Escambia County is on 90-day clock before it loses almost half of its Baker Act capacity

A planned policy shift at a Pensacola hospital means patients in mental health crisis may have to be transported as far as Okaloosa County or Bay County for assistance.

Earlier this month, state officials, Escambia County legislators and the top county and city public safety officials held an emergency conference call to avoid a potential disaster in local emergency mental health care.

HCA Florida West Hospital CEO Gabe Bullaro sent notice this month to the Department of Children and Families that they would no longer be a receiving center for Baker Act and Marchman Act patients. The notice was to go into effect last week, but local stakeholders were able to reach an agreement for a 90-day reprieve.

Currently, Escambia County has just two receiving centers, Florida West Hospital, which sees about 70 Baker Act patients a week, and Baptist Hospital, which sees about 100 Baker Act patients a week, according to multiple officials the News Journal spoke to for this story.

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"Once Baptist reaches capacity, where do these folks go?" state Rep. Alex Andrade, R-Pensacola, asked. "State law requires that if a law enforcement officer picks up someone and has to Baker Act them, they're not allowed to drop them off anywhere but a designated receiving facility. And then EMS is even more restricted. EMS, by law, can only take them to hospitals."

If the notice were to go into effect and Baptist Hospital reached capacity, other Baker Act patients would have to be taken to the next closest designated receiving facility in Fort Walton Beach or even as far away as Panama City.

Florida West and Baptist Hospital officials came to an agreement on the emergency conference call earlier this month that Florida West would delay implementation of its notice for 90 days, and all pediatric Baker Act patients would be taken to Baptist Hospital.

Florida West's notice to DCF was another blow to an emergency mental health care system that appears to have been limping along for the last year.

Last year, Lakeview Center Inc., which had the capacity for 10 beds that could receive Marchman Act patients, shifted away from inpatient care after it ended its partnership with Baptist Hospital, adding more stress to the system.

Escambia County still listed Lakeview Center as a Baker Act and Marchman Act receiving facility on its transportation plan last updated in 2020.

State Rep. Michelle Salzman, R-Pensacola, told the News Journal she stood up her Mental Health Task Force of Northwest Florida for leaders to be in the same room to talk about problems they were facing.

"It's very, very disappointing, the fact that we have a mental health task force, and these two hospitals could not come together and have a conversation until after the senator is involved, the legislators are involved, the Secretary of DCF is involved," Salzman said.

The Baker Act allows law enforcement officials, a court or doctors to involuntarily commit someone for a minimum of 72 hours for a mental health evaluation if they are a danger to themselves or others. The Marchman Act is similar but deals with substance abuse and allows a person to be involuntarily committed for up to five days to receive addiction treatment.

A law enforcement officer or ambulance crew transporting a Baker Act patient to a receiving facility can't leave that patient until the person is screened by a mental health or substance abuse professional.

State Sen. Doug Broxson, R-Gulf Breeze, said first responders and patients could be stuck in a waiting room for hours because of staffing shortages at hospitals.

Broxson added an unprecedented number of overdoses has compounded the problem as many of those patients are brought in under the Marchman Act.

"It's really the lack of personnel to handle what they have in normal times, and then to add all this new self-inflicted health injury on top of that, it's just more than (Florida West) can handle," Broxson said.

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So far this year, Escambia County Emergency Medical Services has responded to 1,338 overdose calls, according to the county's EMS dashboard. From 2020 to 2021, Escambia County experienced a 354% increase in deaths from fentanyl.

Escambia County Sheriff Chip Simmons was also on the call this month and told the News Journal it would be a "nightmare scenario" if the community lost half of its Baker Act patient capacity.

"Baker Acts are an emergency by nature, which means we're involved with individuals that we think may harm themselves or others," Simmons said. "So, we can't walk away from them. We have to take action."

Last year, Simmons said ECSO handled 1,600 Baker Act cases and this year is on track to reach 1,800.

Understanding all the moving parts

Florida West issued a written statement to the News Journal about the decision, saying it was made to ensure pediatric patients are transported directly to receiving facilities that are licensed to provide those patients care.

Florida West has 56 behavioral health beds at its hospital, but none are licensed for the treatment of pediatric patients. Florida West officials said they were concerned that pediatric patients were having to wait for hours at their hospital only to be transferred to a facility licensed to treat pediatric patients.

Baker Act receiving facilities are required to take all patients regardless of their age, meaning a hospital could not opt to take only adults or only children.

