Pierce County Judge Says Boarding The Mentally Ill In ERs Violates State And Federal Law

A Pierce County Superior Court judge said Monday that temporarily boarding the mentally ill in hospital emergency rooms without treatment violates state and federal law. County and state attorneys have asked for the ruling to be put on hold while they appeal.

The suit originated with 10 patients who were temporarily boarded at hospitals in Pierce County.

Under Judge Kathryn Nelson’s ruling attorneys for patients waiting more than 72 hours for a mental health evaluation could argue that they be immediately released.

Officials like Amnon Shoenfeld said that’s not a good solution because it means people who could be deemed a danger to themselves or others may not get the care they need. Shoenfeld, the director of King County's Mental Health, Chemical Abuse and Dependency Services Division, said he’s been talking about the issue of boarding for 20 years.

Some hospitals are better equipped to handle patients who need a higher level of psychiatric care, like Harborview Medical Center in Seattle.

Darcy Jaffe is chief nursing officer at Harborview. She said the hospital boards as many as eight patients a day in the emergency department. They’ve created a special program to deal with the situation.

“A psychiatrist is assigned to them and psychiatric nurses take care of them,” Jaffe said. “We bring the treatment to them in somewhat the same way they would receive it if they were in our psychiatric units. So that when they do transition to the psychiatric unit their care already starts."

But Jaffe said it’s not ideal and the need is only increasing.

Shoenfeld said in recent years the state has lost 150 community psych beds, more than 200 state hospital beds, and funding is on the decline. “We’ve gotten into this perfect storm of less hospital beds, stricter laws that make it more likely for people to be committed, reduced community treatment funding and increased population,” said Shoenfeld. “All of that is put together and made a major crisis in the state.“

Monday’s ruling upheld an earlier court commissioner ruling. The State Attorney General’s office, which is planning an appeal, said the commissioner had no authority to rule on the issue of boarding.