State lawmakers will hold a public hearing today on Gov. Charlie Baker’s bill to combat the state’s opioid epidemic. One of the legislation’s most controversial elements is a proposal to allow doctors to commit patients with substance abuse issues for up to 72 hours without a court order. For nurses, and especially those in emergency departments, that provision is alarming.
“Our emergency departments are already overcrowded with patients suffering from mental health conditions due to the lack of beds and services in the system,” Massachusetts Nurses Association President Donna Kelly-Williams said. “In fact, one study, conducted by the state’s Mental Health Advisory Committee in 2013 found that more 40,000 patients with mental health conditions are boarding in our hospital EDs each year, waiting for several hours to several days for appropriate care and services. The addition of thousands of patients suffering from addiction will only exacerbate this crisis.”
Kelly-Williams is not alone in questioning the 72-hour hold proposal. Her concerns echo those of Sen. John F. Keenan, D-Quincy, who is a leading voice in the legislature on substance abuse. Keenan wrote in The Patriot Ledger last week that although he applauds Gov. Baker’s efforts to provide additional addiction treatment, “based on the Commonwealth’s past experiences in relying heavily on emergency departments as the front doors to mental health treatment, I am convinced the proposal is incomplete.”
Keenan also highlighted legislation that would require insurers to pay for more care for addiction. Yet this alone is not enough.
“The state and our private-sector facilities need to open more beds for those suffering with mental health conditions and addiction,” Kelly-Williams explained. “We need an increase in outpatient and transitional programs for those with addiction. In addition, the MNA has filed legislation that would establish a pilot program that would reopen beds at Taunton State Hospital for the care of patients with mental illness outside of hospital emergency departments. We also need to pass the Patient Safety Act, legislation that would require safer staffing in hospitals, including our EDs, which are severely understaffed, causing long delays in care for all types of patients.”
New research by registered nurse and Boston College associate professor Judith Shindul-Rothschild demonstrates the need for the Patient Safety Act and shows our existing ED problems. Throughout Massachusetts, there are hospitals with EDs that far exceed the number of patients a nurse can care for safely. There is a strong, statistically significant relationship, between the numbers of patients cared for by an RN in Massachusetts EDs and how quickly patients are evaluated by a qualified health care professional, according to Shindul-Rothschild.
This lack of safe limits leads to patients waiting in tremendous pain. At Boston Medical Center, a Level 1 trauma center, patients wait an average of 94 minutes to be treated for a long bone fracture. It is hard to imagine how adding even more patients to our already over-burdened emergency departments will help anyone.
“The bottom line,” Kelly-Williams said, “is our state and our nation are failing to provide appropriate care and services for those suffering from mental illness and addiction, and the proposed use of hospital EDs as a dumping ground for these vulnerable patients is not only bad policy; it is a disservice to those most in need.”