Soapbox

Emergency room doctors need more flexibility

Additional beds are set up in the hallway of an emergency room, which in California and other states are being crowded by an influx of mental health patients.
Additional beds are set up in the hallway of an emergency room, which in California and other states are being crowded by an influx of mental health patients. New York Times file

It’s a fearful thing to have to go to the emergency room. Unfortunately, when those in a mental health crisis are brought in from the street, there are appalling delays in receiving proper treatment, much to the frustration of ER doctors.

That’s due to a long-obsolete state law that ties the hands of these highly trained physicians, creating a situation that is unfair to all patients in the ER. I’m referring to “5150” holds, named after the section of state law that authorizes an involuntary 72-hour detention for those who are believed to need mental health services to prevent harm to themselves or to others. While the intent of that law is public safety, the reality is that these involuntary holds keep many people with behavioral health conditions from getting timely treatment.

This situation is not acceptable. That’s why a broad coalition of groups – including the California chapter of the American College of Emergency Physicians, California Psychiatric Association and California Hospital Association – is collaborating on a legislative solution.

Assembly Bill 1300 by Assemblyman Sebastian Ridley-Thomas, D-Los Angeles, would give ER doctors the authority to determine whether a 72-hour hold is needed – or whether patients would be better served outside the emergency room. The bill faces a critical vote June 8 in the Senate Health Committee.

Modernizing the law would get patients the mental health services they need much more quickly, and would free up the ER to treat other patients who need immediate medical help.

Every day in California, there are an estimated 800 individuals being held in hospital emergency departments on “5150” orders. Most don’t belong there. In fact, approximately 70 percent of these patients could have their needs met through community-based services. Instead, many of these individuals are forced to wait in the ER for hours, even days, before they can be released back to their families and to the care they need.

Aimee Moulin, an emergency room physician at UC Davis Medical Center in Sacramento, tells me that, under that law, she is unable to use her medical training to evaluate mental health patients in the way she assesses all other patients.

I know firsthand from my days on patrol that some patients simply need to sober up. Others may need to be stabilized before being referred to a community program. Instead, they are forced to wait, compromising the true mission of the emergency room.

AB 1300 is not a comprehensive fix, but it is a much-needed first step toward streamlining delivery of mental health care.

John McGinness is a former sheriff of Sacramento County and professor of criminal justice. He can be contacted at john.jpm.solutions@gmail.com.

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