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Commentary: Concerns Raised About Crisis Triage Center in Las Cruces; Operator Responds

Commentary: Experienced registered nurses fear that the Crisis Triage Center is so badly run it could really harm someone and harm Doña Ana County.

It’s run by RI, specifically by Karina Diaz, a certified art therapist/psychotherapist who is not a nurse. Pre-opening, one source said Diaz “kept firing employees, amazing human beings,” including Freddy Hernandez, a highly experienced nurse whom the source called “a ray of sunshine.” RI says it did not fire Hernandez, a temp, and that it has fired no CTC staff nurse.

When contacted, Hernandez calmly discussed his experience at CTC, adding he’d wanted to contact Jamie Michael because he doubted she was aware of the depth of the problem. He’d been on committees trying to make CTC happen, and was “extremely disappointed,” particularly after that long community effort. He said Diaz lacked experience with such a facility. “She didn’t know what to order, when to order, or how things should go,” but micromanaged people anyway. “She’d sneak up on us and say, ‘Why are you talking?’ and you had to ask for permission to go to the bathroom.” He warned her, “You’ll lose your nurses. You have to treat them like adults.” Psychiatric nurses are scarce. Asked if I could use his name, Hernandez replied, “Of course. It’s very important that the County know about this.”

Another nurse who joined (then left) CTC early said that Diaz was so unkind to nurses that after one incident, another employee asked, “Why is she always after you guys?”

Another nurse said, “I’m scared for our County. They’re going to wind up having some dire thing happen. We need the CTC, but we don’t need it under this woman’s reign,” adding, “the County thinks it’s going all wonderful ‘cause that’s what Karina is reporting.”

More recently, experienced RN Pamela Field, who’s pretty well-known locally, worked with CTC. She called it “dangerously mismanaged,” and “a gross waste of taxpayers’ money. There are few “guests.” One source said most guests are either developmentally disabled persons whom “the home brings in after they’ve had a fit, mostly to give the home’s staff a break from dealing with them,” or homeless folks. It’s a safe place. They get their clothes washed and move on.” (A few are having psychotic breaks, and belong there.)

Diaz reportedly insists on admitting people whose safety requires they go into the hospital. Field said CTC tries to detox alcoholics with very high alcohol levels, without medications. That’s a serious medical situation, not merely a psychological one, and potentially dangerous, particularly without meds immediately available. CTC lacks med, but tries anyway; and some of the necessary meds aren’t easy to procure. Field said Diaz was “not qualified to be overseeing nurses. She shouldn’t be directing nurses’ discussions, or dealing with controlled drugs.” Field ultimately declined a shift because she couldn’t ethically try to detox someone with a high blood alcohol level, without meds. RI says it operates ethically and will soon apply for a license permitting storage of controlled drugs.

One man reportedly presented with congestive heart failure and serious fluid overload, and anxiety. Diaz reportedly advocated admitting him, to treat anxiety, though his situation was medically dangerous and the CTC had neither an EKG machine nor meds to treat fluid overload. (RI disagrees with this account.)

This is what I’m hearing from extremely qualified nurses who want county management and citizens to hear the truth. We should listen.

 

RI International Response:

Commentary: Please accept this letter as a response to the Opinion Column published on October 3rd related the Doña Ana County Crisis Triage Center (CTC) in Las Cruces. The column reads as an attack on the program’s Director who is a bilingual clinician independently licensed to practice in New Mexico and New York, brings years of experience leading programs focused on serving Hispanic communities, and represents someone born in raised in the Juárez / El Paso / Las Cruces community. The column inaccurately reports that (1) leadership restrict team use of the restroom and, (2) “admission” decisions are driven by the Director, when continued stay is determined by licensed medical doctors (psychiatrists) based on individual evaluation that includes review of assessments completed by licensed clinicians and nurses. The nursing manager, a bilingual registered nurse leader with a long history of living in and serving this community, provides supervision and support of nurses working within the center. 

RI International operates more crisis receiving centers than any organization in the nation and serves as the service provider for the Crisis Triage Center (CTC).  The program is designed to connect people in mental health and substance use crisis to care in real-time. This is the only program in the region offering this type of no-wrong-door access to mental health and substance use care that individuals with acute physical health challenges find in any hospital emergency department. We understand that many potential team members have spent their entire behavioral health work history in programs that screen out individuals at the front door and this is a big change for them. RI International hopes to find more team members interested in making life-changing impact in the lives of those we serve during some of our guests’ most difficult days. Our no-wrong-door approach to triage all in need is exactly what the best practice standards demand in the SAMHSA National Guidelines for Behavioral Health Crisis Care.

Additionally, there is incorrect information about the guest who visited the CTC with congestive heart failure; however, RI will not discuss any services provided to any guest that could contain identifying and protected health information. It is important to note, that with any guest who comes to the CTC, a Doctor is consulted regarding the individual’s care. In cases where a guest may be transferring from another facility, it is common practice to have the Doctors from each facility speak with one another prior to a guest admission to the CTC. As mentioned above, everyone is welcome at the CTC and a Doctor ultimately decides the appropriate level of care. 

Program Director Karina Diaz has embraced the values of providing crisis services to anyone, anywhere, anytime; including adults with developmental disabilities, homeless challenges, substance misuse, and anyone who is voluntary for services age 18 or older. Much like the hospital emergency department analogy suggests, the CTC is a short-term crisis intervention that works to resolve the immediate crisis and/or connect the person to care that best aligns with the needs of the person/family. For those guests needing a higher level of care, the person is triaged, assessed and connected to the care that’s needed. The CTC operates within the boundaries of our Department of Health license and Board of Pharmacy licenses. We store non-controlled medications on site and obtain controlled medications from a local pharmacy after they are prescribed by our psychiatrist (medical doctor) based on the unique needs of the person served.

We welcome suggestions to improve our services but believe these comments represent an overt personal attack on the Director. As her Supervisor, I have witnessed Karina Diaz’s strong commitment to this community and her team on a consistent basis. Karina and the leadership team at the CTC understands the importance of treating those we serve and our team members with respect. The CTC is committed to delivering the best guest experience possible during one of the guest’s most challenging days.

At RI we take pride in being able to provide excellent services to those in crisis whoever they are, wherever they are, and any time that it’s needed. We look forward to continuing to serve the needs of our community. 

 

Thank you,

Marleigh O’Meara 

RI International

Vice President, Southwest Region