Kansas acts to end overcrowding at Osawatomie State Hospital, but policy worries some

A new state policy aimed at ending chronic overcrowding at Osawatomie State Hospital in Kansas has mental health workers concerned that more psychiatric patients could end up in jails, rather than in hospital beds.

The policy puts new limits on admissions of psychiatric patients. It was initiated this week after federal regulators took the unusual step of threatening to cut off Medicare and Medicaid funds to the hospital — about a fifth of the facility’s budget — if the hospital doesn’t fix its overcrowding problems by Feb. 13.

When Osawatomie is approaching capacity, it no longer will accept patients who’ve agreed to voluntary commitment for treatment, and it will triage, based on their diagnosis, patients who are involuntarily committed because they pose a threat to themselves or others.

Community mental health centers, which provide initial care to people in crisis and refer patients to hospitals, will be responsible for finding alternative sources of care.

That will leave many mental health centers searching for resources that have grown increasingly scarce as more psychiatric hospital facilities have closed, said Kyle Kessler, executive director of the Association of Community Mental Health Centers of Kansas.

“It’s a significant concern. They’re going to do their best to provide treatment,” Kessler said. But patients “could be waiting for services in emergency rooms or jails. That’s the last thing we want.”

Osawatomie State Hospital, about 50 miles southwest of Kansas City, is one of two psychiatric hospitals operated by the state. It is licensed for 206 patient beds, but for much of this year it has been running above capacity. It serves the Kansas City area as well as most of the eastern half of the state.

An October inspection, prompted by several complaints, found that the hospital was housing 258 patients, putting it at about 125 percent of its capacity.

Inspectors also discovered such poor medical care and miscommunication among doctors, nurses and pharmacists that the federal Centers for Medicare and Medicaid Services said patients’ health and safety were in immediate jeopardy.

One diabetic patient was admitted to the hospital with a toe ulcer that was allowed to fester until the patient had to be transferred to another hospital and have the toe amputated. A patient with blood clots in the legs wasn’t adequately treated and ended up in the intensive care unit of another hospital. A third patient with an irregular heartbeat was prescribed a risky dose of an essential heart medication that was then discontinued by a pharmacist without consulting the patient’s doctor.

The Centers for Medicare and Medicaid Services, known as CMS, warned the hospital to correct those care problems immediately or face loss of funding this Monday. An inspection of the hospital this week found that those immediate life-threatening problems had been corrected.

But serious overcrowding issues that federal regulators considered unacceptable remained, and on Tuesday, the hospital was told it had 90 days to clear up those problems or once again face loss of funding.

Federal officials said state facilities rarely face such penalties. “I don’t recall any other state hospitals that have been in this situation” in Kansas or Missouri, said Jennifer King of the CMS regional office in Kansas City.

Kansas officials expressed confidence that restricting admissions to Osawatomie was a good start to solving its overcrowding problems.

“Obviously, we need to up our game,” said Angela de Rocha, spokeswoman for the Kansas Department for Aging and Disability Services. “These are systemic problems we have to address. We think these things will fall into place once we have a solid handle on the (hospital’s) census.”

Involuntarily committed patients make up the “lion’s share” of Osawatomie’s patients, de Rocha said. But the hospital also has many patients who could be treated elsewhere, including about 50 who may be eligible for services through the Department of Veterans Affairs, she said.

Patients voluntarily admitted to Osawatomie represent “a minor pressure on the system,” de Rocha said. “But we’re at the point where every patient counts.”

The new state policy puts the admission restrictions in play whenever the census at Osawatomie reaches 185 patients. It was set at lower than capacity to allow for surges in demand, de Rocha said. For example, the hospital was a couple of patients below capacity right before Thanksgiving, but was 18 patients over capacity by the end of the holiday weekend.

Osawatomie has had a decadeslong history of spikes in its census that have put it over capacity. But the problem has become unusually persistent since April, de Rocha said. She speculated that the state’s efforts to publicize the services available at community mental health centers has brought more people seeking help.

The dwindling supply of hospital psychiatric beds has been ongoing for decades nationwide, as states closed hospitals that did little more than warehouse patients. Changes in insurance reimbursement have led some private hospitals to close their psychiatric units, sometimes to convert them to other, more profitable services.

“It’s a crisis, but it’s been brewing for a long time,” said Amy Campbell, lobbyist for the Kansas Mental Health Coalition. “This is not an issue where we can turn to the community mental health centers and say, ‘Deal with it.’ These are life and death situations.”

Kansas has several initiatives in place to provide more community-based mental health services. The state has arrangements with several private hospitals to admit psychiatric patients, and it sends regular emails to community mental health centers alerting them where alternative beds are available.

In April, the Rainbow Mental Health Facility — a state psychiatric hospital in Kansas City, Kan., that had been largely mothballed — was reopened as Rainbow Services Inc., a 24/7 crisis stabilization center operated under contract with the state by Wyandot Center, Wyandotte County’s community mental health center.

The new facility has a “sobering unit” for up to six people, a six-bed medically supervised crisis observation unit for stays of less than a day and a 10-bed crisis stabilization unit where patients will stay for up to 10 days. Its goal is to keep people with mental illnesses or substance abuse disorders in Wyandotte and Johnson counties out of jails, emergency rooms and psychiatric hospitals.

Wyandot CEO Randy Callstrom said Rainbow Services has succeeded so far in keeping more than 100 patients in the community who potentially would have been admitted to Osawatomie.

“This points to a larger statewide need for more hospital beds or more resources in the community,” Callstrom said.

The state is now developing a similar community program for the Wichita area.

This story was originally published December 5, 2014 at 6:19 PM with the headline "Kansas acts to end overcrowding at Osawatomie State Hospital, but policy worries some."