EKL unit winds down service

The special mental health emergency room located on LSU’s Earl K. Long Medical Center campus is scheduled to close its doors to new patients April 8.

The Mental Health Emergency Room Extension has operated as a relief valve of sorts to take pressure created by patients with psychiatric problems on local hospital emergency rooms.

The Earl K. Long facility’s April 15 closure means its end, too.

“People will be going to the local emergency rooms. They will be brought by sheriff’s deputies, policemen, come on their own or be brought by friends and family members,” Capital Area Human Services Executive Director Jan Kasofsky said.

“Hospitals are going to have to prepare to take on an additional 2,000 people who are a danger to themselves or others, who are desperately in need of stabilization and potential further hospitalization.”

“It has the potential for being fairly disastrous,” said Dr. Beau Clark, the East Baton Rouge Parish coroner and an emergency room physician who deals with people with mental health issues in both jobs.

Already, the area has too few beds available to treat patients with mental illness, Clark said.

“There would be a problem if you increase that shortage,” he said. East Baton Rouge is the largest parish in the state and takes patients from smaller parishes, Clark said.

The MHERE has been staffed by LSU physicians and nurses. Its patients are first screened in the emergency room for medical problems, then are transferred to the specialized unit for stabilization, assessment and arrangements for the level of services they need.

Prior to its existence, local hospitals complained about being inundated with patients with mental health issues who were taking over emergency room beds — sometimes for days — as placements were sought for them.

By coroner’s order, Clark said he can keep someone in a hospital emergency room for up to 15 days.

“We had worked to get a crisis receiving center license,” which would allow operations without an associated hospital, Kasofsky said. “We assumed we could have the MHERE and Capital Area would staff it.”

Then, LSU officials said they were not going to allow the unit to continue to operate on the north Baton Rouge Earl K. Long campus, called EKL, because the property was going to be declared surplus property and sold, Kasofsky said.

That meant that a new building would have to be found and renovations done. Lease payments would be making project financially unfeasible, she said. If it had been allowed to stay open on the EKL campus, Kasofsky said, it would have required an extra $500,000 annually to operate because half the clients are indigent.

Kasofsky said she hopes that a private provider will come in and operate the crisis receiving center, but they won’t be able to get reimbursed for the indigent patients, either.

“The closure of any psychiatric services will bring more here,” said Randy Olson, chief executive officer of Lane Regional Medical Center in Zachary. “They will be taking up space we would otherwise have for medical services.”

Olson said the hospital as 20 exam rooms in its emergency department and two are set up to handle patients with mental health issues. “When we get more it really becomes a challenge,” Olson said.

He said Lane has no psychiatric services, but has some behavioral health specialists.

General Health System interim president and chief executive officer Dr. Evelyn Hayes said the General’s Mid City hospital has seen about a 20 percent increase in psychiatric consults in its emergency room. “That’s an existing situation. It’s difficult to project the impact once the MHERE closes,” she said.

“Certainly the accelerated closure of EKL and the MHERE is something we are focusing our attention on,” Hayes said. “I think that all of the hospitals are realizing the growing intensity of the challenge associated with the closure of some of the mental health and behavioral health programs.”

She said General Mid City is focusing on programs for seniors.

Hayes and Stephanie Manson, vice president at Our Lady of the Lake Regional Medical Center, called the Lake, said their hospitals are committed to serving the needs of the community.

Manson said mental health access is a challenge for the community and has been for quite some time.

Manson and Hayes talked about a community working group, including executives of the area’s hospitals, trying to come up with a solution. “We are going to continue to go down that path,” Manson said.

The closure of the emergency unit “may increase our volume, certainly. We don’t have a good idea on the numbers,” said Manson.

The Lake has increased its in-patient psychiatric beds by 20 in the last couple of months with 69 beds now available, Manson said.

Once patients are stabilized in the hospital emergency room, Manson said placing them becomes part of the challenge.

Coroner Clark, as an emergency medical physician, said the LSU Earl K. Long facility operated emergency mental health unit that “frees up a bed in my regular ER for heart attacks or strokes ... As it’s set up, they get the appropriate psychiatric treatment. It bridges the gap before the patient is put in an inpatient setting.”

And more often that not, he said, the patient can be stabilized and set up to receive less costly out-patient care.

“It is a remarkable bridge,” Clark said. “If you take that away how many more admissions are we going to have where it could have been addressed on an out-patient basis.”