(7-23-21) Thank you Washington Post for posting my opinion piece yesterday that explains how patient dumping is playing a role in overcrowding Virginia’s state mental hospitals.
OPINION: Virginia’s mental health hospitals are burdened by patient dumping: Admissions at state hospitals have ballooned and are now overloading the system.
Most Virginians experiencing a mental health crisis are taken to hospitals under a temporary detention order (TDO), which permits the hospital to hold them for up to 72 hours for their own protection if they meet certain criteria, such as being dangerous or exhibiting self-harm. In 2017, there were 25,852 Virginians hospitalized under TDOs. Most were treated at private hospitals and released within days. Only the most ill were sent to state mental hospitals for extended care. The number of TDOs dropped last year to 24,125 patients. Yet admissions at state hospitals have ballooned and are now overloading the system.
The reason: Private hospitals are using a 2014 law to rid themselves of troublesome patients, including those with dementia or patients with intellectual disabilities, many with no mental illnesses. Under the “bed of last resort” law, state mental hospitals must accept any psychiatric patient that a private hospital turns away. The law was enacted after state Sen. Creigh Deeds (D) rushed his 24-year-old son, Gus, to a crisis center only to be told workers couldn’t find a local available psychiatric bed within the 72-hour TDO period. Sent home, Gus slashed his father’s face with a knife before ending his own life.
Before the 2014 law, private hospitals accepted 90 percent of all TDO patients. Last year, that number fell to 75 percent. The coronavirus pandemic was partly to blame because hospitals began using psychiatric beds for coronavirus patients knowing they could push TDO patients onto the state. But as the coronavirus crisis abated, greed and convenience kicked in. Psychiatric beds historically are money losers. Surgical beds are hugely profitable. Hospitals began cherry picking, refusing TDO patients.
The Northern Virginia Mental Health Institute in Falls Church opened in 1968 as a short-term state mental hospital with 94 beds designated for patients needing acute care. Before the 2014 law, 20 percent of its patients were admitted under TDOs. Today, 90 percent of its patients are under TDOs sent by local private hospitals, often for flimsy reasons — “patient can be better treated by state.” A recent study found Virginia private hospitals dumping TDO patients with “severe burns requiring acute care, unstable seizures, acute respiratory distress, intravenous fluids or IV antibiotics that the state facilities are simply not designed, equipped, or staffed to treat.”
Ending patient dumping will not solve staff shortages or much-needed modernization at long-neglected state hospitals. At Piedmont Geriatric Hospital, 25 of its 123 patients died last year. “If one out of five patients died at any other facility, it would be front-page news. Yet, because the deaths “only impacted geriatric people, they are considered somehow ‘allowable’,” the Disability Law Center in Richmond, which monitors state deaths, reported. Piedmont patients don’t have nurse-call buttons in their rooms, and one patient reported living in soiled clothing for seven days before staff changed her. At the same time state hospitals are full, there are 220 patients stuck in them who have been cleared for discharge but can’t leave because they have no place to go. There is not enough supportive housing or community-based treatment. Freeing those beds for sick patients would greatly help.
Adding staff, providing robust community care and fixing dilapidated buildings will take time and money. Repealing the “bed of last resort” law could be done quickly and would help end today’s crisis. State hospitals were intended to help the uninsured and those who required longer-term care. Private hospitals should not be dumping a female psychiatric patient onto the state simply because she has a urinary tract infection.
Pete Earley is the father of an adult son with a mental illness and serves on a federal panel that advises Congress about mental health issues. His book, “Crazy: A Father’s Search Through America’s Mental Health Madness,” was one of two finalists for a 2007 Pulitzer Prize.
About the author:
