As budget writers in the New Hampshire House finalize their draft of the state’s next two-year spending plan, they face a key question: how to address emergency room boarding, the longstanding state practice of housing mental health patients, sometimes for weeks, in hospital emergency rooms due to a lack of psychiatric treatment beds.
The issue has been the subject of multiple rounds of litigation in state and federal courts, where judges have ruled that ER boarding is illegal, violates individuals rights, and improperly diverts resources hospitals need to treat other patients.
Tucked inside Gov. Chris Sununu’s recent budget proposal was a provision that would require every hospital in the state to be a designated receiving facility, or DRF, which means that it’s equipped to “provide care, custody, and treatment to persons involuntarily admitted to the state mental health services system.”
“I’m changing one word of the law,” Sununu noted during remarks Tuesday to the Concord Chamber of Commerce. “It doesn’t say hospitals ‘may’ have DRF beds; it says hospitals ‘shall’ have DRF beds.”
But lawmakers on the House Finance Committee rejected that change this week, along with a separate Sununu-backed provision that would undercut the state’s duty to "immediately" move patients involuntarily committed due to mental health crises out of hospital emergency rooms to facilities equipped to treat them.
“The concern is, and I think it’s legitimate, is that folks on the outside side say, ‘Well, you take out ‘immediately,’ and all of the sudden they are going to continue to sit there in the ER, until whenever,’ ” Rep. Keith Erf, a Republican from Weare, noted during a hearing Monday shortly before budget writers removed the governor’s proposals dealing with ER boarding.
Melissa St Cyr, a lawyer for the state health department, told committee members she would ask the governor’s office “if there is other language that they might suggest, since this was their language."
The New Hampshire Executive Council will, meanwhile vote Wednesday on several contracts to expand mental health bed capacity. That includes a proposal to spend $15 million in federal pandemic relief money to partner with SolutionHealth, the health system that includes the Elliot Hospital in Manchester, to build a $60 million, 125-bed behavioral health hospital in southern New Hampshire.
Under the agreement, SolutionHealth will commit to operate the facility for at least 10 years.
A similar deal, with Portsmouth Hospital parent company, HCA, was announced last year but foundered.
“It’s really great. We’ve cut the contract, but we haven’t signed it yet,” Sununu said of the SolutionHealth plan.
State officials also will ask the Executive Council to approve spending $1 million in federal money to help Mary Hitchcock Memorial Hospital in Lebanon open a five-bed mental health unit.
If completed, the new treatment capacity could ease the ongoing burden placed on hospital emergency rooms, where the state reported Tuesday that 28 adults were waiting for treatment beds to open.
But as Sununu expressed optimism over the prospect of fresh treatment beds, he also stressed his anger towards New Hampshire hospitals in general for not being a better “community partner” in addressing the mental health crisis.
“I’m calling bullshit on the hospitals,” the governor said at one point.
The New Hampshire Hospital Association last month won a federal lawsuit challenging the state over ER boarding.
“Everyone takes responsibility for being a positive impact around the mental health crisis, and the hospitals came with their lawyers,” Sununu said. “No way, man, I’m going to fight you, tooth and nail. I’m not going to accept it.”
Asked for a response to the governor’s comments, New Hampshire Hospital Association President Steve Ahnen noted in a statement to NHPR that a federal court ruled that the state is failing its most vulnerable citizens with an illegal practice.
“Rather than calling names and lashing out, it’s long past time to resolve this matter so that patients in acute psychiatric crisis and their families know that New Hampshire is supporting them, and that they will always be able to receive the care and treatment they need,” Ahnen said.
