Medical University Hospital has run out of space partly because of psychiatric patients who have nowhere to turn except the emergency department, the MUSC Board of Trustees was told Thursday.
The downtown facility is running at "110 percent" capacity, said Medical University Hospital CEO Pat Cawley said.
"It's a real issue," Cawley said. "It's not an easy solution."
It's not unique to MUSC.
Leaders at other Lowcountry hospitals attest to the same problem.
"We estimate about 10 percent of our (emergency department) beds across the system are dedicated to mental health patients on an average day," Roper St. Francis spokesman Andy Lyons said. "It’s a constant dilemma."
Even the new 10-bed Tri-County Crisis Stabilization Center, designed to keep psychiatric patients off the street and out of the ER or jail, hasn't solved the problem, Cawley told the MUSC board.
The Charleston County Criminal Justice Coordinating Committee recently reported the crisis stabilization center diverted 433 patients away from emergency departments and inpatient hospital beds last year but Cawley estimated the center itself needs 30 more beds to meet the community's need.
"(MUSC is) still jam-packed," he said. "It's like we're swimming upstream."
MUSC will open a new children's hospital on the peninsula late next year and a pediatric ambulatory center in North Charleston before that, freeing up some existing space downtown. But those projects will only ease capacity problems for two years, Cawley said.
MUSC wants to build a $325 million, 128-bed hospital in Summerville but has not been granted permission from the S.C. Department of Health and Environmental Control to proceed. The timeline for that project is indeterminate.
Meanwhile, Trident Health has filed its own "Certificate of Need" application with DHEC to build a 43-bed, freestanding psychiatric facility near its North Charleston hospital. Approval for that project, estimated to cost $35 million, also hangs in the balance.
Rob Dupont, director of Lowcountry Transitions at Trident Medical Center — the hospital's behavioral health arm — said patients with psychiatric needs also show up in the hospital's emergency room. In 2017, Trident Health created a separate space dedicated for psychiatric patients in the ER and opened a nine-bed psychiatric unit almost four years.
But those beds are always full. There simply isn't enough room, Dupont said.
"We’re seeing very much the same thing that MUSC is seeing," he said. "It puts a burden on the whole health care system."
During Cawley's remarks Thursday, some MUSC board members lamented that psychiatric patients often have no ability to pay their hospital bills because they are uninsured. The hospital MUSC wants to build in Summerville could drive more revenue for the system because it would allow MUSC to expand its surgical capacity, they said.
"That's where we make the money — surgery," said board member Charles Thomas, an Upstate doctor.
MUSC President David Cole pointed out that the hospital must treat patients who show up at the emergency department, regardless of their ability to pay, because federal law requires it.
Every day, Cawley estimated, up to 25 patients with psychiatric or behavorial health issues stay at the ER at MUSC because the hospital can't discharge them.
A few factors are driving this trend, he said, including the opioid crisis and the fact the patient base in South Carolina is growing. Also, he said, the stigma surrounding mental health treatment isn't as bad as it used to be, so more patients are seeking help.
That's not necessarily a bad problem, he said, but the current health care system isn't set up to deal with the influx.
"We are constantly full," Cawley said.