SF General reduces psychiatric care

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A 22-bed psychiatric unit at San Francisco General Hospital will be taken out of service, and re-opened only if the facility experiences a high caseload of patients exhibiting the worst signs of psychiatric crisis, the Bay Guardian has learned.

As of Nov. 19, five patients were receiving care in that unit, 7B, according to spokesperson Rachael Kagan. None had symptoms that rose to the level of requiring acute care. Instead, they were classified as sub-acute patients, a distinction that essentially means they didn’t present an immediate threat to themselves or others.

But under a new policy that will take effect after they have been released, all 22 beds in 7B will be closed – unless they are needed for acute patients who do reach that critical threshold. The unit will be staffed only if patients can’t be accommodated in the hospital’s other acute psych unit, which has 21 beds.

The decision was made in response to a changing financial picture under federal health care reform, Kagan explained.

“There is a big push … to ensure hospitals are only providing acute care,” Kagan said, and this trend is driving efforts to reduce sub-acute patients. “It fiscally makes more sense,” she added, because insurers pay higher rates for acute care than for lower levels of treatment.

Yet some hospital staff members are nervous about the implications of this shift, because it means fewer patients will be able to access psychiatric care at SF General until they represent a danger to themselves and/or the general public – at a time when demand for these services is on the rise.

“To us, it’s a matter of priority for the city,” said Brenda Barros, an employee at SF General who is active with hospital union SEIU 1021. “Do you want to take care of these people, or don’t you?” 

Some staff members are doubtful that 7B will reopen. An internal SF General memo issued Nov. 18 informed 7B staff: “Our census will be gradually reduced until we won’t have any more patients. Then 7B will be closed.” The memo added, “this came from [SF General CEO] Sue Currin due to budgetary constraints.”

However, a second internal memo went out the following day, to “clarify” the first one. In that message, Nursing Director Kathy Ballou wrote: “We are not closing psych beds or any beds.” Instead, beds in 7B would be closed unless “we get acute patients needing that level of care,” she wrote. “As in other hospitals, we are accountable to our operating budget.”

Further complicating matters, said Barros, is that patients can fluctuate rapidly between needing acute care and a lower level of attention. “They absolutely can swing back and forth.” She added that patients initially requiring a lower level of care could experience worsening conditions if they're unable to secure an appointment in time to get help, and delays are very common.

Kagan emphasized that the unit wasn’t being closed down, but did confirm that sub-acute patients would no longer be able to receive treatment in 7B. Instead, those patients will be placed with various service providers throughout the city, she said. “The goal is to move the patients to their appropriate placement.”

Meanwhile, this shift coincides with an overall rise in citywide demand for psychiatric services. According to a report delivered to the Police Commission earlier this year, SF General had 6,293 patient admissions for psychiatric holds in 2012, a sharp increase from 5,837 in 2009.

While there were deep cuts to the city’s Department of Public Health during the economic downturn, Mayor Ed Lee has recently trumpeted a boost to city coffers thanks to growing economic activity. But if the city's financial health has improved, it seems odd that its flagship safety-net hospital would be put into the position of reducing psych care due to budgetary pressures when that kind of care is sorely needed.

For Barros, it's a matter of whether or not city officials will decide to allocate more funding for mental health services. “If they don’t have enough money in Public Health,” she said, “then they need to put more into Public Health.”

Comments

responsibility for treating these folks to different providers now that the patients will be compelled to carry insurance.

Presumably the city has known this for some time. Expect more of the same.

Posted by Guest on Nov. 21, 2013 @ 3:45 pm

"rationalization" - dumping a million Californians from their health care plans, followed by dumping another ten million Californians from their health care plans, once the employer mandate kicks in...

Posted by racer さ on Nov. 21, 2013 @ 5:08 pm

I don't want to say I told you so, but I told you so.

Posted by Guest on Nov. 21, 2013 @ 5:32 pm

If you like your psychiatric unit, you can keep your psychiatric unit! Period!

Posted by racer さ on Nov. 21, 2013 @ 5:10 pm

Obamacare is a suicide pact that the Democrat Party made with itself.

Posted by marcos on Nov. 21, 2013 @ 8:44 pm

Marcos is talking sense. Has hell frozen over?

Posted by Super Patriot on Nov. 22, 2013 @ 7:22 am

While the Republicans watch with smug glee, and rub their hands at the prospect of taking back the Senate in 2014.

Posted by Guest on Nov. 22, 2013 @ 7:28 am

And with Reid paving the way with the nuclear option for the Republican, who have not forgotten how to play for keeps, to run the table if the take the Senate, who can deny that the two party game is One Big Sham.

