County, Tri-City to negotiate on psych facility

SAN DIEGO - County supervisors voted today to allow the Health and Human Services Department to formally negotiate with Tri-City Medical Center officials on a possible new psychiatric facility.

The board nixed a proposal by Supervisor Jim Desmond, who originally submitted a letter requesting $14 million for a new psychiatric facility in Oceanside to replace the one that Tri-City closed last September. The Tri-City closure means most patients now on an involuntary psychiatric emergency hold are taken to the county's psychiatric hospital in San Diego or Palomar Medical Center in Escondido.

If supervisors and Tri-City's board of directors had approved the original proposal, the county would pay for constructing a facility, while Tri-City would operate it.

Before the vote, Desmond asked to remove the financial request and start negotiations with Tri-City. The board will revisit the issue in September.

"I don't believe Tri City is looking for a handout -- they just want to survive,'' Desmond said.

Desmond, whose district includes several North County communities, said there aren't enough beds to accommodate those with serious mental health needs. There has been a large increase in involuntary psychiatric holds, which strains law enforcement resources, he said.

"We have a behavioral crisis in North County, and it's getting worse,'' Desmond told his colleagues.

He said his original proposal was not perfect, but would have established a dozen "crisis stability unit'' spots and 16 beds within a new and much-needed facility.

Tri-City is offering a good site on its campus without community opposition or other related issues, Desmond said.

"If you think putting up new housing is difficult, siting a behavioral health facility is impossible,'' he added. "If we were to go it

alone, we'd have to find a site, build, deal with the community and not be reimbursed. Partnering with our hospitals is the best of a bad situation. We need the hospitals, as much as they need the county.''

Leigh Anne Grass, who chairs Tri-City's board of trustees, said she appreciates efforts by both Desmond and Supervisor Kristin Gaspar to find a solution.

"We will continue to do what's right for the residents of our district,'' she said.

Oceanside Police Department Chief Frank McCoy read a letter from Oceanside Mayor Peter Weiss asking the county "to develop effective strategies to balance behavioral health needs.*

Weiss wrote that the original county proposal discriminates against those with insurance, and that all patients should have access to appropriate mental health care services.

Board Chairwoman Dianne Jacob said the county should negotiate with other hospitals that are interested and should not have to pay the entire cost for a facility.

"We're directing the (chief administrative officer) to negotiate; what's fair for one is fair for all,'' she said, noting that Tri-City walked away from its responsibility last year.

"This is a partnership we would be creating with Tri City, not a bailout,'' Jacob added.

Gaspar said the county was "going back to the drawing board and that's OK.''

She noted that reimbursement rates for this type of care are extremely low, making services harder to provide.

"When it comes to equitable spending, we need to manage expectations,'' Gaspar said, adding that strategic investments are what's needed, including partnerships with hospitals.

Supervisor Nathan Fletcher said the Tri-City situation was in contrast to other hospitals that treat behavioral health patients, including Palomar, Scripps, University of California San Diego, Sharp and Rady Children's.

"It's hard to have a partnership when one party says it's not their obligation,'' he said in reference to Tri-City.

Fletcher added that he has grave concerns that taxpayer funds would pay for private insurance facilities, and "if we go down that road it will never end.''

Fletcher later said that while he supports negotiations with Tri-City, "it is important to note that these efforts are essentially at the same place they were a year ago.''