Las Vegas Sun

September 24, 2018

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Unstable funding jeopardizes clinic serving mentally ill, addicts in downtown Las Vegas

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Steve Marcus

A patient rests in a dorm in WestCare’s Community Triage Center, a substance abuse and mental health clinic in downtown Las Vegas, Thursday, May 3, 2018.

WestCare Tour

A view of a dorm room during a tour of WestCare Thursday, May 3, 2018. Launch slideshow »

A man on a recent afternoon walked into WestCare, the substance abuse and mental health clinic in downtown Las Vegas, looking for help.

One moment, the man sat with a staff member who patiently took his information. The next, he walked around the facility wearing a gown and prepared to begin treatment.

The 50-bed facility at 323 N. Maryland Parkway is credited with helping 5,000 patients annually. But it is also struggling with funding and could shutter in the coming months, leaving Southern Nevada without the area’s lone detox treatment facility serving the indigent.

The group’s clinic on Fourth Street closed in November. Same for a location in Reno last month. Officials at the downtown location are determined to not be next.

WestCare last week obtained a $508,265 commitment from local hospitals to keep its Community Triage Center open through June 30, giving the funding entities time to reconvene and renegotiate a longer-term solution, said Dan Musgrove, a consultant with the nonprofit group.

Musgrove said the commitment was made via letter of intent from Southern Nevada hospitals and contingent on local and state governments also providing equal shares. The roughly $1.5 million would cover the deficit the facility has amassed over the current fiscal year, which concludes at the end of June.

The funding would briefly delay the clinic's possible closure on May 31, when cash flow from a bank credit line is expected to dry out, Musgrove said.

The center was founded in 2002 to alleviate overcrowding at emergency rooms and city jails, and in turn cut down costs. WestCare spokesman Bob Vickrey said the facility serves many from the homeless population, emphasizing that the staff of about 40 doesn’t turn away anybody.

The facility was long funded through an “interlocal agreement,” in which local municipalities, state government and hospitals split the cost.

That was until mid-2016 when the last agreement expired. Since then, the nonprofit has been self-funded and faced with a “severe funding crunch,” Musgrove said.

The state has matching funds ready to be released, said Julie Kotchevar, who heads Nevada’s Division of Public and Behavioral Health, but it is waiting on documentation relating to the letter of intent and possible action Tuesday from the Clark County Commission, which two weeks ago held a contentious meeting with WestCare representatives.

Commissioners questioned the group’s representatives about discrepancies in figures of what services the clinic provides and to whom.

“I don’t think you honestly answered anybody’s questions today,” Commissioner Marilyn Kirkpatrick said.

Some of the disagreements are outlined in an audit of the facility conducted by Clark County Social Services and released in January. The reps were asked to bring further documentation and more senior staff for the next meeting.

“A lot of good, hard questions were asked of WestCare and staff. ... I think everyone realizes that this is an important community program,” Musgrove said.

Part of the dispute is connected to money owed by the nonprofit to its partners for services that ended up being covered by Medicaid.

Two and a half years ago, when funding for the mentally ill became available through the Affordable Care Act, the facility began processing billings, Vickrey said.

Last year, Medicaid dollars accounted for about half of the facility’s funding, Vickrey said. And eventually, he said, WestCare hopes the federal program will cover a larger percentage, and the facility now staffs a representative who is available to assist in Medicaid signups five days a week (up from two).

But for now, “It isn’t the end-all,” he said.

The state and the county are in discussions to find long-term options for providing the services, Kotchevar said, noting that she doesn’t to see the same thing that happened in Reno — where a WestCare triage center last month was shut down with no previous announcement — happening in Las Vegas.

“Let’s take a little bit of the emotion and sense of urgency out of it, look at the actual data and ask what is the array of solutions that are available, where should we go from here, so we’re not making a rash decision that doesn’t solve the ultimate problem,” Kotchevar said.

The data indicates clients spend two to three days on average at the facility, which also has a wing that offers longer-term treatment options and contacts to other service providers, Vickrey said. Figures suggest that 32 to 34 beds are occupied on average each day, Kotchevar said, although that number can dip to 10 to 12.

When patients arrive, they meet with a technician who checks and secures their personal property. Then, they shower and change into a gown before a physician assistant checks them to determine a rehabilitation plan, Vickrey said.

Some plans include participating in recovery meetings and activities like mild yoga and music therapy in the common area.

Sometimes staff at WestCare see patients “five, six, seven, eight, and nine times,” Vickrey said. And they’re always received with the “same warm welcome.”