After years of planning and preparation, Marian Regional Medical Center’s new Behavioral Health Outpatient Unit is ready to open, and local health professionals say it’s needed more than ever after the trauma of the past pandemic year. But red tape at the state level is road-blocking the unit from accepting patients just yet, leaving hospital and elected officials searching for clarity.
Dr. David Ketelaar, a Marian emergency medicine physician and the lead on the project, said the behavioral health unit is a big part of Marian’s efforts over recent years to shore up its mental health services for the community. The unit has been in the works for at least five years, he said.
“In my prior role as the [emergency department] medical director … I saw that crisis units of this type were starting to pop up elsewhere in the state of California and across the country,” Ketelaar said. “So I came to our hospital, and our hospital then went to the county, with this idea.”
The facility plans to be open 24 hours a day for “intervention, assessment, evaluation, therapy, and support for those experiencing a mental health crisis,” according to a statement from the hospital. When it opens, Ketelaar said the unit will bring a whole new type of service for the Central Coast community.
“There are other crisis units in San Luis Obispo and in Santa Barbara, but they don’t take patients on an involuntary basis,” Ketelaar said. “So that really limits their effectiveness from the hospital standpoint because the persons we are holding, waiting for mental health care in our emergency department, are generally ones who are so ill that they require involuntary care.”
But mental health services like this, Ketelaar said, are notoriously complex when it comes to funding streams, contracting, and licensing. In an Aug. 4 letter to California Department of Public Health (CDPH) Director Dr. Tomás Aragón, signed by Assemblymember Jordan Cunningham (R-San Luis Obispo), state Sen. Monique Limón (D-Santa Barbara), and state Sen. John Laird (D-Carmel), the elected officials probed for answers as to why the agency hasn’t approved Marian’s new unit yet.
According to the letter, the hospital first submitted its application to CDPH in February, and then resubmitted it in April after the state requested that the hospital change some terminology in its application.
Then, on Aug. 6, the hospital’s application to add a Behavioral Health Unit to their existing license was denied, CDPH told the Sun in an email. When asked what specifically didn’t meet the requirements, the department said it could not respond before the Sun’s deadline.
Marian CEO Sue Andersen told the Sun that the hospital will now make changes to its application and resubmit it to CDPH. Simultaneously, as recommended by CDPH, the hospital will also seek licensing through the county and the Department of Health Care Services’ mental health division, an alternate way to get the unit licensed.
Andersen said the county is already on board, and Marian will go with whichever licensing avenue is approved first to get the unit open as soon as possible. She added that hospital officials will be in conversation with CDPH this week as they sort things out.
“We went and visited other units in the state that are very similar to our unit, and they’re all licensed by CDPH, so we fully expect that we will get licensing,” Andersen said. “We hope to make a lot of headway this week … because our concern is the patients that are suffering right now without having ample services in Santa Maria.”
According to the letter written by Assemblymember Cunningham and state Sens. Limón and Laird, based on similar units, the license approvals process typically takes about two months.
“But, for reasons unexplained, it has been nearly four months since CDPH received a revised application, and Marian Regional Medical Center has had no explanation of why the application has not been approved,” the letter said.
The legislators add in their letter that CDPH has completed licensing for other equivalent behavioral health units in different parts of the state.
“All the while, similar units already operate in Sacramento (Mercy San Juan Medical Center) and San Pedro (Providence Little Company of Mary Medical Center) under CDPH licensure,” the letter said. “This behavioral health center is needed in this community, and is fully staffed and ready to open. The delayed licensing process has cost the nonprofit hospital hundreds of thousands of dollars, money that could have been spent on patient care.”
Cunningham told the Sun that, from his experience, rural areas have a harder time getting things approved at the state level.
“They’ve approved licenses for very similar facilities in urban areas,” he said. “I’m pretty familiar with the state taking its time on stuff that affects rural California. … It tends to require some involvement from elected officials to get it going. I wish it weren’t the case.”
Ketelaar said there is no shortage of need for a unit like this to open: He expects the outpatient unit’s eight chairs to be full or close to full as soon as Marian gets the go-ahead from the state.
“Right now, every day in Marian’s emergency department, we’re holding several persons awaiting inpatient mental health care,” he said. “Every day when we try to transfer these patients, we run into roadblocks because there’s a lack of availability. Many of these patients have a crisis that, if we were able to work with them in the right setting, intensely with mental health services, with psychiatrists, and with specially trained staff, we can shorten that crisis period.”
And after the past year of economic turmoil and COVID-19 tragedy, the need for better mental health services is higher than ever, Ketelaar added.
“There was a great need before the pandemic, but it’s only significantly increased the need since the pandemic,” he said.
Until Marian’s Behavioral Health Outpatient Unit gets the state’s stamp of approval, the patients who need this type of care can’t get it.
“The longer we go without this unit being open, the greater impact it has in terms of creating greater need,” Sen. Limón told the Sun. “It’s a health issue, and it’s a safety issue.”
Reach Staff Writer Malea Martin at mmartin@santamariasun.com.
This article appears in Aug 12-19, 2021.