Greater Dayton Area Hospital Association

1
Proposed Closing of Twin Valley Behavioral
Health A Community Discussion
February 22, 2008
2
Overview

• On January 31 Governor Strickland announced the
  proposed closing of Twin Valley Behavioral Health
• Community leaders convened to discuss community
  implications
• Participants include government, hospital
  leaders, educators, behavioral service providers,
  and the business community
• Questions have been raised for the Ohio
  Department of Mental Health

3
Dayton Region is Unique - No Public Hospital

• Top 100 healthcare metro regions Dayton ranks
  52nd
• Only 4 metro regions larger than Dayton do not
  have a public hospital
• Only 7 regions smaller than Dayton do not have a
  public hospital
• 88 of metro healthcare regions have some type
  of public hospital (City, County, State and/or
  University)
• Toledo, Cleveland, Columbus Cincinnati all
  have public hospitals

Public Hospital (88)
American Hospital Association Guide
4
Safety Net Task Force

• Diverse community stakeholder group
• Hospitals
• Business community
• Clinics
• Local governments
• Human service providers
• Draft report being constructed
• Environmental assessment
• Menu of options for further study

5
Total Uncompensated Care Costs for
Montgomery County Hospitals
126.7 million
6

Emergency Department visits increased by almost
15 between 2000 and 2005.
Emergency Department Visits in Montgomery
County2000 and 2004
Number of Visits
Source AHA Annual Survey Database, Fiscal Years
2000 and 2004
7
2007 Reroute Statistics
8
Hospitals on the Brink

• Psychiatric units at local hospitals are not
  equipped to handle the type of patients treated
  at Twin Valley Behavioral Health
• Level of acuity
• Length of stay

9
Montgomery County

• Cost to transfer patients to other State mental
  health facilities - 200,000 per year for
  Sheriffs Department
• Emergency department utilization
• Significant impact on an already fragile safety
  net system
• Impact on ADAMHS will include limited discharge
  planning, less timely access to services, and
  limited ability to monitor quality of services
  for patients out of county

10
Miami County Upper Valley Medical Center

• All Adult Psychiatric patients from Darke,
  Shelby, and Miami County utilize UVMCs (Dettmer)
  psychiatric unit.
• Dettmer Adult Psych unit is a 17 bed unit that
  operates above 85 occupancy (no additional
  capacity).
• The Tri-County (Miami, Darke, Shelby) averages
  over 5 patients per day at Twin Valley Behavioral
  Health.
• Dettmers unit is a single open unit.
• No psychiatric intensive care area.
• Significant hospital staff and other patients
  safety concerns.
• Travel distance to Toledo (120 miles) is
  estimated to be a 5 hour round trip.
• Local law enforcement will not be able to be out
  of the county for 5 hours at a time without
  decreasing the safety of our communities.

11
Greene County Greene Memorial Hospital

• GMHs Behavioral health Unit serves not only
  Greene County, but also serves patients from
  surrounding counties as well
• 19-bed unit with only 1 seclusion/restraint room
  to handle TVBH patients
• GMH would incur sizable costs in staffing and
  facility upgrade to handle higher acuity patients
• Increased travel required for transfer of
  patients will be significant

12
Wright State University School of Medicine
Professional Psychology

• Since 1978 more than 300 psychology students,
  interns, and post docs have utilized the
  resources of TVBH
• Last training year (2006-07) 2 practicum
  trainees, 1 intern, and 1 post doc fellow
  completed training at TVBH
• TVBH is uniquely positioned as the only public
  mental health inpatient facility readily
  available as a clinical training resource often
  with forensic involvement
• Due to the planned closing the TVBH training
  position was removed from the match process
  impacting 16 applicants

13
Wright State University School of Medicine -
Psychiatry

• In 2008 all 40 psychiatry residents have an
  experience at TVBH
• Medical student rotations through TVBH are the
  strongest recruitment element in psychiatry
• TVBH offers an attractive training experience in
  forensic psychiatry that produces highly
  qualified clinicians prepared to treat a
  challenging patient population with extensive
  needs

14
Community Impact

• Healthcare Safety Net system already under
  stress
• Less public resources per capita and per patient
  to deal with healthcare issue than other regions
  in the State of Ohio no public general hospital
• Hospitals ill-equipped to handle these cases
  safely and effectively
• Human cost - Not in the best interests of the
  patient, the patients family, other hospital
  patients and the community
• Direct impacts to residency training and
  recruiting
• Very little lead time for community to respond to
  potential closure

15
Questions

• What were the deciding factors utilized by the
  Ohio Department of Mental Health to recommend
  closing Twin Valley?
• Are uniform cuts across all departments Board in
  the best interest for the Dayton region and for
  the State of Ohio?
• What is the percentage of cuts in the Department
  of Mental Healths budget compare to other state
  departments?
• Was the fact that the Wright State University
  School of Medicine residency program could be
  adversely impacted by this closure factor into
  the decision-making process?
• Was the fact that the Dayton region does not
  have any public general hospital taken into
  consideration when this decision was made?

16
Questions

• How does TVBH compare to other state facilities
  in
• operating costs?
• capital costs?
• staffing?
• length of stay?
• Did the Ohio Department of Mental take into the
  consideration the vast amount of overcrowding
  prevalent in the Dayton regions emergency
  departments?
• If Twin Valley is closed, what resources will
  the State of Ohio provide to the Dayton region to
  assist with this transition physical
  improvements to hospitals, transportation costs,
  increased security costs, etc.?