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Plan would impact patients; Mental health shift opposed here, by Taunton area officials.

Byline: Lee Hammel

An architect of replacing the outdated state hospitals in Worcester and Westboro with the state-of-the-art Worcester Recovery Center and Hospital said the new facility was never intended to care for patients outside of Central Massachusetts.

Former Mental Health Commissioner Elizabeth Childs said the governor's plan to close Taunton State Hospital will result in inferior treatment for patients from Southeastern Massachusetts who will be hospitalized in Worcester, 50 to 100 miles from their homes.

While Taunton area residents use the hospital here, Worcester legislators, nurses and the mayor worry that there will be less access for residents from areas served by the Worcester and Westboro state hospitals to the 320-bed state hospital that opened in October 2012.

Dr. Childs, a psychiatrist who headed the state Department of Mental Health from 2003 to 2007, said, "from our experience we know that patients are best served close to their home. We want families to be active participants in a hospital stay'' and want to keep patients' ties to their community during and after a hospital stay.

Moving patients from the community where they've gotten outpatient services can result in "an isolated type of treatment'' removed from "a continuum of care,'' she said. "Continuity is one of the single most important prognostic indicators for success in treatment.''

Dr. Childs was co-chairman of the facilities study commission that planned the Worcester Recovery Center and Hospital and instituted a 2004 study that recommended reducing the statewide inpatient population from 900 to 740. The facilities commission planned "to continue to have regional presence in northern, western, central, southern (Massachusetts), and Boston,'' she said.

Worcester legislators and Mayor Joseph M. Petty are joining with Southeastern Massachusetts lawmakers and human service advocates to oppose the governor's plan to close Taunton State Hospital and shift many of its patients to what turns out to be 52 beds never used in the 260-bed adult continuing care portion of the Recovery Center. There also are 60 beds for adolescents in the $302 million, 428,000-square-foot hospital.

It's a perplexing controversy, as DMH officials say the proposal will not change the number of continuing care beds for people with mental illness. DMH says that there have been 626 such beds in the state since Westboro State closed in mid-2010, and says that's all the continuing care beds that are needed in the state.

But nurses, doctors and legislators ask why, then, are patients with mental illness "boarded'' in hospital emergency rooms -- 3,500 per month -- and stuck in acute care behavioral health beds for an average of 30 days before they can get into an available continuing care bed.

In Massachusetts, acute care is given to patients -- ideally for three to seven days -- in private psychiatric hospitals or in behavioral health wards of general hospitals such as UMass Memorial (53 beds) or St. Vincent (13 beds). Longer treatment after that is given in six hospitals operated by or contracted with DMH.

This is the third time Gov. Deval L. Patrick has proposed closing Taunton State, the only provider of continuing mental health care in Southeastern Massachusetts. Two years ago the Legislature went along with closing all but 45 of its 169 beds.

It's all become too much for Terry Delaney. A registered nurse with 20 years in psychiatry, she walked through the door of the emergency mental health service at UMass Memorial five weeks ago into a new world -- the world of medical, not psychiatric, emergency medicine.

"It's extremely frustrating,'' Ms Delaney said of the lack of resources and different rules plaguing psychiatric patients. "Every patient that came in had such a long wait.

"It's disheartening to tell them they'd have to wait for eight hours to get a psych evaluation and then tell them we'll have to hospitalize you somewhere in the state maybe 11/2 hours away because we had no bed -- that's the closest available.

"Or tell them to get a therapist in the community. However it will take six to eight weeks before anyone has an available slot.

"And people will say 'that's all you can do for me?' I was constantly apologizing for things I had no control over.''

That took place in an environment where people were stuck in the emergency room from four to 75 hours recently.

Some of the delay is paperwork and insurance regulations that laugh at parity for people with psychiatric illness, she said. But some of it is lack of available hospital beds, and using beds for Taunton patients that should go to Worcester patients "would be a huge'' impact, Ms. Delaney said.

