A decision last week by the Kansas Department for Aging and Disability Services to limit admissions to Osawatomie State Hospital has had an immediate effect on the state’s mental health system.
Marilyn Cook, executive director at COMCARE, the community mental health center in Wichita, says the state’s decision to suspend admission of voluntary patients and more closely screen involuntary admissions recently prevented the center from transferring several patients thought to be a danger to themselves or others.
“Last Friday, we screened three people who were determined to need involuntary treatment,” Cook says. “We had two more on Saturday, and two more on Sunday for a total of seven over the weekend.”
All seven, she says, were denied admission to the state hospital. Instead they were placed in “medical (hospital) beds somewhere in this community.” COMCARE, Cook says, was told the seven would-be patients were denied admission to Osawatomie because they were “already in a safe place,” a reference Cook understood to mean emergency rooms in the city.
After court appearances Wednesday, all seven patients were admitted to Osawatomie State Hospital.
While in Wichita, some of the patients — it’s unclear how many — were hospitalized at Via Christi Health System.
“We were able to meet their needs, although not without considerable effort on the part of physicians we work with,” says Roz Hutchinson, a spokesperson for Via Christi.
Carol Manning, executive director at the Wichita-based Mental Health Association of South Central Kansas, says the delayed Osawatomie admissions underscore persistent gaps in the state’s network of mental health programs.
“Seven in one weekend? Wow, that’s a lot,” she says. “What we’re seeing here, I think, is that demand for higher-acuity services is outpacing the resources that are available both locally and at the state level.”
On Wednesday, 61 of the 226 patients at Osawatomie State Hospital were from Sedgwick County, according to a KDADS report.
The numbers cited by Cook match those provided by KDADS Secretary Kari Bruffett, who said Tuesday that 11 “involuntary” patients were admitted to Osawatomie State Hospital over the weekend and seven from COMCARE were denied admission.
KDADS last week announced an immediate suspension of voluntary admissions to Osawatomie after federal surveyors threatened to block a significant portion of its Medicare payments.
The agency also said involuntary admissions would be “aggressively triaged” and that would-be patients were not to be sent to Osawatomie unless their transfer had been pre-approved by an “admissions officer” or an on-duty physician.
The new policy is designed to reduce the number of patients at Osawatomie, which in recent months has often exceeded its licensed capacity.
Bruffett said state officials know the policy creates “challenges” for community mental health centers. But she said conversations in recent days with several center directors have led her to believe that they “understand and appreciate the need for the policy.”
Cook understands the reasons for the policy but predicts it will have ripple effects throughout eastern Kansas, the hospital’s catchment area.
“It’s looking like people who have a need for involuntary admission to the state hospital may have delays getting that level of care,” she says. “That care is going to have to come from somewhere. I’m not sure where.”
Sandy Horton, executive director at the Kansas Sheriffs’ Association, says he expected to policy to lead to more people ending up in jail.
“I don’t like saying it, but when the resources that we’re talking about here aren’t available in the community, we see more people getting arrested for minor violations and being taken to jail,” Horton says. “It’s probably not the best place for them to be, but it may be the only place.”
He adds: “I’ll be surprised if this doesn’t have an adverse effect on law enforcement.”
Prompted in part by the Osawatomie census issues, federal surveyors inspected the hospital in October and cited it for several deficiencies. Among other things, the surveyors uncovered several instances of poor care. One resulted in a diabetic patient having to have a toe amputated. Another led to a patient whose blood clots weren’t properly treated being transferred to another hospital’s intensive care unit.
A survey report obtained from the federal Centers for Medicare and Medicaid Services also documented an instance where a pharmacist discontinued a patient’s heart medication without consulting the patient’s doctor.
State officials said last week that after a second inspection, federal officials had approved a plan for improving conditions at the Osawatomie hospital.
KDADS continues to work with CMS on a “plan of correction” related to census issues at the 206-bed hospital. The agency has 90 days to implement the plan.
Note: This story has been updated to correct information from KDADS Secretary Kari Bruffett about the number of people denied admission to Osawatomie State Hospital over the weekend.
