Pennsylvania doctors complain of lack of psychiatric beds and seek solutions

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About 200 doctors across the state are echoing concerns that their Pittsburgh colleagues recently raised about burgeoning psychiatric caseloads -- and they've come up with a proposal for easing the crunch.

The Pennsylvania Medical Society's House of Delegates on Oct. 27 passed a resolution complaining of a shortage of inpatient psychiatric beds and asking the state to implement a computerized tracking system so hospital emergency departments would know in real time where inpatient psychiatric and detoxification beds are available. Maryland has operated such a system, on a limited basis, since last November.

Because of the shortage, patients sometimes wait hours or days in emergency departments waiting for placement, said Michael Turturro, chief of emergency services at UPMC Mercy.

"In the meantime, they're not getting the same type of treatment they would get as an inpatient," said Dr. Turturro, past president of the Pennsylvania chapter of the American College of Emergency Physicians, one of the organizations that raised the issue with the state medical society.

Psychologists, psychiatrists and nurses from this area complained of a bed shortage in "After Mayview," the Pittsburgh Post-Gazette's September series about the state of mental-health services in the region nearly five years after the closure of Mayview State Hospital.

The hospital in South Fayette cared for residents with serious and persistent mental illness, and some healthcare professionals said its closure, combined with state budget cuts to outpatient treatment programs, had strained community hospitals' emergency departments and inpatient psychiatric units.

The loss of other inpatient beds -- through the closure of St. Francis Hospital in Lawrenceville, for example -- is said to have contributed to the crunch. Other officials also blamed cuts to state medical assistance rolls, which may have disrupted residents' outpatient care and forced them to seek help only in emergency rooms.

Doctors in other parts of the state have reported similar problems, according to the medical society.

While resources have decreased, "I don't think anybody's saying the population of people with psychiatric disorders is going down," said Bruce MacLeod, Pennsylvania Medical Society president, medical director of the emergency department at West Penn Hospital and vice chairman of emergency medicine for the Allegheny Health Network.

However, government officials have disputed the notion of a bed shortage.

"There is not a shortage of inpatient psychiatric beds across the state," state Department of Public Welfare spokeswoman Carey Miller said in an email. "There are not waiting lists to receive inpatient psychiatric services, and there are not reported capacity issues. In the event there would be concerns in regard to a shortage of beds, our Office of Mental Health and Substance Abuse programs would address the issue ..."

Allegheny HealthChoices Inc., the Downtown organization that planned Mayview's closure, also has said it has data showing that inpatient beds have been available consistently around the region.

Dr. Turturro said a tracking system would help doctors find those beds. "Ideally, it would be something the state should operate and fund," he said.

Dr. MacLeod said it's too soon to know how much the system would cost, but doesn't believe it would be prohibitive. Part of the present difficulty is the diversity of patient needs, he said, noting the beds available at a given time may be restricted by gender, age or type of illness.

The cost of the Maryland system was not immediately available.

It consists of two databases, one in which emergency departments list the characteristics of patients they're trying to place and another in which inpatient units specify the types of beds available and types of patients they're able to serve, said Richard Alcorta, who helped develop the system as the state medical director of emergency medical services.

In the first three months alone, the system helped place more than 258 patients, the emergency department physician said. He said colleagues have called it a "significant improvement in placement."

The system is voluntary, however, and Dr. Alcorta said fewer than 50 percent of emergency departments and inpatients units are participating so far. The Maryland Hospital Association said participation is modest because the state is still working out kinks in the system and some hospitals still consider it more convenient to make phone calls in search of available beds.


Joe Smydo: jsmydo@post-gazette.com or 412-263-1548.

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