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Concerns Grow over Unit Closing

Inova Health Systems defends decision.

The proposed closing of the psychiatric unit at Inova Alexandria Hospital will cause many problems for patients, Community Services Board (CSB) staff who serve them, as well as the police.

That's according to Phillip Bradbury, the chairman of CSB, who expressed his concerns before City Council last week.

“One of the Board’s prime functions is to protect the interests of persons with mental disabilities, including advocacy on their behalf when the occasion demands. I am here to express the Board’s deep concern over the announced closing of the in-patient psychiatric unit at Alexandria Hospital on or about Jan. 1, 2004,” he said.

In a statement provided to The Gazette Packet, Inova Health Systems, the parent organization of Inova Alexandria Hospital, explained the reason for the closure.

“Inova Health Systems is conducting a comprehensive review of the acute health-care services in the communities we serve across Northern Virginia. Our goal is to ensure that we are best matching our services and facilities with the health-care needs of the community.

“Part of the study is focused on in-patient psychiatry services. Inova currently provides those services with 34 beds at Inova Fairfax Hospital, 23 beds at Inova Mount Vernon Hospital and 19 beds at Inova Alexandria Hospital.

“While our psychiatry units at Inova Fairfax and Inova Mount Vernon hospitals are well-utilized and have consistent physician/staff coverage, this is not the case at Inova Alexandria Hospital.

“Increasingly across the nation, more and more physicians who care for psychiatric patients are shifting from providing that care in in-patient hospital settings to offering those services in outpatient clinical settings. This is the case at Inova Alexandria Hospital, where patient utilization of in-patient beds has decreased dramatically,”. the statement read.

THAT IS ONLY part of the story, according to Dr. F. J. Pepper, the chairman of the Department of Psychiatry at Inova Alexandria Hospital.

“It is true that more psychiatrists are choosing to provide only outpatient care,” Pepper said. “However, we were told not long ago, by a consultant, that our unit was fine for the next five years or so and then it would have to be re-evaluated. Deciding to close it now came out of the blue,” he said.

Pepper has served as chairman of the department at Alexandria Hospital on four previous occasions and will hold the position for two years. He is now the only psychiatrist who is providing services to patients at the hospital. He admits that on-call coverage has been an issue.

“There were some concerns, but with staff from the Alexandria Mental Health Center, we have things covered pretty well,” he said.

Beginning on Oct. 1, the CSB will have five psychiatrists working with patients at the hospital. They will share on-call responsibilities with Pepper. “That means that each of us will cover about five days a month, and that is fewer days than I have covered in the past,” Pepper said.

CSB PROVIDES THE doctors and other staff because Inova Alexandria Hospital is the primary provider of in-patient psychiatric care for CSB customers. According to Bradbury, the hospital’s psychiatric unit admits more than 700 customers each year, 80 percent of whom are Alexandria residents.

“Closure of the unit will have a very serious detrimental effect on their lives in ways that may not be readily apparent,” Bradbury said.

Involuntary commitment is one of the primary concerns. About 200 people each year are involuntarily placed in the psychiatric unit at Inova Alexandria Hospital.

“At present, that process is straightforward since Alexandria Hospital usually has beds available,” Bradbury said. “CSB staff evaluate the patient, and if hospitalization is required, our staff facilitate the process. If the patient requires involuntary hospitalization, otherwise known as [a] temporary detention order, the police must become involved and must stay with the patient until the patient has been checked into the psychiatric unit.”

THAT HAS POLICE concerned as well. “We know the staff at Alexandria Hospital and have worked out the process,” said Capt. Blaine Corle, who serves as the liaison on mental health issues that involve the police department. “Right now, the process takes about four to five hours, and because we are familiar with the security personnel at the hospital, and because there is an off-duty Alexandria police officer working at the hospital on weekends, we can frequently send one officer to be with the patient until that patient has been placed in the psychiatric unit.

“If we have to transport patients to Mount Vernon or Fairfax, that process could take double the amount of time that it currently requires, and I will definitely have to send two officers, even for routine situations. Then, if you have to go to Fairfax Hospital during rush hour on any day, you might as well figure on having two officers out of service for their entire shift. This is a real problem.”

But what can be done?

“I believe that they ought to find a way to keep the unit open,” Pepper said. “You can’t have a full-service hospital without a psychiatric unit. If it’s going to cost Inova some money, they need to find it. The bottom line shouldn’t be the bottom line.”

At Bradbury’s request, Alexandria mayor William D. Euille has appointed two members of City Council, Councilman Rob Krupicka and Councilman Paul Smedberg, to serve on a task force with members of CSB. The task force will operate out of the City Manager’s office.

“The proposed closing needs to be closely scrutinized,” said City Manager Philip G. Sunderland. “It has potentially significant effects not only on city residents but also on a number of city departments that share responsibilities for the hundreds of clients who, up to now, have been cared for in the unit.

"Alternative facilities, quality of care, increased cost, these and other factors will be addressed over the next two to three months by a city manager committee that includes members of City Council and the CSB.”