PrairieCare is seeking to double-bunk its young psych patients

PrairieCare, a fast-growing Twin Cities mental health provider, is seeking state permission to double-bunk pediatric patients at its psychiatric hospital in Brooklyn Park, due to the number of children and teens who can't find open beds when they suffer mental and behavioral crises.

The for-profit provider wants to add second beds to 21 of the 50 inpatient rooms at its year-old hospital, and filed a plan this fall with the Minnesota Department of Health, which must now decide whether to recommend the project to the Legislature.

"Particularly during the school year, when we all understand the pressures on youth are particularly high, our facilities are running at near-capacity and most of the others are running at near-capacity," said Dr. Joel Oberstar, Prairie­Care's chief executive.

While adding hospital beds amid a shortage sounds intuitive, the proposal is raising old questions about Minnesota's pediatric mental health system — such as whether the state could avoid the need for costly hospital beds by creating more outpatient services, and whether PrairieCare is the best choice for an expansion.

PrairieCare has been a lightning rod since its predecessor, Prairie St. John's, was rejected in a bid to build a 96-bed psychiatric hospital in Woodbury.

Undeterred, the organization rapidly opened outpatient clinics and day-treatment centers across the Twin Cities, and then opened a 20-bed pediatric hospital in Maple Grove, which was replaced last year by the current 50-bed hospital.

While the latest proposal wouldn't require a new building, Minnesota requires legislative approval for any expansion beyond a hospital's licensed bed capacity. This time, PrairieCare appears to have more backing.

"All too often, children in mental health emergencies are being made to wait in emergency rooms or in pediatric units of the state's hospitals," wrote Dr. David Agerter, the association president.

PrairieCare has come under criticism because of its for-profit structure, in a state where most health care providers are nonprofits, and accusations that it cherry-picks patients with private insurance at the expense of those with lower-paying coverage such as the state's Medical Assistance program for the poor and disabled.

Only 26 percent of patients admitted to PrairieCare's hospital in 2014 were covered by Medical Assistance, according to state hospital records.

That increased to 35 percent in 2015, and Medical Assistance patients also stayed longer than privately insured patients at the new hospital last year.

Whether that means PrairieCare is taking its fair share of low-income patients is unclear. Allina Health reported that 41 percent of admissions in a recent 12-month period to its child psychiatric units in Minneapolis and St. Paul involved Medical Assistance. Children's Hospitals and Clinics of Minnesota had a Medical Assistance rate of 45 percent last year, but it has no psychiatric units.

Federal regulations oblige the hospital to take such patients, he said. "They're accepted before we even know what their insurance is."

Proposing shared-patient rooms is unusual in an era of mostly private hospital rooms, but it would let PrairieCare expand quickly, Oberstar said.

Patients' histories of psychosis and aggression would be evaluated before pairing them with roommates, but Oberstar said it would be easier with teens than adults. "A lot of the youth like to have roommates," he said. "It's consistent in a way with how they live their lives."

The Health Department has until February to make a recommendation to the Legislature. Approval will likely require an explanation of how PrairieCare's expansion will fit with Minnesota's ever-changing mental health system.

The state is adding a new level of care — psychiatric residential treatment — which could reduce the need for inpatient beds by giving hospitals a place to send psychiatric patients when they are stable.

As things stand today, PrairieCare argues that Minnesota needs more pediatric psychiatric hospital beds. Metro hospitals had none available for adolescents on 25 days this May, PrairieCare argued in its proposal to the state.

At least a temporary increase in beds was recommended last month by Gov. Mark Dayton's Mental Health Task Force, which was formed to address problems in the state's mental health system.

While other services could reduce the need for costly inpatient care, discussing them does nothing for the patients languishing right now in emergency rooms and other locations while awaiting inpatient psychiatric care, said Dr. Bruce Sutor, the clinical practice chair for psychology and psychiatry at Mayo Clinic.

Sutor served on Dayton's task force and, separately, co-wrote a letter offering Mayo's support for PrairieCare.

Adding beds in existing rooms would be an affordable and flexible approach, given how the demand for pediatric psychiatric beds changes with the school calendar, he said. "What you don't want is to build 50 more beds and have those beds sit empty or half empty during the summer."

"We're not serving the same number of people, children and adults — we're serving more," she said. "Unfortunately, there is a need. We wish there wasn't, frankly."