By Reuven Blau and Greg B. Smith, THE CITY
(This story was originally published on December 2nd by THE CITY.)
The inpatient detox units at all 11 city-run hospitals are about to close — steering people struggling with alcohol and drugs back into already busy emergency rooms, THE CITY has learned.
The shutdown, expected to occur in the next few weeks, worries some nurses now working the emergency rooms of the city’s Health + Hospital Corp. facilities.
The detox units provide a fully-staffed 24-hour-a-day operation where patients can go through the difficult process of weaning themselves off drugs and alcohol under the supervision of doctors and nurses specially trained to deal with withdrawal.
Patients undergoing the grueling process can become violent. Some nurses currently handling general emergency room assignments where the patient load can sometimes be overwhelming fear the extra burden will be too much.
At Manhattan’s Bellevue Hospital, for example, federal hospital statistics cited “very high” emergency room volume as of 2017. Last year, ER wait times for patients in the general medicine and psychiatric units there ranked far above the national average.
“We approach any such closing with great concern about the fate of patients deemed in serious need of acute care,” said Leon Bell, director of public policy for the New York State Nurses Association. “We are not opposed to transitions to new care settings so long as the quality of the care for all New Yorkers is guaranteed.”
Bell said the union “is opposed to any reductions in vital community health services and will work to make sure that the patients served by Bellevue’s detox unit will continue to have access to the care they need.”
He noted that the union “is confident that patient needs will be addressed by NYC Health + Hospitals through expanded outpatient services and through the use of other appropriate inpatient units.”
The change appears to be part of the “restructuring” HHC has been hinting at over the last two years amid the hospital system’s dire financial straits. HHC faces a projected gap of $1.8 billion in its fiscal 2020 operating budget and has moved to cut costs by $700 million annually through substantial staff reductions.
The city-run system has struggled financially for years, primarily because it provides care to a high percentage of uninsured patients shunned by private hospitals. While HHC accounts for 17% of all patients in the city, 53% of its ER clients arrive without insurance.
Bell cited statistics making clear that city-run hospitals provide the largest percentage of detox services in the city: 40% of alcohol-use cases, 37% of cocaine use and 35% of other drug-use inpatient discharges. They also handle a disproportionate share of psychiatric patients, including 60% of inpatient schizophrenia cases, 50% of bipolar disorder and 44% of major depression.
“Acute care inpatient psychiatric detox clinics play a very critical role today,” Bell said. “This is especially true at Bellevue Hospital and others in the NYC H+H system, which cares for under-served populations — patients who have no other alternative.”
Bell said that some private for-profit hospital systems have closed inpatient beds that serve psychiatric and detox patients, leaving HHC to pick up the slack.
“These psychiatric and detox inpatient services are very costly to provide and are poorly reimbursed,” he said. “They are, in a word, unprofitable.”
New Treatment Approach
Evelyn Hernandez, a HHC spokesperson, confirmed the plan to shut down the detox units, which she described as “severely underutilized.”
“NYC Health + Hospitals is making the transition to a more comprehensive model of care,” she said. “We are replacing the inpatient Substance Use Disorder (SUD) detox model that has been severely underutilized — detox beds across the New York City Health + Hospitals system run empty more than 60% of the time.”
Hernandez said new teams of addiction counselors, doctors and formerly addicted “peers” will work with patients in the ER and direct them into outpatient treatment. The new approach will include therapy and a regimen of the narcotic suboxone, which is designed to wean individuals off substance addiction.
She said last week that only four patients occupied the beds in the Bellevue detox unit. Once that unit is closed, potential detox patients who arrive at the regular emergency room and need to be treated inpatient will be handled by the hospital’s regular Medicine Department.
In the last year, she said, many more staff handling outpatient care have been trained in addiction treatment. Once the detox centers are shut, for HHC will provide “outpatient intensive, medication and therapy” for patients “who are stable and want to begin treatment,” she said.