Involuntary detentions tax county

Kootenai County officials say the county can’t afford to continue housing people who are high on drugs and alcohol at Kootenai Medical Center until those people sober up and receive a mental health evaluation.

In fiscal year 2006, the county had to scrape up an extra $223,000 – more than double what was budgeted – to pay for involuntary mental holds. These are the people whom law enforcement brings to the emergency room for observation for fear they will harm themselves or others.

The total county bill was $423,400 – just a portion of the true cost. KMC charges the county 81 percent, or the Medicaid rate, of the actual cost and over the years has written off hundreds of thousands of dollars to help the county deal with the always growing expense.

Yet cost is only one issue. The other major concern is that KMC doesn’t always have room to hold these people, who are often belligerent and violent.

That’s why the county, law enforcement and KMC are working to find money, likely grants, for a new 24-hour observation facility. It’s a less expensive alternative to the hospital.

Officials envision it as a first stop, a place where mental health workers could sift out those who need hospital services from those who just need a safe place to sober up, all without racking up hospital costs.

Commissioner Rick Currie, who is expected to become the new commission chairman in January, sees it as a priority for 2007.

“It’s something I would like to put on the front burner,” Currie said. “We’ve been trying to get this for a long time.”

So far in 2006, KMC has housed 275 people who were taken to the emergency room by law enforcement. Of those people, 129 were discharged the next day after they sobered up and no longer showed potential of hurting themselves or others.

“There’s a lot of wasted dollars and charges on those individuals who don’t need to be in a hospital or mental health unit,” said Carmen Brochu, KMC’s vice president for patient care services.

County Finance Director David McDowell said it’s difficult to extrapolate what portion of the $423,400 bill was for the 129 patients who left KMC after sobering up. The patients don’t normally pay any of the bill unless they have insurance. Brochu said that’s rare.

“Those people do not belong in the hospital, but the law says we cannot put them in jail,” Sheriff Rocky Watson said. “We are going to solve this problem. We just don’t know how yet.”

This is how officials see the proposed observation facility working: Law enforcement officers would bring the involuntary mental hold to the observation facility. The next day, a mental health worker would examine the person and determine whether they need hospital treatment or if they can go home.

The people who need additional monitoring and mental health services would go to KMC.

Brochu said it’s a way to save the county money and ensure that people are getting appropriate treatment.

A couple of times a week, KMC is full and unable to admit more involuntary mental hold patients.

It’s been a problem since about 1992 when the Idaho Legislature passed a law prohibiting law enforcement officers from putting patients with possible mental illness in jail if they had committed no crime, she said.

It’s difficult for KMC to calculate how much it actually costs per day to keep an involuntary hold patient, Brochu said. She estimates the cost at about $635 per day. The county pays 81 percent, or about $514. Of the 275 people taken to KMC so far this year, 62 patients stayed at the hospital one or two days, until they were determined safe to discharge by a mental health worker.

Fifty-one patients were deemed mentally ill. In those cases, Brochu said, a judge comes to the hospital to conduct a commitment hearing to determine whether the patient should go to the state mental institution.

KMC also takes involuntary mental holds for the other four North Idaho counties, which also would have access to the proposed observation facility.

Boundary, Bonner, Benewah and Shoshone counties combined brought 31 patients to KMC this year. All of those were committed to the state mental institution.

Brochu said that’s because these counties are much more selective on whom they transport to KMC.

The county commission recently directed the county grant writer to put together a need proposal. Brochu said other communities, including Ada County and Spokane, have similar observation facilities.

“There is no easy answer,” she said. “We’re just barely getting to the drawing board.”