Protocols needed for Title 25 patient acceptance

WORLAND – Washakie County Commissioners heard concerns from the county Maintenance Department, Sheriff’s Office, County Attorney’s Office and Lighthouse staff after damages to the Lighthouse facility, due to several episodes from out-of-county patients.

The seven-bed Lighthouse center run by Cloud Peak Counseling, houses almost 70 patients per year, per average, from Big Horn, Hot Springs, Park, Fremont and Washakie counties. A 2017 expansion brought more room to the facility, with a social detox and high risk area, at a total cost of $97,000.

Currently, under Title 25, patients entering the Lighthouse for care are assessed for possible risk (suicide or self-harm) or alcohol or drug abuse, and held until they have been stabilized or released by court order.

In April, a violent Fremont County patient did considerable damage to bathroom and holding facilities at the center, including dismantling a toilet to use parts as a weapon.

Most recently, a patient from Teton County damaged the facility and became so violent that the patient had to be transferred to the Washakie County jail. Once there, the patient did further damage to the facility and himself.

In response, Teton County law enforcement refused to take the patient back, resulting in intervention from the county attorney and a Teton County judge ordering the return of the patient to Teton County.

Another out-of-county patient required extra medical attention after being transferred with a serious medical condition that went undisclosed. The patient was eventually flown to Billings.

“They issue we face,” noted Washakie county Sheriff Steve Rakness, “is being limited at the jail to deal with mental health issues.”

Lighthouse Director Mark Russler explained that out of 108 patients received so far, only two have been a problem. “It doesn’t’ happen very often, but when it does it’s a major problem.”

Russler also explained that all 23 counties have different transportation and Title 25 procedures, and sometimes they are not as forthcoming on information as they could be.

“We are screening each patient in detail, but not being told everything in regard to some patients we receive,” said Russler. “We are not getting full disclosure from other counties.”

In 2016, law enforcement and health officials from neighboring counties discussed the cost effectiveness of maintaining Lighthouse as an alternative to sending patients to the Wyoming Behavioral Institute (WBI) in Casper and it was pointed out that per diem spending on patients at Lighthouse was approximately half of that at WBI, at $325 per patient compared to $750.

Fifth Judicial District Court Judge Robert Skar noted that it was worthwhile to expand, for neighboring counties to use, because Lighthouse offers the court a choice over both WBI and the State Hospital for patients under court ordered for treatment.

Due to the most recent damage, County Attorney John Worrall warned that the facility could easily become a “dumping off point” for neighboring counties, and noted that from a county standpoint, it’s perfectly acceptable to send the county-of-origin a bill for the damages.

“I’m all for mental health but I don’t want Washakie County to become a dumping ground for other counties’ problems,” said Worrall.

Sheriff Rakness expressed a need to have a list of who to call when a patient needs to be removed to the jail, so that that county can retrieve their patient.

All in attendance, with the commission’s approval, agreed that an official protocol needs to be drafted and a contract needs to be presented to counties with patients in the system, to agree to Washakie County’s terms regarding Title 25 patients, treatment and hosting at the Lighthouse.

The Sheriff’s Office agreed to evaluate security needs at the Lighthouse and offer advice and access to law enforcement vendors for upgrades.

“We didn’t do anything wrong here,” said Worrall, “but it turns out we weren’t ready.”