Deal with Christus Spohn provides few details about psychiatric services

Sept. 28--CORPUS CHRISTI -- When the Nueces County Commissioners Court approved the Memorial hospital agreement -- a wide-ranging deal with the Christus Spohn Health System to eventually shut down and demolish the 70-year-old medical complex -- they agreed to move psychiatric services somewhere else

Where, exactly, they didn't know.

Christus Spohn committed to "maintain the availability of psychiatric and behavioral health services," according to the 10-page tentative agreement approved by the Commissioners Court and county Hospital District board on Sept. 15. With the Texas Department of State Health Services preparing a statewide mental health plan, Christus Spohn and the Hospital District wanted to review the state plan before cementing the details.

The agreement didn't specify a location for psychiatric and behavioral health services beyond somewhere in Nueces County.

"I would like to know where they're going to provide their services," said Diane Lowrance, executive director of the Behavioral Health Center of Nueces County.

Questions about the location and other unknowns prompted County Commissioner Oscar Ortiz to vote against the agreement, but County Judge Loyd Neal and the remaining commissioners approved the letter of intent and supporting documents.

"And this is one reason why we wanted to slow this down and kind of have a chance to delve a little further in detail into some of these areas," Ortiz said, adding later: "I share Diane's concerns. Where is it going to be located? And who is going to be doing the care?"

Under the agreement, Christus Spohn would build a new community clinic on the Memorial hospital property.

The new 40,000-square-foot clinic named for civil rights leader Dr. Hector P. Garcia would provide primary care on the Westside.

Meanwhile, Christus Spohn would expand the emergency department at Shoreline, which would absorb the region's only Level II trauma center and two medical residency programs located at Memorial. The project would add 196 hospital beds at Shoreline and cost approximately $325 million, according to Christus Spohn.

Afterward, the nonprofit health system would shut down and demolish Memorial hospital.

Christus Spohn currently provides inpatient psychiatric services to adults at Memorial and contracts with Bayview Behavioral Hospital to provide inpatient services to children and adolescents. Psychiatric evaluations and involuntary commitment hearings also take place at Memorial.

Psychiatric patients with and without insurance rely on Memorial, along with Nueces County Jail inmates. Police also bring detainees who may have serious mental illness to Memorial for emergency psychiatric commitments.

People with insurance have other options, including Bayview Behavioral Hospital on Wooldridge Road. People covered by the government-funded Nueces Aid Program, which serves the poorest Nueces County residents, and jail inmates rely solely on Memorial.

Sheriff Jim Kaelin said nobody had consulted with him about the new agreement between the Hospital District and Christus Spohn, but added that he trusted the Commissioners Court to strike a solid deal and maintain psychiatric services.

"And for me, as sheriff, my concern is that they do it," Kaelin said. "I'm not specifically concerned where they do it."

Nobody wants people with mental illness stuck in jail, Kaelin said, and Nueces County needs to have a medical facility available for appropriate treatment. When beds aren't available at Memorial, the Sheriff's Office assigns deputies to drive inmates with psychiatric problems nearly 145 miles away to San Antonio.

"We probably make that trip once to twice a month," Kaelin said.

The health system broadly committed to "maintain the availability of psychiatric and behavioral health services," including access for local law enforcement, psychiatric assessment services and a commitment hearing location.

"Spohn will provide adequate availability of inpatient psychiatric beds for Nueces Aid Beneficiaries, patients under emergency detention warrant, and adult Behavior Health Center of Nueces County (formerly Nueces County MHMR) patients," according to the agreement. "Spohn will evaluate and, as appropriate, modify such number of inpatient psychiatric beds in the future based on patient demand and community need."

The agreement doesn't specify how many inpatient psychiatric beds Christus Spohn would maintain after demolishing Memorial.

"I think the key word there is who makes the determination of what 'appropriate' is?" Ortiz said.

The Caller-Times submitted written questions to a Christus Spohn spokeswoman on Sept. 9, asking how many crisis and inpatient psychiatric beds the health system currently had at the Memorial, Shoreline and South hospitals. After two weeks and repeated follow-up questions, the health system never provided a number.

Hospital District CEO Jonny Hipp said he didn't know how many inpatient psychiatric beds Christus Spohn maintains.

The Hospital District board approved the tentative agreement on Sept.

10 and the Commissioners Court signed-off on Sept. 15. They plan to meet again during December or January to ink final documents.

Christus Spohn and the Hospital District agreed to back several major commitments with monetary incentives.

The health system spends $6 million annually to maintain Memorial and make other major capital expenditures. Under the tentative agreement, the annual capital expenditure will gradually drop to $600,000 by 2017.

Both the Hospital District and Christus Spohn agreed to deposit the difference between the $6 million required by the current agreement and the lower amounts required by the new agreement into an escrow fund. The health system would receive the money after meeting various benchmarks, including upgrading the emergency department at Shoreline and opening the new clinic.

None of the escrow provisions involves psychiatric and behavioral services.

Hipp said the escrow account was designed to back concrete commitments, including the construction projects and Christus Spohn earning the Level II trauma center designation at Shoreline. Establishing clear, non-subjective measures for psychiatric and behavioral services would have been more difficult.

"I think, overall, Spohn is committed to providing those services," Hipp said, adding that the final documents contractually obligate the health system to provide psychiatric and behavioral health services.

Both the Hospital District and the Commissioners Court have been talking about the proposal since September 2012.

They originally wanted the agreement to protect three key services: indigent health care, which the Hospital District is charged with providing to the poorest Nueces County residents; the region's only Level II trauma center, which is currently located at Memorial; and two medical residency programs.

"And psych was the fourth one, if you recall, and it was added later in the game," Hipp said.

The Department of State Health Services isn't required to submit the statewide mental health plan to Gov. Rick Perry and the Texas Legislature until Dec. 1. That document may impact any agreement between the Hospital District and the health system, Christus Spohn CEO Pam Robertson told the Commissioners Court on Sept. 15.

"And the reason that the state plan is so important is because there's been an acknowledgment by the state that there's not a single solution to behavioral health," Robertson said. "It's not a one provider or one solution. It really is going to require a collaborative approach."

The agreement isn't just about how Christus Spohn and the Hospital District provide psychiatric and behavioral health services today, Robertson said, but about the future of mental health services.

"The state is kind of going through the same thing that Memorial is going through," Lowrance said, with an aging system of state-run hospitals and living centers.

Negotiating a new agreement between Christus Spohn and the Hospital District provides a rare opportunity to re-examine the system, Lowrance said, adding that she's optimistic that psychiatric services will improve as a result.

The Commissioners Court recognized the importance of psychiatric services and will closely watch how they're provided under the new agreement, said Commissioner Joe A. Gonzalez.

"That's something we need to really monitor," Gonzalez said. "How is it really going to be handled?"

Twitter: @CallerDaveH

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