After killings, hospital will do its own mental health screenings

Morton Hospital in Taunton, under fire for releasing an apparently suicidal man who went on to kill two people and injure five, on Thursday abruptly pulled out of the state-run system used to screen Medicaid patients who show up in emergency rooms with mental health issues.

The hospital did not directly connect its decision to the release Tuesday morning of the suspect, Arthur J. DaRosa, who was shot and killed later that day after a violent spree at a Taunton home and a nearby mall. Instead, the hospital suggested the move was prompted by the state-run system’s failure to promptly evaluate patients two days later, on Thursday morning, leaving them lingering in the emergency room.

The failure “to provide critical and timely services continues to put patients at risk,” Michele Fasano, a hospital spokeswoman, said in a statement.

The action was taken amid a longstanding dispute that Morton and some other hospitals have had with the system that requires hospitals to use independent clinicians, instead of their own doctors and nurses, to evaluate Medicaid patients seeking mental health treatment. It also came as state health officials have launched a review into the handling of DaRosa’s case.

“While the administration is reviewing the specifics of this tragic circumstance in cooperation with law enforcement, efforts to improve the mental health system must always be ongoing,” said Michelle Hillman, spokeswoman for the state Executive Office of Health and Human Services.

State officials said decisions to release Medicaid patients from a hospital are not made solely by the outside screening system, but must also be approved by the hospital’s own emergency room physician. Morton Hospital, in a statement, said state law only requires emergency room doctors to sign off on patients’ physical health before they are released.

The evaluations for Medicaid mental health patients at Morton are conducted by Taunton/Attleboro Emergency Services, which is run by the state Department of Mental Health. Most other hospitals use private contractors to provide those services.

In addition to providing mental health screenings at Morton Hospital, Taunton/Attleboro Emergency Services screens hospital patients and families who dial its hot line in 11 other municipalities, including Mansfield, Middleborough, Raynham, Rehoboth, and Seekonk.

Morton’s action came after it released a statement Wednesday night, in response to questions about the DaRosa case, indicating that it was the state’s specialists — and not the hospital — who were to blame.

DaRosa was brought by ambulance to the emergency room Monday evening after relatives said he was threatening to kill himself and had told them the devil was playing tricks on him and trying to poison his children.

DaRosa was released hours later, about 4 a.m. Tuesday.

Morton Hospital has not explained why DaRosa was not held for treatment, saying it is barred from disclosing confidential patient information. It is not clear what specific role the state-run Taunton/Attleboro Emergency Services played in DaRosa’s case.

But the hospital said, “If the state-contracted agency responsible for conducting evaluations in the Emergency Department had requested an admission to a psychiatric bed, there were beds available within the hospital’s network.”

After he was released, DaRosa went to work and then to his child’s soccer practice.

Authorities say he then went on a rampage, fatally stabbing an 80-year-old woman in her Taunton home and a 56-year-old man dining with his wife at a Bertucci’s restaurant in a mall four miles away.

DaRosa, 28, was then shot and killed by an off-duty sheriff’s deputy who had been eating dinner at Bertucci’s.

DaRosa’s relatives have criticized Morton Hospital for releasing him.

“If Morton could have done a little bit more and kept him there, none of this would have happened,” DaRosa’s aunt, Liz DaRosa, said Wednesday. “He wanted the help. He asked for help.”

Told Thursday about Morton’s decision to pull out of the state-run system, Liz DaRosa said: “It’s pretty sad they have to wait for a tragedy” to act.

“If they knew the company was bad and not giving good service, why wouldn’t they get rid of them before this?” she said.

The hospital, which is part of the Steward Health Care System, said it has long complained about a two-tiered system used to evaluate mental health patients.

Under the system, privately insured patients who show up in emergency rooms with mental health issues are screened by the hospital’s own doctors and nurses.

But when most Medicaid patients arrive in an ER, they are evaluated by clinicians from a contractor selected, overseen, and paid for by the state departments of public health and mental health.

The outsider then decides whether the patient should be admitted to the hospital for treatment or released.

The system, established more than two decades ago, was designed to ensure that patients who did not need hospitalization were treated in less expensive settings, such as community clinics and group homes.

But some hospitals have expressed concerns about the arrangement, saying their own doctors and nurses are better suited to determine patients’ needs.

“As we have said in the past, the current policy mandating that the evaluation process must be carried out by a third-party state contractor is misguided,” Julie Masci, another Morton Hospital spokeswoman, said in a statement.

Many have questioned whether the separate screening system for MassHealth patients violates the state’s mental health parity law, which requires that mental health patients be treated no differently than those with other ailments, said David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems, which represents 44 psychiatric and substance abuse hospitals.

“We have been back and forth with the state for many months and years on this,” said Matteodo, whose association is officially neutral on the issue. “The state believes this is another level of care, that it is not a violation of parity, that they’re diverting a lot of people from hospitals and, therefore, they are serving a valuable role.”

In withdrawing from the system, Morton said it would use its own hospital staff to evaluate Medicaid patients with mental health issues. It is not clear, however, if the state will reimburse the hospital for those services.

“If a hospital admits a MassHealth patient without using the Emergency Services Program, they won’t get paid,” Matteodo said.