A photograph taken outside of the Sheridan Memorial Hospital Emergency Department. Courtesy photo provided to the Wyoming Tribune Eagle on Wednesday.
An entrance to Sheridan Memorial Hospital. Courtesy photo provided to the Wyoming Tribune Eagle on Wednesday.
A sign for Sheridan Memorial Hospital. Courtesy photo provided to the Wyoming Tribune Eagle on Wednesday.
A photograph taken outside of the Sheridan Memorial Hospital Emergency Department. Courtesy photo provided to the Wyoming Tribune Eagle on Wednesday.
An entrance to Sheridan Memorial Hospital. Courtesy photo provided to the Wyoming Tribune Eagle on Wednesday.
A sign for Sheridan Memorial Hospital. Courtesy photo provided to the Wyoming Tribune Eagle on Wednesday.
The Sheridan Press Via Wyoming News Exchange
SHERIDAN – Sheridan Memorial Hospital was not designed to accommodate people in mental health crisis. It does not operate an acute psychiatric unit; it does not offer inpatient psychiatric services.
Despite this, SMH accepted approximately 150 patients held under Title 25 in 2021, hospital CEO Mike McCafferty said.
Sheridan Memorial Hospital’s reception of patients held under Title 25 – and its role as the de facto inpatient psychiatric facility in Sheridan County – results in enormous staffing, security and financial burdens for the hospital, McCafferty said.
When a law enforcement agency calls Sheridan Memorial Hospital to tell emergency room staff an involuntarily committed patient is on the way, hospital staff jump into action to make space in the hospital safe for a Title 25 patient.
Staff roll away IV poles and supply carts and remove oxygen tubing and shower curtains, said SMH’s then-director of critical care, Lynn Grady. They take away any items not bolted to the walls or floors the patient might use to harm themself or others.
When the patient arrives, usually with law enforcement, at Sheridan Memorial Hospital’s Emergency Department, the first step is medical stabilization, SMH Emergency Department Medical Director Dr. Luke Goddard said. Often, Goddard said patients arrive after attempting to hurt themselves, so the hospital treats physical injuries first.
Patients are also sedated, Goddard said.
Once the patient is medically stabilized, mental health evaluations begin, Goddard said. Within 24 hours, a social worker or psychiatrist evaluates the patient’s suicide and other mental health risks and reports back to SMH staff, explaining what level of mental health care would be appropriate for the patient.
If a mental health professional deems the patient safe to go home, no further care is required of SMH. In fact, if at any time the patient is no longer exhibiting suicidal ideations, a physician and nursing team will start developing a discharge plan, according to SMH’s then-director of quality, Liz Mahoney.
If not, SMH staff reach another decision point, Goddard said: Will the patient stay at SMH or be transferred elsewhere?
(A hospital representative told the Wyoming Tribune Eagle on Wednesday that both Mahoney and Grady have left the hospital since interviews were conducted with them about involuntary hospitalizations.)
SMH operates two safe rooms, intended for anyone experiencing a mental health crisis and requiring stabilization, Mahoney said. The rooms are tiled and ligature free – or designed to ensure ropes and other materials cannot be tied to furniture or other fixtures – with beds bolted to the ground and an observation window.
These rooms are not without their drawbacks, SMH Hospitalist Dr. Derek Gilbert said. Often, both safe rooms are occupied, and hospital staff and patients have to do the best they can with other rooms. The safe rooms are also centrally located right next to the nurses station to allow for easy access, but if psychiatric patients are loud, they can disrupt other patients’ healing.
Although SMH’s emergency and hospital rooms are not designed to be converted into miniature acute psychiatric units, SMH’s facilities are nonetheless used to care for patients during Title 25 holds because Wyoming lacks adequate inpatient psychiatric beds, McCafferty said.
Experts estimate states should have about 50 beds per 100,000 residents – meaning Wyoming should have nearly 300 inpatient beds. The state currently operates fewer than than 200 behavioral health beds.
Wyoming also has the highest percentage – by 13% – of residents living in mental health provider shortage areas in the country.
A 2021 report from the U.S. Health Resources and Services Administration and nonpartisan data analysis organization USAFacts found 96.4% of Wyomingites live in a mental health care provider shortage area, compared with 37% of people nationally.
None of this is good news for the state with the highest suicide rate in the U.S.
This lack of care providers, hospital officials agreed, has dire consequences for individuals, Sheridan Memorial Hospital and beyond.
At SMH, Title 25 patients have also necessitated additional staffing in some cases. McCafferty said the hospital hired a security team as a result of Title 25 holds.
Although Goddard said Sheridan County law enforcement have been very helpful in staying with patients to ensure hospital safety, incidents sometimes happen, resulting in unsafe environments for SMH staff.
Since 2017, SMH has added $1.1 million annually to its budget to enhance services and safety related to Title 25, McCafferty explained.
Throughout a titled patient’s time at SMH, a “one-to-one sitter,” or an SMH staff member tasked with supervising the patient at all times, is assigned to the patient’s bedside, Grady said. Although these sitters need not be licensed professionals – they can be certified nursing assistants – they nonetheless pose a significant cost to the hospital.
One-to-one sitting responsibilities monopolize the employee’s time and energy, Grady said. For instance, a one-to-one sitter would be required to remain with one titled patient while a nurse would normally be expected to care for five to six patients.
This staffing pinch is exacerbated by the ongoing pressures of the COVID-19 pandemic. Health care providers are exhausted from treating repeated onslaughts of COVID patients – at times, having to treat double their average daily patient load – Grady said, but still have to care for behavioral health patients, which are also emotionally taxing.
“It’s a circus, at times,” Gilbert said of the competing challenges of COVID-19 and Title 25. “It’s a rodeo.”
To read this entire story online, go to the website of The Sheridan Press: www.thesheridanpress.com
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