Legacy Health doctor working to bring psychiatric ER to Portland not a fan of 'drop-off' centers

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Legacy's Research Institute, at 1225 N. E. Second Ave., is the proposed site for a new psychiatric emergency department in Portland.

(Maxine Bernstein/The Oregonian)

Portland's settlement with the U.S. Department of Justice demands myriad reforms and also calls for the opening of a drop-off and walk-in mental-health crisis center.

But Tuesday, Legacy Health's director of behavioral services -- who is working to bring a psychiatric emergency department to Portland -- said if she had her druthers, she would never hear the term "drop-off center" again.

"With all due respect, I would love to get rid of the term 'drop-off,'" Legacy's Dr. Chris Farentinos told a state legislative committee in Salem. "We don't drop off people who have heart attacks."

Instead, Farentinos argued that the proposed psychiatric emergency department, which would accept walk-in patients and patients transported by ambulance, would   provide immediate care to people suffering mental health crises and would respond to the needs identified by federal Justice officials.

While it's not exactly what the federal Justice Department and Portland police had envisioned, it responds to the gap in care that has police serving as first-responders and transporting people in deep psychiatric crisis in the back of their patrol cars, Farentinos said.

The police are "really not in the business of medical emergencies,'' Farentinos told the state House Interim Committee on Human Services and Housing.

The plan is to open a psychiatric emergency department in Legacy's Northeast Portland building, which now is home to the Legacy Research Institute's labs and state hospital beds. The research institute will move into a building under construction next door, and the state hospital is moving its beds out by May.

The cost of remodeling the building for a psychiatric emergency department is estimated at $45 million. Legacy Health has committed $10 million in the real estate value and raised another $21 million in private donations. An outstanding $14 million balance must be raised through the community, private foundations and government agencies. Gov. John Kitzhaber has set aside $1 million in the Oregon Health Authority's budget toward the department's psychiatric care.

The new department would help alleviate the crowding in regional emergency rooms, advocates said.

In the last year, nearly 10,000 patient visits in the Legacy Health hospital emergency departments were for behavioral health issues. Every day, the emergency departments hold 10 to 20 patients who are awaiting psychiatric beds, and the patients end up waiting hours to get psychiatric care, according to Farentinos.

She said the average length of stay now for psychiatric patients in the regular emergency departments is 16 hours, compared with two hours for those suffering physical ailments.

The new psychiatric ER will allow police to call an ambulance and allow emergency medics to assess a person's needs and take the person directly to the facility. There, the patients will be treated immediately in a more humane, open living room-type setting by psychiatric experts, Farentinos said.

Committee vice chairman State Rep. Andy Olson, R-Albany, asked if additional training would be provided to emergency medics to transport these patients.

Farentinos said there would be additional training for both emergency medics and police to help them recognize mental health emergencies. The new model allows for more humane treatment of patients suffering mental health crises and avoids unnecessary hospitalization, advocates say.

In Alameda County, California, 75 percent of the patients who arrive stay less than 23 hours, while the other 25 percent are admitted to in-patient care that can last as long as eight days.

Legacy's plan would also include 101 in-patient psychiatric beds at the new facility, with 22 of those serving adolescents. Whether Legacy could bill Medicaid for the crisis stabilization care will play a big factor in whether the planned psychiatric ER becomes a reality, health care officials say.

The Alameda model is feasible in California because of a Medicaid code for crisis stabilization that reimburses the facility on an hourly basis, from a minimum of two hours to a maximum of 20 hours. Legacy studied the model and concluded that a reimbursement rate of $100 an hour would make the psychiatric emergency department in Portland sustainable. Alameda County's hospital receives $109 an hour.

Deborah Friedman, the director of behavioral health services for Health Share of Oregon, shared Farentinos' concerns about a drop-off crisis center. In written testimony, she said, "behavioral health experts do not believe that a police drop-off center would provide appropriate care for people experiencing psychiatric emergencies.''

But Health Share is supportive of the Legacy plan for a psychiatric emergency department. Health Share is a non-profit organization founded by five competing health systems to oversee care for the Oregon Health Plan.

"We believe that it's an important component to the health care system that doesn't exist today,'' Friedman testified. "We are committed to funding this service when it's available for our members.'' Hospital representatives have been meeting monthly with police and other health care providers in Portland to discuss the plan for the new psychiatric emergency department.

A federal Justice Department official has been at those meetings. David W. Knight, a special assistant U.S. Attorney in Oregon and civil rights coordinator, has said the U.S. Attorney's Office supports a center that will help first responders and families connect individuals suffering mental health problems with immediate treatment.

But federal Justice officials also are pushing the state to provide additional funding for community-based mental health services.

Legacy envisions the new psychiatric emergency department serving as a hub that will connect patients to community-based services before they're released. There would be office space at the building for community-based services to "help navigate these patients back into the community,'' Farentinos said.

Committee chairwoman state Rep. Carolyn Tomei, D-Milwaukie, said she's pleased there seems to be better collaboration between the state, county, city and private providers.

"I think it's somewhat gratifying to learn you're working together,'' Tomei said.

-- Maxine Bernstein

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