Cleveland policy restricts EMS from taking people in crisis to Cuyahoga County Diversion Center

In 2021, Cleveland ambulances made close to 76,000 transports of people in need of medical assistance of one kind or another.

Of all those ambulance trips, none were to carry people to the county’s new diversion center on the East Side of Cleveland.

That’s because the city requires that all ambulance transports end at an emergency room.

Cleveland Mayor Justin Bibb recently announced a policy change that makes it easier for police officers to bring people undergoing a mental health or substance abuse crisis to the Cuyahoga County Diversion Center. The new policy rescinds a requirement created under the previous administration that the city’s prosecutor approve any transport to the diversion center.

The policy change is expected to help more people get care at the underutilized treatment facility. But Bibb’s announcement did not include any mention of revisiting the EMS policy.

Cleveland paramedic Timothy Sommerfelt is secretary for the EMS employee union, CARE Local 1975. In October, around the same time as admission to the center was expanded to include people who had not committed a crime, Sommerfelt sent an e-mail to EMS Commissioner Nicole Carlton asking whether EMS would start bringing people to the diversion center.

“I sent her an e-mail and she said EMS will not be involved in any way with the diversion center,” Sommerfelt told Ideastream Public Media.

The e-mailed response from Carlton, dated Oct. 18, 2021, says three things.

One: There is no change to EMS policy. Two: If police are on scene and they are in the process of diversion center referral, EMS has no involvement. And three: EMS will not be making referrals to police to go to the diversion center.

“So we’re not allowed to even call police and say, ‘Could you take this person to the diversion center?’” Sommerfelt said.

EMS Commissioner Carlton declined through a spokesperson to comment for this story. The city did not directly acknowledge the existence of this policy but said officials will meet in coming weeks to review it.

Ideastream Public Media filed a public records request for internal communications by the public safety director, EMS commissioner and EMS medical director about transport to the diversion center. The request was rejected as overly broad.

The county’s diversion center opened in May 2021 to some fanfare. Cuyahoga County Executive Armond Budish described it as “changing the culture from a total incarceration to treating people.”

But it has struggled to fill its 50 beds. As of mid-December only 186 people had used the facility, with no more than 10 beds in use at any one time.

According to Sommerfelt, there’s evidence that there could be benefits to EMS using the diversion center. For instance, he said 25 individuals generated 1,951 calls to EMS in 2020.

“What that says to us is that just transporting people to the hospital is not meeting the needs of those 25 individuals. We’d love to explore alternatives to just ER transport,” Sommerfelt said.

Seventeen missing words

This is not the first time Cleveland has indicated it does not want EMS resources used for these kinds of transports.

In 2018, the city removed 17 words from a new police crisis intervention policy. The policy had been approved by a federal judge overseeing the city’s consent decree the previous year.

In the court approved version, officers were required to check for EMS availability before transporting a nonviolent person in the middle of a mental health or other medical crisis who does not want to get into a police car.

That part of the policy was removed in the version adopted by the city.

When asked about the change during a public forum on the consent decree in November, Safety Director Karrie Howard said the city likely posted the wrong version of the General Police Order, known as a GPO.

“I will look into the claims of the article on Ideastream and get the correct GPO posted,” Howard said.

But that version, with the 17 words removed, remains online and is the only public version signed by then-Police Chief Calvin Williams.

Paramedic Sommerfelt understands this policy. EMS is short staffed, he said, but the hospital-only transportation policy is still too restrictive.

“If we’re there already and we already gotta take somebody somewhere, does it matter if it’s the emergency room or the diversion center? Not where I can see,” Sommerfelt said.

The city did not provide a response to a question about the reason for the hospital-only transportation policy.

One possibility is that Medicaid and Medicare only reimburse for trips to emergency rooms. But some cities, including Memphis, Tenn., have acquired a waiver to that rule.