Healthy Choices

Sacramento hospitals, nonprofits work to take pressure off emergency rooms

Sutter General Hospital’s emergency department was packed on a Tuesday afternoon. Mothers and the children they cradled on their laps slumped languidly on green plastic chairs. Men held ice bags on swollen hands while others hunched over, clutching their abdomens. Heads turned only to hear a nurse read names off of a growing list.

Another nurse holding a clipboard apologized to patients for the long wait. The length of stay, from entry to discharge, averages three hours and 46 minutes at the midtown facility. After her announcement, a young man with a puffy jaw reached out to shake her hand. She recognized him from his last visit, just a few days earlier.

In the opposite corner, Theresa Haliey and Robert Walton made light conversation near the television. Haliey was experiencing pain beneath her gut, but she said the doctor she usually sees at WellSpace Health recently left the midtown clinic. Her husband brought her to Sutter knowing she’d be seen eventually. He said he’d received care there numerous times before.

“My wife is in pain – she’s been in pain for a couple of weeks – I had to drag her in here by her hair,” he said. “This is my spot. They know me well here.”

Returnees like Walton are common in the emergency department, the formal name for the space encompassing waiting rooms, exam rooms and offices, where those without regular doctors turn up when things get rough. The number of people visiting emergency departments has been on the rise in Sacramento County and throughout the state since the recession, officials say, and hospitals are seeking to divert those patients to more appropriate medical facilities, especially as more and more people acquire health insurance.

WellSpace Health (formerly The Effort) and other nonprofits focused on serving Sacramento’s low-income population have teamed up with hospital systems to address the issue. Jonathan Porteus, WellSpace CEO, said he’s been working for years to create a “blanket of care,” which would fill in the vast gaps between Sacramento’s major facilities with clinics for the uninsured and newly insured. The most recent clinic opened near the Mercy San Juan Medical Center in mid-October.

“We’re trying to stop people’s bodies from going through these horrible medical cycles where they have to get to this extreme state to even get care,” Porteus said. “We want to be preventive and proactive about it, and that’s what the hospitals want.”

Both Sutter Medical Center and Dignity Health are collaborating with community-based health providers to reroute non-urgent cases through what they’ve dubbed navigator programs.

At Sutter, there are two navigators employed by WellSpace Health who work at Sutter General Hospital and Sutter Roseville Medical Center to connect patients with any resources they might need – be it insurance, a primary care provider, food stamps or housing. When emergency department staff spot a visitor who needs help, they call case management, which then places them with a navigator for further assistance, said Mark LaSalle, head of case management at Sutter Medical Center.

Between 2006 and 2011, emergency department use increased 14 percent statewide and 33 percent in Sacramento County, said Brian Jensen, regional vice president for the Hospital Council of Northern and Central California. The number of mental health case admissions increased 47 percent throughout the state and 93 percent in Sacramento County – nearly doubling over the five-year period.

The change has led to increased wait times, stressed emergency department staffs and uncomfortable waiting room interactions, prompting several hospitals to increase security in those areas, Jensen said. He noted that a bed that could be used to treat 12 emergencies in a 24-hour period might hold one psychiatric patient for an entire day.

“What that does is it takes up the bandwidth, so to speak, that that facility has to treat truly emergent crises,” he said. “For every person that is there because they have a cold that’s not super severe, for every person who’s there because they just haven’t been to a doctor in a long time, someone with a more threatening situation may have to wait longer.”

Gilbert Perez, a drug addict turned church leader now living in a Mercy Housing-sponsored community for formerly homeless adults, said he used to frequent the emergency department but now receives primary and mental health care at a WellSpace clinic in his building.

Wringing his hands, which he said are chronically damaged from fighting, the 60-year-old described the anxiety and depression he suffered after two decades in and out of prison. He describes himself as “still not fully functional,” but credits the WellSpace liaison who got him into the facility four years ago for saving his life.

“There was a lady from The Effort named Lydia – she directed me,” he said. “It was a long process. Everything’s a long process. You have to just make it through until that time comes. … If an old dope fiend, ex-con like me with no common sense can do it, anyone can do it.”

Perez said the resources for the homeless have definitely expanded since he was on the street. He used to look up clinics in the yellow pages, he said, and was regularly disappointed by the lack of offerings.

“Where would you find those sorts of resources on the street?” he asked. “They’re so scattered, so under cover, it’s hard to find those resources.”

WellSpace Health now runs eight health centers, six satellite centers and two residential treatment centers. In between those are county clinics and a growing number of community health centers run by nonprofit providers such as Elica Health Centers, Cares Community Health, and Health and Life Organization. There are also a number of minority-specific clinics, such as the Native American Health Center in midtown.

While these groups all serve a similar mission – providing care for the uninsured and underinsured – they’re also competing for funding. WellSpace, Health and Life Organization, and Elica all attained federally qualified health center status in the last five years, which allows them to charge lower rates to Medi-Cal patients because the U.S. Department of Health and Human Services foots some of the bills. Cares Community Health recently achieved “lookalike” status, which means it fits most of the criteria but isn’t eligible for the same federal grants.

“Historically we’ve called it ‘walking the plank,’” WellSpace’s Porteus said. “You’ve left a hospital and it’s like you’re walking into the unknown. ... It’s getting better now – more of us are doing health care – but these programs and our expansion of our health centers were built to help bridge the gap between the plank and the community.”

Dignity Health launched its own navigator program in August 2013 in partnership with Health Net, an insurance provider, and Sacramento Covered, a nonprofit focused on increasing health insurance enrollment. Sacramento Covered employs the six navigators, who are dispersed throughout Dignity’s four emergency departments. An estimated 59 percent of all visits to those sites are for primary care, according to Dignity, as the newly insured population grows under the Affordable Care Act.

The patient health navigation program is an extension of Dignity’s community health referral network, implemented in 2010, which partners the four hospitals with 15 community-based clinics where patients with no or little insurance can find care. Since that program started, 60 percent of referred patients have not returned to the emergency department.

Even so, the departments continue to be filled with primary and mental-health patients, said Ashley Brand, manager of community benefit for Dignity. She said she’s not sure six navigators can fix the problem, but they do make a difference in patients’ lives.

“This isn’t about a medical provider or a nurse,” she said. “They really need a community liaison. It’s really powerful, and it takes a special person. ... The patients really feel that the navigators are looking out for them.”

Call The Bee’s Sammy Caiola, (916) 321-1636.