From the Desk of Kathi Ann StringerCorona, CA 92882
CNMHC – Far South DirectorFor Immediate Release [E]
January 18, 2005
Dear Joan Chang,
Psychiatric patients are being illegally held over the maximum time limit of 24 hours at Riverside Emergency Treatment Services (ETS), a division of Riverside County Regional Medical Center (RCRMC). At this time, patients are sleeping on the floor, sitting upright in chairs overnight, and lying on the 4 recliner chairs in the dayroom. The following are problems contributing to the over-crowding in the assessment unit, aka ETS, and appears to be currently, and has been for years, out of compliance with California Laws and Regulations, because many patients are NOT out of the ETS assessment unit within 24 hours in part due to the following reasons:
- Patients not discharged or admitted in the first 24 hours
- Minors requiring 1:1 in designated rooms.
- Soaring population in Riverside County.
- Non-responsive MH County administration
When police, or certified staff presents a patient to ETS on a 5150, patients can be detained for up to 72 hours per W&I, § 5150. Furthermore, W&I § 5152 demands a patient shall receive an evaluation as soon as possible. However, a much narrower regulation in pursuit of Title 22, § 71517 (c), demands that an assessment of the patient shall be completed within the first 24 hours. Once the patient is assessed in the first 24 hours, s/he must be released, or admitted for evaluation and treatment for up to a total of 72 hours. (Note: Assessment defined W&I, § 5150.4, and Patient defined Title 22, § 71051, (a), (1))
Once the patient is admitted for evaluation within 24 hours W&I, § 5008 (a), the patient is entitled to different accommodations per regulations (admission = status change). In pursuit Title 22, § 71611, patients shall be accommodated with minimum room arrangements, e.g. floor area, room identification number, and per Title 22, § 71615 and § 71619, a bed, mattress, chair and provision for privacy shall be provided for each patient. However, because many patients are not admitted and held over in ETS, they are deprived of their legal and mandatory right to a bed, chair, floor area and privacy, and in addition, patients are entitled to a patient lounge with adequate space for social activities per Title 22, § 71627, and that is not happening in an overcrowded ETS assessment unit. Furthermore, additional regulations support the notion that the administration and medical staff shall review the situation and take corrective action to remedy this problem, see Title 22, § 71217; and § 71501 (3). Also, per Title 22, § 71047, the nursing unit does not have adequate bedrooms with supporting facilities and consequently is not maintained as a planned as an organized unit.
In addition to the patient being deprived of accommodations after the 24-hour time limit, patients are further deprived of their patients’ rights to see visitors per Title 22, § 71507 (3) and W&I § 5325 (c) while on ETS, since ETS will not allow patients visitors.
Additionally, the preamble for SB-130 passed in last quarter of 2003, is now Health & Safety Code – Division 1.5 that mandates the reduction for use of seclusion and restraints, made reference to overcrowding and tight spaces that contribute to the unnecessary use of seclusion and restraints. Therefore, not only are patients at a higher, and an immediate danger to risk for excessive force & restraint, patients also experience loss of accommodation and privacy when not off the ETS unit within the 24-hour time limit.As supporting evidence, I am attaching the minutes of ITF meetings for years 2000 to 2001 indicating evidence that patients are on the ETS unit longer then 24 hours. (This was posted on a private Internet page. It appears that ITF hired an agency because the employees were not able to get along with the management and many other problems).
Therefore as patient that has been in ETS many times and witnessed the violations for myself (I have also slept on the floor and held over 24 hours), and as A Director for the California Network of Mental Health Clients, I am requesting and stating the following: ETS is an Acute Psychiatric Hospital per Title 22, §71005 and § 71040 (a)(2), and Health & Safety Code, §1250 (c); §1250.2 (a) and is subject to licensing modification per Title 22, § 71105 (a), (2) for increased bed capacity due to admitting patients on ETS and failing to transfer them to the hospital units (Insensitive Treatment Facility (ITF)) within the 24-hour limit, or deciding to hold the patient on ETS past the 24-hour limit while waiting to find another hospital and transport. Additionally, I am requesting the State Department of Health Services visit ETS per Title 22, § 71101, and notify ETS of deficiencies of compliance and request a plan for corrective action, delineate a time allotted for correction and follow-up with a repeat inspection, and if inspection fails, consider action to suspend or revoke their license, or demand ETS stops accepting patients in when at full capacity.I hope you are able to expedite this matter because the problem is affecting a significant population of patients, and also putting clients at risk to be unnecessary secluded and restrained on a daily basis. In the interim:
- Please acknowledge receipt of this letter and position of intent to remedy the problem with timetables.
- I am also requesting a copy of the problems identified and corrective action addressed concerning these problems once established/resolved.
- Additionally, I am requesting a meeting with your investigative agent shortly before s/he visits ETS.
Thank you for your time and consideration to this very important matter for myself and for my constituents that I represent with the California Network of Mental Health Clients.
Sincerely,
Kathi Stringer
Kathi’s Mental Health Review http://www.toddlertime.com
Far South Director of the California Network of Mental Health Clients
Participant of Riverside QIC
Member of the Riverside Mental Health Western Regional Board
Editor of the Performance Improvement Newsletter (PIN)Enclosed:
Chart – ETS Stats on Yearly Admits/5150
Chart – ETS Stats on Admits/5150 w data
ITF Minutes from Year 2000