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Psyched Out

Patients are being pushed aside because of profits and policies

May 25, 2011, 1:00 am

 As soon as she saw the truck, Desiree Larranaga knew something terrible had happened.

The white Ford belonging to her friend Anthony Vigil was parked in the dirt past the end of Jaguar Drive, just outside Santa Fe city limits. It all added up too predictably: Vigil, 36, had argued with his girlfriend Theresa Diaz just days before and said that he wanted to kill himself. Diaz managed to keep the keys to the gun safe away from him, but called 911 after he started to cut his throat with a knife. Vigil was evaluated at Christus St. Vincent Regional Medical Center, but was released within approximately two hours. 

A few days later, on Feb. 10, Larranaga went looking for Vigil after he failed to show up for work. His truck was parked just a few hundred feet from the pipeline bridge where Vigil had told Diaz he would hang himself. Two parking tickets tucked under the truck’s windshield wipers fluttered in the breeze. 

Afraid to look in the arroyo, Larranaga summoned law enforcement. Vigil, an orthopedic medical technician, youth baseball and basketball coach, and father to three kids, had hung himself from a chain-link fence along the bridge.

“He was not even admitted for a psychiatric evaluation or anything,” Vigil’s mother Veronica says of her son’s experience at the hospital just days before his suicide. “They should have done that. They should have kept him for 24 or 48 hours, and they didn’t do that. They let him out in less than two hours…If they would have admitted him and evaluated him it might have saved him.” 

Vigil’s family members are not the only Santa Feans left questioning CSV policies after a loved one was denied access to the inpatient psychiatric unit (IPU). Increasingly, patients experiencing a mental health crisis are simply denied access to the IPU. Instead, they are often treated in the emergency department (ED) with a one-time dose of medication and then discharged, transported to Santa Fe County Adult Detention Facility or simply ejected back on the street after their needs are deemed noncritical. The costliness of inpatient psychiatric care, combined with a lack of sufficient coverage by Medicaid and Medicare, creates a major disincentive for CSV to take these patients on, as well as a skewed set of criteria with which to screen patients for admission.

Jenny Montoya, who spoke to SFR on condition that her real name not be used, escorted a close friend to the emergency department at CSV in January when he stopped taking his medication and was refusing to eat. Hospital staff told Montoya that her friend, who suffers from schizophrenia, was not going to be admitted. But when Montoya revealed that she knew some of the hospital’s major funders, the staff changed its tune.

“The [emergency department] doctor and [emergency department] nurse agreed that he needed to be admitted to the psych ward, but the social worker that came on [duty] was like, ‘No, I’m not doing it,’” Montoya says.

Montoya’s connections were enough to get her friend admitted to the IPU—but only for 24 hours. When he returned for a follow-up outpatient appointment, he left without treatment after being told he needed to pay $200. A couple of months later, paramedics transported him to the ED again after he gave himself life-threatening injuries during a psychotic episode. This time he was admitted immediately because of his extensive injuries, Montoya believes.

Kat Jackson, who also spoke under a pseudonym, has been to the ED at CSV on several occasions as a result of her bipolar disorder. Each time, she was treated with the antipsychotic Haldol and released shortly thereafter, instead of being admitted into the IPU. Haldol is a treatment sometimes used on schizophrenic patients that temporarily suppresses the “feel good” neurotransmitter dopamine.

“They gave me [Haldol] and kind of checked on me to see how I was responding to the medication and eventually let me go…If they wanted to get somebody stabilized, they would admit them, or they would ship them to the state hospital [in Las Vegas],” Jackson says.

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