Sitting at his desk Monday at High Plains Mental Health, Walt Hill had no idea what was going to happen if a child in the 20-county area of northwest Kansas, which the agency serves, has a psychiatric crisis that requires hospitalization.
As of Monday, KVC Hospitals, 205 E. Seventh St., closed its 12 beds that for 12 years have been reserved for kids under 18 who are suicidal or dangerously aggressive.
“From our 20 counties, we would send 180 children a year,” said Hill, CEO of High Plains, the mental health agency that serves the residents of northwest Kansas. “About one every other day.”
Youths in crisis stay anywhere from three to eight days, Hill said during an interview with The Hays Daily News. Now kids in the 20-county area will have to go to Wichita, Kansas City, Denver or Kearney, Neb., for care.
Staying connected, or getting support from parents and pastors, will be a problem, Hill said. But another, perhaps even more critical, issue is transportation. In the past that was the job of parents or law enforcement.
Over the weekend, several children were still brought to KVC Hays, Hill said. But no more.
“I guess the admissions were still open at KVC Hays,” he said. “But as of today they will go to Wichita.”
The problem has worried legislators and law enforcement since the closing was made public in early September.
Rep. Troy Waymaster told Ellis County commissioners earlier this month at their regular commission meeting that he and other legislators took a three-day mental health tour in September of the facilities in western Kansas. Even getting to KVC Hays has been difficult for some kids across the 20 counties.
“I have to say that being on that mental health tour was very eye opening,” Waymaster said. “Especially what some of the children in the state are subjected to when they go to these facilities, what the families have to endure, and so that’s going to be an issue that we’re going to be having quite a bit of discussion of as well.”
Sen. Rick Billinger and Rep. Barb Wasinger have also expressed concern about the closing during recent legislative updates to the Ellis County Commission and Hays City Commission.
“How does a child and their parents, who are in Goodland or Colby or St. Francis, when the child is physically aggressive or terribly suicidal, how do they get to Wichita or Kansas City?” asked Hill, whose agency is a neighbor just down the block from KVC.
“It’s a big difference between law enforcement driving six blocks, or parents, bringing a child over six blocks, versus getting them to Wichita or Kansas City, while the child is physically aggressive or ready to jump out a car door because they’re suicidal,” Hill said. “It isn’t uncommon that our children at West Side School have to be hospitalized here at KVC.”
Legislators and Hill say the reasons for KVC's elimination of its acute care beds in Hays aren't clear.
At a Legislative Budget Committee hearing Oct. 2 in Topeka, legislators questioned officials from the Kansas Department for Aging and Disability Services about why nothing was done sooner to address the closing crisis, according to a transcript Hill provided of the session.
KVC has switched all its short-term acute crisis beds in Hays to 30-90 day psychiatric residential treatment facility group home beds, called PRTF by the industry, confirmed Blythe Hinderliter, director of KVC marketing. Eventually KVC Hays will increase from 38 to 50 PRTF beds, she said.
“We were getting conflicting information on what we were told on the tour and what we’re being told in Topeka,” Waymaster told the Ellis County Commissioners. “They’re going back and seeing what is the actual reason KVC is closing the acute care portion of that facility and making them all PRTF beds.”
The closing essentially violates a promise the state of Kansas made 12 years ago when it closed its acute care kids beds in Larned and contracted the service with KVC. The state at that time promised residents of northwest Kansas the service would be available through KVC, said Hill.
But two and a half years ago, from what Hill can tell, KVC was told by KDADS that the federal Centers for Medicare and Medicaid Services had said KVC was mixing two different kinds of patients, long-term versus acute crisis, in a way not allowed by law.
To fix the problem, KVC was told to separate the long-term hospitalized youths from youths in crisis.
According to the hearing transcript, Andy Brown, KDADS commissioner of behavioral health services, told legislators that KVC said keeping the acute care beds wasn’t financially feasible. Youths would now have to be served by KVC’s new 52-bed Wichita hospital, which opened this summer.
But Hill said KVC told him the problem was a needed modification in Hays to replace a suspended ceiling with either a permanent drywall ceiling or a higher suspended ceiling, to eliminate the possibility of hanging. KVC told Hill the fix was not financially feasible.
“Of course I wondered why doesn’t the state give them the extra funds to remodel the facility, since it’s state hospital beds?” Hill said.
Waymaster at the October hearing said legislators should have been told about the Hays closing sooner, before KVC sent out a formal letter to High Plains and KDADS.
“There was a lot of mishandling, I think, in this situation,” Waymaster said at the hearing. “And now, the kids who need the help the most are going to be suffering from it.”
Hill indicated to the legislative committee that the closing was abrupt.
“We received notification on a Monday that those beds were going to be closed the third week of October because of an issue with CMS and payment,” Hill told the committee. “That's all I'm aware of. I've not been privy to more details. There have been no discussions in western Kansas about this, about the impact, before or after the decision was made.”
KDADS’ Brown told legislators at the hearing that KDADs would help if it could, according to the transcript.
“If we were able to find a way to identify a provider on the western side of the state, that we could license for these sorts of kids for the acute care, we'd be happy to do that,” Brown said.
KDADS is required to enforce the CMS rule about mixing the two kinds of kids, said Brown.
“KVC made the decision to close the facility, not us,” he said.
The situation has been a problem for a number of years, and one that the state and KVC have worked around by the “grace of God,” Brown told the committee. He became aware of it when he was appointed commissioner in May and became obligated to enforce the CMS rule.
Mixing the two different groups of kids has resulted in assaults in the past, Brown said, but he doesn’t know how many. Billinger asked him to find out.
The legislators also asked that KVC come and explain its side of the story.
Dave Anderson, director of clinical programs at High Plains Mental Health, said in an interview that the situation will be a hardship for both youths and their families, and possibly communities. With beds at KVC, youths get their treatment locally, where their families can participate.
“These would be some kids from Goodland, Colby, Norton, Dodge,” Anderson said. “Now all those kids and their families are going to have to go to Wichita or Kansas City. And what that means is a lot of them are not going to get that care. Not having those resources available means people don’t get care and that puts more people at risk.”