Hours can stretch into days. Days can stretch into a week or longer. And lots of times that patient (if truly acutely mentally ill - i.e. a danger to him/herself or others) is occupying a valuable/scarce bed in the ER . . . with the ED physicians playing "babysitter".
Been there. Done that. Must . . . suppress . . . the urge . . . to throw things.
The medico-legally inspired game of "medical clearance" [i.e. psychiatric patients must be "cleared" of all but the most minor medical illnesses before admission to a psych ward . . . the theory held by many institutions (not this writer) being that psychiatrists (who are MD's) are not "real" doctors] is something that can only truly be appreciated by those of us who have played it.
It is a nationwide problem (that I saw fairly often in the ED setting when I worked in an ED setting), and it is actually nothing new . . . particularly since North Carolina's efforts to privatize (from a public system) and "out-source" mental health care to communities (under the deep-blue Sleazely administration) failed not just miserably, but uber-miserably. Purely and simply there was NO oversight.
Mental health care "reform" in North Carolina had the same result that I fear Obamacare will have on the rest of medicine nationwide.
The number of inpatient psych beds available in North Carolina has gone WAY down. Likewise, reimbursement SUCKS, and the number of providers (like primary care providers, psychiatrists are unfortunately the Rodney Dangerfields of medicine . . . in other words, they generally "don't get no respect" from people like our Bobby) is also dwindling.
Now, even in normal/prosperous times this would be very bad, but given the recent economic meltdown, the sheer volume of depressed and otherwise suffering/unable-to-cope people bearing down on these already-busting-at-the-seams resources is increasing astronomically.
Likewise, President Obama didn't think tort reform was a necessary part of healthcare reform, so the risks of taking care of psych patients remains enormous. Nevermind that someone's family/neighbors/most intimate associates don't know their loved one is about to blow or morph into a serial killer . . . but psychiatrists are expected to have crystal balls and be able to predict every nuance of the human mind from one twenty-minute encounter.
Moreover, for all of the noble prattle about society treating patients with mental disorders/diseases with care and compassion, it's pretty much prattle - especially when it comes from the lips of liberals.
Wanna denigrate someone in the blogosphere? No worries. Call them "batshit crazy". Or better yet, let our resident "satirist", very much aware of his own "sociopathic tendencies" (yet somehow unable to subdue them for any length of time), "diagnose" the targets of his wrath as "criminally insane" or "crazy" or "bipolar". And don't even get me started on our local "fact-checker".
I digress. The hero in Chip's story (that would be Bob - it's always Bob - Bob NEVER does any wrong) wrote a letter to Victoria Whitt, the CEO of Sandhills Center (where Randolph apparently ships its psych patients), flexing a certain small body part up and down (that's lawyer talk from the good-ole-days) about the Center not always accommodating a psych admission in a "timely fashion".
From the article (it's in blue because it's just so darned progressive):
The letter cites both the North Carolina Administrative Code and a state statute as supporting the concerns.
“Psychiatric patients seen in our Emergency Department have a need for direct face-to-face consultations from a psychiatrist,” Morrison wrote. “We and our emergency physicians have made this known repeatedly in the past to Sandhills. To date, Sandhills has not addressed this need.
“We believe this is a quality issue in ensuring that patients receive the type and level of timely treatment they need. There are patients routinely waiting in our ED for several days who need a face-to-face consultation from a psychiatrist. It is our belief that a significant number of patients being held for psychiatric admission might be discharged and managed as outpatients after a psychiatric evaluation.”
Sandhills is a local management entity (LME), charged by the state with ensuring that people in the eight counties it serves, including Randolph, have access to quality mental health, developmental disabilities and substance abuse services.
To her credit, Sandhills' CEO recognizes self-serving (we'll get to that) grandstanding tripe when she sees it, passed the letter on to her legal counsel (not-to-mention state officials), and there will be a formal response soon. In the meantime she told the CT's Chipper that she "totally disputes" the Bobber's accusations (referencing the difficulties I've already described above).
I think I'm gonna side with Victoria Whitt here (you knew that was coming). I know all too well that the state of North Carolina oftentimes requires duties of institutions and individuals that it does not support/protect . . . like say, requiring physicians to blow the whistle on bad care/bad doctors . . . but then doing ZERO, ZIP, NADDA to protect them (from people like . . . I dunno . . . Bob Morrison) when they do.
Those of us who have done "business" with the Bobber (and his oily side-kick Steven Eblin) also recognized, very quickly, the REAL motivation for the Courier (always in the pocket of its biggest advertiser) presenting this story as "news":
The hospital wants the business. Not the business of actually taking care of the very severely mentally-ill (for everyone knows there's no money in that). But the business of shuffling the chairs for the short-timers (i.e. the people most likely to be productive when they are stabilized/recover and pay their bills . . . it's actually potentially lucrative - because of the way services are "covered" by insurance - insurance that generally does not value or reimburse psychiatric services in the same fashion that it does the medical or surgical . . . a good chunk of psych, you see, is often a "cash" business).
Enter stage left, a Randolph County company called "Therapeutic Alternatives", which functions as the current local broker of inpatient psychiatric care (i.e. who really needs that inpatient bed): A member of a mobile crisis team from this company talks with the patient and family (as appropriate), said Kenny Burrow, company CEO. Sometimes they consult with a psychiatrist by telephone.
