Magazine article Developments in Mental Health Law

Supreme Court of Virginia Holds That the University of Virginia Health Services Foundation Is Not Entitled to Assert Charitable Immunity Doctrine as a Defense to Lawsuits

Magazine article Developments in Mental Health Law

Supreme Court of Virginia Holds That the University of Virginia Health Services Foundation Is Not Entitled to Assert Charitable Immunity Doctrine as a Defense to Lawsuits

Article excerpt

Individuals experiencing acute psychiatric distress often approach the emergency room of a local hospital when they are in need of care, either because they need emergency services or because they lack adequate health care coverage and these are the only services available to them. In addition to delays in accessing emergency room services, which are common for all patients, a survey of emergency department directors released in 2008 by the American College of Emergency Physicians (ACEP) found that such individuals can wait twenty-four hours or longer for an inpatient bed when they are deemed to be in need of hospitalization, principally because of a lack of available psychiatric beds.

Of the 328 emergency department directors who responded to the survey, almost 80% said their hospital "boards" psychiatric patients in the emergency department. "Boarding" is the practice of holding patients who have been determined to be in need of hospitalization in the emergency department while waiting for an inpatient bed to become available. This boarding may include placing the patient in an emergency department hallway, with 60% of the directors stating that their emergency department did not have a dedicated area for psychiatric patients. Thirty percent said their hospital boards psychiatric patients between eight and twenty-four hours, while 10% said patients wait more than a day on average. Nearly 80% said psychiatric patients tend to wait four hours or more, while only 30% of non-psychiatric patients waited that long. The main reasons given for boarding were the lack of in-house inpatient psychiatric beds and no other facility being able or willing to accept transfers of these patients. Only half of the hospitals had psychiatric units, with the number of psychiatric beds in the community dropping 12% in the United States since 2000 (the number of hospital beds overall fell by 4% during this period). Hospitals are reported to be closing their units because of inadequate payments from government and insurers, unpaid costs for the uninsured, and too few psychiatrists willing to work in hospitals.

The principal author of the survey noted that the care of these patients while they are being boarded rarely involves a mental health specialist and the environment of a busy emergency department may exacerbate the symptoms of these patients, often requiring them to be sedated, rather than providing the specific care they need. The President of the ACEP added that "'[b]oarding' is an appalling fact of life in our nation's emergency departments, and too often our most vulnerable patients--psychiatric patients in this instance--bear the biggest burden." She also stated that "[p]eople with psychiatric emergencies have nowhere else to turn, and they are suffering" and that "[a]bout three-quarters of survey respondents agreed that psychiatric patients in the emergency department require more nursing and other resources than non-psychiatric patients." AMERICAN COLLEGE OF EMERGENCY PHYSICIANS, PSYCHIATRIC PATIENTS, INCLUDING CHILDREN, ROUTINELY BOARDED IN EMERGENCY DEPARTMENTS (2008), http://www.acep.org/pressroom.aspx7LinkIden tifier=id&id=39170&fid=1636&Mo=No&acepTit le=Psychiatric%20Patients,%20Including%20 Children,%20Routinely%20Boarded%20In%2 0Emergency%20Departments; Julie Appleby, Mentally Ill Face Extra-Long ER Waits, USA TODAY (June 16, 2008), http://www.usatoday.com/news/health/2008-06-16-ERwaits_N.htm.

In general, the number of people coming to emergency departments continues to increase, with nearly 114 million patient visits in 2003, the highest number ever. At the same time, the overall capacity of emergency departments has decreased, with the number of emergency departments decreasing by 14% since 1993. Because hospital emergency departments are mandated by federal law--the Emergency Medical Treatment and Labor Act--to medically screen and stabilize all patients regardless of their ability to pay, increasing numbers of uninsured or underinsured patients in the United States are going to hospital emergency departments. …

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