Your source for news in Hot Springs County
Thirty-one people attended a special Title 25 meeting on Monday night to discuss the hospital’s stand on Title 25 patients and what can be done to eleviate the problem.
The issue arose a couple of weeks ago when the hospital board informed the county commissioners they would no longer hold Title 25 patients at the hospital once they were medically stable due to safety concerns for staff and other patients. Once they are stable, the hospital wanted the patients moved to another facility.
Among those in attendance were the county commissioners, county clerk, hospital board and physicians, members of the town council, sheriff’s department, police department and mental health professionals.
In addition, Tom Forslund, Director of the Wyoming Department of Family Services and Stefan Johansson, Administrator of Health Policy and Evaluation came down from Cheyenne to be in attendance.
The hospital board said the concerns were brought to them by the medical staff. A lack of regular or consistent law enforcement personnel to watch the Title 25 patients was what prompted them to take action.
Dr. Travis Bomengen said mental health is not part of their standard care. They are required to get them appropriately detoxed or medically stabilized, but they just don’t have the facility to keep them safe once stabilized and without law enforcement on scene, they just cannot do it.
“If they are psychotic, its a danger for the staff and other patients,” Bomengen said. “We want them where there is knowledgeable personnel and appropriate facilities.”
County commission chair John Lumley stated there is $25,000 in a fund to pay for this sort of thing and looked to the police department and sheriff’s office to take care of it.
Bomengen indicated they had been told, specifically from the police department, that they were not allowed to stay after bringing a Title 25 patient into the emergency room.
Sheriff Lou Falgoust said his department stays with patients they bring to the hospital that are brought in from within the county, but not with patients brought in by the police department.
By state statute, a patient brought in under Title 25 may be held for 72 hours without being charged.
County attorney, Jerry Williams said he tries to get the patient before a judge for a title 109 hearing within the first 24 hours so they can get them transferred out to an appropriate facility such as the Lighthouse in Washakie County or the Wyoming Behavioral Institute (WBI) in Casper as soon as possible.
“The government cannot take control of them until after the title 109 hearing,” Williams said. “Everyone has certain rights. Once that’s done, we can treat them, send them someplace where they can get appropriate care.”
Williams said they need a safe place for the patient the night before the 109 hearing. Sometimes, WBI and the Lighthouse are full. There have been times when they have had to wait five days before they could be transferred to an appropriate facility.
“We’re not asking you to fix their mental health problem,” he said, “we just need to find the best place to hold them until the legal procedures are in place. This isn’t automatic.
“We understand your worry. We don’t expect a 100 pound nurse to wrestle with them.”
Mental health in the county doesn’t have anywhere to hold them either.
Of the 30-35 calls a year mental health gets to come to the hospital for an evaluation, only about five of the patients will actually be Title 25.
“Very rarely do we get someone who is that psychotic or dangerous,” said Alan Braaten.
Another part of the equation that is difficult to manage is transportation to a facility after the 109 hearing.
Most of the Title 25 patients are indigent, have no insurance and cannot pay for the transportation. Williams said its sometimes a trick to even get them to the Lighthouse in Worland, a problem that has gotten worse in the last six months since no one wants to step up and take care of it.
Judge Robert Skar said this is really a county-wide problem because of our proximity to resources.
“It all depends on what’s going on and what needs to be watched for,” he said. “We went through this same arguement 25 years ago. I’m not putting them in jail unless there is a criminal need.”
Forslund said this is not a unique problem.
“We hear it from around the state,” he said. “We have a state hospital that is filled up with a number of people that shouldn’t be there, but no one else will take them. The common feature is they are violent and can potentially hurt themselves or others, so no private facility will take them. So, we get them and it backs up the whole system.”
Forslund added the legislature is going to be looking at rebuilding the state hospital to try to provide some assistance for the counties, but until then, we have to live with what we have.
“There has been a significant uptick in T25 cases, a 45-50% jump statewide,” he said. “As a result, we have to pay the other hospitals because we don’t have the room for them. Costs have been between $12-$16 million.
“Sometimes we’ve had the money to cover it all, but there have been times we’ve had to suck it up and make cuts in other areas to cover it. We’re working county to county to figure this all out.
“At the end of the day, this is a local problem and I encourage you to look at it from a community perspective – what is going to work best for you?”
Police chief Steve Shay said a lot of this problem was initiated by his department.
“In the 80’s a counsellor would come in and give us the decision and then we’d decide whether or not to keep them in jail,” Shay said. “A suicide started the whole thing with the hospital not wanting to keep them there unless there is someone to sit on them.
“I have finite resources (in my department). Sometimes we have just one person on at night. Do we sit on a Title 25 or watch our citizens?
“I feel sometimes like the decisions are taken out of our hands on whether we transport them or not. We have a lot of demands placed on us nd there have been times when we just don’t have anyone to go over there and sit with them. It keeps us away from what we should be doing.”
Williams said transporting a Title 25 patient to WBI for example is a problem since they cannot be treated until the 109 hearing has been held. WBI cannot give any drugs or anything else without the hearing or a judge’s order.
If someone is brought in on the weekend, unfortunately they may sit for three or four days without treatment until the hearing can be arranged on Monday morning.
Lumley questioned Margie Molitor, hospital CEO, if we are able to provide the security, is the hospital willing to allow the Title 25 patient to stay until the hearing?
“Many places transfer them straight out of the emergency room,” Molitor said. “I don’t know why we’re set on keeping them here until the hearing. Other places don’t.
“But, if you can provide security, we’re OK with it. We have just felt alone and unsafe.”
Lumley then questioned the problem with having personnel to cover the patient.
“There was a money problem,” Shay said. “The fund was for any agency who had to sit on them for Title 25 and we weren’t getting reimbursed from the fund. Maybe we could use that fund to bring in people for this specifically.
“I’m thinking off duty detention officers, retired officers, those who would already be qualified to do it.”
As a whole, the group agreed to look into some sort of “pool” of people who could be called in for Title 25 patients, with the hospital agreeing to let the patients stay as long as there is an officer there to sit on them.
Tuesday’s
developments
With this being somewhat of an emergency issue, the county commissioners took up the discussion with the sheriff’s office at their meeting on Tuesday.
“The sheriff’s office is going to have to step up and take care of everybody,” Lumley said. “We don’t want to take a chance on the loss of a life or someone harming themselves. If we’re going to help the citizens of Hot Springs County we’re going to have to do something for the people even within the town, not just the county.”
After doing some research after last night’s meeting, Williams said he cannot find any hospital in the Big Horn Basin that transfer’s Title 25 patients out immediately.
“It is illegal to transport them,” he said. “A doctor alone cannot make the decision. All the paperwork has to be in place first. Its checks and balances.”
Falgoust said, even though they have fewer deputies than the police department, they would continue to absorb the extra duty. He voiced concerns about using a “pool” situation, worried about things like liability and training.
“We will do what we have to do for the citizens,” he said.
Reader Comments(0)