Mental Health


Psychiatric Boarding

The Washington State Supreme Court granted a 120-day stay Sept. 5, 2014 to its recent ruling that ends the practice of psychiatric boarding in the Emergency Department. The court’s decision means that the process used for Single Bed Certifications will remain in effect until Dec. 26. Between now and the end of the year, the state will be bringing online and providing ongoing payment for 145 new treatment beds for involuntarily detained patients. Many of these beds are located at freestanding psychiatric hospitals.

The WA-ACEP Board of Directors voted April 30 to join other healthcare organizations in an amicus curiae brief asking the state Supreme Court to uphold a Pierce County Superior Court ruling that psychiatric boarding is unconstitutional and the state must do more to adequately provide mental health services.

The court determined Aug. 6 that psychiatric boarding was unconstitutional and violate the state’s Involuntary Treatment Act. The state offered no remedy for the current situation or any guidance on how the ruling is impacted by EMTALA.

WA-ACEP leaders are meeting with the Washington State Medical Association (WSMA) and the Washington State Hospital Association (WSHA) in September to continue to evaluate and refine medium and long-term strategies.

 

Viewpoint: Fighting Psychiatric Boarding through Induced Crisis

By WA-ACEP President Enrique Enguidanos, MD, FACEP; and WA-ACEP Secretary/Treasurer Nathan Schlicher, MD, JD, FACEP – Emergency Medicine News Feb 2015
Amicus Brief Timeline
WA-ACEP 2014-15 Psychiatric Boarding Survey

 

Single Bed Certification: New Emergency Rule Effective Dec. 26

Read the Washington State Hospital Association Dec. 16 Bulletin for Practical Guidance for Hospitals
Press Reports

Boarding” Of Psychiatric Patients In Emergency Departments Unconstitutional In Washington State
State Supreme Court rules psychiatric boarding unlawful
Supreme Court strikes down ‘psychiatric boarding’ of mentally ill
Hospitals in Washington state can’t board psych patients in EDs, but where will they go?
Hospitals, doctors and nurses push top court to outlaw psychiatric boarding
Guest: How to help patients after the end of psychiatric boarding
Washington Chapter ACEP Brings Fight Against Psychiatric Boarding to the Courts
State Supreme Court will tackle “psychiatric boarding” debate
Guest: Psychiatric boarding of mentally ill needs to end
A welcome ruling in Pierce County tackling psychiatric boarding
‘Boarding’ mentally ill becoming epidemic in state

 

WA-ACEP Update on Psychiatric Boarding

August 13, 2014
As you are likely aware of, on August 7th the WA State Supreme Court ruled that the practice of psychiatric boarding (i.e. holding involuntarily committed patients without providing continuous psychiatric care – whether in an Emergency Department or “In-House”) is illegal. The next day (August 8th) Gov. Jay Inslee issued a 20-day hold on this ruling, effectively postponing implementation until August 27th.

WA-ACEP wants to remind all of its members that this is a state ruling, which does not in any way mitigate our federal EMTALA obligation to treat and stabilize all patients. Indeed, it is the impression of the WA-ACEP Board that if a patient has been deemed meritorious of an involuntary status by a CDMHP, they are at-risk for instability, and our EMTALA obligation (and that of the hospital) is still in effect until that status changes.

Please know that the leadership at WA-ACEP is heavily engaged in finding a proper solution to this issue. We are proud of our role in joining forces with WSMA and WSHA in bring the well-deserved attention to this issue, and we continue to work with these same entities in seeking proper solutions to this issue. We encourage each of you to work with your local institution to find appropriate solutions for your local status, and we welcome any/all thoughts on solutions to this issue. Also, we encourage all of our membership to engage their local legislators and public on this issue in the hope of bringing adequate resources to this problem.

Please note, we are not able to provide legal counsel regarding how your hospital responds to the Supreme Court’s decision. We offer recommendations and information as a service to our members.

Respectfully,
The WA-ACEP Board of Directors

 

Washington’s Emergency Physicians Applaud Stay for Psychiatric Boarding Ruling

Emergency physicians in Washington State applaud the Supreme Court’s decision today to grant a 120-day stay to its recent ruling that ends the practice of psychiatric boarding in the Emergency Department.

“We are grateful that the Supreme Court gave us the time to implement an emergency action plan to care for these vulnerable patients,” said Nathan Schlicher, MD, JD, secretary/treasurer of the Washington Chapter of the American College of Emergency Physicians (WA-ACEP), which represents more than 700 emergency physicians in the state. “We look forward to working with the state and legislature to ensure that patients enduring a mental health crisis can get the care they need.”

