Special Report: Emergency Rooms in Crisis - WCAX.COM Local Vermont News, Weather and Sports-

Special Report: Emergency Rooms in Crisis

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Hospitals across Vermont tell us they are in the midst of a crisis.  Investigative reporter Jennifer Costa found out  their troubles may affect the quality of care you get when you're having a medical emergency.

The problem boils down to bed space. Emergency departments across the state say they are running out of room to treat patients because more and more beds are being claimed by mentally ill patients that come into the ER and get stuck there. This dangerous back-up is something WCAX reported two years ago. We wanted to know if a new administration is any closer to finding a fix it before something goes terribly wrong.

Why are doctors and nurses at Vermont's busiest emergency department quitting? "Things can get pretty gnarly," said Dr. Peter Weimersheimer, UVM's Emergency Director. "They just said, 'I can't do this anymore.'"

These troubles are linked to a long term problem -- overcrowding in emergency departments. "It can't become the new norm. This is really inhumane management of patients," said Dr. Weimersheimer in 2015.  Back then he said the system would crumble if the state didn't fix it. 

WCAX found that on any given day 30 seriously ill psychiatric patients are dumped in emergency departments across the state. That's three times more people now than two years ago. These patients are suffering. Vermont's hospitals are not contracted to take them, and the state has no where else for them to go. "Nobody perceives this as correct," Dr. Weimersheimer said.

Hospitals have to figure out how to care for just as many patients coming in with broken legs and belly pain, with a fraction of the space, Dr. Weimersheimer said.  UVM says it's not unusual to close 1/3 of its emergency department for these mentally ill patients. That's 14 beds they can't use for every day patients having an emergency. "Grandma may be sitting in the waiting room for hours," Dr. Weimersheimer said.

Doctors say it's been going on for too long and they're worried someone might die. "Someone who gets a delay in diagnosis, who has a missed diagnosis -- we are fearful of someone who has a cardiac arrest while they're waiting to get seen," Dr. Weimersheimer said.

After the WCAX report in 2015, the state promised to clean up these dangerous bottlenecks. "Our care managers are working with the emergency departments everyday," said Vt. Mental Health Deputy Commissioner Frank Reed in 2015.

Some things have gotten better. The 25-bed Vermont Psychiatric Care Hospital, built to replace the run-down Waterbury facility, was rarely full due to staffing shortages and design flaws. Updated census reports now show the hospital has been at capacity for the last year. In Middlesex the state opened a locked, step-down facility -- just as promised, and 52 lower level psych beds have been added across the state. But even with 20-percent more bed space than ever before, patients are still waiting. 

Reporter Jennifer Costa: Is the system working well? 

Melissa Bailey: I wouldn't claim that the system is working well. I also wouldn't say that it's not working at all.

Melissa Bailey inherited this mess from the prior administration. Six weeks into her new job as Vermont's Mental Health Commissioner she says she's faced with more Vermonters suffering from mental illness and she doesn't know why. "I think it's a combination of factors that are contributing to what we're seeing right now," she said.

Wait times doubled after a Supreme Court decision in May that holds mental health workers liable if they don't disclose how dangerous a patient may be. Mental health officials say it's making providers reluctant to discharge. 
Bailey also points to high staff turnover and 400 jobs vacancies at the mental health centers where these patients would go if they were discharged. "Not having the staff on community level to receive people out of inpatient is another factor that's contributing to the clog and flow of the system," she said.

Back in the UVM Emergency Department Dr. Weimersheimer admits there's been a real reluctance on the part of the hospitals to accept this as the new norm.  The hospitals didn't want to build extra beds. They didn't want to do anything in general because they felt that was abrogating the state's responsibility," Dr. Weimersheimer said.

In the short term UVM Medical Center is putting triage staff in its waiting room to determine who needs immediate care and who will wait. Long term it's planning to redesign its entire emergency department so psych patients are completely separated from other patients -- there's no word on how much that will cost.

State Officials say they are now meeting regularly with the hospitals and mental health providers to come up with concrete solutions to fix the flow. 

Related Stories:

The Waiting Game, Part 1   

The Waiting Game, Part 2  

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