Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: THURSDAY, March 12, 1992 TAG: 9203120273
SECTION: VIRGINIA PAGE: A1 EDITION: METRO
SOURCE: CHARLES HITE and DOUGLAS PARDUE STAFF WRITERS
DATELINE: LENGTH: Long
"This lack of care is not a new problem. A whole group of us have been dealing with it for years. But Dr. Gray's suspension brings it into a crisis situation," said Beverly Waldo, director of Youth Haven II, a group home for troubled adolescent girls. "What had been a very tenuous situation has gone over the edge."
At least 76 children and adolescents in public and private agencies who were under Gray's care were at immediate risk of having no way to continue psychiatric treatment. Arrangements have been made to have care provided in 14 of those cases.
Those figures came from the heads of several public and private agencies that provide the vast majority of care to emotionally disturbed youth in the valley.
But there is no doubt that many more children in Gray's private practice also will have great difficulty in getting psychiatric treatment, these agency heads say.
After his license was suspended, Gray said that he has 1,500 patients who will have to find someone else to treat them. Many of those patients - children and adults - soon could be unable to fill Gray's prescriptions for needed medication.
Gray's license was suspended Friday after the state Board of Medicine decided in emergency session that his continued practice would pose a "substantial danger to the community."
The board based its decision on criminal allegations in Roanoke County that Gray sexually molested a 16-year-old. The board also claimed Gray misused his position as a psychiatrist by taking sexual advantage of patients - some of them adolescents. He is accused of threatening one patient and manipulating others with drugs.
"There's a real crisis in care for children right now. Dr. Gray saw many children in private practice who weren't seen by us or other agencies," said James Sikkema, director of community health services for Mental Health Services of the Roanoke Valley.
"Our phones have been ringing off the hook," he added. "People are asking, `What do I do? Where do I go?' "
Part of the problem, Sikemma and others said, is the general lack of psychiatrists for children nationwide. Gray was one of only three psychiatrists in the area with a specialty in children and adolescents. There were already long waiting lists to see the doctors.
Compounding the problem, Sikemma added, is the fact that Gray "saw the lion's share" of children enrolled in Medicaid, the state and federal health care program for the poor. Gray also was the only child psychiatrist readily willing to take new Medicaid cases when asked by mental health agencies. "He would say `Yes,' " Sikemma said.
Because nearly all the children under the care of public and private agencies are on Medicaid, Gray's loss will mean "increased pressure on every psychiatrist and pediatrician in town" to make up the gap, Sikemma said.
If the psychiatrists and other physicians don't fill the gap, many mentally unstable children could be sent to jail or state mental hospitals. "We've got some very, very, very sick kids out there," Sikemma said.
The immediate goal of agency heads is to find care for the 62 children now without care who had been sent to Gray from group homes, foster care programs and correctional facilities. To do this, agency heads are asking adult psychiatrists to care for adolescents. Other physicians are being asked to team up to provide care for children 13 and under.
A long-range goal is to attract more child psychiatrists to the area and establish a medical facility that can at least provide short-term psychiatric treatment for children on Medicaid and other indigent children.
The lack of such a facility in the area makes psychiatrists reluctant to treat poor patients, Sikemma said, because there is no place to send children in a crisis.
Only Lewis-Gale Psychiatric Center has units designed specifically for children and adolescents. But the center cannot collect Medicaid because federal law prohibits payments to freestanding psychiatric facilities.
Lewis-Gale does see a limited number of charity patients, and Mental Health Services has a small fund to pay for some limited-term care for poor children. That fund, however, was not included in next year's state budget.
Roanoke Memorial Hospital had admitted adolescents receiving Medicaid for psychiatric care. But the hospital stopped seeing teen-agers in December because it had to put them on the same floor with adult psychiatric patients. Sikemma said his agency supported Roanoke Memorial's decision to stop the service even though it aggravated the problem of finding in-patient treatment.
The nearest state mental health hospitals to treat children and adolescents from the Roanoke area are Southwestern Virginia Mental Health Institute in Marion and DeJarnette Hospital in Staunton. Recently, a child had to be sent to Eastern State Hospital in Williamsburg because that was the closest facility with a psychiatric bed available.
One possible solution is to put a unit for children and adolescents at Catawba Hospital, a state facility that now treats primarily elderly patients.
The Mental Health Association of the Roanoke Valley adopted a position paper in 1990 backing such a facility at Catawba. Sikemma says Catawba administrators have included it in proposed budgets, but the concept never has been approved by state mental health officials.
by CNB