Part I of a two-part series on mental health needs in Chaffee County— Heart of the Rockies Regional Medical Center and Chaffee County leaders along with EMTs and other medical providers are faced with a sticky conundrum – how to more efficiently transfer behavioral health patients to in-patient treatment centers from the local hospital.
HRRMC CEO Bob Morasko has made it an issue for months, complaining that despite a contract with Chaffee Country Emergency Medical Services (EMS), patients who have been medically cleared at the hospital and scheduled for transfer to a mental health facility can sometimes wait 12 hours or longer for the actual transfer. They sit for hours, often unsupervised, in a room at the hospital.
Morasko said it presents a problem for hospital staff as well as a security risk, and that the wait times are unacceptable. He wants the county EMS to fulfill what he sees as a portion of the contract. Chaffee County EMS Director, Josh Hadley, disagrees.
But the problem has many facets, and the history of the difficulty of such transports underscores the issue of not having a local in-patient mental health treatment resource. The issue is not as simple as whose responsibility it is to mind the patients during that process.
In the past, ambulance firm AMR, based in the Front Range, has been responsible for the majority of such transfers from the hospital. That means long distances for crews to travel for pickup here, and then a transfer back to the Front Range at a designated facility.
When a person is brought into the hospital for assessment, often by law enforcement, it requires two things: a physical medical checkup and a mental health assessment, This assessment is often by a professional from local health provider SolVista, which handles mental health patients. That assessment involves a decision on whether and where to send the patient for treatment; the Front Range, Pueblo or other locales.
Once that decision is made, and contacts made, it can take hours to find an open bed at a facility, and the physical transfer is next. There-in lies the problem.
Previously, a qualified EMT unit like AMR was called for the transfer, perhaps with a vehicle equipped for such patients, with security for both patient and crew in mind. Infrequently, the county EMS is called to provide the transport in a typical medical ambulance.
Morasko says that because they have a contract with EMS for such transfers, he doesn’t understand why patients sit for 12 hours or more for transfer, requiring hospital staff since there are no dedicated hospital security personnel to keep an eye on the patient for their time in the holding room.
Patients can sometimes become restive and upset with the long wait, he points out. This can become a security risk for both the patient and hospital staff, Salida police can be called to the hospital relatively quickly if needed, but don’t have the manpower to leave an officer on duty at the hospital.
Morasko points to a county sales tax increase passed in 2015 that he feels provides enough resources for a solution to the transfer timeliness problem. “If I was getting this sales tax, I’d probably have somebody here immediately,” he said, “because there’s enough money here to support it.”
But Hadley said the original contract language drawn between the county and the hospital in 2017, didn’t have any specific language for the transfer of mental health patients.
From the 2017 contract, he said EMS came to an agreement with HRRMC “To begin to manage their inter-facility transports, meaning a patient that needed to be transported to a front range hospital. We (EMS) would now manage that service delivery.”
For five years before that, it was handled by AMR. The AMR contract also had to deal with patients held ‘on hold’ for extended periods of time.
But Hadley points out the 2015 tax increase was designed to provide funds to stabilize funding for three departments: EMS, improvement of the communications center, and the Office of Emergency Management, not, he said, specifically for the transfer of mental health patients.
Prior to the sales tax, Hadley said they would have about a 50 percent deficit every year, and the county was dependent on Payment in Lieu of Taxes (PILT) funds to make up the shortfall. The community supported the tax increase. But because of the county’s high medicaid medicare population, only about 50 percent for what was billed for services was being collected. Some money is also set aside for future capital expenditures for those three departments, said Hadley.
At the time, HRRMC had a contract with AMR, which also had a separate contract with local health provider Solvista. Solvista has a 24-hour, seven-day-a-week crisis service including behavioral health evaluations and intervention, to manage the mental health patient side of the equation.
Hadley said that at that time there really didn’t appear to be that significant of a need for behavioral health transport v. But by 2019, the situation is changing. “We didn’t even explore it, didn’t pursue it,” he said. “It wasn’t part of any of our contract language, that we would be managing behavioral health transports; there was really no language in the contract that identified us as managing those.”
The issue didn’t come to the forefront until 2018, said Hadley, along with concerns on hospital security for those behavioral health patients while they await transfer. “From my perspective, that’s what’s leading a lot of this right now,” he said.
The hospital also pays an additional $25,000 for the transport services and Morasko says they are doing the non-emergent transport, with the exception of psychiatric patients. “We’re not a psych hospital … we don’t have the staff, because once Solvista places them, then their person leaves, and it’s up to our nurses, who are primarily treating medical conditions, to watch this patient … and our doctors,” said Morasko.
“Bottom line is we’re trying to get these patients placed, and get them there … as soon as possible.”
The hospital board has discussed the issue at past board meetings, with some discussion about how to get county commissioners involved in seeking a solution to the problem. It appears that there is some momentum building behind a concerted effort by all stakeholders to seek a long-term solution.
More on the issue in Part Two: Oh for a bed – HRRMC, County Face Mental Health Patient Transfer Issues
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