SF General reduces psychiatric care

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A 22-bed psychiatric unit at San Francisco General Hospital will be taken out of service, and re-opened only if the facility experiences a high caseload of patients exhibiting the worst signs of psychiatric crisis, the Bay Guardian has learned.

As of Nov. 19, five patients were receiving care in that unit, 7B, according to spokesperson Rachael Kagan. None had symptoms that rose to the level of requiring acute care. Instead, they were classified as sub-acute patients, a distinction that essentially means they didn’t present an immediate threat to themselves or others.

But under a new policy that will take effect after they have been released, all 22 beds in 7B will be closed – unless they are needed for acute patients who do reach that critical threshold. The unit will be staffed only if patients can’t be accommodated in the hospital’s other acute psych unit, which has 21 beds.

The decision was made in response to a changing financial picture under federal health care reform, Kagan explained.

“There is a big push … to ensure hospitals are only providing acute care,” Kagan said, and this trend is driving efforts to reduce sub-acute patients. “It fiscally makes more sense,” she added, because insurers pay higher rates for acute care than for lower levels of treatment.

Yet some hospital staff members are nervous about the implications of this shift, because it means fewer patients will be able to access psychiatric care at SF General until they represent a danger to themselves and/or the general public – at a time when demand for these services is on the rise.

“To us, it’s a matter of priority for the city,” said Brenda Barros, an employee at SF General who is active with hospital union SEIU 1021. “Do you want to take care of these people, or don’t you?” 

Some staff members are doubtful that 7B will reopen. An internal SF General memo issued Nov. 18 informed 7B staff: “Our census will be gradually reduced until we won’t have any more patients. Then 7B will be closed.” The memo added, “this came from [SF General CEO] Sue Currin due to budgetary constraints.”

However, a second internal memo went out the following day, to “clarify” the first one. In that message, Nursing Director Kathy Ballou wrote: “We are not closing psych beds or any beds.” Instead, beds in 7B would be closed unless “we get acute patients needing that level of care,” she wrote. “As in other hospitals, we are accountable to our operating budget.”

Further complicating matters, said Barros, is that patients can fluctuate rapidly between needing acute care and a lower level of attention. “They absolutely can swing back and forth.” She added that patients initially requiring a lower level of care could experience worsening conditions if they're unable to secure an appointment in time to get help, and delays are very common.

Kagan emphasized that the unit wasn’t being closed down, but did confirm that sub-acute patients would no longer be able to receive treatment in 7B. Instead, those patients will be placed with various service providers throughout the city, she said. “The goal is to move the patients to their appropriate placement.”

Meanwhile, this shift coincides with an overall rise in citywide demand for psychiatric services. According to a report delivered to the Police Commission earlier this year, SF General had 6,293 patient admissions for psychiatric holds in 2012, a sharp increase from 5,837 in 2009.

While there were deep cuts to the city’s Department of Public Health during the economic downturn, Mayor Ed Lee has recently trumpeted a boost to city coffers thanks to growing economic activity. But if the city's financial health has improved, it seems odd that its flagship safety-net hospital would be put into the position of reducing psych care due to budgetary pressures when that kind of care is sorely needed.

For Barros, it's a matter of whether or not city officials will decide to allocate more funding for mental health services. “If they don’t have enough money in Public Health,” she said, “then they need to put more into Public Health.”