In summary
Psychiatric hospitals could close beds under proposed state rules if regulators don’t allow implementation time, facilities warn.
The California Department of Public Health delayed emergency staffing rules for acute psychiatric hospitals after significant outcry from hospitals, nurses, law enforcement and lawmakers.
The proposed rules, which would increase the required number of health workers on staff, were set to take effect Jan. 31, roughly one month after the department first published them.
Instead, the department said in a letter to health care facilities that the rules will go into effect June 1.
The emergency rules stem from a San Francisco Chronicle investigation that linked cases of physical assault, sexual assault and death to low staffing levels at for-profit acute psychiatric hospitals. The investigation revealed a loophole in state regulations that allowed acute psychiatric hospitals to employ fewer staff than general hospitals.
Acute psychiatric hospitals treat people — sometimes involuntarily — experiencing mental health crises and who pose an immediate threat to themselves or others.
The proposed rules would require acute psychiatric hospitals to have at all times at least one licensed nurse per six adult patients or one licensed nurse per five pediatric patients. The health department would also fine hospitals $15,000 to $30,000 for each day they are out of compliance.
But hospitals, law enforcement organizations and behavioral health groups say the state’s aggressive implementation timeline will inadvertently lead to the closure of dozens, if not hundreds, of psychiatric beds throughout the state.
Carmela Coyle, president and chief executive of the California Hospital Association, said the four-month delay “averts an immediate crisis in the availability of psychiatric hospital care in California” but still leaves the system vulnerable to closures.
The hospital association had previously estimated that more than 800 acute psychiatric beds would close Saturday if the state did not delay implementation and allow facilities adequate time to hire more staff.
The delay gives hospitals some time to prepare but falls short of the one-year phase-in period many facilities had sought.
Le Ondra Clark Harvey, chief executive of the California Behavioral Health Association, said the emergency regulations don’t account for the behavioral health workforce shortage that has plagued California for years.
Over the next five years, the state’s Department of Health Care Access and Information projects that all 58 counties in California will face shortages of behavioral health professionals. State prisons, state hospitals and developmental centers also face persistent difficulties in hiring enough behavioral health staff, in part because of workforce trends.
Clark Harvey said the regulations need to protect patients and preserve access to existing behavioral health services. “We don’t need rules that risk worsening an already very, very fragile system,” she said.
When psychiatric beds aren’t available, patients get stuck in emergency rooms, causing backlogs, said Jesse Tamplen, executive administrator of behavioral health at John Muir Health.
John Muir Health, a not-for-profit health system in the Bay Area, operates roughly 10% of all pediatric psychiatric beds in the state and takes patients routinely from as far as San Diego and even Oregon. The hospital will need to hire about 30 more nurses by June. If it can’t, it will have to reduce the number of inpatient psychiatric beds available.
“I support CDPH creating regulations to improve safety and quality. That’s not a question,” Tamplen said. “Our regulators are there to support safety and quality. My concern is the speed and the likelihood of unintended consequences.”
The California Nurses Association, which helped pass the state’s first hospital staffing requirements in 1999, takes a different issue with the state’s proposed regulations. The proposed rules allow acute psychiatric hospitals to count licensed vocational nurses and psychiatric technicians toward the staffing ratio. The nurses association, which represents more than 100,000 nurses in the state, argues that only registered nurses should qualify.
“The state is proposing an inferior staffing standard for acute psychiatric hospitals compared to general acute-care hospitals, and that’s unacceptable to California Nurses Association nurses,” the group said in a statement.
