Note: This story has been updated since its original posting to reflect context of Tri-City’s closure of its inpatient psych units in 2018.
REGION — The County Board of Supervisors rejected its fellow supervisor’s proposal to build a $14 million inpatient psychiatric facility in connection with Tri-City Medical Center.
The proposal by District 5 Supervisor Jim Desmond called for the county to put up $14 million for the construction of 12-unit crisis stabilization unit and 16-bed psychiatric health facility on land owned by the public hospital district. Tri-City would have been responsible for ongoing operational costs.
Tri-City’s board of directors voted last August to suspend the hospital’s 18-bed behavioral health unit and 12-person crisis stabilization unit, and Desmond’s proposal would essentially have replaced the units lost due to the closure.
But Desmond’s fellow board members felt the proposal was too one-sided, and called on Tri-City to shoulder more responsibility in any proposed partnership.
“I think we have to remember that Tri-City walked away from their responsibility, this is different from any of the other hospitals in the region,” board Chairwoman Dianne Jacob said. “We need to have Tri-City be a partner with the county and not expect the county to give them a handout, that is not going to happen.”
Tri–City Healthcare District originally voted in June 2018 to shut down the units, citing a recent change in federal regulations requiring hospitals to remove from rooms all features that patients could use to hang themselves, known as “ligature” risks, as the primary reason for the closure.
They also cited a $5 million budget shortfall within the department that oversees the unit, as well as a shortage of psychiatrists to staff the unit.
Supervisors, instead, voted to have the county staff continue to negotiate with Tri-City and any other hospital systems countywide for potential partnerships toward creating inpatient psychiatric facilities.
Before the board discussed the item, Desmond said that he felt that the board could not afford to not take action.
“We have a public behavioral health crisis in North County, and it’s getting worse,” Desmond said. “This proposal puts Tri-City back in the behavioral health business, it may not be perfect, as a matter of fact I have been told it’s way too aggressive … taking no action will only make it worse.”
District 4 Supervisor Nathan Fletcher, who has been critical of Tri-City’s perceived lack of action towards reopening the shuttered units, said that the district’s attitude was in stark contrast to other hospital systems across the county, which view behavioral health as a shared responsibility.
Tri-City, in contrast, has in public statements said it is helping the county “meet its behavioral health obligations.”
“It is hard to have a partnership when one party keeps saying, ‘It’s your obligation,’” Fletcher said.
The board’s vote calls for the staff to return to the board in September with an update on negotiations with Tri-City.
Tri-City board Chairwoman Leigh Anne Grass at the meeting said that the public district is
“committed to long-term sustainable community solutions in regards to mental health.”
Grass and supervisors also opposed language in the proposal that would have restricted the 16 units to people who qualify for Medi-Cal or county health insurance. The language was stricken out of the approved motion.
The decision came during the same meeting in which supervisors approved $23.8 million to expand mental health and substance abuse care, including emergency response and crisis centers.
That unanimous vote supports more patient beds, expanded psychiatric emergency response teams (PERT), community-based mental health crisis stabilization centers, more resources for schools and an increased standing contract with Palomar Health.