Who should be transporting mental health patients?
Twice a week on average, a Hubbard County squad car pulls up to St. Joseph's Area Health Services in Park Rapids to transport a mental health patient to a treatment facility.
If the county is complying with state law, the car is unmarked, the officer in plain clothes.
But that's not always the reality. Sheriff Frank Homer said if his transport officer is not available or is already busy, he either has to call in an officer and pay overtime for the transport, to Bemidji, Wadena, Fargo, Brainerd or the Twin Cities, or pull a patrol car off the road, leaving the county one officer short. In that case, both the vehicle and officer are clearly identified as law enforcement.
"It's a hot subject in terms of the state sheriffs doing transports," said Homer.
"Transportation is an issue," agreed Hubbard County Social Services Director Daryl Bessler at Wednesday's county board meeting. "You don't want to put them in a squad car and treat them as criminals. But somebody could get hurt if that person goes into a rage."
"Yeah, they're gonna be aggravated because essentially if the sheriff's office doesn't do it anymore, and there's no statutory authority for the sheriff to do it," the cost will likely be passed on to county Social Services departments because many of the patients are indigent without health insurance, said Hubbard County Attorney Don Dearstyne.
"Now the Legislature can change that," he said.
Bessler said the state is overhauling its State Operated Services division, which oversees behavioral health facilities and treatment, and transportation is one part of that equation under discussion.
"The sheriff's office is at risk and could be liable," Dearstyne said. "What would happen is, and that's what Social Services is concerned about, is if they utilize ambulances like in Wadena, the ambulance transports them, so who pays for that? I believe the bill actually goes to Social Services for the indigent."
"We have to pay the cost of the hospitalization but why should we pay the cost of transportation too?" Bessler asked.
For the past year, several agencies and other stakeholders have been engaged in a spirited discussion as to whether sheriff's departments should be running medical taxi services.
"It's a terrible security issue," said county commissioner Cal Johannsen, a former deputy sheriff.
Mental health transports, and who is legally and financially responsible for them, are becoming a hot button issue.
The state Sheriff's Association recently warned local agencies to stop running patients to hospitals since officers are not legally bound to provide that service.
It's a service many counties are now contracting out, said Homer.
County board members discussed the liability of family members or volunteers taking mentally unstable people to hospitals.
"We may have guns and cuffs and all that good stuff but a mental transport is totally different than a criminal transport," Homer said. "Our officers are trained only to a certain extent as far as handling a mental patient," he added.
"Pulling a gun on a mental patient is probably not a good idea."
Bessler said the issue of transporting mentally unstable patients in squad cars is dehumanizing for the riders.
Since many of those patients have medical and mental health problems, Homer said that adds to the liability his officers could potentially incur.
"We are first aid and CPR certified but when you start talking mental health... If you have someone on medications to sedate them and they code on us, we're not an ambulance that has the know-how and equipment to be able to tend to someone, versus an ambulance," Homer said.
He's been warning the board over the past year his department needs to pass the responsibility to someone more specially trained.
"Law enforcement is trained," Bessler told the board. "They're carrying weapons and have a vehicle with a cage. You want somebody trained."
Homer said 99 percent of all mental health transports have been without incident.
"You never know about that one," he said of the lone chance something could occur.
"That's what we worry about is if you have that one. Who is going to cover us as far as doing our job?"
Another issue for the Sheriff's Department is that the mental health transports cause officers to weigh whether to follow departmental policy or not.
"We've also been told not to cuff mental patients but county policy and sheriff's policy is that anyone that's being transported in a squad car is to be cuffed and secured," Homer said.
Dep. Adam Williams said so far, he has not had any adverse issues transporting mental health patients.
"But you're always watching," he said of the unpredictable riders in his squad car.
"Beltrami is going through talks about contracting," Homer said. "The only time the sheriff's office there will do transports is if there's a court order or it is a case where the individual is ballistic and there could be criminal charges."
Patients can either be court-ordered into treatment, but more often, their path to treatment begins in the home, the sheriff said.
Frequently an officer is called to transport a mentally unstable person to the hospital, where doctors may place the person on a 72-hour emergency hold for their own health and welfare.
Then the doctor issues an order for treatment, which starts the transportation process.
Some counties use ambulances, but the cost is high.
"The dangerous individuals, the sheriff's office would still transport or provide some protection for," Dearstyne said. "But the concern is that if the individual has some medical emergency and these people are both medically unstable and mentally unstable what does the sheriff's office do?
"We're trying to get somebody to do it privately and something cheaper than an ambulance because an ambulance is expensive," he said.
But Homer said he's hoping for a solution before that 1 percent occurrence comes due.