Still Unglued: Behavioral Health Update 2017 · 11/3/2017 · AnMed Health, South Carolina • OIG...
Transcript of Still Unglued: Behavioral Health Update 2017 · 11/3/2017 · AnMed Health, South Carolina • OIG...
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Still Unglued: Behavioral Health Update
2017
Eric J. Neiman
November 3, 2017 WSSHA Fall Conference
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Today’s Topics
• Trends and challenges
• Federal developments (21st Century Cures,
veterans, legislation)
• State developments (legislation, state hospital
morass, new psychiatric hospitals)
• Litigation update
• Duty to warn
• EMTALA
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Did you Know this About
Washington?
• 30/51 for overall mental health ranking
– Mental Health America (11/16)
• 29/50 for national suicide rate
– America’s Health Rankings (2016)
• Drug overdose is state’s leading cause of
accidental death
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History
1963 1973 2005
Community
Mental Health Act
Involuntary
Treatment Act
Washington
Mental Health
Parity Act
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History
December 2013 August 2014 April 2015
T.R. v. Quigley
In the Matter of
the Detention
of D.W.
Trueblood v.
DSHS
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21st Century Cures Act
• A “Christmas Miracle”
- Sen. Alexander
(R- Tenn.)
• Seen by some as a gift
to Big Pharma
• Bipartisan, sweeping
approval within House
and Senate
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21st Century Cures Act
• $1 billion available to states for opioid abuse
prevention and treatment programs
– April 2017, Secretary Tom Price announced
$485 million in grants for States and territories
• $1.6 billion for brain diseases, including
Alzheimer’s
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21st Century Cures Act
• Strengthen leadership and accountability
– Administrator of SAMHSA is now the Assistant
Secretary for Mental Health and Substance Use
– SAMHSA will have a Chief Medical Officer
– Serious Mental Illness Committee
– SAMHSA is to publish a strategic plan
• Substance abuse is now called a substance use disorder
(SUD)
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Veterans
• Suicide initiatives
– 20 suicides per day, prevention is top clinical priority
• Expansion of emergency mental health services to
OTH veterans
– Effective 7/5/17
• Telemental health services (since 2003)
• RxP (since 1999)
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Veterans
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CDC: Where You Live Matters
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2017 Legislation
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• HB 1713 (2016) Integrates ITA and substance use disorder treatment (4/18)
• HB 1427 (2017) Response to opioid crisis
• HB 1547 (2017) Psych beds exempt from CON until 6/19
• SB 5435 (2017) Expanded disclosure of mental health PHI
• SB 5800 Duty to warn (did not pass)
• Budget
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2017 Legislative Funding – Two Views
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2017 Legislative Funding – Two Views
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Single Bed Certification Quarterly
Update – January 2016
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Single Bed Certification Quarterly
Update – July 2017
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The Certificate of Need Program
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The Certificate of Need Program
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The Certificate of Need Program
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Spokane 100
Tacoma 120
Lacey 75
Vancouver 72
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Litigation Update
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Litigation Update
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Missouri Court of Appeals Decision
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Missouri Court of Appeals Decision
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State Hospital Update
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State Hospital Update
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History
December 2013 August 2014 April 2015
T.R. v. Quigley
In the Matter of
the Detention
of D.W.
Trueblood v.
DSHS
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Fines: $34,266,000
Attorney Fees: $2,376,120.60
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Volk v. DeMeerleer, 187 Wn.2d 241,
386 P.3d 254 (2016).
• Washington Supreme Court case.
• Double murder-suicide in July 2010.
– Patient had received outpatient treatment for mental health
issues with the same psychiatrist for years.
– Patient killed his former girlfriend and one of her children, and
attacked another of her children with a knife.
– Patient had last seen his psychiatrist three months before the
killings.
• He reported having suicidal thoughts when depressed, but
had not expressed a specific intention to harm anyone.
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Volk v. DeMeerleer – Holding
• The Washington Supreme Court ruled that a psychiatrist could
be liable for homicides and other violent acts committed by a
patient, even though he had never identified the victims as
targets of violence.
– The relationship between a mental health professional and a
patient creates a duty to “take reasonable precautions to
protect anyone who might foreseeably be endangered by” the
patient’s condition.
– Whether the patient’s “actions were foreseeable…is a
question of fact that should have been resolved by a jury.”
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EMTALA
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EMTALA
• “In the case of psychiatric emergencies, an
individual expressing suicidal or homicidal
thoughts or gestures, if determined dangerous to
self or others, would be considered to have an
EMC.”
• EMTALA Interpretive Guidelines, § 489.24(d)(1)(i),
Appendix V of State Operations Manual.
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AnMed Health, South Carolina
• OIG claimed that in 36 incidents,
patients presented to AnMed
ED with unstable psychiatric
emergency medical conditions.
• Patients not examined or treated
by on-call psychiatrists.
• Patients not placed in empty beds in psych unit.
• Instead, patients were involuntarily committed in AnMed
ED for 6 – 38 days each.
June 23, 2017
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AnMed Health, South Carolina
$1,295,000
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AnMed Health, South Carolina
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EMTALA Resources
• State Operations Manual, Appendix V – Interpretive
Guidelines
– https://www.cms.gov/Regulations-and-
Guidance/Guidance/Manuals/Downloads/som107ap_v_
emerg.pdf
• Patient Dumping, US Commission on Civil Rights
(September 2014)
– http://www.usccr.gov/pubs/2014PATDUMPOSD_928201
4-1.pdf
• HHS OIG
– https://oig.hhs.gov/fraud/enforcement/cmp/index.asp
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Questions?
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