BOARD STRATEGIC & FACILITIES PLANNING COMMITTEE

Monday, April 25, 2016 Palomar Medical Center 5:30 p.m. Buffet for board members & invited guests Raymond Family Conference Center 6:00 p.m. Meeting 2185 Citracado Parkway, Escondido, CA 92029

PLEASE TURN OFF CELL PHONES OFF OR SET THEM TO SILENT MODE UPON ENTERING THE MEETING ROOM

Form A

Time Page Target

CALL TO ORDER 6:00

Public Comments1………………………………………………………………...……………………. ....15 N/A 6:15

*Information Item(s)

1. *Approval: Minutes – Monday, March 28, 2016 (ADD A-Pp4-6).….……...………….……………. …...2 ……1 6:17

2. Presentation: Crisis Stabilization Unit, Sheila Brown, VP Continuum of Care (Add B-Pp8-23)… .…40 …....2 6:57

Public Comments1…………………………………………………………………………...…………. ….15 N/A 7:12

ADJOURNMENT 7:13

Board Strategic & Facilities Planning Committee Members -- **Voting Members **Ray McCune, RN, Chair **Robert Hemker, President and CEO **Jeffrey Rosenburg, M.D.

**Jerry Kaufman, PTMA, Director Alan, Conrad, MD, EVP Physician Alignment **Paul Neustein, M.D.

**Aeron Wickes, MD, Director **Maria Sudak, RN, MSN, CCRN, NEA-BC, VP PMC / CNO PMC

**Dara Czerwonka, MSW, 1st Alternate **Cheryl Olson, RN, MS, NEA-BC, VP POM/PHDC, ICNO POM/PHDC

Della Shaw, EVP Strategy Jean Larsen, Foundation Philanthropy Officer Matt Soskins, Associate General Counsel

Diane Hansen, EVP Finance PH Foundation Board Member Dan Farrow, AVP Hospitality & Facilities

Frank Beirne, EVP Operations Brenda Turner, EVP Human Resources

Next Meeting: Monday April 25, 2016 – Palomar Medical Center, Raymond Family Conference Center

NOTE: If you have a disability, please notify us by calling 760-740-6375 72 hours prior to the event so that we may provide reasonable accommodations

__________________________________ Asterisks indicate anticipated action. Action is not limited to those designated items. 1 5 minutes allowed per speaker with a cumulative total of 15 minutes per group. For further details & policy, see Request for Public Comment notices available in

meeting room

Minutes

Board Strategic & Facilities Planning Committee

Monday, March 28, 2016

TO: Board Strategic & Facilities Planning Committee MEETING DATE: Monday, April 25, 2016 FROM: Debbie Hollick, Committee Secretary Background: The minutes of the Board Strategic & Facilities Planning Committee meeting held on Monday, March 28, 2016 are respectfully submitted for approval (Addendum A). Budget Impact: N/A

Staff Recommendation: Staff recommends approval of the Monday, March 28, 2016 Board Strategic & Facilities Planning Committee meeting minutes as presented. Committee Questions: COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: Required Time:

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Crisis Stabilization Unit (CSU)

Form A Crisis Stabilization Unit April 2016

TO: Board Strategic & Facilities Planning Committee MEETING DATE: Monday, April 25, 2016 FROM: Sheila Brown, R.N., M.B.A., FACHE, Vice President Continuum Care

Background: The Crisis Stabilization Unit (CSU) is a new program that provides a separate, specialized treatment setting for behavioral health patients who are initially seen in the Emergency Departments. Over 4,500 Behavioral Health patients are seen in Palomar Health’s Emergency Departments annually. The CSU will relieve the crowding in the EDs by providing an alternative setting for behavioral health patients, along with rapid stabilization and the initiation of treatment. Advantages of the CSU are it will free up individual ED beds for use by patients seeking emergency medical care. In addition, it will reduce the crowding of the inpatient Behavioral Health beds. When the Palomar Health Downtown Behavioral Health Inpatient Unit moves to Villa Pomerado Facility, on the Pomerado Campus, it will result in a loss of five beds and the CSU will help to mitigate this issue.

Budget Impact: Funding is from Proposition 63, which resulted in the Mental

Health Services Act (MHSA) which collects a 1% tax on California millionaires that goes toward the mentally ill.