"We are working with our community leaders to update the Escambia County and Santa Rosa County Transportation Plans to help ensure there are no delays for patients who are in need of specialized care from pediatric behavioral health professionals trained to treat children," Florida West's statement said. "We will continue to operate HCA Florida West Hospital Mental Health and Wellness Center to ensure the community has access to a wide range of inpatient mental health and wellness services."

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Florida West said it remains committed to providing high-quality care for the community.

Baptist Hospital currently holds a license for 90 behavioral health beds, and 26 of those beds are licensed for pediatric patients.

Baptist Hospital CEO Mark Faulkner told the News Journal that it makes sense for Baptist Hospital to be the only receiving facility for pediatric and adolescent Baker Act patients, but a long-term plan is needed when the 90 days runs out.

"We are working through that as we speak," Faulkner said. "We're working with the regulators like DCF, and the Agency for Healthcare Administration, as well as our local elected officials. We've been in conversations with county commissioners, our local delegation and just understanding all the moving parts."

Faulkner said about 10% to 15% of the Baker Act patients are children and adolescents. Often Baptist Hospital's Behavioral Health Medicine Unit in its emergency department is at capacity, Faulkner said.

Baptist Hospital plans to relocate to a new campus next year, where its licensed behavioral health beds will drop from 90 to 72.

Faulkner said although there are 90 licensed beds, only 86 beds are in semi-private rooms.

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"We often find ourselves having to operate at capacity much less than those 86 operational beds," Faulkner said. "Often, we'll need to place patients in a private room setting because of some clinical concerns, and so what is on paper at 86 beds is more like 60 to 65 beds in terms of daily capacity."

Faulkner said, "the vast majority" of the 72 behavioral health beds in the new hospital will be in private rooms.

"Therefore, we'll effectively increase our capacity to take care of inpatients even though it might appear that rooms are coming offline in terms of our licensure," Faulkner said.

Possible solutions

Andrade said one issue that needs to be addressed is the reimbursement rate for Baker Act patients who don't have insurance.

"We've got to figure out a way to help offset these costs because it's a high-risk, high-losing proposition to provide this service right now for uninsured patients," Andrade said. "Medicaid does not reimburse nearly enough for this not to be a profit loser for a hospital that does it."

Lakeview Center spokesperson Kelsi Gulig told the News Journal in a statement the center ended its inpatient detox services at its Friary Treatment Center because there wasn't enough funding.

"Lakeview Center is supported by state funding, but there was not enough to cover the full program cost at the Friary," Gulig said. "We saw additional challenges during the COVID-19 pandemic when people were reluctant to seek care in residential settings."

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Salzman said there is a huge amount of state funding to set up a central Baker Act receiving facility to evaluate patients and then send them to the facility that can best treat them.

"This model works very well in Tallahassee, and they have an HCA Hospital, a Baptist Hospital-type, and they have that receiving facility there," Salzman said.

Simmons said he is hopeful a solution will be found before the 90 days end.

"Right now, we're just kind of stuck on what we can do with these people short of waiting in an emergency room parking lot or driving to Fort Walton," Simmons said. "I don't think that the residents of Escambia County want our deputies waiting for hours in a parking lot or driving to Fort Walton."

Escambia County Commission Chairman Jeff Bergosh was on the conference call this month and said finding a solution is a big problem for the community and will place a large burden on law enforcement and emergency services.

Bergosh said the county has funds coming from opioid litigation lawsuit settlements that could possibly be used as a local match for state funding and will likely be discussed by the county commission in the future.

Bergosh said the current system is a big problem for the community.

"It's all about money, and it really makes me angry because there's a lot of money flying around from the federal government to the hospitals," Bergosh said. "They're highly subsidized by the federal government, and they're nonprofits. That's what we're told. Two of them are (nonprofits), one of them is a for-profit, but they're all acting like for profits because they're trying to dump these services that don't make any money."

Both Baptist Hospital and Ascension Sacred Heart are nonprofit hospitals, while Florida West is for-profit.

Salzman said she believes the new Baptist Hospital campus would be the best location for the new facility, but it will take the entire community working together to develop a system that works.

Faulkner said Baptist Hospital wants to be a part of the solution.

"We don't know what that's going to look like," Faulkner said. "I don't think anybody can predict that, but what we want in this is a better platform for better care for our community."

Jim Little can be reached at jwlittle@pnj.com and 850-208-9827.

This article originally appeared on Pensacola News Journal: Florida West will stop taking Baker Acts, halving Escambia capacity