Empty Hospital Bed in a Ward
(3-27-16) If you are a Christian, Easter is a sacred day of worship, remembrance and family so I will ask for your forgiveness for posting a blog on Easter. But I want to alert you to a news story in today’s Richmond Times Dispatch by Sarah Kleiner, who thankfully is continuing to probe the preventable death of Jamycheal Mitchell in Virginia.
Kleiner discovered there were 115 empty beds available in the state’s 1,500 bed system during the four months that Mitchell spent psychotic in jail waiting to be sent to Eastern State Hospital. He was one of 34 prisoners waiting for a bed at Eastern State Hospital in Williamsburg. Another fifty others were waiting for beds at other facilities, according to earlier reports.
All of those prisoners could have been assigned a bed but weren’t. Instead, they were left to languish in jails for an average of three months.
Mitchell died from a heart attack caused by him “wasting away” waiting for a hospital bed. The 24 year-old had lost more than 10 percent of his body weight when he was found dead in his cell covered with feces with urine on the floor in August 2015. He had been arrested for taking $5 of snack food from a convenience store without paying.
Kleiner noted in her story that:
A judge had ordered Mitchell to Eastern State Hospital in Williamsburg. Shortly before he died, there were 34 people on a waiting list to get into the hospital, even though 16 of the hospital’s 294 beds were empty, as were nearly 100 others across the state.
Dr. Jack Barber, interim commissioner of the Department of Behavioral Health and Developmental Services, did his best in an interview with Kleiner to defend the state. He explained some empty beds are designated for specific genders, ages and criminal status, and by the severity of a patient’s mental illness.
“We don’t tend to run people all over the state, so if someone were in Southwestern Virginia, we wouldn’t send them to Eastern State because there was a bed there,” Barber said. “It is a hassle for law enforcement. It’s a much longer distance from their support network, if they have it.”
I know and respect Dr. Barber, but his explanation is disappointing — to say the least.
How would Barber react if someone he loved needed a heart transplant and was told that it would be a “hassle” to drive them across the state for an emergency operation, adding that, it’s better for the patient to be home near their support network?
Home in Mitchell’s case was a jail cell where he slowly starved himself to death.
A cynic might be tempted to believe that the state was intentionally maintaining a waiting list by keeping prisoners in Virginia jails because of indifference and for financial reasons. The cost of incarcerating a prisoner varies considerably in Virginia depending on each jurisdiction, but Fairfax County has one of the highest cost per inmate at about $50,000 per inmate per year. It costs at least four times that much — about $200,000 — to keep at patient in a Virginia state hospital per year. Simple math tells us that keeping 84 ill people on a waiting list in a jail is saving the state nearly $13 million a year at Fairfax incarceration prices.
Transporting patients across the state in search of beds is nothing new and a poor excuse for denying someone medical help. When I appeared on NPR a few years ago, the then head of our local Community Services Board, which delivers mental health services in Fairfax County, acknowledged that he often couldn’t find beds in our county. Fairfax, the richest county and most populated county in the state, was transporting 300 patients each year to other counties. This is not only a Virginia problem. During my travels, I have been told that in some states, such as Iowa, patients have been sent out of state to find a bed.
A recent study cited in Psychiatric Times based on a computer statistical analysis in North Carolina found that the average need for psychiatric beds in the U.S. was 39 beds per 100,000 residents. Virginia averages 22 beds per 100,000.
Ever since the 1960s when President John F. Kennedy called for the closing of state hospitals and treatment of individuals with mental illnesses in local communities, there has been a fight between advocates who want more state hospital beds and those who argue that tax dollars could be better spent on community based care. While there is an unresolved argument going on about whether or not everyone can be successfully treated in a community setting, there is no argument that the Housing First model and Assertive Community Treatment are the most successful tools to helping people recover in a community setting. Sadly, few communities have sufficient housing, especially for individuals with serious mental illnesses and addiction problems.
Kleiner’s story noted this:
Part of the problem the department is trying to solve is how to get people out of mental hospitals once they’ve been treated. About 160 to 200 of the state’s beds are occupied by patients who have been deemed stable enough to leave but who don’t have anywhere to go.
Those beds and the ones that are unused represent up to 20 percent of the state’s inventory.
State Sen. Creigh Deeds has been leading a crusade to improve mental health care in Virginia ever since the tragic death of his son, Gus. In a recent speech, Deeds talked about how Virginia needed to look outside its borders to examples in Bexar County, Texas (San Antonio), Miami-Dade County, and Albuquerque, New Mexico, where jail diversion systems have reduced inappropriate incarcerations and saved tax dollars.
He also stated that Medicaid expansion under Obamacare would cover almost 60,000 uninsured Virginians wrestling with mental illness, echoing estimates by the state Department of Medical Assistance Services. “Medicaid expansion would be the single best way to improve mental health care in Virginia,” Deeds said.
Virginia’s conservative Republicans have blocked Medicaid expansion and continue to fight it on the nonsensical argument that Virginia taxpayers would be stuck with a huge bill if the federal government decided at some later time to cut back on Medicaid payments.
I’m thrilled that reporter Kleiner is continuing to dig into the Mitchell case. It appears that no one in the state has grilled the private for-profit firm, NAPHCARE, which was hired by the jail to provide mental health services to Mitchell and other prisoners.
The Office of State Inspector General still has not released a copy of its investigation into Mitchell’s death even though rumors have circulated that it’s probe was completed in December. Why? Nor has the disAbility Law Center, which is Virginia’s Protection and Advocacy for Individuals with Mental Illness Program, said a word about Mitchell even though it is responsible for protecting persons with disabilities in institutions.
Clearly, the state Department of Behavioral Health and Developmental Services is not the only state agency that has dropped the ball when it comes to doing its job.
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