CPEP—the Comprehensive Psychiatric Emergency Program run by St. Joseph’s Hospital—serves about 7,000 patients a year. There are no published figures about its budget, but St. Joe’s budget is $402 million. You can bet that CPEP is costing several of those millions. Information about CPEP is not forthcoming.
When I called CPEP and asked how many beds they have, I was told they couldn’t give out that information.
Why don’t you give them a call yourself at (315) 448-6555 and see what you can find out?
Meanwhile, here’s another story that the Post-Standard isn’t reporting.
Puttin’ in the Fix
Dr. Ghaly would see his patients in the hospital in the morning; in the afternoon he would see his patients in the office, and then, a couple nights a week, he would go to work in CPEP. The days’ after, when he would see me, he often would be frustrated and distressed: CPEP wasn’t big enough or staffed well enough to care for all the patients who were coming there.
It is practically impossible to get psychiatrist’s to cover CPEP; it’s not desirable duty. Therefore, there is only one psychiatrist on the service at a time. Patients come in by choice or are brought in by coercive police action and must be seen by a psychiatrist before they can leave. The psychiatrist can treat and discharge, or admit to “the back.”
The back of CPEP consists of a nursing station, a drug room, a couple showers and bathrooms, and a day room that has a couple tables, some chairs and a television. It also has eight patient “rooms” too small to accommodate anything more than a single bed and a night stand.
Patients are not treated in the back. They only are held there until they can be transferred to a regular inpatient psychiatric unit. The patients are medicated but receive no other kind of therapy, support or intervention. And they are not supposed to remain in CPEP for more than three days.
The problem is that there is nowhere for the CPEP staff to transfer patients to. There aren’t enough beds available locally on inpatient psychiatry. Syracuse has psychiatric units in the Veterans Administration Medical Center, SUNY Upstate Medical Center, Community General Hospital, and Hutchings Psychiatric Center.
Hutchings is the state hospital and there have been continual efforts to reduce its patient population or shut it down. It was built in 1972 and has a dozen buildings but currently only three are being used for adult inpatient service. It has 105 beds to serve five counties. The number of beds at the other facilities is not publically reported, but is about forty beds each.
Hutchings is the only place that admits children and adolescents, and it has 30 beds for that use. There used to be a private hospital, Benjamin Rush Center, whose owner had wisely read the future and created a large children’s’ unit in the 107-bed facility. After the owner’s death, the hospital was sold to Four Winds, and then closed by the state for “numerous deficiencies.” Speaking from experience, on its worst day Four Winds was better than Hutchings on its best day. But when the state investigators come, are they going to hold a private facility to the same standard as a state facility?
There is bias against treating people for profit, no matter how well and how successfully they are treated. Additionally, the argument is that the state hospital has to be kept open no matter how poorly it treats people (“We will work with the staff and try to engender improvements.”) because the need is so great. The state can’t shut itself down; it has to have some place to put people. Besides, Medicaid charges for Hutchings treatment are less than Medicaid charges for private treatment. In the end, it is never about the quality of care; it is always about the money.
The end result of the shortage of inpatient psychiatric beds is that patients back up in CPEP and general hospital emergency rooms. The director of Upstate Medical Center’s children’s emergency room attended a public hearing and made it very clear that he didn’t want children with mental problems in “his” emergency room. So what happens? Nine-year-old Michael ends up sharing space at CPEP with Al the convicted killer.
When there are no vacant beds in the county, CPEP staff have to start searching the state to find any bed, anywhere. Patients are sent out-of-county, away from their family, friends and homes, in order to receive treatment. In Central New York there is a gross failure of hospital administrators and government officials to plan and work effectively to meet the needs of patients with psychiatric diagnoses.
Mental illness is neither glamorous nor popular, and is treated behind locked doors, so it gets ignored. St. Joseph’s cardiac care services are ranked number one in the state; Crouse Hospital has the best Neonatal Intensive Care Unit in a fifteen-county area; Upstate has the only Level I Trauma Center between Pennsylvania and Canada; Community General—well, it does the best it can. But nobody wants to provide for patients who are mentally ill.
So it ends up with Dr. Ghaly standing in front of me with bloodshot eyes and steam hissing from his ears. I ask him what’s wrong and he replies, “Eh! CPEP . . . !” He saw thirty patients in the last twelve-hour shift. That is about twenty minutes per person to interview a complete stranger, make a diagnosis, figure out a treatment, sell it to the patient, and then write the notes the state requires. In these circumstances would you feel that your daughter or father had been treated properly? (To be continued)