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Tri-City Postpones Suspension Of North County Inpatient Psychiatric Unit

Tri-City administrators hear public testimony on their decision to suspend operations at the inpatient psychiatric units, August 21, 2018.
Alison St John
Tri-City administrators hear public testimony on their decision to suspend operations at the inpatient psychiatric units, August 21, 2018.

Tri-City Healthcare's board of directors has confirmed its decision to suspend inpatient services for people facing a mental health crisis.

At a packed board meeting this week, the board heard three hours of testimony before voting to suspend operations indefinitely at their Behavioral Health Unit in October.

Sheriff’s Deputy Dave Schaller said the whole region will be affected by the closure of Tri-City’s inpatient beds.


“We’re already seeing an increase in the calls for mental health-related services and now we’re seeing a reduction in options as far as where to take people to get help in these emergencies,” he said. “This is a ripple that will affect countywide.”

County Supervisors Kristin Gaspar and Bill Horn, along with several North County mayors, signed a letter asking the board to keep the unit operating until the end of the year, to give the region time to adjust.

But board members said no viable solutions have emerged since its unexpected vote in June to suspend operations. The board cited inadequate reimbursement rates for psychiatric services, costly facilities upgrades required by the federal government and a shortage of qualified psychiatrists.

Labor groups representing about 80 workers who received layoff notices said the board’s June vote violated the Brown Act and did not give the public enough time for input. The board agreed to a second hearing this week.

Residents, elected officials from Oceanside and Vista along with law enforcement officers showed up at the Tri-City hearing and asked the board to find a way to keep the units open.


Oceanside City Councilman Jerry Kern said the closure will affect North County law enforcement.

“The sheriff’s department out of Vista and Encinitas, the police department in Carlsbad and Oceanside — it’s going to take an officer out of service to transport these patients down to Rosecrans instead of taking them to Tri-City,” Kern said. “We’re going to take them out of the area, so we’ll lose an officer for several hours depending on traffic, so I’m very concerned about this.”

Police Capt. Ray Sweeney said the number of detentions of people experiencing severe mental health crises is increasing. He quoted statistics showing 3,142 detentions — known as “5150s” — requiring crisis intervention and inpatient care in Oceanside, Vista, Carlsbad, Solana Beach and Encinitas in 2016.

In 2017 that number grew to 3,569.

Psychiatric nurse Jenny Hall said the number of people they can treat in the psychiatric inpatient units is already limited by a lack of around-the-clock doctors and psychiatrists. Tri-City’s strategy of expanding outpatient services won’t work, she said.

“The patients who are eligible for outpatient care are not the patients we see on an inpatient basis,” she said. “The community is going to be overwhelmed by the amount of people that are needing professional help, and taking the police officers and firefighters off the streets for hours and hours at the time is unacceptable.”

The California Nurses Association said it will picket the hospital on Thursday from 6 p.m. to 8 p.m. to “alert the public to this potential public health crisis, and to demand action from Tri-City Medical Center.”

Dr. Cary Mells, an emergency room physician, said trying to deal with the growing mental health challenge is affecting Tri-City’s ability to deal with other health issues in the community. He thanked the board for taking the action to protect the hospital.

Board Chair Jim Dagostino said the healthcare district staff, “will not risk closure by thumbing their nose” at new federal upgrade requirements, which are estimated to cost almost $8 million. He said the Behavioural Health Unit was losing between $4 million and $5 million a year, and that hopes things would improve under a partnership with UCSD have not materialized.

The district has tried to float bonds in the community three times to pay for federally-mandated seismic retrofits and failed to get the necessary community support. Dagostino said the bottom line is that the hospital is relying on a loan from HUD to help pay for earthquake retrofits. Without that, he said, “This hospital will go the way of Fallbrook and San Clemente.”

Fallbrook's hospital stopped admitting patients in 2014. San Clemente’s hospital and emergency room closed in 2016.

“To reconsider this vote," Dagostino said, “we must see tangible solutions. Hope and promise is not an option “

In their letter to the Tri-City board, supervisors Gaspar and Horn said a conference is scheduled for Oct. 30 “to present comprehensive assessment of the state of inpatient psychiatric care in San Diego County and provide recommendations for addressing this crisis from both an immediate and long-term approach."

Tri-City Postpones Suspension Of North County Inpatient Psychiatric Unit
Tri-City Healthcare’s board of directors confirmed its decision to suspend inpatient services for those facing mental health crises.

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