(Only sometimes?)
Therapeutic Alternatives already offers two crisis respite beds for patients with minimal mental health needs at Brookstone Haven, an assisted living facility in Randleman, but soon those beds will be replaced.
Recently, Therapeutic Alternatives was given state approval to convert 16 beds in one wing at Brookstone Haven to a facility-based crisis unit. The space will be totally separated from the assisted living quarters, Burrow said.
The new unit will be staffed with nurses, a doctor, mental health professionals, a licensed clinical social worker, technicians who will provide direct care, and a psychiatrist.
It will not be an inpatient psychiatric hospital, or suitable for patients with severe mental health issues, but it should help with the overcrowding at the emergency department, he said. It will be designed for people who need short-term stabilization, typically three to five days, Burrow said.
Now you can bet your farm (if the bank hasn't taken it) that Bob wants a piece of that action. Indeed, as I am reading the fine print of this story, Bob wants to COMPETE with Therapeutic Alternatives (barely off the ground in its own endeavors) by bullying Sandhills into opening a transitional psych unit at the Former Walker Treatment Center on Pritchard Street. And Asheboro's most over-paid "non-profit" executive (or as I like to call him, UNCONVICTED FELON) is willing to publicly denigrate Sandhills and the good people who've done their best to cope with a bad situation (largely out of their control) to do it.
Take it from the home-grown Pediatrician who does not play on "teams" that would let babies die: Morrison is a MASTER of the not-so-subtle slam. He characterized Sandhills personnel as “people who want to do a good job.” Translation: "They're not going a good job".
The man's a real piece of work.
Moreover, just like he's done with so many Asheboro physicians over the years (manipulating both hospital-employed and private MD's/their practices alike - as pawns on his giant chessboard of greed), our Bobber wants to run the show, get all the credit (for the work mostly done by under-paid/under-appreciated others), and (most importantly of all), at least "break even" (translation, Sandhills can pay the bills-that-really-kill).
Make no mistake people. Bob's "suggestion" is all and ONLY about his "non-profit" cornering a local "market" (before someone else does) and making money on the backs of the mentally-ill . . . and the professionals who take care of them.
Meanwhile, Therapeutic Alternatives can rot, and some poor unsuspecting psychiatrist-doctor schmuck out there . . . most likely an idealistic newbie buried under a big medical school debt . . . is going to get hammered by the 24/7 call. Because Bob's too cheap to hire more than one psychiatrist. It's like the time he recruited and hired three Pediatricians all at once and expected the practice to be making a profit in less than a year.
I bought that bridge-to-nowhere once before . . . and totally gave at the office.
Now sometimes, I can read Chip Womick's fawning press-releases-disguised-as-news and let them pass. But the following quote from Morrison (citing North Carolina Codes & Statutes - and setting a September 1 deadline to bully Sandhills into some kind of "partnership" agreement that no doubt favors Randolph) made the blood boil and birthed this post (not to mention my comment - surprisingly enough, still posted/not deleted at the Courier Tribune):
“We don’t want it to be adversarial,” he said. “Nobody wants to get into court actions or those kinds of things. But we’re trying to make enough noise about this so that some of the resources that are available are made available when the most acute patients are in need ...
“We’re not going to quit taking care of these folks (it's not nobility folks, it's because of a little thing called EMTALA) but we put some deadlines in it to try to get responses that don’t drag out for an extended period of time,” Morrison said. “The risks for these patients are real. We need to do what we can to advocate for them.”
Yeah right. Let's be REAL CLEAR here people. I've endured TWELVE YEARS of "adversarial" courtesy of Bob Morrison and his "team" of opportunistic, soul-sucking non-profiteers. Make no mistake, if there is a medical niche to be over-run and manipulated for profit, they will do it. And I can assure you that Robert Morrison is the LAST person on the planet Earth who should be lecturing ANYONE anywhere on patient advocacy . . .
. . . or on following the letter of the law.
What brass balls this guy has!!!
And if I were Victoria Whitt, I would be directing all of Bob's taxpayer-subsidized lawyers (and anyone at the state level doling out "Certificates of Need" for new psychiatric facilities) to Dr. J's Housecalls and asking them, "How about that general statute, boys? You want some NOISE, you sanctimonious poser? Don't talk to me/my institution about our obligations until you-all acknowledge your own short-comings/mistakes/downright ILLEGAL shenanigans and make amends."
In other words, don't pass GO, Bobber. GO DIRECTLY TO JAIL!
Evening Addendum: In the interest of full disclosure, I suppose I should admit another reason that this article, as I've digested it over the last few days, has made me seethe. Friends who still work in Asheboro have told me that, in the face of a low census and budget-cutting, Randolph has a hiring-freeze in effect and is cutting hours for its nurses - nurses who need and want to work.
But Bob remains. His cronies (the same cronies who've run the town and FNB into the ground) shield and protect him. Even as he pulls stunts like this, he continues to collect the phat pay-check from the "non-profit". He can lie to (and about) physicians - and cheat them in Court and totally get away with it. He can bully other institutions (Sandhills is not the first), and threaten litigation over state laws that are clearly very selectively enforced (or he would have long ago gotten the boot).
And I'm just sick and tired of it. When is someone going to reign this guy in?
