Govt., health leaders need to wake up to mental health crisis

By Union Democrat staff January 31, 2012 08:02 pm

If a community is indeed judged by how it treats its weakest members, Tuolumne County government, law enforcement and health care leaders are guilty of making us all look bad.

We are, of course, talking about what has happened to our county’s system of emergency psychiatric care over the past two years, highlighted in a Jan. 20 Union Democrat investigation.

 We found cost-cutting measures at Tuolumne General Hospital, approved by the county Board of Supervisors in 2007, while mostly thought out, inadvertently jeopardized the lives of dozens of the county’s mentally ill. When problems surfaced, they were either not recognized or ignored.

In carrying out the closure of the county’s acute psychiatric ward in 2009, our experts farmed out care for patients deemed a danger to themselves or others — colloquially called “5150s” — to neighboring counties. These patients first are taken to Sonora Regional Medical Center, usually by Sonora police or Tuolumne County sheriff’s deputies. They are then evaluated by a doctor and, eventually, transported to a secure mental health clinic in Modesto, Vallejo or Visalia by a county behavioral health worker.

“Eventually,” we found, can be a matter of hours or even days, before an out-of-county bed is found. These patients are often left unattended in the waiting room or unsecured medical offices.

Problem is, all too often these people — bored, frustrated — just walk out.

Sometimes someone at the hospital notices, but not always.

County officials seemed to have been either completely unaware of the problem, or deliberately ignorant, up until the past year.

This was the lead on an April 2010 Union Democrat story about the acute care transition a year in:

“Despite last year’s closure of Tuolumne County’s acute psychiatric ward, mentally ill people are getting the help they need — and at a lower cost to the county, according to Behavioral Health Department Director Bea Readel.” Readel retired in July that year.

The same story had Sheriff Jim Mele saying, “I think Bea Readel and her staff have done a very good job.”

Barely a year after this upbeat report, a suicidal Jamestown woman, Marlo Chadwick, walked from the hospital as so many have. Her disappearance was undiscovered by county Behavioral Health for days and, only after her sister reported her as missing (no one else had thought to), Chadwick was found dead under a tree in a pasture less than a mile from the hospital.

We found that 5150 walk-aways were common even before the Chadwick tragedy — numbering about two a week.

To Mele’s credit, he may have been under the impression the transition was a success because Sonora police usually respond to calls about patient walkways (the hospital is in the city limits). In Readel’s case, she was carrying out orders and had never really welcomed cuts to her department.

Sonora Regional health care officials say their hands are largely tied because, legally, they can’t restrain people against their will and mental health care is not their mandate.

All are legitimate excuses and may help explain the gaping hole in our social safety net.

But more disappointing than the lack of foresight — or insight — by our leaders has been the lack of action since Chadwick’s death. 

In fact, about three months after she died, a 5150’d man who wandered away from Sonora Regional was hit by a car while crossing Mono Way.

What to do? A few possible solutions seem obvious:

• From a law enforcement angle — follow Calaveras County’s no-nonsense way of addressing the very same patient-transfer issue. Sheriff’s deputies stay with 5150 patients at Mark Twain St. Joseph’s Hospital until a behavioral health crisis workers takes over.

• From a county mental health angle — line up more out-of-county beds and transport these folks faster if you plan to continue shipping them out of county. Obviously, if following Calaveras County’s model, you can’t have a deputy standing in the ER at Sonora Regional for two days.

• From a hospital point of view — have someone keep an eye on these folks and call the cops when they walk away. This, of course, will only work if officers or deputies actually respond quickly to such calls, which is not always the case.

• From a county government perspective — either adequately fund the program you have created or scrap this whole thing and reopen and staff the locked unit at Tuolumne General. The mostly-empty hospital building, after all, is slated to reopen as offices for several county social services agencies. A return to the past may not be such a bad idea, as Sonora Regional and Behavioral Health officials we contacted agree the system worked better before 2009.

There certainly are other solutions our county government and health care leaders could look into if they put their minds to it collectively.

But the time to act is now. The lives of dozens of people are on the line, as is our reputation as a thoughtful, caring community.