Commissioners disappointed with hospital district

The Hot Springs County Commissioners were blindsided at their meeting on Tuesday when Ron Jurovich, attorney for the Hospital District informed them that as of October 1, the hospital will no longer be accepting Title 25 patients for evaluations and holds.

According to an article in last week’s Independent Record, the district board made the decision after nurses and other staff expressed concern for their safety when Title 25 patients that are suicidal or homicidal are brought to the emergency room.

Jurovich said the hospital is not designed for that kind of patient care, but there are four hospitals in the state that are designated for the care of Title 25 patients.

If a patient is brought in by ambulance, police department or sheriff’s department, the hospital will evaluate their physical condition and treat them for those issues, cuts, bruises, broken bones, etc., but once the patient is medically stable they must be moved to another facility, such as the Wyoming Behavioral Institute (WBI) in Casper.

The hospital is going to require law enforcement be available while the patient is being stabilized and on the premises when they are discharged to be sent to another facility.

Jurovich went on to say the solution is very simple, that the Department of Health said the patient should be turned over to a “gatekeeper,” a mental health professional, and that arrangements can be made with the state to cover costs of transportation.

This will create a problem as none of the health professionals in Hot Springs County are qualified to admit mental patients to the hospital, so we have no local “gatekeeper” available. Even if one were available, there would still have to be an agreement between the mental health professional and the hospital. Jurovich said until that piece is put in place they will no longer accept Title 25 patients.

“I am very disappointed,” commission chairman John Lumley said. “The commissioners have been very supportive of the hospital and the hospital district. I wish we could have had this discussion before coming in and blindsiding us with this decision.

“We would have liked a meeting with the hospital, the county, town and mental health.”

Jurovich said that was the way they had wanted to handle things, but once it was out in the open they had no choice but to come to the commissioners in this way.

County Attorney Jerry Williams did not become aware of this situation until Monday evening.

“The losers are going to be the people of the county who will suffer,” Williams said. “We’re going to have to find something. It would have been nice to do this before ships were burned.”

Lumley added that it appears that now they have a district they are no longer willing to work with the county.

The sheriff’s department has and will stand at the hospital for security when Title 25 patients are brought in from the county, however, the police department does not and the sheriff’s department will not sit with patients brought in from within city limits.

Williams pointed out there is the Lighthouse program in Washakie County which is closer than WBI, but there is not always room for them to take patients in. This is a real issue, but the citizens of our county need taken care of, he added.

Title 25 patients need to be separated from the general jail population but there is no room available at the detention center for such cases, nor does the counseling center have any kind of facility to accommodate Title 25. Additionally, those patients can be held for up to 72 hours without any sort of formal charges.

Hospital District Board vice chairman, Heath Overfield, said he doesn’t think the hospital is unwilling to work with the commissioners.

“This has been going on for a year and our hands were tied,” Overfield said. “Our medical staff was worried about their safety. We have every intention to work with you, however or whenever we can. The only recourse we had was making a stand on what we can or cannot accept.”

District Board chairman Bill Williams agreed, saying, “This has been festering with the medical staff for months, if not years. It's simply staff and patient safety.”

Bill Williams said they have tried to get law enforcement to come sit on scene with only marginal success.

“We will get them medically stable,” he said, “but we are not going to put our staff in danger. We need to get them transferred out of here as quickly as possible, somewhere like WBI.

“And this didn’t just crop up. Its been building for about a year. We feel its cost us nursing staff because of the unease and fear created by the situation. We need to refine how we handle these patients and how to get them out of here.”

Rather than question if this has been building for a year, why the district didn’t come to them sooner to figure things out, the commissioners suggested they have a meeting with the District, law enforcement, mental health and also call in the State Department of Health to come to some kind of agreement on the process from this point forward.

In other business, commissioner Phil Scheel filled the commissioners in on the status of the roof at the Hot Springs County Senior Citizen’s Center.

Scheel went on the roof with the inspector, Dave Kaufman with CRSI, and it was determined the roof is at catastrophic failure stage.

If the roof were to fail in the winter with a heavy snow, they would not only lose the roof, but all of the new remodeling inside, the kitchen and everything else inside.

While the commissioners would like to have everything done before winter, they are not entirely sure what can get accomplished before the snow flies.

They determined they would hire Nelson Architects out of Riverton, an architect they have used for county projects in the past, and fast track their work for a second opinion as soon as possible.

Additionally, they would like to have someone do an asbestos check as asbestos abatement would be an additional cost and time lag to completion.

The commissioners agreed to keep Kaufman on board to oversee the project and they are going to check with their insurance company to see what, if any, portion of the project can be covered with an insurance claim.

Any costs are going to have to come out of either emergency expenditures in the budget or out of the county’s reserves.