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Tri-City approves agreement with County to build 16-bed psychiatric unit

OCEANSIDE — During a special board meeting at Tri-City Medical Center on Aug. 29, the board of directors approved a memorandum of understanding (MOU) between the hospital and the county to build a new psychiatric health facility.

Before the MOU becomes official, the County Board of Supervisors must approve of it as well. Supervisors will vote on the MOU on Sept. 10.

According to the MOU document, the new approximately $10 million, 16-bed facility would be constructed on vacant land on the hospital’s main campus. Both the county and the Tri-City Healthcare District would equally fund the new facility’s development, with the county to pay for construction and Tri-City to contribute property. Additionally, Tri-City would receive a no-interest loan from the county that will be repaid using “cash and in-kind services.”

By entering the MOU, the county and Tri-City are committing to working together to develop all the final details of the agreement, or what the document refers to as the “Proposed Arrangement.” The goal is for both parties to “take all reasonable efforts” to complete that arrangement by Dec. 31.

The MOU follows more than a year after Tri-City decided to suspend operation of its 18-bed inpatient behavioral health unit, a portion of which also served as a 12-chair crisis stabilization unit that helped to mitigate the number of people who needed inpatient care.

Tri-City made the decision to close its inpatient behavioral health unit last year due to a change in federal regulations that required them to remove ligature risks — features that patients could use to hang themselves — from rooms. That meant the behavioral health unit’s drop ceilings, which consists of removable tiles that hide pipes and other fixtures, had to go.

According to Tri-City Chief External Affairs Officer Aaron Byzak, the cost to remove the drop ceilings together with other accompanying renovations was nearly $8 million and would have taken nearly two years to complete. If the hospital were cited for the ceilings, it would have had only 60 days to fix the issue.

With an accreditation survey also coming up at the time, Tri-City didn’t want to put its license at risk. The district also cited a $5 million budget shortfall within the department that oversees the unit and a shortage of psychiatrists to staff the unit as other issues contributing to its decision to suspend.

Since then, conversations between the county and Tri-City about what to do next haven’t stopped.

In June, the Board of Supervisors rejected District 5 Supervisor Jim Desmond’s proposal to build a $14 million inpatient psychiatric facility with 16 beds and 12-chair crisis stabilization unit. Desmond’s fellow board members felt his proposal was too one-sided and believed Tri-City needed to take more responsibility in such a partnership.

If approved by the County Board of Supervisors, the new MOU would not include arrangements to build a crisis stabilization unit.

Desmond told Tri-City’s board of directors at the special meeting that it was a “great moment” for Tri-City and the county.

“Despite obstacles that were out there, despite adversity and despite threatening letters, we came to a conclusion working together to make sure that the services are provided,” Desmond said.

Tri-City wants a “comprehensive, sustainable community solution” to come out of the agreement.

“It has to be sustainable in order for us to continue to provide the service,” Byzak said.

According to Byzak, Medi-Cal, California’s version of Medicaid, has “very poor” reimbursement rates for hospitals. About half of the patients in the inpatient behavioral health unit were Medi-Cal patients.

“Essentially hospitals largely lose money on every Medi-Cal patient they see,” Byzak said. “In the nine years prior to our suspension, we lost a little over $34 million just on behavioral health.”

The hospital expanded its outpatient behavioral health service hours to accommodate the inpatient unit’s suspension, but Byzak said Medi-Cal doesn’t cover intensive outpatient behavioral health services.

What Tri-City wants is the right amount of reimbursement to operate a new inpatient psychiatric health facility.

Editors Note: An earlier version of this story wrote Medi-Cal doesn’t cover extensive outpatient behavioral health services. The Coast News regrets the error.