As of July 1, Palomar Health’s hospitals in Escondido and Poway stopped accepting patients picked up on involuntary mental health holds. The move means that law enforcement officers, and other professionals such as members of emergency psychiatric response teams, may no longer bring those experiencing severe mental distress to the emergency departments at Palomar Medical Center Escondido or its sister facility in Poway for evaluation, putting additional strain on already busy first responders. Section 5150 of the state Welfare and Institutions Code allows first responders to detain individuals if they believe that person may be a danger to themselves or others or gravely disabled. However, a qualified medical professional — generally a licensed psychiatrist or psychologist — must quickly follow up with an evaluation, deciding whether each person detained should be treated in a locked unit for up to 72 hours or if their symptoms can be addressed on an outpatient basis. Letters from Palomar Health obtained under the California Public Records Act show that Palomar notified Luke Bergmann, director of behavioral health services for San Diego County, of its intention to stop receiving such cases in the spring. A final notice, sent on June 5, notes that “psychiatric services are not considered part of the ‘basic service’ requirement within a general acute care hospital.” But that doesn’t mean that Palomar can simply turn prospective patients experiencing mental health emergencies away. A federal law, the Emergency Medical Treatment and Active Labor Act of 1986, often called EMTALA, requires all hospitals that participate in the government’s Medicare program to screen and stabilize all patients who arrive in their emergency departments, regardless of their ability to pay. In its letter to the county, Palomar acknowledged that while first responders should no longer deliver 5150 patients to its emergency departments, it will still have to serve those who arrive of their own volition. “Palomar is aware of its obligations under EMTALA, and it will continue to comply with EMTALA’s requirements for any patients seeking medical care, including medically screening, stabilizing, and appropriately transferring any patient seeking care in our emergency departments,” the notification letter states. In an email, Diane Hansen, Palomar’s chief executive officer, said it was necessary to withdraw Palomar’s hospitals from receiving 5150 transfers due to “a lack of funding,” though she did not indicate which funding, in particular, was involved. Asked Wednesday whether it was the obligation of a public health care district, one that receives public financial support from taxpayers, to continue providing this service, Hansen said that the decision was a matter of resource allocation. “We have limited resources, and we have to put those resources where we think they’re going to be the most impactful,” Hansen said. Like many medical providers, Palomar has struggled through severe financial distress since the COVID-19 pandemic, paring back some services, such as the labor and deliver unit at its Poway hospital, as it works to bring its bottom line back to black. Withdrawal from receiving 5150 patients is just the latest reduction in Palomar’s overall behavioral health offerings. In April, Palomar announced that it would close its only remaining inpatient mental health care unit, a 12-bed locked space at Palomar Medical Center Poway. That move followed the closure in 2023 of a 17-bed geriatric psychiatric unit operating under a temporary state waiver on a standard patient floor at the same hospital. While leadership cited an expiring waiver as the main reason for closing the 17-bed unit, the reason for shutting down the 12-bed adult facility was that doing so would “allow the health system to focus resources” on building a new 120-bed psychiatric hospital on the southern portion of Palomar’s Escondido campus in partnership with Lifepoint Health, based in Tennessee. The project will certainly be a boon to the region, increasing the overall number of beds available for those with mental health care needs, and even featuring a special space for treating military veterans. At a recent groundbreaking ceremony for the facility, officials said they expect it to open within 18 months. It is unclear how much access the region’s Medi-Cal beneficiaries will have to the new facility. Federal law restricts using federal matching funds for facilities with more than 16 beds, and San Diego County’s behavioral health department has historically been reluctant to contract for Medi-Cal care in such facilities because all funding must come from state allocations. In the meantime, North County hospitals are devoid of locked units necessary to treat those with severe symptoms. A new 16-bed unit built by the county on the campus of Tri-City Medical Center in Oceanside is nearly complete, but no information was available this week on when the facility will begin admitting patients. Previous estimates indicated that a grand opening was likely toward the end of 2024. In the meantime, Palomar’s exit from the 5150 process forces law enforcement agencies to take detained patients further for initial evaluation. Lt. Damian Jackson, the professional standards and development officer for the Escondido Police Department, said that preliminary data indicates that officers are more often having to transport these cases to the county-run psychiatric hospital in San Diego, a destination that is more than an hour-long round trip from Escondido. “During the two-month period of July and August alone, EPD officers were taken out of service and unavailable to respond to calls within our city for approximately 31 hours while handling these transports to other facilities,” Jackson said in an email. The San Diego County Sheriff’s Office, on the other hand, characterized the change as having minimal impact. There is an additional caveat that affects Palomar’s decision to stop receiving and evaluating 5150 cases. Though its emergency departments are no longer involved, a 16-chair crisis stabilization unit at Palomar Medical Center Escondido is still up and running under contract with the county behavioral health department. Bergmann, the county behavioral health director, did not specify this week which patients are able to be admitted to this unit or who is currently performing the required psychiatric evaluations. Jackson said that the facility has not met the needs of most of those who have been picked up on 5150 holds. “Admittance there is highly scrutinized and must be devoid of any and all drama … meaning the person has to want to go, be completely cooperative, communicative and compliant,” Jackson said. “That individual accounts for less than 1 percent of any of the people police would typically respond for or take into custody under 5150. “In the vast majority of those cases and incidents where (the Crisis Stabilization Unit) would be applicable, the person either self-transports or is transported by a friend or family member and there is no need for police intervention (or) action.” Palomar has not made it clear whether it intends to resume accepting 5150 cases once its new mental health care hospital opens. Bergmann said he is concerned the health system’s departure from the network of hospitals that collectively form a safety net for those with emergency mental health care needs could spread, especially as the region implements the requirements of Senate Bill 43, a new law that expands the definition of the term gravely disabled, now including those with substance abuse disorder. At the urging of local hospitals, county supervisors delayed implementation of the law for one year over concerns that emergency departments would be overwhelmed by the predicted increase in detentions under the expanded definition. The board is scheduled to discuss the matter Tuesday with Supervisor Jim Desmond asking his colleagues to support a demand that the state provide millions in additional annual funding to defray estimated increases in the cost of care. Palomar’s decision to opt out of voluntary participation in the triage of 5150 cases, Bergmann said, could have broad effects. “I am concerned that this is the first domino to fall in what could be a larger pattern,” he said.