SAN DIEGO: Mental Health Care Finally Got County’s Attention

From the biggest rethink of mental health care in decades to caring for the smallest baby in the world, 2019 was a particularly eventful year in San Diego County health care.

As was the case in 2016 when a deadly hepatitis A outbreak spread through the region's homeless population, infectious disease repeatedly generated national headlines over the past 12 months. In June, it was an outbreak of shiga toxin-producing E. coli virus at the San Diego County Fair followed in December by an outbreak of bacterial infections among black tar heroin users in Chula Vista that put 10 people in local hospitals and killed seven.

The long-running legal consequences of a clandestine patient video taping scandal at Sharp Grossmont Hospital and the state's crackdown on doctors who write hundreds of vaccination exemptions, which snared Dr. Tara Zandvliet in San Diego, also drew attention from outside of the area.

But health care in San Diego County, an industry that employs about 170,000 people from Otay Mesa to Oceanside, had plenty going on in 2019 that didn't end up trending from coast to coast.

It was a significant span of 365 days for the region's collective capacity to cope with an ever-growing number of residents facing unmet mental health needs. After Tri-City Medical Center in Oceanside decided to shut down its behavioral health units in 2018, it became clear that the shelf life was short for several other mental health hospitals in San Diego, prompting leaders to pledge that they would take bold action in 2019 to shore up a system that was too often failing to meet increased demands for service.

They weren't bluffing.

Mental health care finally got county's attention in 2019 https://t.co/KqY7pbsE9l [Top Stories] pic.twitter.com/vRmvGBV6On

— The San Diego Union-Tribune (@sdut) January 6, 2020

For decades, San Diego's individual health systems have largely handled the issue on their own, building facilities sized and staffed largely to meet their own needs. But 2019 truly found a new era of cooperation across organizations that often compete with each other for business.

The most visible symbol of this new “we're in this together” spirit is a dismal county-owned property on Third Avenue in Hillcrest that used to house the county's child protective services department. The county had planned to put the derelict property up for sale to be turned into high-priced condos. With a sweeping view of Mission Valley and across Mission Bay, there is no doubt that whatever development deal came out of the property would have been particularly sweet for county coffers.

But newly-elected supervisor Nathan Fletcher had a different idea. Noting that the property is situated within walking distance of Scripps Mercy Hospital and UC San Diego Medical Center Hillcrest, Fletcher floated the idea that the property would better serve as a mental health hub than as another high-rise rent repository.

The rest of the board quickly agreed to explore the idea and UC San Diego Health, which has to replace its existing Hillcrest mental health unit due to impinging construction plans, followed suit. In October, a favorable feasibility study in hand, Fletcher assembled a group of health care executives at the weed-choked parking lot of the property where all embraced his vision of cooperating on a facility that is to offer a broad range of services from outpatient consulting and medication management to quiet respite for those in immediate crisis.

Later that month, the county announced that it plans to quickly convert part of its existing Live Well center in Oceanside for a similar kind of development, offering a range of comprehensive services designed to keep medical professionals in regular contact with those who need help. The goal is to reduce the need for expensive inpatient beds by treating lower-level psychiatric problems more immediately and thoroughly and preventing such situations from escalating to the point where multi-day stays in locked hospital units are necessary.

It's a major shift toward prevention that has drawn applause from many, including Cathryn Nacario, chief executive of NAMI San Diego, the local chapter of the National Alliance on Mental Illness.

“For sure, 2019 has been an absolutely transformative year, because we have seen nothing like this,” Nacario said. “I think finally the message is getting out that there is no health care without mental health care.”

She credited the county Board of Supervisors for listening to the recommendations not just of professionals but also of those who receive services in reshaping the system's very underpinnings under the guidance of Dr. Luke Bergmann, director of county behavioral health services. Fletcher, she added, has been a true change agent not just for speaking on the issue in public, but for holding numerous planning meetings behinds the scenes where so many gathered to discuss how the system should change toward prevention.

“He has been, I think, just very passionate about this issue, and he has been very vocal in a way that has brought people together,” Nacario said.

Innovation in 2019 was not restricted to mental health care.

The year saw the Sharp Transitions program, which works to keep chronically-ill patients out of the hospital by providing direct access to round-the-clock health care assistance, win national recognition through the Hearst Prize for excellence in population health. Having served 3,000 people across the county since 2007, the program has become a model for how the often-inefficient health care system can prevent hospitalization, saving both cash and preserving quality of life.

Sharp Mary Birch Hospital for Women and Children also saw significant change in 2019. It celebrated the birth of Saybie, who, at just 8.6 ounces, was believed to be the world's smallest baby to survive a cesarean birth and months in the neonatal intensive care unit. It also saw the first four graduates of its new chronic pain program, which was modeled after a similar clinic in New Jersey. Rady ended the year on the highest note of its existence, accepting a $400 million gift from Earnest and Evelyn Rady to help re-think how it cares for the region's sickest kids.

San Diego's West Health, the organization funded by philanthropists Gary and Mary West, also made significant inroads in 2019. The organization celebrated the opening of one of the first three geriatric emergency departments in the nation, and the only one on the West Coast, while also opening the region's first geriatric emergency department at UC San Diego Jacobs Medical Center and the creation of its first PACE program inside a classily-renovated former DMV office in San Marcos. PACE, short for Program of All-inclusive Care for the Elderly, is nationally known for its ability to preserve the health of frail seniors through comprehensive services from nutrition to dental care.

The heart transplant program at UC San Diego Health also saw its stature increase, posting the best one-year survival rates in the nation for the first time in its history, according to the Scientific Registry of Transplant Recipients. The program's survival rates at one year post transplant were listed as 30 percent better than they were five years ago despite the program significantly increasing its volume and embracing the use of hearts from donors who might not have been considered viable in the past.

It wasn't a perfect year for university health. As reported by inewsource, Dr. Kang Zhang, a prominent eye doctor at Shiley Eye Center, was put on leave after FDA reports showed he allegedly put research patients in harm's way.
Of course, focusing on highs and lows doesn't really paint the full picture. It's clear, said Nathan Kaufman, a San Diego-based health care consultant and keen observer of all things health care-related, that health systems are generally hurting at the moment due to long-standing trends that have dramatically cut reimbursement levels, and thus profit margins, across the board.

Whether it's in hospitals or doctors' offices, he said, consumers should expect continued efforts to control costs and to compete for patients with commercial health insurance coverage as state programs such as Medicare and Medicaid continue to demand ever-greater efficiency from medical providers.

“On the financial side, I'd say that it's tough all around,” Kaufman said. “For patients, deductibles and copays are still too high, and we're seeing even privately-insured patients delaying care when they're not able to meet those deductibles. For the health systems, everybody's going after the same patients, and that's a situation where, eventually, you're going to have winners and losers.”

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