friday, Aug. 3.

“Patients are being evaluated for medical and mental health emergencies as usual in the emergency department,” Tri-City’s statement said, adding that the unit averaged three to four patients per day prior to its suspension.

Opened in 2017 under contract with San Diego County Behavioral Health Services, the unit provided comfortable recliners in a quiet setting to provide up to 24 hours of recuperation time for patients experiencing psychiatric symptoms. It was not clear Wednesday how Tri-City was providing similar respite care for patients with its crisis-stabilization unit closed.

Alfredo Aguirre, director of county behavioral health services, said in a recent email that while his department did have an “agreement” with Tri-City to shutter its crisis-stabilization unit on Friday, Aug. 3, the public hospital district remains a designated provider of emergency psychiatric services.

“They have obligations to provide mental health staffing to their emergency department to respond to mental health-related emergencies,” Aguirre said.

The executive has said in the past that Tri-City will need his department’s approval before it can close its locked psychiatric ward. But Aguirre was not available Wednesday to discuss whether his department has identified replacement capacity to receive patients brought in on “5150” holds after being declared a danger to themselves or others by law enforcement.

Citing financial, regulatory and operational difficulties, Tri-City’s elected board voted on June 26 to close both units within 60 days. In the meantime, many in the community have begged the board to reverse its decision out of fear that having no location for emergency psychiatric hospitalization on the North County coast will put too great a burden on other already-full facilities.

The county Board of Supervisors and city government officials have also worried that law enforcement officers would need to transport patients much further away and families would spend much more time on the road to visit hospitalized loved ones.

August appears to be the month where everything will come to a head. In addition to working with the county to find replacement capacity, Tri-City’s board of directors also faces push-back from the Service Employees International Union, which recently sent a letter alleging that the board’s June decision violated open meetings law and is thus null and void.

Emily Rich, the attorney who sent the letter, said she has not yet received a response, but Tri-City has until late August to reply.

In an interview last week, Dr. Joe Parks, medical director for the National Council for Behavioral Health, said hospitals that close their inpatient psychiatric units often end up treating psychiatric patients in their emergency rooms because federal law requires treatment of anyone who walks through their doors. Even if law enforcement is no longer bringing in 5150 holds, that doesn’t obviate the need to treat walk-ins. Doing so without a locked psychiatric unit, he said, simply makes it more difficult to do the job.

“They’ll still be doing psych services, they’ll just be doing them poorly,” Parks said.

In San Diego County, 18 different acute care hospitals operate behavioral health units.





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