By contrast, medical patients are seen immediately by a doctor or at worst get sent a mile down Belmont Street to UMass' Memorial campus and have multiple options, Ms. Delaney said.

DMH officials declined to be interviewed for this story. But in written answers to questions, they said they are planning the transition of the final 45 beds at Taunton State to the Recovery Center to begin this spring and be complete by the fall.

That will still leave a capacity of 626 continuing care beds in DMH, which "is sufficient to meet the needs of the Commonwealth,'' according to DMH spokeswoman Anna Chinappi.

It would cost an additional $5 million a year to open Worcester's 52 beds while continuing to use the 45 Taunton beds, she said. In December there were 205 patients in the 208 available continuing care beds in Worcester.

The department has not used the 52 beds, she said, because for the past two years the Legislature required the department to operate 45 beds in Taunton instead of closing it. Historically about 80-85 patients from Central Massachusetts have occupied DMH continuing care beds on any given day and the census at the Resource Center on average has been 83 patients from Central Massachusetts, Ms. Chinappi said.

"The department operates a statewide system of inpatient beds and does admissions on a statewide basis,'' Ms. Chinappi said, dismissing that the Worcester hospital was intended only for Central Massachusetts patients. "While the location of a patient's home community is taken into consideration for placement, patients are placed where there are available beds and what makes sense clinically. We make every effort to ensure an individual receives treatment in a timely manner in an appropriate placement.''

The only acute care beds that DMH operates -- 32 total -- in Pocasset and Corrigan Mental Health Centers, are in Southeast Massachusetts, and the department plans to add $6 million to its community-based services in that region, Ms. Chinappi said.

She also said, "There is no connection between the number of DMH adult continuing care beds and emergency room boarding of psychiatric patients. Individuals who present in crisis, this would include Worcester residents, are treated at acute hospitals or private psychiatric hospitals.''

There are 595 patients in the 626-bed continuing care system, she said, and between 1,800 and 1,900 patients in the 2,480 acute psychiatric beds in general hospitals or private psychiatric hospitals.

Sen. John F. Keenan, D-Quincy, chairman of the Mental Health Advisory Committee studying the issue, asked, "If that's the case, why do we have emergency department and acute care backups?''

The committee's consultant, Abt Associates in Cambridge, submitted a preliminary report March 15, 2013. The report backs DMH's position, concluding "that Massachusetts should continue the practice of seeking integrated community settings as the first choice, rather than electing to provide increased amounts of institutional care.''

Yet, Abt says the 626 continuing care beds "represents DMH's funded continuing bed capacity, not a number of beds needed for the population based on a scientifically derived formula, nor is the distribution of continuing beds based solely on prevalence estimates a reliable predictor of area need.''

That means rather than an "objective or therapeutic underpinning,'' David Schildmeier of the Massachusetts Nurses Association says, "the allotment of beds, both in number and geography, is based entirely on the DMH's attempt to provide services based on limited funding driven by political not clinical decisions.''

Transferring patients out of Southeastern Massachusetts also "goes against the administration's goal of ensuring that patients with mental illness receive care in their own community,'' Mr. Schildmeier said.

He and nurse Lisa Goss and others scoff at DMH, saying there certainly is a connection between patients boarding in emergency departments because there are no available acute care beds. And there are no acute care beds open because patients are stuck in those because there are no continuing care beds open for them.

Spokesmen for UMass Memorial and St. Vincent Hospital declined to make officials of those hospitals available for interviews regarding any backups in their emergency rooms and acute psychiatric beds and what financial impact that has.

In written comments Robert Brogna, media relations manager at UMass Memorial, said, "Acute inpatient units have a short-term treatment model and the longer the patient remains in acute care the more the short-term model becomes repetitive.''

He did not answer other questions about the numbers and length of time patients are stuck in acute care units awaiting placement in continuing care beds. Instead Mr. Brogna discussed the emergency department, saying, "At any one time there are over two patients who are stuck in (our) emergency department awaiting inpatient placement for over 24 hours.''

