Editor’s note: Anne Galloway contributed to this report.
Officials at Fletcher Allen Medical Center said Tuesday that mentally ill patients from the Vermont State Hospital in Waterbury are putting staff at the Burlington hospital at risk.
Fletcher Allen officials say the current situation is risky for both patients and staff, especially if potentially dangerous patients who were previously under state care can reject treatment.
Seven patients were transferred from the Waterbury facility on Aug. 28 to Fletcher Allen when floodwaters filled the Vermont State Hospital.
The Waterbury facility is closed indefinitely, and state officials haven’t decided whether they will rebuild the Brooks Building, which housed about 50 patients before Tropical Storm Irene destroyed the structure.
That means VSH patients who began their stays at Fletcher Allen and other hospitals around the state could remain at those facilities for months to come. In addition, new patients are beginning to overwhelm hospital emergency rooms.
At a hearing at the Statehouse on Tuesday, Christine Oliver, the commissioner of the Vermont Department of Mental Health couldn’t give lawmakers a timeline for interim and long-term placements for patients. Oliver is looking for alternative housing, including a facility that could house 25 to 30 patients, but it will be months and perhaps years before permanent situations are found for severely mentally ill Vermonters.
Oliver said her team has explored a variety of options, including temporary modular units (which were rejected by the Department of Buildings and Grounds), several sites, including the now-defunct Pine Ridge school facility. At this point, she said her department continues to search for options. “Try as we might, we don’t have anything yet,” she told lawmakers. “No one wants a solution more than I do.”
Lawmakers couldn’t come to a decision on Tuesday about permanently closing Brooks, which would cost about $1.2 million to renovate. The facility has not met federal certification requirements since 2003, and as a result the state has lost about $8 million a year in funding from the Centers for Medicare and Medicaid for patients who qualify for federal assistance. (It costs about $24 million a year to run the hospital.) Mental health advocates have long pressed officials to close the facility, which lumped together violent patients who pose a risk to public safety and patients with severe dementia and other conditions that require 24/7 treatment. Lawmakers said they would prefer to permanently close the antiquated facility.
Meanwhile, patients with violent behaviors are being held at Southern State Correctional Facility in Springfield under an executive order from the governor (patients housed in the prison are under the care of the Department of Mental Health, not the superintendent of the prison).
The other patients have been relocated to local hospitals, including Fletcher Allen, Rutland Regional Medical Center, Central Vermont Medical Center and the Brattleboro Retreat. Second Spring, a facility for patients who are “stepping down” from VSH level treatment, agreed to take an additional eight patients shortly after the flood. The community hospitals have been asked to provide emergency “beds” on an ongoing basis for the more than 250 patients who typically cycle through the Vermont State Hospital each year. The average stay at the Waterbury facility is 2 months, according to Oliver.
Robert Pierrattini, Fletcher Allen psychiatrist and chair of UVM’s Dept. of Psychiatry, said in an interview that on the day of the flood Vermont lost a third of its psychiatric care beds. That has created an ongoing overcrowding problem. Since August the patients at Fletcher Allen have changed, but some remain aggressive and violent. “When you put them into a dorm-like setting with others in a different mix than at the State Hospital, it can be dangerous,” he said.
Vermont takes longer than other states to adjudicate involuntary commitment cases, which has increased risks in some cases, Pierattini added. ER beds are full and staff is more stressed than usual. “I hope people understand that we need some interim capacity,” he said.
Interim president and CEO of Fletcher Allen John R. Brumsted acknowledged during a trustees meeting on Tuesday that the hospital wasn’t fully prepared to “incorporate some state hospital patients.” Chief Nursing Officer Sandra Dalton commended the staff, but agreed that “it’s been very difficult. Some of these patients are huge and act out.”
Fletcher Allen Trustee Paul Danielson, a South Burlington-based oral surgeon, said the state hospital has handled the most difficult patients in the past. “We’re not that well equipped, and this presents a risk to patients and staff,” he said. “The Dept of Psychology is trying to accommodate, but the situation is putting staff at risk.”
Danielson also warned that this could develop into a civil rights issue, since “in some cases the hospital will need a judicial order to medicate a patient. But the courts can be slow.” In response, hospital officials hope to persuade members of the judiciary to “address this and make these people more manageable.”
“We’re trying to keep the heat on, because this isn’t in the best interests of patients.” Brumsted said.
Part of the push may come in the form of op-ed columns that explain the hospital’s situation and make the case for a dedicated facility to replace the state hospital.
Another push? Lobbying the Legislature.
Jill Olson, vice president of political and legislative affairs for the Vermont Association of Hospitals and Health Systems, told lawmakers in Montpelier that emergency rooms are overwhelmed by the number of patients who are coming to hospitals for help. The demand for services will worsen, she said, as the holidays approach.
“The situation is getting more and more serious as every day passes,” Olson said.
The influx of mental patients is having an impact on services for other patients, she said, and it creates an environment that “isn’t conducive” to everyone else.
In emotional testimony before the Mental Health Oversight Committee, a panel of state representatives and senators, Olson said the state is no longer in an emergency situation and must find interim placements for patients right away.
“This process is taking way too long,” Olson said. “We need a decision now about what the plan is. We need to choose an imperfect solution today.”
Olson suggested that lawmakers and the Shumlin administration may not have a choice but to renovate the Brooks building and send patients back to the Vermont State Hospital. “That’s not what anyone wants, but emergency departments are a worse place for patients,” she said. “All we can do is keep people safe from harm.”
The hospitals she represents have deep anxiety about the state’s continued search for options, Olson said.
Once a decision is made about a new or renovated facility, it will take months to bring new “beds” online. A new hospital would take four years to complete, and the expansion of interim emergency and “step down” placements at facilities that provide care for patients who will be integrated back into the community could take months to put in place, officials said.
Rep. Ann Donahue, R-Northfield, who co-chairs the oversight committee, expressed dismay with the ongoing disaster response approach to the situation. She is worried that CMS will not accept the emergency care arrangements; that patients won’t receive adequate treatment at the Springfield correctional facility; that decisions about how to replace the Vermont State Hospital will continue to be pushed back and that crowding at Second Spring and local hospitals will lead to insufficient care for patients. Meanwhile, VSH staff are living in hotel rooms around the state to maintain treatment for patients who have been relocated.
“I don’t think we can keep going in disaster response mode and extend this week by week on an ongoing basis — it’s not sustainable,” Donahue said. “There’s a limit to how far we can push the disaster response. It puts everyone in the system in jeopardy.”
Editor’s note: This story was updated at 6:11 a.m. and 6:34 a.m. on Oct. 12. Correction: The average stay at Vermont State Hospital is two months. The average stay at Second Spring is seven months. We incorrectly reported the average length of stay at the VSH.
