The Lawrence Memorial Hospital emergency room sign is shown in this file photo from 2008.

Dale Beaulieu stood silently before the Lawrence Municipal Court judge last week when his case was called, hands clasped in front of his sturdy 6-foot frame, his gray hair trimmed closely in a crew cut.

Beaulieu, who appeared to be in his late 50s or early 60s, was charged with misdemeanor battery for allegedly assaulting a Lawrence Memorial Hospital emergency room nurse over the July 4 weekend.

Hatem Chahine, his court-appointed attorney who was handling several defendants making appearances that day, looked at Beaulieu’s file and made a statement to the judge indicating that Beaulieu had mental health issues, and the case may need to go through additional processes. The case was delayed until Oct. 25.

It is not the first time a mental health patient has been in court for striking an LMH emergency worker. But this time the court room did have a different feel to it. As the case was delayed, 14 people, most of them dressed in black hospital scrubs to show their solidarity, got up and left as well.

One of them was Frank Ronan, the nurse who’d been assaulted.

“The reason we came down here is because we don’t want this to be treated like a simple assault on Massachusetts Street,” Ronan said. “The fear was that this would just get passed through the desk at municipal court, and I’m not really even sure what happened in there today.”

Ronan said the attack occurred the morning of July 4 when Beaulieu was pacing outside of his hospital room in a way that was agitating other patients. When he asked Beaulieu to return to his room, Ronan said, Beaulieu became aggressive and struck him in the temple with the full force of his fist, knocking him unconscious.

Ronan said there are at least 32 states where any such attack against an ER worker would be a felony. But Kansas does not have such a law.

Furthermore, he and other hospital workers said, because of well-documented problems at the state’s mental hospital in Osawatomie, there has been an ever-increasing number of psychiatric patients showing up in the LMH emergency room in recent months, with those patients staying for ever longer periods of time, resulting in a rapidly increasing number of attacks against emergency room workers.

“Fourth of July was when I was struck, and since that time there’s been a noticeable escalation,” he said. “We hold (mental health) people in our ER for over 100 hours sometimes because there’s just not places to put these people.”

Several of Ronan’s coworkers said they’ve had similar experiences. And they said they do not believe they’re getting enough protection or support, either from the state’s mental health system, from LMH itself or from the criminal justice system.

Rob Kort said he’s been assaulted more in the five years that he’s worked in the emergency room than in the whole 30 years he worked as an ambulance emergency medical technician.

“And three of the people I’ve been assaulted by have been charged, but they have bench warrants. Nothing’s come about with those people,” he said.

Problems at Osawatomie State Hospital

Local officials both within and outside LMH trace much of the recent increase in emergency room loads to problems at Osawatomie State Hospital, the only state facility that accepts involuntary admissions of psychiatric patients.

“On a local basis, some of the behavior of patients coming into ER has been escalated by the situation with Osawatomie State Hospital,” said LMH spokeswoman Janice Early. “We have more patients who are staying longer, waiting for an inpatient bed at Osawatomie.”

For several years, OSH suffered from staffing shortages while its patient count was consistently at or near its capacity of 206 beds. Beginning in the fall of 2014, according to a Legislative Post Audit report, federal officials threatened several times to cut off its Medicare funding over violations of federal health care policies.

Angela de Rocha, spokeswoman for the Kansas Department for Aging and Disability Services, which oversees the hospital, said that in January 2015, the hospital stopped accepting voluntary admissions. And in June of that year, it eliminated 60 of its beds, reducing its capacity to 146 patients.

In addition, she said, the state implemented a “triage” system for taking new involuntary admissions. Under that system, patients who show up in emergency rooms or who are taken into custody by law enforcement must be screened first by a community mental health center, which then must consult with the admissions department at OSH to determine the proper placement.

Even after going through those steps, she said, there is often a waiting list for admissions into OSH. But by the agency’s method of counting, the average waiting time is only 39 hours.

Lawrence officials, however, say that doesn’t include the time that patients are waiting for a decision about whether they’ll be sent to Osawatomie, and in Lawrence those patients can linger in the emergency room or other part of the hospital for as long as four or five days before they are transferred or released.

Despite those measures, in December 2015, the Center for Medicare and Medicaid Services cut off Medicare funding for OSH citing numerous staffing and safety concerns, the worst of which was the rape of a female staff member by one of the hospital’s patients — a rape that was stopped only when two other patients intervened because no other hospital staff was in the area.

Since then, de Rocha said, OSH has been divided essentially into two hospitals, with separate staff and administration. On one side is an “acute care” hospital, which the agency hopes will be recertified to accept Medicare patients.

The other, “licensed,” side of the hospital can accept any patient.

But Rebecca Proctor, who heads the Kansas Organization of State Employees, a union that represents OSH nurses and other staff, said that in order to meet Medicare guidelines, the acute care side must have enough staff to prevent people from working excessive overtime, which has put more pressure on the remaining staff on the licensed side.

“Overtime numbers have gone back up on the licensed side,” Proctor said. “You can’t overwork staff on the side they’re trying to recertify; that would violate CMS requirements.” CMS refers to the Center for Medicare and Medicaid Services.

Impact in Lawrence

Lawrence Memorial Hospital has 27 beds in its emergency department, three of which are designated for mental health patients. But Ronan said there can be as many as nine or 10 mental health patients in the ER at any given time, and they sometimes stay for days at a time before they are transferred.

Yvonne Routte, another ER nurse at Lawrence Memorial, said that puts a strain on the entire department, and it affects patients who come into the ER for other kinds of emergencies.

“We can hold them for days at a time,” she said. “They get put on a list, and they can be as high as 20 on the list, and if we only have three beds, those three beds get used up pretty quickly. And that pulls our staff in the main ER away from taking care of critical patients.”

On Sept. 22, executives at LMH sent a memo to the entire emergency department staff, saying they were aware of the strain they were under and they were taking steps to address it.

The memo, from chief operating officer Karen Shumate and vice president of nursing Sarah Bradshaw, said the hospital was taking several steps, including the hiring of an additional five to six temporary registered nurses with ER training to relieve some of the strain on the hospital’s own staff.

“We know the past months have been stressful for a variety of reasons,” the memo stated. “Some of those challenges are newer for us, such as the care and support of mental health patients coming in to the ED and experiencing much longer lengths of stay. We are actively considering solutions for the most effective way to handle these patients you are now caring for these longer periods of time.”

Hospital spokeswoman Janice Early said LMH is doing everything it can to address the situation, including beefing up security, hiring more staff and training more of its staff in how to manage crisis situations.

Not just Kansas

Early said Kansas is not alone in dealing with an increase in mental health emergencies coming to hospital ERs.

“Really what we are seeing is what is happening in ERs around the country,” she said. “Some of it is fallout from what is happening in the behavioral health system throughout the country. Some of it is from the increase in opioid addiction. There is a lot of pressure on caregivers around the country.”

But she said those problems are exacerbated in Kansas because of the situation at Osawatomie State Hospital, “the only place where we can transfer involuntary admissions.”

David Johnson, CEO of the Bert Nash Community Mental Health Center in Lawrence, said the decline in mental health resources throughout the country in recent years has been alarming.

He said that from 2009 to 2012, community mental health programs nationwide lost a combined $5 billion in public funding while roughly 4,500 inpatient psychiatric beds were closed. But there has been no corresponding decrease in the number of people needing psychiatric treatment.

“It’s hard to work out from those kinds of numbers,” Johnson said.