He said, "The longer the patient remains and the more clinical support provided to stabilize and hold the patient, the greater the financial loss we incur.''

Mr. Brogna said UMass Memorial "conducted 6,325 emergency psychiatric evaluations and we supported 182 individuals who were evaluated in the community and then needed to be held in the Emergency Department before a discharge to an Inpatient Unit could be established.''

UMass Memorial Health Care has 136 Inpatient Psychiatric Beds, with 53 of these beds provided by UMass Memorial Medical Center.

Ms. Goss, a nurse in a UMass Memorial psychiatric unit, said there are always one or two of the 27 patients in her unit there because there is no continuing care bed available from DMH. People who came for treatment of not longer than a week can be stuck from two weeks to two months waiting for a continuing care bed, said Ms. Goss, who like Ms. Delaney spoke to the paper as members of the Massachusetts Nurses Association, rather than on behalf of the hospital.

The patients should be getting long-term treatment, including individual therapy, which an acute care unit does not offer, Ms. Goss said. "They're being done a disservice'' while not getting the treatment they need and at the same time keeping someone else from getting the acute in-patient treatment they need.

Dr. Gregory Voturo, immediate past president of Massachusetts College of Emergency Physicians, said his organization has been working with the DMH trying to keep Taunton State open.

Dr. Voturo is chairman of the UMass Memorial Healthcare emergency medicine department. He oversees emergency rooms in Clinton, Marlboro and Health Alliance hospital. He also oversees UMass Memorial's emergency room in Worcester, but not the separate emergency mental health service at UMass Memorial, which is overseen by the psychiatry department.

HealthAlliance emergency room in Fitchburg has issues with boarding behavioral health patients and in the past year Marlboro Hospital had a pediatric psych patient in the emergency room for almost a week, he said. Dr. Voturo said he had been unaware that two wards of 26 beds are going unused in the Worcester Recovery Center.

In previous years Mr. Petty sponsored a proclamation against closing Taunton and testified to that effect before a Legislative committee. He recently met with the legislative delegation, which he believes is unanimous in its opposition to the administration plan.

He said the state should put more money into mental health so that people from Taunton won't have to travel here to visit their loved ones. And where are the support services, the mayor asked, if they release Taunton patients into the Worcester community.

Sen. Harriette L. Chandler, one of four Worcester Democrats who commented, said the state has reduced the inpatient census from the 800s to 626 since she served on the commission that she said planned the new hospital to care only for Central Massachusetts residents. The governor wants to transfer patients from Taunton to Worcester but "if you had diabetes or cancer you wouldn't have to travel 100 miles to get your care.''

State Rep. Daniel M. Donahue, D-Worcester, said, "I think there's a need to keep both open'' -- the 45 beds at Taunton State and the last 52 beds at Worcester. He said he's in favor of providing needed services even if it means more money in the budget.

State Rep. Mary S. Keefe, D-Worcester, said, "I'm disappointed the governor's returning to this issue. It would be a real hardship on families in the southern part of our state, having to think about traveling between 50 and 100 miles.

"Imagine if you had a son or a daughter that were hospitalized and you're trying to work -- and I'm talking about people with vehicles, never mind someone who doesn't have a vehicle.''

Rep. James J. O'Day, D-West Boylston, said a transfer of patients from Taunton to Worcester will "put a strain on the ability of residents from Central Massachusetts to have access to high quality mental health treatment. That means not only at WRCH, but also at St. Vincent and UMass Memorial hospitals, where he said acute beds are filled to capacity.

Mr. Keenan said the advisory committee's consultant report is preliminary and a final consultant report is due March 1. The Advisory Committee's own recommendation should come out in time for the Senate deliberations on the budget if not in time for the House's.
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Title Annotation:Local
Author:Hammel, Lee
Publication:Telegram & Gazette (Worcester, MA)
Geographic Code:1U1MA
Date:Feb 16, 2014
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