The last patient of Anne Arundel Medical Center's psychiatric unit was discharged yesterday, and with her departure, the 15-year-old unit is now effectively closed.
Hospital administrators, who need state approval to officially shut down the unit, said there is no real need for it, given the low admission rates for the past two years.
But some mental health professionals say it should remain open as a community service, and they fear the quality of patient care will deteriorate if the unit closes.
"It hurts the community if there's no focus for psychiatric care," said Arthur M. Warwick, director of the hospital's Inpatient Psychiatric Unit and an opponent of its closing. "One of the reasons patients get better treatment locally is because they can then be better integrated into the community."
Whether the unit closes permanently will be decided after a hearing set for May 18 before the Maryland Health Resources Planning Commission, the state agency that regulates hospital services. Anyone who attends the 7 p.m. hearing at the county Health Department on Harry S. Truman Parkway in Annapolis can testify, said James E. Stanton, executive director of the planning committee.
Mr. Stanton wouldn't speculate on whether his agency would approve the Annapolis hospital's request to close the unit. But he said it would be unusual for the commission to force any hospital to maintain a service, particularly if it demonstrates the service is underused and patients can be served elsewhere.
Mr. Stanton said he expects the commission to make a final decision within two weeks of the hearing.
Betty Schweitzer, vice president of Patient Care Services for the medical center, said the hospital has shown that closing the unit will not hurt patients or the community.
"We've been running at about 5.3 patients average, or about 42 percent capacity," she said. "[Other hospitals] could pretty easily absorb the patients."
North Arundel Hospital in Glen Burnie, which has an 18-bed psychiatric unit, has shown an interest in taking the medical center's patients and has the space to do so, Ms. Schweitzer said. Calvert Memorial Hospital in Prince Frederick will take patients from South County, she said.
Anne Arundel Medical Center, which administrators say is strapped for space, plans to move its oncology unit into space occupied by the psychiatric unit.
The 12-bed unit, opened in 1978, started loosing patients almost 10 years ago, Ms. Schweitzer said. But the real drop hit two yars ago when insurance companies began clamping down on coverage for in-patient psychiatric care, she said.
"We're now way under capacity. We went from 80 percent to 40 percent," she said, meaning that at any given time, more than half the beds are empty.
The unit has not lost money because the hospital has raised its rates to cover expenses, she said. As a result, it costs about $650 a day for psychiatric care at Anne Arundel, compared to about $500 a day at other facilities, including North Arundel.
"We're now the most expensive unit in the state," she said. "We've had insurance companies say [to patients] if you want to get treatment here, you have to pay the $150."
She also noted the unit has always had "voluntary admissions," only taking patients who want to be hospitalized. In recent years, insurance companies have cut way back on voluntary admissions, preferring to pay only for patients who are committed because they are a danger to themselves or to others.
Ms. Schweitzer said the hospital considered changing the unit to take involuntary patients or adding out-patient services for voluntary patients, but did not have space to do either.
Some mental health professionals said the hospital could have done more to save the unit, altering services to meet community needs and making it more financially viable.
"They could have hired a consultant to take a look and see what they could do better," Dr. Warwick said.
Both Dr. Warwick and Thomas E. Arthur, chairman of the county's Mental Health Advisory Committee, said they think the space issue could be worked out. Plus, they noted, changes could have been made over the years to boost admissions -- if the hospital was committed to having a unit.
"We're certainly concerned about whether there's going to be enough beds once they close," Mr. Arthur said.