Concerns about our Crisis Triage Center

Experienced registered nurses fear that the Crisis Triage Center is so badly run it could really harm someone and harm Doña Ana County.

It’s run by RI, specifically by Karina Diaz, a certified art therapist/psychotherapist who is not a nurse. Pre-opening, one source said Diaz “kept firing employees, amazing human beings,” including Freddy Hernandez, a highly experienced nurse whom the source called “a ray of sunshine.” RI says it did not fire Hernandez, a temp, and that it has fired no CTC staff nurse.

When contacted, Hernandez calmly discussed his experience at CTC, adding he’d wanted to contact Jamie Michael because he doubted she was aware of the depth of the problem. He’d been on committees trying to make CTC happen, and was “extremely disappointed,” particularly after that long community effort. He said Diaz lacked experience with such a facility. “She didn’t know what to order, when to order, or how things should go,” but micromanaged people anyway. “She’d sneak up on us and say, ‘Why are you talking?’ and you had to ask for permission to go to the bathroom.” He warned her, “You’ll lose your nurses. You have to treat them like adults.” Psychiatric nurses are scarce. Asked if I could use his name, Hernandez replied, “Of course. It’s very important that the County know about this.”

Another nurse who joined (then left) CTC early said that Diaz was so unkind to nurses that after one incident, another employee asked, “Why is she always after you guys?”

Another nurse said, “I’m scared for our County. They’re going to wind up having some dire thing happen. We need the CTC, but we don’t need it under this woman’s reign,” adding, “the County thinks it’s going all wonderful ‘cause that’s what Karina is reporting.”

More recently, experienced RN Pamela Field, who’s pretty well-known locally, worked with CTC. She called it “dangerously mismanaged,” and “a gross waste of taxpayers’ money. There are few “guests.” One source said most guests are either developmentally disabled persons whom “the home brings in after they’ve had a fit, mostly to give the home’s staff a break from dealing with them,” or homeless folks. “It’s a safe place. They get their clothes washed and move on.” (A few are having psychotic breaks, and belong there.)

Diaz reportedly insists on admitting people whose safety requires they go into the hospital. Field said CTC tries to detox alcoholics with very high alcohol levels, without medications. That’s a serious medical situation, not merely a psychological one, and potentially dangerous, particularly without meds immediately available. CTC lacks med, but tries anyway; and some of the necessary meds aren’t easy to procure. Field said Diaz was “not qualified to be overseeing nurses. She shouldn’t be directing nurses’ discussions, or dealing with controlled drugs.” Field ultimately declined a shift because she couldn’t ethically try to detox someone with a high blood alcohol level, without meds. RI says it operates ethically and will soon apply for a license permitting storage of controlled drugs.

One man reportedly presented with congestive heart failure and serious fluid overload, and anxiety. Diaz reportedly advocated admitting him, to treat anxiety, though his situation was medically dangerous and the CTC had neither an EKG machine nor meds to treat fluid overload. (RI disagrees with this account.)

This is what I’m hearing from extremely qualified nurses who want county management and citizens to hear the truth. We should listen.

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[The above column appeared this morning, Sunday, 3 October 2021, in the Las Cruces Sun-News, as well as on the newspaper's website and KRWG's website. A related radio commentary will air during the week on KRWG (90.7 FM) and KTAL-LP. (101.5 FM – http://www.lccommunityradio.org/), and will presently be available on demand on KRWG’s site.]

[First, let me clarify that the two RNs named in the story were not the only RN’s with whom I spoke, and that not every source was an RN.]

[Second, this is not about RI International’s basic mission of providing crisis services to anyone, anywhere, anytime, or about the use of peer counselors with “lived experience” in helping people who are addicted to substances. Peer counselors can be essential.  Nurses I spoke with didn’t disagree with the principle; but they were concerned about aspects of the implementation, including the tough line-drawing required between helping everyone and ensuring urgent medical needs are met. RI says that “a licensed MD Psychiatrist” who I believe operates by telehealth, from out-of-state, “oversees all the medical decision making for the CTC.” An off-site RN Site Director from another location also consults when necessary; and it’s my understanding that they ultimately overruled Diaz with regard to treating the person mentioned in the column who was suffering from congested heart failure. RI stated, “There is incorrect information about the guest who visited the CTC with congestive heart failure,” but noted that RI would not discuss “any services provided to any guest that could contain identifying and protected health information.”]

[Finally, I hope RI International and county management treat this as helpful criticism.  The people I spoke with are well-regarded nurses with no problem finding other employment.  By RI's account, none were fired.  Nor is is necessarily pleasant to speak out about these things.]   

 

Meanwhile, butterflies have visited the Maximilian sunflowers a whole lot, the last few days:

 

 

 

 

 

and someone slept through the whole show: