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Tri-City officials cited 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. Courtesy photo
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Tri-City votes to suspend mental health units Oct. 2

REGION — The Tri-City Healthcare District board affirmed Aug. 21 that it would shutter its inpatient psychiatric facilities by Oct. 2, a decision widely panned by residents, law enforcement and elected officials.

The board voted 5-2, with RoseMarie Reno and Laura Mitchell opposed, to uphold the earlier decision to suspend the hospital’s 18-bed behavioral health unit and 12-person crisis stabilization unit, which had already shut down with the county’s approval.

Tuesday’s decision would likely displace nearly  100 workers in the units and force residents with psychiatric emergencies out of the region for treatment.

Tri-City Healthcare District originally voted in June 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 suspension. 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.

District officials said after Tuesday’s meeting that as long as the hospital operated the units without fixing the ligature risks — which would require a $7.9 million renovation — it exposed the hospital and patients of the facility to undue risks.

“I think the important thing was to minimize risk to patients” said Aaron Byzak, Tri-City’s governmental and external affairs director. “There was an identified risk that we’ve made very clear to the community and the board of directors. There has been no answers or solutions forthcoming to address that issue so the board made the decision it made this evening.”

Members in the audience who stayed to the end of the four-hour hearing booed and jeered the board, screaming “shame on you.”

Before that, a string of elected officials and high-ranking law enforcement officers implored the board to reconsider the decision to shutter the units, saying that it would directly affect public safety countywide.

“This is one of those decisions that has consequences beyond Tri-City’s boundaries,” Vista City Councilman John Aguilera said.

Law enforcement officers said that the closure would mean that police officers transporting so-called “51-50” patients to the next closest facilities — Palomar in Escondido and the county’s unit on Rosecrans in San Diego — would be out of rotation for hours making the trips during rush hour.

Some in the audience pointed out that the hospital has never had a reported suicide in the impacted units, and that leaving it open for a few more months to work with stakeholders to find a less drastic solution wouldn’t raise that risk.

Board of Supervisors Chairwoman Kristin Gaspar wrote the district a letter asking them to keep the inpatient facilities open until Dec. 31 to allow the county time to find a solution.

Others asked the district to hold off until later in October.

Employee union representatives accused the board of violating the state’s open meeting laws in June when it hastily voted for the suspension. The Service Employees International Union, which represents many of the 80 mental health employees who received layoff notices after the board’s decision, demanded that the vote be re-taken.

Union rep Mali Woods-Drake called on the public to vote out Tri-City incumbents in October. “We need to work together to end the (James) D’Agostino (chairman) regime and elect a board that works for us and alongside us.”

District officials said the allegations were not what prompted the Aug. 22 redo. They said they wanted to give the public an opportunity to come up with a solution to the immediate problem.

But in the end, D’Agostino and the majority said they were not comfortable keeping the units open longer, especially as the hospital is in the midst of a review window by the Joint Commission, which accredits hospitals.

If the commission finds the hospital out of compliance, it could prompt the Center for Medicare and Medicaid Services, or CMS, to strip the hospital of its Medicare funding.

“This would shut the hospital down,” D’Agostino said. “That is a risk I am not willing to take.”

Members of the hospital’s staff spoke during the public hearing as well, defending the board and hospital administration for its decision, which they said was difficult, but necessary.