LG Health's behavioral intervention staff are concerned about the impact of the layoffs (2023)

Behavioral health workers at Lancaster General Hospital are concerned about recent budget cuts to almost half of their department and the elimination of third shift, putting vulnerable patients at risk of longer stays and becoming distressed.

Lancaster General Health officials counter that there are other systems in place to treat patients that were once the responsibility of laid-off employees.

Without a third shift, there will be fewer opportunities for behavioral health professionals to try to de-escalate situations, which could increase patient distress and physical behavior, a behavioral health expert told LNP | Lancaster Online. Patients could stay longer, the employee argued, which could harm patient outcomes.

"The community deserves to understand exactly why this was done," he told LNP | Lancaster Online. "It touches people very deeply. Not sure who will be there to fill the void.

Eighteen members of the Behavioral Health Intervention Team were among 62 positions cut by Penn Medicine Lancaster General Health in late April in what it described as an effort to be more efficient and increase operating margin. LG Health said the 42-person team is part of the overall behavioral health service, including about 100 employees, including physicians and clinical staff. Since the job cuts were announced in late March, 13 affected employees have transferred to other jobs in the system, including three people who worked on the Behavioral Health Intervention Team.

LG Health recently told LNP it expects the total number of positions eliminated to save about $4.3 million a year.

Four LGH employees who were not fired turned to the LNP | LancasterOnline about the layoffs and agreed to speak to a reporter on the condition that they not be identified because they were concerned about retaliation from their employer for speaking to the media.

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

Abolishing the third shift could have a particular impact, one employee said, because people need help the most at night.

"It's dark and people feel isolated," says the behavioral health worker. "It doesn't really make sense to me. We all know mental health crises don't have a timeline."

Workers said they were concerned about how people in need would be treated without specially trained health workers to assess and care for them at night.

"I was 100% direct patient care," one employee told LNP| Lancaster Online. "Ambulance providers don't have time to spend with these patients and often seek our expertise."

The employee fears that the patients might be given drugs that would subdue them, or that the patient would simply be put aside until they could be evaluated by a behavioral medicine worker on the day shift. But the day shift is also suffering from downsizing.

The health system says prescribing is a decision the doctor makes based on what's right for the patient, not a staffing situation.

LGH says behavioral health is changing

LNP | LancasterOnline asked the health system about employee concerns and the implications of behavioral health cuts. LG Health responded by saying that the opening of Lancaster Behavioral Health Hospital five years ago at 333 Harrisburg Ave. in Lancaster City has changed the way patients present to urgent care, allowing many to be admitted directly to that facility instead of the LGH emergency room.

"These changes have led to an evolution in how we care for the behavioral health needs of patients who enter our ED (emergency department) and hospital environments 24/7," spokesman John Lines wrote in an email on behalf of LG Health. "Patients, families and community partners who play a role in ensuring timely and compassionate behavioral health care can continue to count on us to provide quality care to all patients."

Behavioral therapists interviewed by LNP | However, LancasterOnline said third shift patient volume has not changed since the behavioral hospital opened. They said the county behavioral hospital and other facilities send patients to LGH at 555 N. Duke St. in the city of Lancaster, especially when their mental health or substance abuse problem is complicated by a medical condition. That referral could be for a medical condition such as high blood pressure or poisoning.

dr. LG Health Chief Medical Officer Michael Ripchinski said the third shift saw the fewest serious psychiatric patients.

"That (third shift) was our lowest number of high-acuity psychiatric patients coming through our doors," Ripchinski said.

The evolution of behavioral health care is part of an ongoing $182 million renovation of LGH's emergency department, which has a dedicated room to protect staff and patients who come to the emergency room with substance and mental health issues, it said. John Herman, CEO of LG Health. At the end of April, an emergency reception for patients with mental illnesses was opened.

Ripchinski said the decision to commit someone to a mental health facility has always been and will always be a physician-led process. That is, the doctor makes the final decision on the schedule and treatment plan. Physicians and psychiatrists may have taken into account the input of behaviorists who spent extended time with the patient, but treatment was ultimately the physician's responsibility.

Ripchinski said emergency room doctors and on-call psychiatrists are still responsible for patients. Services continue, but it is different who provides them, they claim in healthcare.

"Yes, it's a change in workflow, if you will, in the third (shift), but we've engaged our doctors with our nurses to make sure patients are still getting the evaluation and care they need, Ripchinski said. . . . That's the most important part.

Nurses will also be involved.

"For example, fellow nurses help us screen patients for suicidal risk, either on floors or in our emergency department," Ripchinski said.

He said first and second shift behavioral health staff will take over the job, specifically finding places for people seeking treatment.

"As you can imagine, these patients wait a long time for their bedside visits and we often have to provide them with psychiatric care while they wait for their beds," Ripchinski said. "Help comes in those other services. However, it is not as perfect as before and our teams are adapting to it."

The changes are part of an ongoing response to financial pressures on the health care system, caused in part by the pandemic, including higher labor costs, increased staffing and lower payments to insurers, Herman said.

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

Judy Erb, executive director of Lancaster County Behavioral Health/Developmental Services, said her department has been in contact with LG Health management about the layoffs.

"We are confident that the restructuring of LG Health is not expected to impact crisis intervention," it said in an emailed statement. "Our Crisis Staff will continue to respond as usual if and when requested by LGH."