La Porte County sees spike in emergency detention transports to non-local mental health facilities

“They’re very time consuming,” said Sheriff John Boyd.

Not only are the transports time consuming, they’re costly. Each emergency detention transport requires two deputies, due to the possibly dangerous nature of the detainee, meaning double the accumulation of overtime.

Already the sherif’s department has had to appear before the La Porte County Council to acquire an additional $60,000 due to burning through one third of its overtime budget on these transports.

“It’s very difficult on our manpower,” Boyd said. “It’s taken away from some of the grant and traffic projects we want to work. We’re really worried about burnout.”

Burnout is a pressing concern, as just recently the sheriff’s department were issued five emergency detention transports in one weekend, and even once had six issued in a single day.

With the sheriff’s department now responsible for safeguarding county lakes, due to a grant from the Indiana Department of Natural Resources, Boyd worries the increased workload of these transports will make his deputies unable to add this new responsibility.

“We’re the only sheriff’s office that we know of in the state of Indiana that has been burdened by this,” Boyd said.

According to La Porte County Chief Deputy Ron Heeg, the Porter County Sheriff’s Department has handled three out-of-county transports, around 4 percent of what La Porte County deputies handle.

Calls left with the Porter County Sheriff’s Department’s Public Information Officer went unreturned.

So where are these transports coming from?

“Ninety percent are coming from La Porte Hospital,” Heeg said.

Since the closure of the seventh floor, La Porte Hospital no longer has a behavioral health unit. Unequipped to deal with those suffering from psychiatric disorders, the hospital must transport these individuals to facilities that can deal with such matters.

It is unclear, however, why the Porter County Sheriff’s Department hasn’t also had to handle as many of these transports as La Porte County, since Porter Regional Hospital also doesn’t boast any mental health services.

Both Porter Regional Hospital and La Porte Hospital are owned by Community Health Services.

Due to a lack of mental health facilities near La Porte Hospital, many of these transports end up being farther than 50 miles away, which is the Medicaid cut off distance before pre-approval is required for reimbursement.

According to La Porte County EMS Administrator Andrew McGuire, Medicaid pre-approval for these types of transportations can take 12 to 24 hours.

Boyd stated oftentimes these transport patients are homicidal or suicidal, which is why the emergency detention was issued in the first place.

“We can’t wait,” said La Porte County attorney Doug Biege. “These folks are in distress and, according to the doctors, a danger to themselves or others so they have to be transported right away.”

These transports are not new, however. What is new is the sheriff’s department hefty involvement.

Eric Fenstermaker, assistant administrator for La Porte County EMS, stated county EMS has done a few of these transports, but both he and McGuire stated they simply don’t have the ambulances to spare.

“We’re barely making it by with what we have,” McGuire said, EMS handling so many 911 calls they’re seeking a new, seventh ambulance just to keep up with day-to-day responsibilities.

“There is no way we can take ambulances off the street,” McGuire added.

So who was handling these transports before the county began shouldering the responsibility?

Private ambulance services

“They were doing them,” McGuire said. “All the sudden, they stopped.”

The exact reason why private ambulance services have quit handling these transports for La Porte Hospital is unclear. 

Fenstermaker stated he believed it had to do with the private ambulance services no longer being reimbursed.

McGuire stated these types of transports don’t pay much with reimbursement usually not being enough to cover the expense. Which, for a for-profit private ambulance service, isn’t ideal. On top of this, the Medicaid policy of not reimbursing for these longer trips without pre-approval – which often isn’t attainable in these cases – would mean private ambulances services wouldn’t even acquire payment from Medicaid.

The Medicaid policy doesn’t appear to be the catalyst, however, for the sudden exit of the private ambulance services handling the majority of these transports for La Porte Hospital.

“We were told this (policy) wasn’t new, this has been in place for awhile,” McGuire said, adding EMS looked into the matter when exploring the idea of handling some of these types of transports.

McGuire is also unsure why private ambulance services have quit handling these transports for the hospital. He stated his own phone calls have gone unreturned when seeking answers.

Whatever the reason, the responsibility and the cost has now fallen on the sheriff’s department and the county.

Biege points out, however, that the responsibility has always laid on the county as stated by Indiana Code.

According to IC 12-26-5, regarding emergency detention, “the expense of the transportation under this section shall be paid by the county in which the individual is present.”

In regards to who was shouldering the cost prior to La Porte Hospital seeking court orders for these transports – which the sheriff’s department, by law, must enforce – several county officials have heard mention of a supposedly large bill possibly being presented to La Porte County from a private ambulance service.

Biege stated this bill has not been presented to the county, however. The bill was in regard to services handled by the unnamed private ambulance service in the last year.

Conversations are ongoing between the county and La Porte Hospital about how to better handle emergency detention transports and mental health care in general.

If La Porte Hospital were to re-open a floor dedicated to behavioral health, Boyd stated they would no longer have to “get rid of the problem” by transporting these patients away.

“We need the community to put pressure on La Porte Hospital and CHS to do something about mental health here in La Porte County,” Boyd said.

In Michigan City, Franciscan Health boasts a limited number of beds for those suffering from mental disorders. Boyd would also like to see the new Michigan City hospital expand care in this area.

Biege said State Rep. Scott Pelath, D-Michigan City, has made a request for the FSSA to re-examine the pre-approval rules for emergency detention transports. If the pre-approval process was quicker or the rules changed to allow reimbursement for these 50-mile plus transports, private ambulances services perhaps would take up the duty again.

Officials at La Porte Hospital declined to answer specific questions about emergency detentions, but released a statement saying the issue is "complex and involves multiple entities," including inpatient mental health facilities, county courts, police, hospitals and ambulance services. 

"La Porte Hospital medical professionals and administrators have been engaged in ongoing dialogue with multiple entities about how to improve the transfer process in La Porte County," the statement said. "This requires an in-depth discussion of the root causes for the need for transfers. The hospital is committed to continuing this discussion, and is working diligently to help our county services and fellow medical professionals in our community safely and effectively meet the needs of these vulnerable patients.”

Ron Donahue, owner of private ambulance service inHealth, also issued a statement stating his organization had been in discussion with all the parties involved and that the issue was a question of "balancing the rising costs of healthcare and making sure we meet the needs of all the people within our community."

"From what I have seen and experienced, the hospital, county and our ambulance crews truly want to resolve the issues and provide a better outcome for these individuals," Donahue said in the statement. "As we continue to work together toward a solution, our hopes are we can offer assistance and guidance to help these individuals before they experience a mental health emergency."