Gulf Bend's outpatient facility stops accepting patients after state visit

Melissa Crowe By Melissa Crowe

Aug. 26, 2014 at 5:57 p.m.
Updated Aug. 26, 2014 at 11:02 p.m.

Just eight months into a new outpatient program, Gulf Bend Center has stopped accepting patients needing mental health services, officials confirmed Tuesday.

Until Gulf Bend officials and state regulators reach an agreement on how to staff the extended observation unit, which accepted its first patient Jan. 6, the new facility, which is on the sixth floor of Citizens Medical Center, will remain empty.

State regulators instructed the center to not admit any patients after making their first visit to the mental health unit Aug. 15, according to email records provided by Gulf Bend Center.

The state's concerns centered on not having enough staff on hand to provide for consumer and staff safety, including one-to-one observation as needed and not having a physician or a psychiatric nurse on call 24 hours a day to evaluate individuals face-to-face or via telemedicine as needed. The state also said no registered nurse was on site 24 hours a day, seven days a week.

Lane Johnson, director of clinical programs and services at Gulf Bend, said it's all semantics.

"The agreement was let's stop admitting people and help you (the state) see and understand what it is we've built here," Johnson said. "How can you worry about medical coverage when you're sitting on top of a six-story hospital? It's ludicrous."

Johnson said the state's concerns have nothing to do with the level of care that's provided, the need that exists and what the observation unit has accomplished.

"The bottom line is, when you innovate, there aren't regulations that fit that innovation, so you use the closest thing you have, which is not for this program," Johnson said.

Because the state had not designed the regulations for this program, the unit was evaluated by crisis mental health standards, which Gulf Bend officials say should not apply.

Crisis stabilization units provide treatment to people who are being held against their will or are the subject of a protective custody order.

In Gulf Bend's extended observation unit, patients stay for an average of 13 hours and are free to leave as they wish.

"We've demonstrated a way to help people quicker and cheaper, and that has merit," Johnson said. "It's worth slowing down and helping people figure that out than to abandon the project."

Gulf Bend Executive Director Don Polzin said the staff is working to reach an agreement with the state to get services back in place.

Regulators saw issues with ongoing assessment and supervision by physicians, nurses and other medical staff was resolved, but Polzin said patients received the quality of care they needed.

The $1.2 million project, funded by a Texas Department of State Health Services grant and an in-kind match from Citizens Medical Center, is geared toward helping people who are in a psychiatric emergency but do not need the intensive care of inpatient treatment, Polzin said.

Polzin said the goal was to use resources that were already available - the county-owned hospital and medical staff already on board - in order to match the grant with about $400,000 of in-kind contributions.

Unless the Gulf Bend and state regulators reach an agreement for shared-services, Gulf Bend could be responsible for coming up with $400,000 to hire medical staff to sit in the unit, said David Way, Gulf Bend's associate executive director.

"Rather than hiring full-time employees, say five nurses to the tune of $300,000, to cover 24 hours a day in this unit, we have access (to medical staff) at any time we need from the hospital," Way said.

Until the program is brought back online, emergency rooms and jails could fill up with people who need better treatment.

Madonna Coughenour, the chief nursing officer at Citizens Medical Center, said the unit helped patients with behavioral issues who would otherwise wind up in the emergency room or jail.

Patients can receive counseling and get stabilized on medication.

"This opportunity has allowed for an appropriate placement of patients," Coughenour said.

The state has 30 days to complete its report of the visit.

"If anything, the state learned a little bit from this new model," Polzin said. "We would hope they would rethink the criteria for which they had established."



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