Galveston psychiatric hospital won't reopen for years, another medical side effect of Hurricane Ike

From the Galveston Daily News in Texas:

GALVESTON — It could be five or more years before the University of Texas Medical Branch reopens its 20-bed psychiatric hospital, forcing some area residents to travel farther for inpatient care and marking another medical side-effect of Hurricane Ike.

Except for a geriatric unit at Mainland Medical Center, Rebecca Sealy Hospital at the medical branch was the only adult, inpatient psychiatric facility serving Galveston and Brazoria counties.

Since the September storm, the medical branch has established adult inpatient psychiatry services at St. Joseph Medical Center in downtown Houston.

Those services, however, are available only to clients of The Gulf Coast Center, the regional Texas Mental Health and Mental Retardation authority funded by the government and which coordinates services for clients. Private patients not referred by The Gulf Coast Center would not be treated by medical branch doctors at St. Joseph.

Extensive storm damage to Rebecca Sealy, which had employed about 74 people, and shortage of space for beds for the general public is the main reason for the indefinite closure, David Marshall, the medical branch’s interim chief operating officer, said.

Reopening Rebecca Sealy, badly damaged by flooding, would require a lot of time and money, Marshall said. Regulators require psychiatric hospitals to have specific security and infrastructure.

Restoring beds for the general public at John Sealy Hospital is a priority, Marshall said.

“Our focus has and continues to be restoration of services that meet the needs of a majority of our patients,” Marshall said. “There is a limited amount of campus ready for patient care. To create space for inpatient psychiatry would take the available, valuable space offline for a significant period of time for renovation to meet the regulatory requirements for inpatient psychiatric facility.”

Before the storm, John Sealy had 550 beds. As it works to double the size of rooms to attract more paying customers and reconfigures the John Sealy Hospital to prevent future flood damage, the medical branch is expected to have the capacity for 230 beds for the general public and 100 for prisoners it treats through a state contract.

There’s no room to move psychiatric beds to John Sealy Hospital, officials said.

The medical branch is expected to receive about $1.4 billion from insurance proceeds, and federal, state and private funding for repairs and storm-proofing its campus. But how many beds it will be able to reclaim is central to recovery. About $150 million appropriated by state lawmakers for a second tower that would yield another 220 beds hinges on a local funding mechanism to help pay for hospitalization of the county’s underinsured residents.

Brazoria and Galveston counties have seen improvements in mental health service since state lawmakers met in the last session, Mike Winburn, executive director of the Gulf Coast Center, said.

Before the storm, the center paid the medical branch about $2.4 million for 20 psychiatric beds at Rebecca Sealy Hospital.

About 65 percent of the patients it sent to the medical branch were indigent. Since the storm, state lawmakers have given the center another $1.7 million to pay for psychiatric beds. The organization has opened a 10-bed center in Texas City and plans to open another 10 beds in Angleton. Those 20 “crisis respite” beds are for people who need hospitalization for seven to 14 days.

It also has a contract for 16 beds with St. Joseph, Winburn said. The Gulf Coast Center also contracts for beds at Austin State Hospital.

Before the storm, law enforcement officials and families had been forced to wait hours at the medical branch to have a mentally ill patient assessed and admitted to Rebecca Sealy, which before the storm, admitted 225 patients in 2008 and received another 1,631 patients transferred from other facilities.

But the Gulf Coast Center operates various outpatient programs and is using telemedicine for quick assessment of whether patients need to be hospitalized. Waiting time for patients to be admitted is shorter at St. Joseph, Winburn said.

Although the loss of beds in Galveston isn’t ideal, area patients are being served, Winburn said.

Inpatient psychiatric care is unprofitable.

Low reimbursement rates from commercial managed care and governmental payers are the reason more hospitals across the nation are closing their psychiatric units.

The medical branch historically lost more than $4 million a year providing inpatient psychiatric care at Rebecca Sealy.

The National Alliance on Mental Illness, the nation’s largest grass roots mental health organization, has called the access to acute inpatient psychiatric care a crisis.

Nationally, more than 197,000 inpatient beds have been lost since 1990, according to an April 2009 report by the alliance.

The dwindling number of psychiatric beds in the United States doesn’t mirror demand, said Dr. Robert Hirschfeld, professor and chairman of the medical branch’s Department of Psychiatry and Behavioral Sciences.

Hirschfeld declined to pass judgment on the medical branch’s decision to keep Rebecca Sealy Hospital closed indefinitely.

“I’m looking forward to UTMB being able to provide inpatient care to our community as soon as possible,” Hirschfeld said.