Palomar Medical Center / Photo by Adriana Heldiz

North County police officers say they are spending more time away from their patrols and instead waiting in emergency rooms following the closure of Tri-City Medical Center’s Oceanside behavioral health units last year.

Police in Oceanside, Escondido, Carlsbad and North County sheriff’s deputies are now queuing in other hospitals’ ERs with so-called 5150 patients, leading to longer waits that can for hours keep officers from responding to other calls for help.

The uptick in hospital waits has also forced North County law enforcement agencies to drive some mental health patients to the county’s psychiatric hospital in San Diego’s Midway district despite the more than 30-minute drive each way.

The Tri-City closure has left police with fewer options to connect patients they consider a danger to themselves or others with medical care. Where they once typically went to Tri-City’s ER or one of Palomar Health’s ERs in Escondido or Poway, more officers are now often being forced to wait significant amounts of time in Palomar ERs or to make the long drive to Midway.

Oceanside police Officer John Janda said Oceanside officers could once count on being of pocket for 90 minutes to two hours when they could take patients to Tri-City Medical Center. Now, with the closest hospital off the table for 5150 calls, ER waits have increased and drives to Midway are more common.

“You can almost guarantee you’re going to be out of the mix for at least three hours on any 5150 call,” said Janda, Oceanside’s psychiatric emergency response team officer.

Police in Escondido and Carlsbad and sheriff’s deputies in North County report similar turnaround times and changes following the Tri-City closure. All agencies also said officers have occasionally faced ER waits as long as six to eight hours.

Police leaders in Escondido and Carlsbad said they are spending more city money to ensure there are reinforcements when officers are tied up at local hospitals.

As mental health patients pour into ERs countywide, North County is facing an especially urgent crisis following the Tri-City closure. It’s lost crucial mental health resources at a time when the need is skyrocketing, and police are among those feeling the crunch.


For years, Oceanside police were among a handful of North County agencies that took 5150 patients to Tri-City Medical Center’s ER. Escondido police, meanwhile, have long taken many of their patients to Palomar Medical Center Escondido in the northern part of the city.

Per state mandates, police must take 5150 patients to one of several local ERs and other facilities licensed to accommodate those patients. Police say Tri-City’s Oceanside ER no longer qualifies following the closure of its behavioral health units.

Tri-City Medical Center / Photo by Adriana Heldiz

Tri-City has said it was forced to shutter its inpatient beds and crisis unit due to new federal patient safety regulations plus financial and staffing challenges.

Tri-City and County Supervisor Jim Desmond, who represents the area, recently tried to persuade county leaders to invest $14 million to help Tri-City open at least 16 inpatient psychiatric beds and 12 short-term crisis beds at its Oceanside campus. That proposal fell flat at a Board of Supervisors meeting last month.

Tri-City spokesman Aaron Byzak said in a statement that the district has engaged in “a variety of discussions with both public and private providers of mental health services” and hopes the county and other health providers will continue looking at opening crisis units where law enforcement officers could drop off patients, including in the cities along the coast and across the Highway 78 corridor.

County officials have committed to a plan to open walk-in crisis centers in North County and elsewhere in the region, but it’s not clear how soon they might materialize.

Absent those additions, officers and 5150 patients from all North County cities are for now inundating Palomar’s ERs. As a result, officers sometimes choose to drive patients dozens of miles south to the county’s psychiatric hospital, where they typically spend less time waiting for a bed.

“It’s a longer drive but seems to have a quicker turnaround,” Carlsbad Assistant Chief Mickey Williams said.

Data released by the county following a public records request shows the number of North County patients discharged from the county’s Midway psychiatric hospital has more than doubled – from 167 patient discharges from September 2017 through June 2018 to 346 discharges during the nine-month span ending in mid-June.

Craig Sturak, a spokesman for the county’s health and human services agency, noted that county supervisors recently voted to add 54 new staffers to work at the county’s psychiatric hospital but said current staff have been able to handle the increased volume of patients thus far.

Sturak said county behavioral health officials are reluctant to attribute the increase solely to the Tri-City closure.

Yet Palomar has also experienced a surge in mental health patients during the same period following the Tri-City closures.

Data from the Office of Statewide Health Planning and Development reveals Palomar’s Escondido ER alone saw a 34 percent spike in patients primarily seeking mental health treatment in the first quarter of this year compared with the same period in 2018.

Palomar officials say that has translated into longer waits for ER patients seeking a bed. They also report that the average length of stay for mental health patients who have secured an ER bed has doubled since Tri-City’s decision to shutter its inpatient units, leaving the hospital with fewer options for patients who need a higher level of care.

“If you’ve got more people coming into the (emergency department), more of them are waiting for another placement,” Palomar behavioral health district director Don Myers said. “Then anyone else coming in is going to wait longer.”

Acknowledging the crush of patients, county supervisors last month signed off on an immediate $4.4 million infusion for Palomar to hire more staff to aid mental health patients and expand its crisis stabilization work. The hospital district is also poised to receive another $6.4 million to support its efforts next year.

Palomar Health officials say they have already hired 20 new staffers and expect to hire at least two dozen additional workers in coming months.

Sheriff’s deputy Andy Gale, who is assigned to the agency’s Vista station, said he has appreciated Palomar’s efforts to address the rush of visits from police, but said he’s sometimes spent significant portions of his shift waiting in the ER.

“Basically, we just wait there until there’s a bed,” Gale said.

Janda, the Oceanside officer, said that for years, PERT team officers would relieve beat officers at the hospital when there were hours-long ER waits. They don’t have time to do that anymore.

Janda said the influx of calls and the closure at Tri-City have limited the number of 5150 calls his specially trained team is able to respond to during their shifts.

“The impact is huge,” Janda said. “Where before we might be able to do four or five 5150 calls in the course of a day, we’re pretty well burnt after three.”

Fearing hours-long waits and public safety backups, Carlsbad police proactively opted to sign an up to $35,000 contract with ASAP Security in March to provide on-call assistance with transports out of their city when police leaders decide relief is needed.

Williams, the Carlsbad assistant chief, said police there have used the service 14 times in the past few months, a total that could also include instances where security officers transported prisoners to local jails or hospitals, which the contract also allows.

“It’s a tool for the watch commander to free our officers up in the city,” he said.

Escondido Police Chief Craig Carter said his officers’ doubled waiting times have led his department to more frequently ask officers to come in early for their shifts when their colleagues are tied up ferrying patients. He could not immediately estimate the frequency of those overtime requests but told VOSD he hopes to begin tracking overtime tied to 5150 transports, as those calls have become more routine since the Tri-City closure.

“If officers are tied up on a 5150 call at the hospital and other calls come in, and there’s not an officer available to handle it, you’re going to have to call someone in to handle it,” Carter said.

Lisa is a senior investigative reporter who digs into some of San Diego's biggest challenges including homelessness, city real estate debacles, the region's...

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