Sunday, April 13, 2014

Officials and Mental-Health Advocates Query Hospital's Plans

Not everyone's admitting that there was a quick and decisive battle between Memorial Medical Center (MMC), and the City, the County, and some concerned citizens.

According to several sources, MMC closed its psych ward and sought to reject at least one mentally troubled individual whom police brought in for evaluation. Police, following normal procedure by taking the fellow to MMC, declined to take no for an answer.

Tuesday, MMC Marketing Director Mandy Leatherwood completely denied that the hospital had closed the unit, tried to close it, or told anyone it was being closed; that the hospital had refused or tried to refuse anyone service; and that nurses had been transferred from the psych ward.

But non-hospital sources say MMC advised the police April 1 that the psych services were ending. On that date MMC's contract with psychiatrist Dr. Ernest Flores expired. Flores had been overseeing the ward. The two sides have different views on why a new contract could not be worked out.

Mental health advocates were livid. One said the closure made no sense, because even without Dr. Ernest Flores there were other options: Mesilla Valley Hospital, which specializes in mental health, could have done the work under a temporary contract; or UNM or Las Vegas could have sent a team down here temporarily.

Ron Gurley said that the folks leasing the hospital had never wanted the obligation to deal with mental health problems, had tried at the last-minute to get that requirement removed from the lease, and might now be looking for a way out. “To use a basketball analogy, we need to keep a full-court press on them,” he remarked, adding that there were additional “curmudgeons standing by.”

“I see this as a public health, public safety catastrophe waiting to happen,” County Commissioner Wayne Hancock commented, adding that “this calls for us to get this crisis triage center up and running quicker than we ever anticipated.”

What apparently happened (despite MMC's refusal to talk about it) is that when the Flores contract expired, with no replacement for him, MMC transferred some staff and tried to avoid performing mental health assessments or treatment. Reportedly police brought one unidentified psychotic individual to the E.R., as usual, but the E.R. doctor initially refused to take him. The police didn't back down. The E.R. doctor did, and the patient was assessed and shipped to Mesilla Valley Hospital.

City and County lawyers huddled over the lease and pointed out that it was questionable whether MMC could close the facility at all, and that it was absolutely clear MMC had to give 30-days' notice if it wanted to try.

Both City Manager Robert Garza and County Manager Julia Brown reportedly urged MMC to back off on the closure. One public official says that their message to MMC was, “You guys can't do that” and added, “It's explicit in the lease that MMC will continue to provide mental health services.”

Under that pressure, MMC backed off and conceded its obligation. (One source said that the concession occurred on Friday afternoon.) MMC is reportedly negotiating a contract with Mesilla Valley.

I asked Garza why MMC couldn't have prepared a contingency plan involving Mesilla Valley, or even a temporary team from UNM or Las Vegas. He said that MMC had told him it was surprised by the failure to come to an agreement, and had thought it had a reasonable solution with Dr. Flores. When I called Flores, he was reluctant to discuss the negotiations but said that he and another doctor had provided what they thought was a reasonable proposal, giving MMC two months' notice plus another two weeks, and was surprised when there was no counter proposal. He also said he'd suggested a deal with Mesilla Valley as a solution.

One official said that although service was cut off, MMC was not just turning people away without assessing them. The hospital was essentially referring potential psych patients to Mesilla Valley Hospital – e.g., telling the apparently mentally ill person s/he should go there and where it was – and that “We're telling them that's not enough.”

Although MMC says nothing notable happened, the incident raises a number of questions.

Are critics correct that MMC is looking for an excuse to get out of the commitment to provide psych services under its lease? (Psych services are notably not as profitable as, say, cardiac services.) Are they also right that MMC is in trouble, and those who run it may be looking for someone to sublet or assign their lease?

At a minimum, the incident reminds folks like me, who remember the Hospital from before it moved up to Telshor, that what was a hospital is, as one of its executives used to say, “a quasi-public hospital,” and that the emphasis has moved to the word “quasi.” Public officials tended to be candid and forthcoming about this incident. The quasi-public MMC reminded us it's there to make a profit, not primarily to serve.
[The above column appeared this morning in the Las Cruces Sun-News. ]
[ Meanwhile, it was a busy week, in ways related to a couple of past and future columns.
On Tuesday, county voters resoundingly defeated a proposal for a tax to fund the
Doña Ana Soil & Water Conservation District.  An earlier column had advocated just that result; but we learned during the discussion how valuable an entity a soil & water conservation district could be if it were actually dedicated to thoughtful and imaginative steps toward conservation.  A future column, perhaps next week, will discuss what I think we learned -- and express my resolve to learn more than I now know about the subject.  Simply patting ourselves on the back over this vote, and forgetting again that soil and conservation districts exist, would be wrong.
On Thursday we had to complete our correspondence to the Extra-Territorial Zoning Commission regarding the proposal to zone the area right beneath Tortugas Mountain commercial -- despite the inappropriateness and possible illegality of such zoning.  The mountain has cultural and religious significance and is used by two different tribes from Tortugas for pilgrimages, and the recreation center there is incredibly well-used by hikers, bikers, and picnickers who don't want to be looking down at a nearby McDonald's or Sonic.  There are no similarly-zoned parcels adjacent to this one; the school is quietly not very happy about potential fast-food eateries nearby, the New Mexico Farm and Ranch Heritage Museum would prefer the land not be used for activities that disturb its animals or detract from the attractiveness of the museum to visitors, neighbors don't want the noise or excess traffic and lights, and that extra traffic could even pose not just delays but dangers, with students speeding to and from the high school.   The ETZ will meet on this next Thursday at 6 at the County Commission Chambers at 845 Motel Blvd.  Public input is part of the procedure.
Thursday night, Brad Lancaster spoke.  The event exceeded our fondest hopes.  Brad gave a great talk -- insightful yet fun -- and we were delighted that so many local citizens (and folks from El Paso and Silver City) cared enough to spend the evening hearing about water harvesting, compost, and other practical and sometimes creative ways to make the best use of what we have.   Credit City Councilors (including Miguel Silva and Gill Sorg) for helping arrange the venue, Brad for reducing his usual fee, Jeff Anderson and the Master Gardeners for coming up with the money to pay that reduced fee, and my wife, Dael, for indefatigable efforts both to get the word out and to help arm Brad with specific local facts about our county's climate, rainfall, water usage, and the like.  People who attended walked away inspired and grateful.  I was glad to have been able to help make it happen.]

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