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from Kristen HuangCalMatters
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The California Department of Public Health has delayed emergency staffing rules for psychiatric hospitals after significant outcry from hospitals, nurses, law enforcement and lawmakers.
The proposed rules, which would increase the required number of health workers on staff, were set to go into effect on Jan. 31, roughly a month after the department first published them.
Instead, the department said in a letter to health care facilities that the rules will come into effect on June 1.
Emergency rules derive from a San Francisco Chronicle investigation which links incidents of physical assault, sexual abuse and death to low staffing levels in for-profit psychiatric hospitals. The investigation revealed a loophole in state regulations that allows acute care psychiatric hospitals to employ less staff than general hospitals.
Emergency psychiatric hospitals treat people—sometimes involuntarily—who are experiencing mental health crises and who pose an immediate threat to themselves or others.
The proposed rules would require acute care psychiatric hospitals to have at all times at least one licensed nurse for every six adult patients or one licensed nurse for every five pediatric patients. The Department of Health will also fine hospitals $15,000 to $30,000 for each day they are out of compliance.
But hospitals, law enforcement organizations and behavioral health groups say the state’s aggressive enforcement schedule will inadvertently lead to the closing of dozens, if not hundreds, of psychiatric beds across the state.
Carmella Coyle, president and CEO of the California Hospital Association, said the four-month delay “prevents an immediate crisis in the availability of psychiatric inpatient care in California,” but still leaves the system vulnerable to closure.
The hospital association previously estimated that more than 800 acute care psychiatric beds would be closed on Saturday if the state did not delay implementation and give facilities enough time to hire more staff.
The delay gives hospitals some time to prepare, but falls short of the one-year phase-in period that many facilities wanted.
Le Ondra Clark Harvey, CEO of the California Behavioral Health Association, said the emergency regulations do not account for behavioral workforce shortage plaguing California for years.
Over the next five years, the state Department of Health Access and Information projects that all 58 counties in California will face a shortage of behavioral health professionals. State prisons, state hospitals and developmental centers also face challenges continued difficulties in recruiting sufficient behavioral health personnelin part due to labor force trends.
Clark Harvey said the regulations should protect patients and preserve access to existing behavioral health services. “We don’t need rules that risk worsening an already very, very fragile system,” she said.
When no psychiatric beds are available, patients stay in emergency rooms, leading to a backlog, said Jesse Tamplen, executive administrator for behavioral health at John Muir Health.
John Muir Health, a nonprofit health system in the Bay Area, operates approximately 10 percent of all pediatric psychiatric beds in the state and sees patients routinely from San Diego and as far away as Oregon. The hospital will need to hire about 30 more nurses by June. If it cannot, it will have to reduce the number of available inpatient psychiatric beds.
“I support CDPH creating rules to improve safety and quality. That’s not a question,” Tamplen said. “Our regulators are there to support safety and quality. My concern is the speed and potential for unintended consequences.”
The California Nurses Association, which helped pass the state’s first hospital staffing requirements in 1999, took a different issue with the state’s proposed regulations. The proposed rules allow emergency psychiatric hospitals to include licensed professional nurses and psychiatric technicians in their staffing ratio. The Nurses Association, which represents more than 100,000 nurses in the state, has argued that only registered nurses should qualify.
“The state offers a lower staffing standard for psychiatric emergency hospitals than for general emergency hospitals, and this is unacceptable to the nurses of the California Nurses Association,” the group said in statement.
This article was originally published on CalMatters and is republished under Creative Commons Attribution-NonCommercial-No Derivatives license.