LG Health behavioral intervention workers worry about impact of layoffs

Behavioral health workers at Lancaster General Hospital are worried recent cuts to nearly half of their department and elimination of the third shift will put vulnerable patients at risk of longer stays and becoming agitated.

Lancaster General Health officials counter that other systems are in place to handle the patients that were once the responsibility of laid off workers.

Without the third shift, there will be fewer opportunities for behavioral workers to attempt to de-escalate situations, which could increase agitation and physical acting out in patients, a behavioral health worker told LNP | LancasterOnline. Patients could end up staying longer, the worker contended, which could hurt patient outcomes.

“The community deserves to understand exactly why it was done,” a member of the behavioral health intervention team who was not laid off told LNP | LancasterOnline. “It affects people very deeply. I’m not sure who will be there to fill the void.”

Eighteen members of the Behavioral Health Intervention Team were among the 62 positions eliminated at the end of April by Penn Medicine Lancaster General Health in what it described as an effort to be more efficient and boost its operating margin. LG Health said its 42-member team is one component of the overall behavioral health service, which involves about 100 employees, including physicians and clinical staff. Since announcing the decision to eliminate positions in late March, 13 impacted employees moved to positions elsewhere in the system – including three people who worked on the Behavioral Health Intervention Team.

LG Health eliminates about 65 jobs [update]

Full impact of Penn Medicine Lancaster General Health cuts unclear

LG Health told LNP recently that it expects the total positions eliminated will annually save about $4.3 million.

Four LGH behavioral health employees who were not laid off approached LNP | LancasterOnline about the layoffs and agreed to speak to a reporter on the condition they not be identified because they worried about retribution from their employer for speaking to the media.

Penn Medicine Lancaster General Health has said the layoffs did not include anyone responsible for direct clinical care. That claim offended the behavioral health workers interviewed, who said they do work directly with patients who are at their most vulnerable time medically and psychologically.

The elimination of the third shift could be particularly impactful, said one worker, because nighttime is when people most need help.

“It’s dark and people feel isolated,” the behavioral health care employee said. “To me, it doesn’t really make a whole lot of sense: We all know mental health crises don't have a timeline.”

The workers said they worried about how people in distress would be treated without specially trained health care professionals to evaluate and care for them at night.

“I was 100% direct patient care,” one of the workers told LNP | LancasterOnline. “The ED (emergency department) providers do not have the time to spend with these patients and often look for our expertise.”

The worker fears patients could be given medication to subdue them or the patient may be just set aside until a day shift behavioral health worker can evaluate them. However, the day shift has been impacted by the staff cuts as well.

The health system said prescribing medication is a decision that a doctor makes based on what is right for the patient, not on a staffing situation.

LGH says behavioral health is changing

LNP | LancasterOnline asked the health system about the concerns raised by the employees and the implications of the cuts to behavioral health. LG Health responded by saying the opening of Lancaster Behavioral Health Hospital five years ago at 333 Harrisburg Ave. in Lancaster city has changed how patients show up for emergency care, allowing many to be admitted directly to that facility rather than to the LGH emergency room.

“These changes have led to evolving the way we care for the behavioral health needs of those patients presenting to our ED (Emergency Department) and inpatient environments, 24/7,” wrote spokesperson John Lines in an email on behalf of LG Health. “Patients, families and the community partners who play a role in helping ensure timely and compassionate behavioral health care can continue to count on us to provide high-quality care for all patients.”

The behavioral health care workers interviewed by LNP | LancasterOnline said, however, third shift volumes of patients have not changed since the opening of the behavioral hospital. They said the behavioral hospital and other facilities in the county send patients to LGH at 555 N. Duke St. in Lancaster city, especially when their mental health or substance abuse problem is complicated with a medical condition. That referral could be for a medical condition such as high blood pressure or being intoxicated .

Dr. Michael Ripchinski, chief physician executive for LG Health, said the third shift saw the fewest serious psychiatric patients.

“It (third shift) was our lowest volume of patients that had high acuity psychiatric illnesses coming through our doors,” Ripchinski said.

The evolution of behavioral health care is part of the ongoing $182 million LGH emergency room renovation, which has a dedicated space to keep safe staff and patients who come to the ER with substance and mental health problems, said John Herman, LG Health CEO. The space in the ER for mental health patients opened at the end of April.

Ripchinski said the decision to commit someone to a mental health facility has always been and will continue to be a physician-led process. That is, a doctor makes a final decision on commitment and a treatment plan. Doctors and psychiatrists may have considered input from behavioral health professionals who spent longer time with the patient but treatment was ultimately the doctor’s responsibility.

Ripchinski said the emergency room doctors and on-call psychiatrists will continue to be responsible for the patients. The services remain, but who is delivering them is different, the health system contends.

“Yes, it is a workflow change, if you will, at third (shift), but we do have our physicians engaged with our nursing colleagues to ensure that the patients continue to get both assessment and the care that they need,” Ripchinski said. “That’s the most important part.”

Nurses, too, will be involved.

“Nursing colleagues are helping us with screening patients for suicidal risk, as an example, whether it’s on the floors or our emergency department,” Ripchinski said

He said behavioral health staff on first and second shifts will pick up the work, particularly finding openings for people seeking treatment.

“As you can imagine, these patients wait a long time for their bed searches and we oftentimes have to do psychiatric care while they are waiting for their beds,” Ripchinski said. “Assistance will come in those other shifts. Granted, it is not in the perfect way it was before, and our teams are making the adjustment to that.”

The changes are part of an ongoing response to financial pressures on health care, wrought in part by the pandemic response, including increased expenses for staff, more staff and lower payments from insurers, Herman said.

“We do have to work differently as a result of where we are right now and we will continue to work differently,” Ripchinski said, adding that LG Health is committed to training physicians in the new ways the health system is changing.

Lancaster County Behavioral Health/Developmental Services Executive Director Judy Erb said her department had been in contact with LG Health Behavioral Health leadership about the layoffs.

“We have been assured that any restructuring made by LG Health is not expected to have an impact on crisis intervention,” the emailed statement said. “Our crisis staff will continue to respond as usual if and when requested by LGH.”