Cramer

Cramer

A veteran psychiatrist at the Cambridge Health Alliance psychiatric emergency room is resigning because the Alliance’s plan to eliminate the specialized service and treat mentally ill patients in the main ER will endanger patients and those who care for them, he told Cambridge city councillors at their meeting tonight.

Dr. George Cramer, who said he has worked at the Psychiatric Emergency Service for 14 years, was one in a parade of speakers who denounced the move. Afterward, councillors voted unanimously to ask the Alliance to reverse its decision to end separate emergency services on June 4 and eliminate the jobs of nine psychiatric nurses.

The council order, introduced by E. Denise Simmons, also urged the Alliance to hold public meetings to seek an alternative strategy. Alliance officials said the change will save $1 million a year. The health care system has lost $21.5 million eight months into its current fiscal year.

Asked about the concerns raised at the council meeting, Alliance spokesman David Cecere declined to comment. Last month, he said the change would improve treatment of psychiatric patients and said officials believe staffing and space in the main ER will be adequate.

Alarm over details

Cramer said he resigned two weeks ago, effective June 4 when the change begins, “because I didn’t think it was safe for patients, family members, trainees or students.” He predicted that the new arrangement will  result in “an increased risk” of patients harming themselves, of patients leaving without treatment, of assaults and of staff using restraints.

Cecere gave few details of how the main ER will handle double the number of psychiatric patients it now gets, but without any psychiatric nurses. The Alliance says 2,500 patients a year are seen in the psychiatric emergency room, and another 2,500 already go to the main emergency room.

Cramer said he was alarmed by the details he learned. For example, he said, two rooms next to the busy ambulance bay are being reserved for “highly agitated” psychiatric patients. Nurses can’t see what’s going on in those rooms and there are no video monitors or “panic buttons,” he said.

The main emergency room will have two or three “mental health clinicians,” versus five in the psychiatric emergency room, while caring for more patients, Cramer said. In an email to councillors, he predicted that with the increase in mentally ill patients, “a large percentage” of the care in the main ER will be psychiatric while nurses with “years of experience” will be gone.

Currently mentally ill patients who come to the main ER are assigned to spaces separated only by curtains, in a small room, Cramer said. That raises “very concerning questions about privacy,” he said.

The psychiatric emergency service has a 24-hour phone line that allows patients in crisis or their family members to talk to a clinician, a key resource in bringing someone to treatment, Cramer said. After June 4 the phone will be staffed by a non-clinician who must also handle insurance and other administrative issues, he said.

Speakers, councillors share concerns

Speakers echoed his concerns. Several said they got vital advice over the phone when their child was in crisis, allowing them to avoid a hospital admission. Others described how staff at the psychiatric emergency service calmed an agitated family member. “It’s been my safe place for the last 16 years because it’s my son’s safe place,” said Janann Licklider of Cambridge. She and her husband even bought a condominium across the street from Cambridge Hospital partly because her son could walk to the psychiatric ER on his own, she said.

“I have used the psychiatric emergency room 30 times [for my son] and never had a bad experience,” Licklider said. “I can’t say that about anything else in my life.”

Councillors said they were disturbed that Alliance officials hadn’t notified them of the plan. The Alliance didn’t announce the change. It became known when the Massachusetts Nurses Association, which represents nurses at the Alliance, issued a press release denouncing it.

“It’s quite distressing [that] there was not better communication,” councillor Timothy Toomey said. He said Alliance officials are scheduled to testify May 15 at a hearing on next year’s city budget, and he encouraged members of the public to come.

This post was updated May 6 with comment from a spokesman for the Cambridge Health Alliance.

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