At its June 22 meeting, the Southeast Health Planning Task Force addressed two issues: the lack of obstetrics and neonatal services at Inova Mount Vernon Hospital and the lack of beds for mentally ill people detained for being a danger to themselves or others.
At its May meeting, the task force agreed to write a letter to Sen. John Warner (R), head of the Senate Armed Services Committee, asking him to encourage the Army to consider the region’s perinatal care needs during its planning for the BRAC base realignment. As part of its realignment plan, the Army will be closing Walter Reed Medical Center and shifting some of its caseload to a new hospital at Fort Belvoir. Belvoir’s current hospital, Dewitt, will also be replaced by the new hospital.
Dewitt offers obstetrics care. Inova Mount Vernon does not. According to task force chairman Anne Andrews, studies show that in order to have a cost-effective, high-quality obstetrics program, hospitals must handle a minimum of 3,000 births per year. But, Inova Mount Vernon’s patient population cannot account for these numbers. Currently Mount Vernon residents often travel to Inova Alexandria Hospital or Inova Fairfax to give birth.
Dewitt Hospital does offer obstetrics, but it handles well under 3,000 births per year. According to the task force it performed slightly fewer than 1,000 deliveries in 2005. The task force estimated that if the populations of Belvoir and Mount Vernon combined into a single obstetrics program, the unit would achieve the 3,000 birth benchmark.
“WE BELIEVE it could be mutually beneficial for there to be a jointly operated perinatal services program at IMVH, providing obstetrics and neonatal services to both those receiving care through the military system as well as residents of southeast Fairfax,” the letter reads.
At the meeting, Andrews presented the draft of the letter, as well as a version that the hospital had agreed to cosign. The hospital’s letter was nearly identical. However, it dropped the phrase “at IMVH” from the wording of its request.
Barbara Doyle, Mount Vernon Hospital’s new CEO, said she agreed with the task force that an obstetrics unit in the area was “absolutely a need that must be met,” but she said Inova would not insist that the unit be located at Mount Vernon Hospital.
Task force members could not agree to this change. Jeffrey Mckay, the chief of staff for Lee District Supervisor Dana Kauffman, said security measures on the base would make the hospital too difficult to access.
Gary Lupton, site director for the Mount Vernon Center for Community Mental Health, said his post office is located inside Belvoir, although he lives outside the base. “Going to the post office is an ordeal,” Lupton said, “going to the hospital [would be] no less.”
With the planning for the base reaching its final phases, task force members believed the letter must be sent as early as possible. And they could not compromise on the location of the perinatal unit. “Our whole purpose was to have it here,” said Kenneth Disselkoen, Fairfax’s Regional Director for Human Services.
“We don’t really want to give them a choice,” said Andrews. “It has to be here.”
So the task force sent out its own letter without the hospital’s signature. They requested the hospital send a companion letter in support of a combined perinatal unit.
Andrews said she is optimistic the request will be successful. She said the local military and civilian hospitals had a history of cooperation in certain areas, such as joint replacements. “We just would like a breakthrough of cooperation with the Army to have all their obstetrics,” she said.
In addition to Warner, the letter will also go to Sen.George Allen and U.S. Reps. Jim Moran (D-8) and Tom Davis (R-11).
THE SECOND ISSUE raised at the meeting concerned the detention and hearing procedures for those deemed to be dangerous to themselves or others. Dr. Nooreddin Mirmirani, Director of Inova Mount Vernon’s Psychiatric Unit, described serious flaws in the current system for housing, transporting, and holding hearings for the detained mentally ill.
After a petitioner has requested that someone be held, and that person has been taken to a hospital psychiatric unit, a 72-hour clock begins to tick. A temporary detention hearing presided over by a special justice must be held within this period, according to Jim Kelly, Emergency Services Manager for Fairfax Mental Health Service. But a dwindling number of psychiatric units and the centralization of all detention hearings means many detained people must spend hours being moved between hearings and psychiatric units.
“The issue of where to house them safely … is a very serious matter which has become more troublesome throughout Virginia,” Mirmirani said. In addition, a recent policy requires that all detention hearings be held at Inova Fairfax Hospital.
The hearings were consolidated in Inova Fairfax because the lawyers involved (those representing the mentally ill and those who trained to be special justices) insisted the hearings be as close as possible to their offices near the county courthouse.
MIRMIRANI PROPOSED a solution to the beds and transportation issues. “Why don’t we build a specific facility … dedicated to purely psychiatric patients?” he asked. He described a twenty-bed unit with a medical facility and an adjacent hearing room.
Building this facility would require land, and Mirmirani said there is only one hospital in the area surrounded by adequate, affordable land: Inova Mount Vernon.
Mirmirani said this project would require the cooperation of the county, the state, and Inova. “The question is to get these people together and discuss [it],” he said. “I think the cost is really going to be the issue.”
He said hospitals were closing psychiatric units across the state because the financial numbers do not work. “It’s a [money] losing business.” Mirmirani said. “The question is, “Who really owns these patients?’ … The state has abandoned that. The county can’t do all of it.”
But task force members said Mirmirani’s dream of a self-contained mental health detention facility at Inova Mount Vernon is most likely to be complicated by a fourth party: the lawyers who initially moved all hearings to Fairfax.
According to Kelly, who was not present at the meeting, Inova Mount Vernon used to host the hearings because it had under-utilized bed space. But the court decided it would hold all hearings at Fairfax Hospital more than one year ago.
He said that although patients must now be transported from one hospital to another, “Fairfax … could be viewed as somewhat progressive in that they have a court that goes to a hospital.” Many counties simply hold all detention hearings at a courthouse.
Kelly acknowledged a lack of bed space in the region. “The whole idea of having additional psychiatric beds is well needed,” he said, explaining that all of Alexandria’s patients must travel to Mount Vernon hospital to await their hearings at Fairfax Hospital.
He said the transport problem has been exacerbated by the bed shortage. “We’ve had this loss of beds in the area which makes it more difficult to have a centralized location.” He said Fairfax Hospital is as central as possible.
KELLY ACKNOWLEDGED Mirmirani’s suggestion was a possible solution. “From an ideal standpoint it would be nice to have a facility that had sufficient beds. And I would hope the court would be willing to go there,” Kelly said.
But he doubts that the court would be willing to travel to Mount Vernon. He said most of the lawyers working in the detention hearings do so out of a sense of social responsibility. The pay for appearing at the hearings is poor. Asking lawyers to spend even more time away from the office might be asking too much.
“They’re really acting in kind of a volunteer capacity,” Kelly said. “These are folks that have a commitment to the process, but they are not making a wage … that they would make in their general private practice.”