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Serving Mental Health Clients in Our Communities: Liability Landmines to Avoid PARMA 2012 Monterey, California Febru

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Serving Mental Health Clients in Our Communities: Liability Landmines to Avoid PARMA 2012 Monterey, California Febru

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    1. Serving Mental Health Clients in Our Communities: Liability Landmines to Avoid PARMA 2012 Monterey, California February 16, 2012 3:00 – 4:30 p.m. Jack Blyskal, CPCU, ARM, CSAC-Excess Insurance Authority Linda J. Garrett, JD., Risk Management Services Clyde Thompson, Esq., Haapala, Thompson, and Abern, LLP

    2. Introductions and housekeeping Jack will introduce the session and provide housekeeping info. Emphasize that program is meant to be interactive and attendees are invited to “jump in” during the discussion with comments, questions, stories. Jack will introduce the session and provide housekeeping info. Emphasize that program is meant to be interactive and attendees are invited to “jump in” during the discussion with comments, questions, stories.

    3. Agenda Landmines and hazards for the unwary: Staffing/facilities Outpatient programs School programs Crisis services Inpatient services Correctional care Avoiding the Landmines Linda: Here are areas where you will find the liability landmines. Some will trigger malpractice lawsuits, some will trigger administrative fines and penalties. Clyde: And, where there are administrative sanctions there is the increased risk of civil actions where attorneys will take cases that in the past weren’t so intriguing to them. If they can bring an action in federal court based on discrimination, deliberate indifference, or the ADA, their fees may be paid for (making a homeless, mentally ill client more interesting to plaintiffs’ law firms) Linda: Clyde ,we’ve all heard the saying about mental health care delivery systems in California: “when you’ve seen one county, you’ve seen one county.” Will that give plaintiffs attorneys an advantage if they can find a sister county that does things differently (and arguably better) than the defendant County does? Clyde: Yes, it could because a neighboring county could have what appears to be a better way to provide services and therefore a higher standard of care.Linda: Here are areas where you will find the liability landmines. Some will trigger malpractice lawsuits, some will trigger administrative fines and penalties. Clyde: And, where there are administrative sanctions there is the increased risk of civil actions where attorneys will take cases that in the past weren’t so intriguing to them. If they can bring an action in federal court based on discrimination, deliberate indifference, or the ADA, their fees may be paid for (making a homeless, mentally ill client more interesting to plaintiffs’ law firms) Linda: Clyde ,we’ve all heard the saying about mental health care delivery systems in California: “when you’ve seen one county, you’ve seen one county.” Will that give plaintiffs attorneys an advantage if they can find a sister county that does things differently (and arguably better) than the defendant County does? Clyde: Yes, it could because a neighboring county could have what appears to be a better way to provide services and therefore a higher standard of care.

    4. Why the increased concern? Have Mental Health resources really declined in recent years? National Association of State Mental Health Program Directors estimates that states have cut $3.4 billion in last three years; a March 2008 report by Treatment Advocacy Center found that for every 20 public psychiatric beds that existed in 1955, only one such bed existed in 2005; California has cut $587 million in state funded mental health services in last two years (more than any other state) (NAMI) Landmine: those who need hospitalization are often unable to be admitted and those who are admitted are discharged prematurely with inadequate follow-up

    5. California facilities/beds are dwindling 25 of 58 counties have no acute inpatient psych beds; 45 have no child/adolescent beds 1995 – 181 facilities 2009 – 138 facilities 90/450 acute care hospitals w/dedicated psych units 27 licensed free standing psych hospitals 21 county-run PHFs 1995 – 9353 beds 2011 – 6590 beds 5 350 beds/100,000 citizens in 1955, in 2005 only 17 California beds/100,000 (where a consensus of experts found that 50 beds/100,000 is the minimum requirement) 350 beds/100,000 citizens in 1955, in 2005 only 17 California beds/100,000 (where a consensus of experts found that 50 beds/100,000 is the minimum requirement)

    6. Fewer beds -continued 1995 – CA population: 31.6 million 1995 – 1 bed/3,379 Californians 2010 – CA population: 37.2 million 2010 – 1 bed/5,653 Californians Two years ago 50% of Sacramento beds closed without warning LA Times 12/1/11: Cedars Sinai will close in-patient and out-patient psych services in 2012 (loss of 51 inpatient beds) 6 Linda: that translates only 17 beds/100,000 (where a consensus of experts found that 50 beds/100,000 is the minimum requirement) – the next slide shows a chart compiled by the California Hospital Association. Linda: that translates only 17 beds/100,000 (where a consensus of experts found that 50 beds/100,000 is the minimum requirement) – the next slide shows a chart compiled by the California Hospital Association.

    7. Bed losses since 1995

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