Stanislaus County supervisors decided that family practice doctors in county health clinics shouldn't manage patients with severe mental disorders, even though they are the last resort for some patients.
In a 3-2 vote Tuesday evening, the Board of Supervisors excluded mental health services from the adult indigent health program. The decision also limits the program's dental benefits to $1,000 a year.
About 160 people will still have access to psychiatric drugs at the county health clinics for the next 60 days. But supervisors told the Health Services Agency and county mental health department to come up with another way to manage the patients.
The indigent health program -- also called MIA, for medically indigent adults -- provides medical care for 6,100 county residents who are not eligible for public programs such as state Medi-Cal coverage.
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Because of a general decline in psychiatric services, the health clinics have been treating patients with severe bipolar disorder, schizophrenia and severe depression.
Dr. Del Morris, medical staff chief for the Health Services Agency, said some patients were referred to the clinics with prescriptions written by psychiatrists when county Behavioral Health and Recovery Services took a $4 million budget hit two years ago. BHRS kept managing the most severe patients and referred more stable patients to the health clinics, he said.
The clinics also are getting patients who were released from psychiatric hospitals, former prison inmates who were on psychotropic drugs while incarcerated, and people who don't have access to psychiatrists in the community, Morris said.
Some of the patients have six or seven prescriptions that need to be adjusted to treat the symptoms and prevent organ damage.
"My concern is the lack of access for the most severe patients," he said. "The doctors in the clinics just don't have the expertise."
Supervisors said the Health Services Agency shouldn't be spending money from its budget to treat mental disorders or incurring liability. The agency spends about $300,000 buying psychiatric drugs for those with severe disorders.
Supervisors Bill O'Brien and Jim DeMartini cast the dissenting votes. They stressed the county is responsible for hospitalization costs if patients who are denied medication need to be admitted to the Doctors Medical Center behavioral health center.
Several speakers urged the board to think about the patients who will suffer if they are denied their medication.
Robert Stanford, a community activist who works with the airport neighborhood in southeast Modesto, said some people will become a danger to themselves, family members or neighbors.
Members of the county mental health advisory board said the county had not accounted for the costs of hospitalization, law enforcement, incarceration and the court process for patients who become unstable.
Ceres resident Katherine Roudebush, whose niece gets her meds from the indigent health program, asked where the family can go for psychiatric expertise if she is turned away.
The clinics will continue to try to assist certain patients. Clinic doctors will prescribe medication for minor disorders, such as mild depression. For patients who need stronger drugs, clinic staff will apply for free medications from drug company charity programs, but family doctors will need expert advice on adjusting doses, said Mary Ann Lee, county health services director.
The board expects a report back on getting Behavioral Health and Recovery Services more involved. Also, county health workers could try to enroll more patients in Medi-Cal to cover the costs of drugs.
Morris said budgeting for a single psychiatric liaison would help the health clinics with the patients they manage.
Bee staff writer Ken Carlson can be reached at firstname.lastname@example.org or 578-2321.