Nikki Starr, corporate director of clinical services for Signature Health/Aurora leads the orientation of new staff at Aurora Santa Rosa Hospital, in Santa Rosa, on Tuesday, June 4, 2013. (Christopher Chung/ The Press Democrat)

Santa Rosa psychiatric hospital a missing piece in Sonoma County's mental health network

MARTIN ESPINOZA
THE PRESS DEMOCRAT

From the street, barely visible through the willow trees, the single-story building looks pretty much the same as it did five years ago, when it was closed by Santa Rosa Memorial Hospital, leaving the county without an inpatient psychiatric hospital.

Set far back from the constant hum of traffic, the facility at 1287 Fulton Road has a new paint job and new landscaping.

What you can't see is that on the inside, this crucial missing piece of the regional mental health network has been brought back to life.

Slated to open soon - state licensing inspections are currently underway - the psychiatric hospital ultimately will feature 95 inpatient beds for adults, seniors and adolescents.

For the past five years, local residents requiring inpatient psychiatric services have had to go outside the county, primarily to mental health facilities operated by Marin General Hospital and St. Helena Hospital in Vallejo.

"We're really delighted. Having it here means that our clients will be recovering in the community," said Rita Scardaci, director of the county's Department of Public Health.

About 60 mental health care professionals - including nurses, doctors and support staff - will be working in the facility, which will treat people with a number of conditions, including schizophrenia, bipolar disorder and major depression.

The hospital is expected to initially open two units, for adults and adolescents, each equipped with about 20beds. Another unit for seniors is expected to open in the future as the need grows.

County officials said they are particularly excited about services for seniors and adolescents. There has not been inpatient services for teens in Sonoma County since the mid-1980s.

The new state-of-the-art psychiatric facility is owned by Southern California-based Aurora Behavioral Health Care, which bought the property in late 2009 and has invested more than $4 million to renovate the campus since June 2011.

Aurora, a for-profit private hospital, operates seven other hospitals around the country, including four facilities in Southern California, one in Chicago and two in Arizona.

The Santa Rosa hospital was originally supposed to open sometime in 2010, within a year of Aurora's purchase of the building, but construction delays repeatedly have pushed back the opening date.

The work required to bring the facility up to current state and federal standards for health care facilities has been extensive. The entire building had to be gutted down to the frame before renovations could begin.

To oversee the hospital, Aurora brought in Ken Meibert, a veteran CEO of psychiatric facilities, including Sierra Vista Hospital in Sacramento, which he ran for nine years.

Meibert said Sierra Vista was constructed by the same builder who erected the Fulton Road facility and the two structures have nearly identical footprints. That insight has been helpful in planning the resurrection of the Santa Rosa hospital, he said.

"I know safety features. I know things that need to be built in," Meibert said.

In recent weeks, Meibert has been giving tours of the new facility to various interested parties, including county officials and local law enforcement. Santa Rosa Police Lt. John Nolan toured the new hospital last week and was impressed with what he saw.

"It was as if it was a brand-new facility," he said, adding that the last time he visited the hospital was more than a decade ago, as a police officer responding to an emergency call of a person acting out and tearing up furniture.

Police will continue to take people who are experiencing mental health crises to the county's Psychiatric Emergency Services facility, across the street from Sutter Medical Center on Chanate Road, Nolan said. In cases where someone requires medical services, individuals will continue to be taken to local emergency rooms, he said.

Mental health workers will decide whether to refer patients to Aurora or to facilities outside the county.

The majority of patients admitted to the hospital will be taken there involuntarily, Meibert said.

While police will not be transporting people directly to Aurora, Nolan said the facility "will be a resource" for the local community.

"It will assist in providing mental health services for those in need," he said.

While some county psychiatric patients will be sent to Aurora, others will continue to be sent to hospitals outside the county, said Michael Kennedy, Sonoma County mental health director.

The county has reserved three beds at the facility, two of which are paid for on a per-diem basis by the county and the other donated by Aurora. But Kennedy said the county is likely to use more than three beds to help meet its daily needs, which range between seven to 14 inpatient beds.

Each year about 3,000 people in the county require some form of behavioral health care. Of these, about 25 percent will be referred for hospitalization, Kennedy said.

In 2012, about 600 people were referred for inpatient psychiatric treatment. Of these, about 70 percent were either covered by private insurance or had no insurance at all. The remaining 30 percent are covered by the federal Medicaid program, which covers half the cost of inpatient treatment in the case of seniors and adolescents.

Providing psychiatric care for adults has become increasingly difficult for local governments, given changes in the industry that have shifted mental health care from hospital-affiliated psychiatric units to private "freestanding" facilities.

Adults on Medi-Cal, the state's Medicaid program, are not covered for psychiatric services provided in freestanding facilities. For these patients, the county must pay the full costs of inpatient hospitalization, which is between $1,100 and $1,200 a day, Kennedy said.

Under Medicaid's Institutions for Mental Disease exclusion rule, the federal government is prohibited from contributing funds for inpatient services that are provided at "freestanding" psychiatric hospitals.

"Over time, most hospitals have closed psychiatric units due to them not being sustainable," Kennedy said. "The need was filled by freestanding psychiatric hospitals."

Kennedy said there's a campaign underway asking the federal government to change the exclusion rule, which he said is an outdated requirement that creates an unnecessary burden on local mental health programs.

A precursor to that change can be found in a pilot program created under President Barack Obama's Affordable Care Act. Two freestanding hospitals in California, in Contra Costa County and Sacramento, have been picked by the federal Centers for Medicare and Medicaid Services to receive full funding for adult psychiatric services.

"There is some movement in the right direction," Kennedy said. "It would create more options for our Medi-Cal population."

County officials say Aurora will not only serve local patients, but will play a vital role as a regional facility.

Kristy Kelly, behavioral health director for Lake County, said her department often utilized beds at the Santa Rosa psychiatric hospital and it expects to use Aurora beds in the future. Lake County currently uses psychiatric beds in St. Helena and Yuba City because these facilities are the closest geographically.

"We're always concerned about the shortage of psychiatric hospital beds and certainly Santa Rosa is an area that we have used in the past," she said.

St. Joseph Health in Sonoma County, which operated the old inpatient psychiatric unit, also could become a partner with Aurora. St. Joseph, which owns and operates Memorial Hospital, has provided outpatient mental health services in the area for the past 15 years and currently serves about 30 people daily.

In the past year, St. Joseph has treated about 298 adults, including 35 seniors. Some patients require inpatient services, said Peggy Ledner-Spaulding, manager of St. Joseph's outpatient behavioral health services.

"It's too early for us to speak to those details of how we are going to partner with them," Ledner-Spaulding said. "But we will work with Aurora to support their success as a freestanding facility."

Ledner-Spaulding said the adolescent services were "long overdue."

In the lead-up to this month's opening, Aurora has been training new employees. During a training session earlier this month, employees were gathered in a large room to go over procedures for addressing patient complaints.

"Grievance is a formal report that can be verbal or written," explained Nikki Starr, vice president of clinical services for Aurora Behavioral Health Care.

Meibert said many of the hospital's new employees are local residents who have had to seek employment at health care facilities in neighboring counties.

Renee Sapp, a Petaluma resident hired as Aurora's new registered dietician, was previously working at a mental health center in Berkeley, commuting to and from work every day. Sapp, who moved to Petaluma five years ago from Toronto, said she did not know that a new psychiatric hospital was being readied.

"This job magically appeared," she said. "I really wanted to work in Sonoma County."

You can reach Staff Writer Martin Espinoza at 521-5213 or martin.espinoza@pressdemocrat.com.

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