Staff Recommendation: For information only

Committee Questions:

COMMITTEE RECOMMENDATION: Motion: Individual Action: Information:

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ADDENDUM A

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B O A R D S T R A T E G I C & F A C I L I T I E S P L A N N I N G C O M M I T T E E M E E T I N G A T T E N D A N C E R O S T E R - C A L E N D A R Y E A R 2 0 1 6

MEETING DATES:

MEMBERS 1/25/16 3/28/16 4/25/16 5/23/16 6/27/16 7/25/16 8/22/16 9/26/16 10/24/16 11/28/16 12/26/16

DIRECTOR RAYMOND MCCUNE – COMMITTEE CHAIR P E DIRECTOR JERRY KAUFMAN P P DIRECTOR AERON WICKES, MD P P DIRECTOR DARA CZERWONKA - BOARD ALTERNATE N/A P BOB HEMKER, PRESIDENT & CEO P P CHERYL OLSON, IVP, CNO POM P E MARIA SUDAK, IVP, CNO PMC P P FRANKLIN MARTIN, MD, COS-E PMC P P PAUL NEUSTEIN, MD, COS POM P P STAFF ATTENDEES DELLA SHAW, EVP STRATEGY P P DIANE HANSEN, EVP FINANCE E E FRANK BEIRNE, EVP OPERATIONS P P ALAN CONRAD, MD, EVP PHYSICIAN ALIGNMENT E P BENDA TURNER, EVP HUMAN RESOURCES P P JEAN LARSEN, PHF PHILANTHROPY OFFICER P P PH FOUNDATION BOARD MEMBER N/A N/A DAN STEEBER, INTERIM GENERAL COUNSEL N/A N/A DAN FARROW, AVP HOSPITALITY / FACILITIES E P RN REPRESENTATIVE PMC OR POM P E DEBBIE HOLLICK – SECRETARY P P INVITED GUESTS SEE TEXT OF MINUTES FOR NAMES OF GUEST PRESENTERS

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032816 Board Strategic & Facilities Planning Committee Minutes

STRATEGIC & FACILITIES PLANNING MEETING MINUTES – MONDAY, MARCH 28, 2016

AGENDA ITEM CONCLUSION/ACTION FOLLOW UP / RESPONSIBLE PARTY

FINAL?

DISCUSSION

CALL TO ORDER

The meeting – held in the Palomar Medical Center Raymond Family Conference Center, 2185 Citracado Parkway, Escondido, CA 92029 – was called to order at 6:00 p.m. by committee board member Jerry Kaufman, who served as Chair in Director McCune’s absence

ESTABLISHMENT OF QUORUM

Quorum comprised of Directors Kaufman, Wickes, Czerwonka (1st board alternate) Excused Absences: Director McCune

NOTICE OF MEETING

Notice of Meeting was posted at PH’s Administrative Office; also posted with full agenda packet on the PH web site on Monday, March 21, 2016, which is consistent with legal requirements. Notice of that posting was also made via email to the Board and staff

PUBLIC COMMENTS

There were no public comments

*INFORMATION ITEMS

1. Board Strategic & Facilities Planning Committee Meeting Minutes – Monday, January 25, 2016

No discussion MOTION: By Director Wickes, 2nd by Director Czerwonka and carried to approve the Monday, January 25, 2016 Board Strategic & Facilities Planning Committee meeting minutes as submitted. All in favor. None opposed

N/A Y

2. Strategic Planning Update

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STRATEGIC & FACILITIES PLANNING MEETING MINUTES – MONDAY, MARCH 28, 2016

AGENDA ITEM CONCLUSION/ACTION FOLLOW UP / RESPONSIBLE PARTY

FINAL?

DISCUSSION

Utilizing the presentation distributed in the meeting packet, Executive Vice President Strategy Della Shaw provide an update on the organizational strategic planning, which included the following elements:

o Update on strategic direction setting, strategic framework, and strategic planning

process to-date o Review of next steps in the strategic planning process and schedule o Clarify Board expectations regarding strategic planning o Clarify Board ongoing collaborative involvement in the strategic planning process

Information only N/A Y

PUBLIC COMMENTS

There were no public comments

ADJOURNMENT

Meeting adjourned at 6:56 p.m. by Director Kaufman

SIGNATURES:

COMMITTEE CHAIR

Ray McCune, R.N.

COMMITTEE SECRETARY

Debbie Hollick

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ADDENDUM B

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Board of Directors Strategy and Facilities Committee

Crisis Stabilization Unit Sheila Brown, Vice President/Continuum Care

Palomar Health

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Facts

• One in four Americans experiences a mental illness or substance abuse disorder each year; half will experience a Behavioral Health disorder in their lifetime

• Behavioral Health conditions (mental illness and substance abuse) are the leading cause of disability and death for women and the second highest cause for men

• Based on Palomar Health’s Community 2014 Health Check, Mental Health is one of the top 4 health issues identified as a need in the community

Source: NIMH – National Institute of Mental Health Disorders,

part of the National Institute of Health-2014

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Palomar Health Behavioral Health Services

Inpatient Behavioral Health Services

• Palomar Medical Center

– Downtown (moving in December 2016)

14 acute adult beds

11 Older Adult beds

• Pomerado Hospital

12 acute Gero-psychiatric beds

Planned for December 2016: 20 Adult and Older Adult (combined) acute beds at Villa Pomerado, licensed under Pomerado Hospital.

