Wash. court: Hos­pi­tals can’t board psych pa­tients in the ED

Modern Healthcare - - REGIONAL NEWS - —Beth Kutscher

Start­ing this week, hos­pi­tals in Wash­ing­ton state will be pro­hib­ited from board­ing psy­chi­atric pa­tients in emer­gency de­part­ments while they wait for in­pa­tient beds to open up. The change comes as a re­sult of a state Supreme Court rul­ing.

The prac­tice of hold­ing acutely ill psy­chi­atric pa­tients in EDs—some­times in hall­ways and makeshift hold­ing ar­eas— has reached cri­sis lev­els in hos­pi­tals na­tion­wide as in­pa­tient psy­chi­atric beds have dis­ap­peared. A 2012 sur­vey from the Na­tional As­so­ci­a­tion of State Men­tal Health Pro­gram Di­rec­tors found that 10% of hos­pi­tals are board­ing psy­chi­atric pa­tients for sev­eral weeks.

In an Aug. 7 de­ci­sion, the Wash­ing­ton Supreme Court ruled that the state’s in­vol­un­tary treat­ment act “does not au­tho­rize psy­chi­atric board­ing as a method to avoid over­crowd­ing cer­ti­fied eval­u­a­tion and treat­ment cen­ters.” Gov. Jay Inslee de­layed im­ple­men­ta­tion of the rul­ing un­til Aug. 27.

In 2013, 10 de­tained psy­chi­atric pa­tients in Pierce County sued to block a pe­ti­tion that would have al­lowed the county to hold them for 14 ad­di­tional days. The pa­tients had been boarded in EDs or acute-care hos­pi­tals that were not cer­ti­fied as psy­chi­atric eval­u­a­tion and treat­ment cen­ters.

A trial judge ruled that the pe­ti­tion was un­law­ful, and the Supreme Court, while ac­knowl­edg­ing that the sys­tem is “reg­u­larly over­whelmed,” agreed that pa­tients who are in­vol­un­tar­ily com­mit­ted have the right to be placed in a cen­ter cer­ti­fied for that pur­pose.

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