Supreme Court of Virginia Holds That the University of Virginia Health Services Foundation is Not Entitled to Assert Charitable Immunity Doctrine As a Defense to Lawsuits

Individuals experiencing acute psychiatric distress often approach the emergency room of a local hospital when they are in need of care, either because they need emergency services or because they lack adequate health care coverage and these are the only services available to them. In addition to delays in accessing emergency room services, which are common for all patients, a survey of emergency department directors released in 2008 by the American College of Emergency Physicians (ACEP) found that such individuals can wait twenty-four hours or longer for an inpatient bed when they are deemed to be in need of hospitalization, principally because of a lack of available psychiatric beds. Of the 328 emergency department directors who responded to the survey, almost 80% said their hospital "boards" psychiatric patients in the emergency department. "Boarding" is the practice of holding patients who have been determined to be in need of hospitalization in the emergency department while waiting for an inpatient bed to become available. This boarding may include placing the patient in an emergency department hallway, with 60% of the directors stating that their emergency department did not have a dedicated area for psychiatric patients. Thirty percent said their hospital boards psychiatric patients between eight and twenty-four hours, while 10% said patients wait more than a day on average. Nearly 80% said psychiatric patients tend to wait four hours or more, while only 30% of non-psychiatric patients waited that long. The main reasons given for boarding were the lack of in-house inpatient psychiatric beds and no other facility being able or willing to accept transfers of these patients. Only half of the hospitals had psychiatric units, with the number of psychiatric beds in the community dropping 12% in the United States since 2000 (the number of hospital beds overall fell by 4% during this period). Hospitals are reported to be closing their units because of inadequate payments from government and insurers, unpaid costs for the uninsured, and too few psychiatrists willing to work in hospitals.