‘Some patients who leave here shouldn’t’

By J. TODD FOSTER
Published: April 16, 2006

FISHERSVILLE—When Chad Woodson landed in a local psychiatric unit two years ago, he was lucky to get a bed.

Local patients in crisis today would be even harder pressed to get admitted to Augusta Medical Center’s Crossroads.

For nearly two years, AMC has been down to one psychiatrist—Dr. Timothy Kane—for its Crossroads patients, and he also must see his own private clients.

Psychiatric beds across the state have dried up, officials say, victims of low cash flow and a doctor shortage. In addition, AMC must accept patients from all over Virginia, sometimes leaving locals out of luck.

When Crossroads is full, then even locals are turned away.
“Lots of community hospitals have closed their psychiatric units,” says Dick Graham, AMC’s chief executive officer. “It’s very hard to keep it open.”

Says Donna Hahn, the assistant vice president over Crossroads: “We’re getting calls on our unit for admissions of patients all around the state because of the lack of beds.

“I understand in Richmond, some patients are being held in the emergency room for 48 hours because they can’t find a bed for the patient. That’s where the system is broken.”

Crossroads is licensed to operate 28 beds but is staffed for only half that many. It has lost two of its three psychiatrists since 2004.

For more than a year now, AMC has been advertising U.S.-wide for more psychiatrists.

“Dr. Kane is a hero to us,” says Graham, the AMC CEO. “He has a huge caseload, and if we lost him, we would be in trouble.”

Martha Meade, spokeswoman for the Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services, says it’s not just Virginia but the entire nation where the mental-health system is in a “shambles” because of doctor and bed shortages.

“We do need more services for patients in crisis,” Meade says.

Not only are there staff shortages, but psychiatric hospitals are bound by a criminal legal system that must be balanced against patient rights. Sometimes patients who need continued treatment must be released because they don’t meet the legal criteria for temporary detention orders.

One of those patients was Woodson, who left Crossroads on April 22, 2004, after three days and then on April 25 killed his estranged girlfriend, her roommate and himself.

“Some patients who leave here shouldn’t,” says Graham, adding that no one at AMC could discuss the Woodson case specifically because of privacy laws.

“The system has taken the judgment away from doctors in order to protect patient rights,” Graham says. “In mental health, sometimes the system that is intended to protect the patient from himself and the system that is intended to protect the patient’s rights run headlong into each other.

“The system just breaks down occasionally,” he says.

Many of AMC’s psychiatric patients - and a good portion of all their patients - are uninsured. Those covered by Medicare and Medicaid trigger only limited reimbursements, says Hahn.

Adds Pam Davies, AMC director of behavioral health: “Psychiatrists are hard to come by, especially those willing to practice inpatient medicine.”

The advent of more effective medications has decreased the burden on inpatient psychiatric beds, officials say. Still, when a mentally ill patient is in crisis mode, he or she needs treatment that might not be available - particularly if the patient is demanding to be released.

“We cannot keep patients against their will,” Hahn says.

If patients are a risk to themselves or others, AMC must call in trained counselors from the Staunton-based Valley Community Services Board. If they agree the patient is in crisis, they must convince a magistrate. Even then, patients can be kept only 72 hours before another hearing to determine their longer-term treatment options.

“Sometimes the system works, and sometimes it doesn’t,” Hahn says. “There’s a lot of things about the system that sometimes people get through the cracks.”

Mental-health providers are banking on a major recent initiative by Gov. Tim Kaine to put more beds in local communities. The price tag could reach nearly $200 million, though.

Dr. James Reinhard, Virginia mental health commissioner, calls the initiative “exciting.” And state officials must justify the expense to taxpayers by showing proven results.

Even with more psychiatrists - few medical students choose the discipline because of the stigma and reimbursement issues, Reinhard says - the system will always break down in certain cases.

“You don’t have lab work that tells you a patient is going to hurt themselves or others,” Hahn says. “You don’t have it like you have in other sorts of medicine, so it becomes hugely dependent on the art of it. While there is a lot of science, there’s a lot of art.”