The Washington State Supreme Court determined Aug. 6 that psychiatric boarding was unconstitutional and violated the state’s Involuntary Treatment Act. WA-ACEP joined other healthcare groups Aug. 22 in support of a motion by the Department of Social and Health Services asking the court to grant a temporary 120-day stay of the decision after a plan to open 145 beds was developed in concert with the Governor’s Office. The motion stated that if the decision took effect as planned, it could pose a serious public-safety risk as hospitals and provider groups consider the possibility of having to release patients with severe mental health issues that met the need for detention and treatment, but were turned away due to a lack of an available bed.

The court’s decision today means that the process used for Single Bed Certifications will remain in effect until Dec. 26. Between now and Dec. 26, the state will be bringing online and providing ongoing payment for 145 new treatment beds for involuntarily detained patients. Many of these beds are located at freestanding psychiatric hospitals.

“Washington’s emergency department physicians will continue to take an active leadership role in finding a comprehensive plan that protects patients and communities,” said Schlicher.

WA-ACEP reminds all of its practitioners to keep our EMTALA mandate of providing basic screening and stabilization to all presenting ED patients as we continue to work with our community partners in finding the right solution to this issue.
(September 5, 2014)

 

Washington’s Emergency Physicians Urge Stay of Boarding Decision

The Washington Chapter of the American College of Emergency Physicians (WA-ACEP) is adding its voice to a call from throughout the state’s medical community; urging the Washington State Supreme Court to grant a 120-day stay to its recent decision ending the practice of psychiatric boarding.

WA-ACEP has joined a wide variety of organizations supporting a petition from the Washington State Department of Health and Social Services to the Supreme Court requesting the stay.

“Although we strongly support ending the practice of psychiatric boarding, Washington’s emergency department physicians also support doing so in a thoughtful, well-planned manner,” said Nathan Schlicher, MD, JD, secretary/treasurer of WA-ACEP. “A 120-day stay will keep Washington state government and medical providers focused on putting needed services in place quickly, while still ensuring that patients, their families and their communities can be safe while capacity is increased.”

In supporting the stay, the emergency physicians join a diverse group from across the state’s health-care community, including the Washington State Hospital Association, Washington State Medical Association, Washington Organization of Nurse Executives, Washington State Nurses Association, SEIU Healthcare 1199NW, and the Washington Council of Emergency Nurse Association, Franciscan Health System and the MultiCare Health System.

Emergency physicians are pleased to see the state and providers working hard to find alternatives to the practice of boarding patients in psychiatric crisis in emergency rooms, Schlicher said. “But there is no instant solution to meeting the needs of the entire state.

“We look forward to continuing to work together to find solutions that will ensure that patients enduring a mental health crisis can get the care they need.”
(August 25, 2014)

Psychiatric Boarding Update

The Washington State Supreme Court ruled Aug. 7 that boarding psychiatric patients temporarily in hospital emergency departments and acute care centers because there isn’t space at certified psychiatric treatment facilities is unlawful. See the Supreme Court’s opinion.

As of 2:30pm today, the understanding from the Attorney General’s Office is that effective Aug. 8 they will not be detaining patients to single bed certifications in many communities. We are actively working to a solution on this and hope that it will find a resolution, but you should know that there is a possibility you will be told that a patient must be released as no bed is available.

If this happens, the recommendation from Washington State Hospital Association (as sent out to their members this morning) is that each hospital has its own plan of action in how to deal with this. I wanted to let you all know so that if you have not heard from your administration that you consider reaching out proactively to folks to start making plans on how you will handle this situation, especially over the weekend.

We still are hopeful that there will be a resolution, but at this time I am not certain that will be the case by any means. While this is not the ideal solution we sought, the movement forward on stopping the practice of psychiatric boarding is encouraging. Now we just need to get to the hard work of solving the problem.

Nathan Schlicher, MD, JD

WA-ACEP Secretary-Treasurer and Legislative Chair

 

WA-ACEP Joins Amicus Brief to Address Boarding of Psychiatric Patients in EDs

Washington ACEP joined the Washington State Medical Association, Washington State Hospital Association and Washington Emergency Nurses Association in an amicus curiae brief in a case related to boarding psychiatric patients. The case was recently accepted for review by the Washington State Supreme Court.

The question before the Court is whether patients in need of mental health treatment can be detained against their will while they are not receiving meaningful mental health treatment. The plaintiffs are challenging the commitment process whereby patients are declared in need of involuntary inpatient psychiatric treatment, but because no psychiatric beds are available, the patients are housed in emergency departments or other locations where no such treatment is available. The State’s position has been that some “treatment” in emergency departments is better than the patients staying on the streets as a danger to self or others.

The underlying problem is that the state budget for mental health treatment has been cut deeply over many years. Hospitals board the patients because there is nowhere else for them to go; beds are not available at evaluation and treatment centers or at the two state psychiatric hospitals. As a result, emergency physicians and staff are forced to grapple with the complex psychiatric needs of patients.

The case could significantly impact the way Washington state funds treatment of involuntarily committed patients with psychiatric conditions. The case is on an expedited schedule; the Court will hear oral arguments June 26.