Posted by marcos on Nov. 22, 2013 @ 8:15 am

Jason Grant Garza here ,,, ha,ha,ha ... NO MORE HUMANITY ... NO MORE CIVILIZATION ... SF General is already GUILTY of Patient Dumping and not providing EMERGENCY PYSCH services ... http://myownprivateguantanamo.com/settle1.html and San Francisco Department of Public Health is already breaking medical law by NOT providing services and then on top CRIMINAL FRAUD ....http://www.youtube.com/watch?v=7cP3jCmJFRo&list=TLvtCn2SsSYhOh3GqJnFmtzFKRszIkHrCr

And the Sheriff and SFPD DO NOT arrest for medical law violations (see youtube videos) ... so here is just another way of screwing the people most needy who can NOT have legal representation.

Go ahead take them out back and put them out of "YOUR" misery and let the ILLUSION of COMPASSION, HUMANITY and CIVILITY continue ... and if they ask and point out too many contradictions to YOUR "REALITY and TRUTH" you can always ILLEGALLY and FALSELY 5150 them http://www.youtube.com/watch?v=-XzuUtR-7hQ and http://www.youtube.com/watch?v=AJlOgdW5QHk . And as the doctor told me at the illegal 5150 ... they know the police do this all the time ... and when I asked the doctor what she planned to do about these false and harmful illegal 5150's ... she said it was NOT her job. So no fix, continued ILLUSION and HARM. I reminded the doctor who took an oath to DO NO HARM how having this knowledge and NOT acting on it was helping her patients or complying with the second part of the oath ... to keep from INJUSTICE ... NO RESPONSE. So just more abuse, more illegalities and more damage YET YOU expect this NOT to have an effect ... how clever and INHUMANE.

Here's an article that explains just how much SF cares ... http://www.sfbg.com/2007/06/27/crazy where the byline is This is nuts: A bizarre tale of the insanity that is SF's mental health system written in 2007 ... it is 2013 and what has changed?

Keep DRINKING the KOOL0-AID

Posted by Jason Grant Garza on Nov. 22, 2013 @ 7:43 am

do NOT pay attention to chromefields and his/her uncomfortable slur. He/she must be very uncomfortable hearing the unadulterated truth from some one who has been there, had that done to them. and lived to tell about it.

you or I could walk the S.F. streets ,one night, and fill sll those untaken beds. you perhsps faster than I. I would know where to look in my town, seattle. you and I could easily do it. any one not turning away could do it in 30 minutes if they were already standing in the right streets.

that truth embarases many who read how broken the system is. they cant face what is reality for those who are near what is euphemistically called a "crack" in the system. its a CHASM!!. its the Grand Canyon!!!. and knowing this exists and nothing is being done embarasses some. of course some only say so what? not vgmexmy problem. not on my tax dime.

Posted by waltinseattle on Nov. 22, 2013 @ 10:59 pm

do NOT pay attention to chromefields and his/her uncomfortable slur. He/she must be very uncomfortable hearing the unadulterated truth from some one who has been there, had that done to them. and lived to tell about it.

you or I could walk the S.F. streets ,one night, and fill sll those untaken beds. you perhsps faster than I. I would know where to look in my town, seattle. you and I could easily do it. any one not turning away could do it in 30 minutes if they were already standing in the right streets.

that truth embarases many who read how broken the system is. they cant face what is reality for those who are near what is euphemistically called a "crack" in the system. its a CHASM!!. its the Grand Canyon!!!. and knowing this exists and nothing is being done embarasses some. of course some only say so what? not vgmexmy problem. not on my tax dime.

Posted by waltinseattle on Nov. 22, 2013 @ 11:12 pm

do NOT pay attention to chromefields and his/her uncomfortable slur. He/she must be very uncomfortable hearing the unadulterated truth from some one who has been there, had that done to them. and lived to tell about it.

you or I could walk the S.F. streets ,one night, and fill sll those untaken beds. you perhsps faster than I. I would know where to look in my town, seattle. you and I could easily do it. any one not turning away could do it in 30 minutes if they were already standing in the right streets.

that truth embarases many who read how broken the system is. they cant face what is reality for those who are near what is euphemistically called a "crack" in the system. its a CHASM!!. its the Grand Canyon!!!. and knowing this exists and nothing is being done embarasses some. of course some only say so what? not my problem. not on my tax dime.

Posted by waltinseattle on Nov. 22, 2013 @ 11:12 pm

For adding to the crazy, and for posting the same message 3 times. You and JGG should go in on a time-share somewhere warm. Just make sure you check the foundation for cracks...I mean chasms...no, make that Grand Canyons....

Posted by Chromefields on Nov. 25, 2013 @ 8:34 am

Actually, JGG, they're keeping one bed open just for you. Bring your camera, your internet machine, and a change of clothes.

Posted by Chromefields on Nov. 22, 2013 @ 10:15 am

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