Wednesday, October 12, 2016

[San Mateo] County rebuffs civil grand jury’s report: Officials reluctant to implement recommended youth mental health trauma improvements

San Mateo County officials showed disinterest in implementing recommendations from a recent civil grand jury report focusing on treatment for teens and young people experiencing mental health trauma.
The county Board of Supervisors approved Tuesday, Oct. 4, a response to the “Youth in Mental Health Crisis: What Lies Behind the Emergency Room Doors?” grand jury report initially published Monday, July 18.
The San Mateo County Civil Grand Jury called for better tracking of where young people experiencing mental health emergencies receive treatment, but the county’s response indicated a reluctance to apply some of the suggested improvements citing concerns regarding the threat of patient privacy violations.
Most local youth needing to be hospitalized after experiencing a psychiatric crisis are taken to medical facilities beyond county borders, even though there are 13 hospital beds dedicated to serving teens and kids who require emergency care, according to the grand jury report.
The county Board of Supervisors authorized contracting with Mills-Peninsula Health Systems to offer inpatient mental health care to youth and adults who use Medi-Cal, and the agreement is overseen by the San Mateo County Behavioral Health and Recovery Services, or BHRS, division.
When a patient needing psychiatric care is picked up north of State Route 92, they are taken to the Mills-Peninsula Medical Center in Burlingame. If they are coming from an area south of the boundary, they are taken to the San Mateo Medical Center, 222 W. 39th Ave. in San Mateo.
If space is available, a patient needing inpatient care is taken from their appointed referral site to one of the 13 beds at the Mills Health Center in San Mateo. If the beds are full, they are transported to one of the other nearby facilities in San Francisco, Concord, Berkeley or other Bay Area cities.
As part of an examination into whether the existing amount of beds locally is adequate to accommodate demand, the grand jury attempted to track admission patterns but found insufficient data is available.
Compounding the cause for concern, according to the grand jury report, are studies showing patients are more receptive to care administered closer to home, accentuating the need to offer local psychiatric intake when possible.
But roadblocks exist for officials seeking to beef up record keeping, according to a response from the office of County Manager John Maltbie, as the information available for tracking privately insured patients is limited under the Health Insurance Portability and Accountability Act, or HIPAA, laws.
For those who received Medi-Cal through the county health system, officials expressed a willingness to consider making changes to its policy, according to the response.
“Related to the services provided to its beneficiaries, BHRS will review its current information and will implement modifications if it is determined that such modifications will improve oversight and planning to meet the needs of beneficiaries,” according to the response.
Such an openness was the most the county was willing to consider though, according to the response, as officials will not pursue an investigation recommended by the grand jury into a discrepancy in patient admission rates.
According to the initial report, those referred to by Mills-Peninsula Medical Center to the Mills Health Center are more likely to get a bed than those referred by the San Mateo Medical Center.
The disparity exists because often such services are determined by the patients’ insurance, according to the county’s response.
“While Mills-Peninsula Hospitals service patients who are privately insured in addition to those on Medi-Cal, SMMC’s population is largely Medi-Cal. Bed capacity for the Medi-Cal beneficiaries is limited, thus requiring BHRS to seek services at hospitals outside the county,” according to the response.
The county declined to further investigate the patient tracking sought by the grand jury, according to the report.
“The recommendations will not be implemented because it is not warranted or reasonable,” according to the response.
The grand jury has called for the department to present a report on the issue to the county Board of Supervisors by the end of the year. The watchdog organization has no legal authority to implement policy change, but elected officials are required to respond to a report’s findings and recommendations within two months and governing bodies must respond within three months.
October 5, 2016
San Mateo Daily Journal
By Austin Walsh

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