BEMIDJI - People assessed at North Country Regional Hospital with mental health problems are being asked to find their own way to treatment since money ran out for mental health transports.
"There isn't a firm plan," NCRH Emergency Medical Director Tim Hall told Beltrami County commissioners Tuesday night. "We're leaving the family to transport. Law enforcement has helped if it is a dangerous situation."
NCRH doesn't treat mental illness, so if a patient in the emergency room is determined to need mental health treatment, the Beltrami County Sheriff's Department has provided that transportation to a treatment facility, whether that be in Bemidji, Fargo or Grand Forks.
But as a budget-cutting measure, Sheriff Phil Hodapp ended that practice as of Jan. 1. Other counties are doing the same thing, he said, citing that state law doesn't mandate law enforcement involvement unless public safety is endangered.
That left the hospital and mental health providers up in the air, approaching the County Board late last year for help. Commissioner Jim Lucachick heads a task force working on the problem and he asked for Tuesday night's update.
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He noted that NCRH and Beltrami County kicked in $10,000 each, Upper Mississippi Mental Health Center $4,000 and Stellar Human Services $2,500 to provide services after Jan. 1, hiring cab service or sheriff's deputies.
"That money is all used up," Lucachick said."The county believes it should be a hospital function, and the hospital believes it should be a county role."
Hall said 75 percent of the transports are to facilities in the community, and that all adolescents must be taken to facilities in Fargo or elsewhere. "We have asked Bemidji Ambulance under certain circumstances because they can do third-party billing."
That's one of the problems, officials say, as health insurance companies cover ambulance trips for physical health problems but many do not for mental health problems.
A debate ensued when Lucachick asked the County Board to approve a $700 overrun that occurred after the money ran out. Some commissioners thought mental health transports aren't the county's problem.
"This should be a state obligation," said County Board Chairman Jack Frost. "They would be considered wards of the state. I don't see a simple solution here. I don't see it as a county obligation"
Commissioner Quentin Fairbanks disagreed, saying commissioners took an oath to protect the health of the county's citizens.
"But I don't see state law obligating us to this," Frost returned.
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"This could be the first step on a slippery slope," said Commissioner Jim Heltzer. "This could obligate us to pay ongoing costs. We are the public health board, but I'm not sure we're the mental health board."
"We have stopped mental health transports," Lucachick said.
Commissioner Joe Vene said it wasn't right to let providers eat the overrun, so a motion to pay the $700 overrun passed on a 4-1 vote, with Heltzer opposed.
Heltzer said he wouldn't be surprised "to see more nonprofits come through the cracks" asking to backfill state cuts. "I don't have confidence the state will fix it, given the budget deficit. This is just one of the human services problems we will face."
Vene asked for a read from the North Country Health Services Board on its thinking, and County Attorney Tim Faver will be asked for an opinion if mental health transports are by state law a county obligation.
Lucachick said he would recall the task force to continue to seek solutions for mental health transport funding.
Through Beltrami County's push, it has also become a state issue and Lucachick is on a statewide task force hoping to find a broader solution. That group hopes to make its recommendations by year's end.
