Sunday, November 19, 2017
Health

Finding a place for Hernando County's youngest Baker Act patients

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BROOKSVILLE — One day earlier this month, a Hernando sheriff's deputy approached a boy in the quad area of a local middle school campus.

School administrators had called authorities because the boy was acting unruly and had written on a piece of paper that he hated himself and wanted to die, according to a report the deputy would file later. The boy told the deputy he was sick of taking medications and that he would kill himself.

"(He) stated he is a danger and 'can't even trust himself,' " the deputy wrote.

Before Feb. 1, the deputy would have taken the boy to the Harbor, a mental health center just west of the Suncoast Parkway on Grove Road. But the Harbor has closed its 10-bed crisis stabilization unit for patients taken into custody for their protection under a state law known as the Baker Act. So the deputy drove the boy to nearby Springbrook Hospital, a 66-bed psychiatric hospital for adults that is now the only remaining Hernando County mental health facility that accepts Baker Act patients.

When BayCare Health System officials announced they would close the Harbor's crisis unit in order to focus on outpatient services, they agreed to work with Springbrook to place minor or indigent Baker Act patients at its 72-bed Morton Plant North Bay Hospital Recovery Center in Lutz.

The transition from Springbrook's perspective, however, has been rocky, and patients like the middle school student are the main concern.

"We're doing everything we can to make it work," Springbrook administrator John Sannuto said.

The Baker Act allows people to be taken for mental health examination against their will if they show a substantial likelihood of causing serious injury to themselves or others. They can be held up to 72 hours — longer if a psychiatrist deems it necessary — as health officials devise an appropriate care plan.

State law requires mental health facilities to accept Baker Act patients regardless of age. As part of a local agreement in place for several years, however, Hernando deputies delivered patients up to 64 years old to the Harbor, while Springbrook took patients 65 and older. Now deputies bring all of Hernando's Baker Act patients to Springbrook.

Between Feb. 1 and early Friday, the Hernando County Sheriff's Office had taken nearly 50 people into custody under the Baker Act. Springbrook had received 57 patients, including walk-ins, and 23 of those have been children, Sannuto said.

The number of indigent and uninsured patients has increased, too, but that hasn't been a major concern, Sannuto said. Those patients only need to be transferred to another hospital if Springbrook is full, which so far has been rare.

Springbrook, a private, for-profit hospital, is not licensed or designed to provide in-patient services to minors, though. Doing initial evaluations of young patients and holding them for a short amount of time would not be a problem, Sannuto said.

More often than not since Feb. 1, however, BayCare's Lutz recovery center has not had any of its 16 beds available, so Springbrook staffers have to drive the children to the Vines, a facility in Ocala.

Also, the number of minor Baker Act patients has been well above what BayCare officials, during a briefing before closing the Harbor's beds, indicated they could expect, Sannuto said. In one case, a child waited more than 20 hours before the Springbrook staff was able to find a bed, Sannuto said.

That takes a toll.

"It's not fair for them to be sitting here 20 hours," he said, and requiring loved ones to visit Ocala "is a burden to the families."

The delay in placement is also straining Springbrook's resources, he said. Children must be kept isolated from the rest of the facility and monitored by two staffers, which has increased staffing costs by 2 percent to 3 percent, Sannuto said.

Springbrook's concerns prompted county officials to meet with the two health providers earlier this month to ensure a smooth flow of minor patients.

"It's going to be very critical for BayCare to hold up their end of the deal," said Veda Ramirez, the county's health and human services manager.

That is exactly what the company has done and will continue to do, said Gail Ryder, BayCare's vice president of behavioral health.

The contract with the county requires BayCare to reserve four beds at its Morton recovery center for Hernando's indigent patients and one for the county's indigent minors. There is no contractual obligation to hold beds for other Hernando children.

"If we have a bed available, that child will have that bed," Ryder stressed, "regardless of how their costs are being covered."

There was a "short period of time" this month when the center was full, and that will happen from time to time, Ryder said. When it does, BayCare will help to find a bed at one of its other facilities — Morton Plant Hospital in Clearwater or St. Joseph's Behavioral Health Center in Tampa.

Springbrook will still have to transport the patients, though. The transferring facility is obligated to provide the transportation because it is most familiar with the patient's needs, Ryder said.

One of the problems was a lack of communication between the two facilities, especially on weekends, as Springbrook sought to transfer patients, Ryder said. Springbrook officials now know whom to call to check on availability, she said.

"We've shared our cell phones with everybody," she said.

The apparent uptick in young patients can be attributed to the natural cycle of patient levels, she said. "But I can tell you right now, we have record volumes everywhere," she said, adding that the company will continue to gauge the need in the region and try to add beds accordingly.

All of BayCare's efforts won't change the reality for Springbrook as a Baker Act receiving facility, however, Ryder said.

"That particular designation requires you to do all of what they're doing now," she said.

Sannuto said he is exploring options with the county and state to secure some funding to subsidize the services for children, but the primary goal is to expedite their placement.

"Whatever's good for these kids," he said, "they come first."

Tony Marrero can be reached at (352)848-1431 or [email protected]

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