2 Investigates: New plan to ease John George overcrowding doesn't include more beds

More than four months after 2 Investigates first revealed disturbing conditions at John George Psychiatric Hospital, administrators have now proposed a plan to address overcrowding at its troubled emergency room.

On Monday, hospital leaders presented a plan to control patient numbers at the Psychiatric Emergency Services (PES) department by allowing staff to put a temporary freeze on transfer patients from other emergency rooms around the county. But doctors and nurses said the idea does not go far enough to address the chronic overcrowding and conditions that they call “a powder keg.”

2 Investigates first aired leaked video from inside PES in May, showing mental patients sleeping and eating on the floor in PES. More than four months later, newly leaked video shows patients still curled up on mats in corners and hallways, or sleeping on lounge chairs side by side. Staff members say chronic overcrowding forces them to keep patients on mats, in close quarters, for hours at a time.

For the last three months, the Alameda County Board of Supervisors Health Committee has held three meetings with administrators from Alameda Health Systems (AHS) – which runs John George – discussing potential solutions to the problem. For the first time, AHS leaders presented a plan at Monday’s health committee meeting in Oakland to alter the transfer and referral system, in order to lower the number of patients arriving at PES in the first place.

PES currently accepts transfer patients from other hospital emergency rooms, as well as from walk-ins, ambulance arrivals, and law enforcement holds, known as 51-50s. Law prohibits the hospital from turning away walk-ins or ambulance arrivals.

Doctors and nurses told the supervisors they believed that only freezing emergency room transfers would not go far enough to address PES’s overcrowding problem.

“I think we’re very close,” said nurse Rachael Otis, who called the plan to freeze ER transfers “a good start.”

Otis is among staff members pushing for AHS to cap the number of patients in PES at any time at 50.

“PES is a powder keg,” said Milton Lorig, a retired AHS psychiatrist. “The solution to fixing PES needs to include, at the outset, a cap – 50 is a good number – many more resources, and an expansion of beds because our county is woefully lacking.”

But hospital leaders insist that cap is unrealistic in Alameda County, which has the highest number of 51-50 holds in the state, according to AHS administration.

For months, doctors and nurses – some afraid to reveal their identities – have complained to 2 Investigates about conditions inside PES. They say chronic overcrowding has allegedly put staff and patient safety at risk. Several told 2 Investigates they had witnessed assaults on staff and patients, had urine thrown on them, or been injured on the job.

But Patients’ Rights Advocates director Francesca Tenenbaum said her organization has not seen the number or intensity of patient complaints described by PES staff. She express optimism about the transfer freeze plan, but said that spending more time waiting in hospital emergency rooms instead of getting psychiatric treatment at a crowded PES may not actually be better for patients’ health.

“I think this plan has a lot of potential,” Tenenbaum told the health committee. “There is a risk of trauma to them for spending time in the emergency room. And for people in crisis that is difficult.”

AHS administrators say some of the overcrowding has eased since June, when they hired privately contracted psychiatrists to screen patients 20 hours a day. The average patient volume at PES has dropped from about 56 in May to 47 in July, according to John George officials.

However, the proposal from AHS leadership on Monday did not include any plans to add more beds to PES, which currently only has 11 beds and about two dozen lounge chairs used for sleeping.

The medical group has also launched a pilot tele-psychiatry program with St. Rose hospital, so patients can be evaluated in its emergency room without transferring to PES. Patients are screened by a psychiatrist over a video link. AHS officials say since the pilot program began the patient volume from St. Rose has decreased by about ten percent.

2 Investigates has been attempting to talk to John George Director Guy Qvistgaard for months, but on Monday he again refused to answer questions about patients sleeping on the floor of PES.

While all parties seem to agree that the mental health problem in Alameda County is complex, nurses and doctors expressed concern that as the cold winter months approached they will only see an increase in the number of patients coming through PES’s doors.

“I think there are a lot of gains made in PES, as the data show,” said Otis. “But we are also heading into what is historically the cold part of the year, and I think we who work there know, often times we have increased volume.”

Supervisor Wilma Chan asked AHS officials to return in six weeks with a plan to address PES’s overcrowding that could be presented to the entire Board of Supervisors.

Alameda Health Systems provided 2 Investigates with the following statement Monday night:

“Today, AHS presented to the Board of Supervisors Health Committee and stakeholders a census management plan designed to maintain patient need as the critical factor in determining staffing and volume at JGPH PES. The plan puts clinical considerations as the top criteria in deciding when to delay transfer of patients from community hospital emergency departments to JGPH PES in order to reduce overcrowding. Because of the complexity of behavioral health needs, particularly in a crisis situation, it’s not clinically appropriate to set an arbitrary cap or use other physical conditions (such as the use of temporary mats) as the signal for delaying transfers.

The introduction of triage physicians has already reduced the daily census below the suggested cap of 50 patients on the vast majority of days for the past several months. The census management plan will further reduce the likelihood of that occurrence and decrease the instances in which the use of temporary mats are required. While the census management plan does not call for the addition of more beds, we are continuing to work with stakeholders toward that long term solution, including construction of a stand alone PES.” 

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