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Palomar Health Behavioral Health Services

Outpatient Behavioral Health Services • Intensive Outpatient Program for adult and older adults is located in

San Marcos in leased space. Each patient attends this therapeutic day program two to three days a week

Consultation/Liaison Services • Emergency Departments

– Behavioral Health Liaisons evaluate all patients in the Emergency Department seeking help for a behavioral health problem

– The patients are medically cleared for admission, transfer to another facility or discharged to home or placement in the community

• Palomar Medical Center and Pomerado Hospital Acute Care Units

• Villa Pomerado Skilled Nursing Facility

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Behavioral Health Services Climate

• San Diego County’s hospitals are overtaxed for inpatient behavioral health beds

• Over 4,500 emergency department behavioral health assessments were seen in Palomar Health’s Emergency Departments annually; at least 40% are admitted for inpatient mental health treatment

• At times, patients needing treatment wait for extended periods of time in Palomar Health Emergency Departments - due to limited beds and placement/referral options

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Impact on Emergency Departments

• Delayed treatment of urgent psychiatric condition

• Wait times/Emergency Department Throughput

• Wrong setting despite Emergency Department Providers and Staff doing all they can

• Wasted resources

– Cost (RNs, sitters, security and space)

• Insufficient resources post-discharge

• Psycho-social assessment

• Patients bounce back

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Call for Action

• In November of 2004, California voters passed Proposition 63 to tax all millionaires in California with a 1% tax for the “Mental Health Services Act”.

• In 2015, Palomar Health submitted a response to the San Diego County Request for Information to open a Crisis Stabilization Unit for residents of the North Inland County Region

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Goals of Crisis Stabilization Unit

• Rapidly stabilize the acute crisis

• Treat in a less restrictive setting

• Create a therapeutic alliance

• Provide appropriate aftercare plan

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Crisis Stabilization Unit Scope

• Eight recliner chair unit

• The Crisis Stabilization Unit is open 24 hours a day, seven days a week

• It will be located adjacent to the Emergency Department at Palomar Medical Center

• The length of stay is predicted to be approx. 10 hours; the requirement is for less than 23 hours and 59 minutes

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Criteria for Crisis Stabilization Unit

Inclusion Patients who are:

• Either voluntary or on an involuntary hold (5150)

• 18 years of age and older

• Medically stable and cleared by the Emergency Department physician and psychiatrist

• Demonstrating behavior that is safe for transfer to the CSU

Exclusion Patients who are:

• Under the age of 18

• Medically and psychiatrically unstable for this level of care

• Oxygen-dependent

• Non-weight bearing with transfers

• Diagnosed primarily with organic brain syndrome or profoundly intellectually challenged with the absence of acute psychiatric symptoms

• Solely waiting for placement and not in need of psychiatric treatment

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Crisis Stabilization Unit Staff

Staff include: • California Emergency Physician Psychiatrists cover 10 hours on

site and 14 hours of Tele-Psychiatry

• RNs

• Licensed Behavioral Health clinicians, e.g., LCSWs, Marriage & Family Therapists, etc.

• Behavioral Health Liaisons

• Crisis Stabilization Specialist

• Peer Counselors

• Clerical Staff

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Treatment Provided in the Crisis Stabilization Unit

• Assessment of patient’s condition

• Therapeutic Interventions

• Medications

• Individual Therapy

• Discharge Planning

• Placement Options

• Brief Family Therapy

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Aftercare Plan

Patients leaving the Crisis Stabilization Unit will go: • Home with follow-up with psychiatrist /Psychiatric Nurse

Practitioner

• Primary Care Physician

• Primary Care Physician/Psychiatrist in federally funded healthcare centers

• Mental Health Center

• Intensive Outpatient Program

• Crisis House

• Support Group

• Substance Abuse Center

• Inpatient Psychiatric Unit (Public or Private)

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Benefits of Crisis Stabilization Program

• The Crisis Stabilization Unit will provide the right setting for the right patient with the right professionals at the right time

• The addition of the Crisis Stabilization Unit frees up individual emergency department beds for use by patients seeking emergent care for medical crises

• Twenty percent (20%) of inpatient adult behavioral health patients are discharged within 24 hours of admission; these are ideal patients to benefit from the Crisis Stabilization Unit instead of inpatient

• The Crisis Stabilization Unit frees up inpatient behavioral health beds for patients in need of that level of care; moving the Downtown BHU will result in a loss of five beds

• The Crisis Stabilization Unit is a welcome addition to the Behavioral Health continuum of care to meet the needs of the patients

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Benefits of Crisis Stabilization Unit

• Provides a quiet, safe environment for these medically stable psychiatric patients under the direct constant supervision of trained and professional behavioral health staff

• Less restrictive alternative to hospitalization in a peaceful, quiet environment best-suited for this vulnerable population in a crisis

• Provides timely intervention and rapid stabilization of the patient’s acute crisis

• Develops relationships to build support networks and connects patients with community resources

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Thank You

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