The Mental Health Minute

Articles and news about mental health issues

Mental health transports costly rides on taxpayers’ tab

With all the talking going on about cutting costs and reducing budgets, this issue seems like it would get more attention.  The use of ambulance services for non-emergency transport is really not the optimum use of  city, county, or state services and the cost of doing this certainly must cut into the budgets of those governmental bodies.  Is there another answer?  Surely there is, but what it is seems to be elusive and has escaped all involved.


By MARCIA DAVIS-SEALE – Tribune Staff Writer
Saturday, July 3, 2010 1:09 PM CDT

It’s a high-dollar ride when ambulances roll to pick up mental patients for non-emergency transports. TRIBUNE photo by Marcia Davis-Seale

In the last 12 months, the tab for 3/4 of the Titus Regional Medical Center (TRMC) ambulance transports of mental health patients came, in some form, out of taxpayer pockets, unreimbursed by private insurance agencies, Medicare or Medicaid because the emergency crews served as default taxis in non-emergency situations – their destinations: The TRMC emergency room or a distant mental health facility. Calls for these transports are increasing, and hospital and Emergency Medical Services (EMS) officials say that the risks posed to EMS crews in transporting unstable mental patients adds more than small change to the mounting and potential costs of these rides.

Hospital and county officials offer a myriad of contrasting interpretations of the state law on transporting mental patients.

The hot-potato points of contention came up during a recent hospital board discussion, in which TRMC Chief Executive Officer Ron Davis said, “Texas law states these patients, once they arrive at the hospital, are our patients, but state law says they are to be transported by law officials, and local and county officials are not able to respond to the calls, or don’t want to. This puts EMS crews in a difficult position….Options are to call law enforcement and if they don’t have anybody, we are out of luck. We don’t have any options.”

TRMC Chief Operating Officer Alan McMillin told the Tribune, “Everyone has cut mental health services in many ways, and it’s cost us in other ways.  It ends up costing everyone in an inefficient manner.  Most of these patients are not insured, but even if they are insured, we are taking care of them in the most inefficient and expensive manner.”

According to EMS Director Mark Mallory, “MHMR here frequently calls 911 to get an ambulance to pick up a patient. Whenever they do, the police department rolls that call to the ambulance service, and if a patient wants to go to the hospital, then as a 911 ambulance service, we have to take them to the hospital.”

Mallory reports to McMillin.

McMillin said, “The EMS obligation is to respond to emergency calls as medical responders to those patients. EMS provides that first medical response, and if the person needs further medical treatment, we take them to Titus Regional. We are service oriented, but we have to be so without putting extraordinary burden on the taxpayers.”

He said the last 12 months’ unreimbursed mental health patient non-emergency ambulance transports exceeded $100,000.

“EMS has to respond and determine if it’s a medical emergency; and if it’s not a medical emergency, then the patient becomes the responsibility of law enforcement. EMS calls law officials and gets the response: ‘We don’t have anyone available.’ We’re just not gonna leave the person on the side of the road. We pick them up and take them to the mental health facility that will accept this patient. TRMC is not a designated mental health facility.”

Mallory said in his 5 1/2 years with the EMS here, he’s been aware of a steady increase in the calls for mental health transports, and he’s seen a non-emergency mental health transports turn into emergency situations.

“It is our understanding that when a patient is under an order of protective custody, they are supposed to be in custody. Our concern is our ability to detain or restrain a patient that decides they don’t want to go with us. It can be dangerous. We’ve had none of our responders seriously hurt, but we’ve had some people that have gotten bumps and bruises and scrapes working those transports”

Mallory said part of the basic training for any EMT or paramedic is working with patients who can be uncooperative and might need restraining, “but the training is designed for patients that we pick up at a scene and get them to a hospital, making a transport of 5-10 minutes, as compared to transporting them for several hours to a distant mental health facility.” He said EMTs could calm the patient with medication only if a physician orders it, but that many of the mental health facilities would not accept a medicated patient.

“We’ve been very, very lucky. One [transport], on the way to an institution, decided he was going to get out the back of the ambulance and we were fortunate to stop the ambulance before he did get out.” Mallory said a DPS officer and passengers in two other vehicles stopped to help the EMS crew. “We were someplace in the neighborhood of Rivercrest School, on the way to Sherman.”

“Part of the overall problem is we have no local mental health inpatient facilities,” Mallory told the Tribune. “These are all out of town – Terrell, Sherman, Greenville, Dallas, Longview, and Tyler.” So the closest out-of-town transport would be a round trip of about 120 miles to Greenvilleâ€-for a fee that won’t get reimbursed of almost $2400.

“Almost every county in a seven-county area covered in our Northeast Texas Advisory Council is having the same problem,” McMillin reported to the hospital board.

“They [TRMC-EMS] averages 440 requests for service a month, transporting an average of 302 patients per month, showing a three percent increase in respondents and six percent increase in transports, with much of the volume not justifying the use of a dedicated emergency vehicle,” McMillin said. “We are trying to get elected officials aware of what this is and minimize trips, specifically transport of mental health patients. There is not a good place for those patients to be seen. Budget crunches faced by all the different agencies have resulted in the hospital -specifically the ER – as a place of last resort for mental health patients, and that’s not really the best place for them, and transporting them by the mobile intensive care units is not the best method. We are trying to find a solution.”….[more]…

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July 7, 2010 - Posted by | Mental Health | , , , , ,

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