Vermont State Hospital. VTD/Josh Larkin
A majority of members of the House Human Services Committee expressed support on Wednesday for a 25-bed facility in Central Vermont that would replace the Vermont State Hospital.
The Waterbury facility, which was damaged in the Tropical Storm Irene flooding that devastated the town of Waterbury, had enough capacity for 54 patients.
The committee has been asked to fast track passage of a plan to provide treatment for patients with severe psychiatric problems. House Speaker Shap Smith set the deadline for the bill to emerge from House Human Services at end of this week. House Corrections and Institutions is working on a financing plan concurrently. The bill would then be up for passage on the House floor before it goes on to the Senate. The governor wants the legislation on his desk by Feb. 17.
Gov. Peter Shumlin has proposed a 16-bed facility, and at a press conference on Wednesday, reiterated his stance that the state doesn’t need a larger psychiatric hospital. His administration has advocated for a community-based support system for the severely mentally ill and a four decentralized institutional settings for care. In all, his plan includes 41 beds — 14 at Brattleboro Retreat, six at Rutland Regional Medical Center and four secure placements at the Windsor correctional compound.
Lawmakers and the Shumlin administration are expediting the standalone bill so that the state can move ahead with plans to create new capacity at two regional hospitals, a prison compound and a proposed new facility in central Vermont as soon as possible. Patients who were displaced at the end of August and new patients who need acute psychiatric care have been sent to treatment facilities around the state. State officials are anxious to finalize plans so that permanent “no refusal” psychiatric beds can be made available to patients as needed.
In discussions on Wednesday, 7 out of 10 lawmakers on the Human Services committee, including the chair, agreed that the state needs a state-run facility with at least 25 beds. Most also said the structure should be designed in such a way that wings can be added on to it in future if the community mental health system plans and placements at regional hospitals don’t work out.
After each of her committee members voiced their opinions on the key issue in the draft legislation, Rep. Ann Pugh, D-S. Burlington, said she struggled to make a decision.
“I came at this wanting to come to yes with the governor’s proposal,” Pugh said. “I’m three-quarters of the way to yes.”
Pugh said she believes it’s important to have a geographically dispersed system for acute care and she “fully supports” placements at Rutland Regional and Brattleboro Retreat. A facility in Central Vermont, she said, will have to serve as the main facility in northern part of the state, and given the larger size of the population, she believes a 16-bed facility is too small.
A new facility, she said, won’t be enough to guarantee quality care.
“We need to do things differently,” Pugh said. “We’re not just talking about building beds. The kind of care and treatment needs to be different. We need to discuss what recovery means and flesh that out if we want a recovery-oriented system.”
Rep. Anne Donahue, R-Northfield, supported a 25- to 30-bed facility in Central Vermont along with units in Rutland and Brattleboro. She wants the state facility to be large enough to accommodate the spikes in patient population. The 16-bed plan would create a situation in which there would be no excess capacity in the system for patients for about 20 days a year, she said.
“This is not a hospital patient level that stays the same — it’s very much in flux,” Donahue said.
The Shumlin administration is using an average patient count to drive its patient capacity model. A more accurate picture of the daily need, she said, is an actuarial analysis in the 2006 Milliman report to the Legislature that projects psychiatric patient load through 2016. In a chart produced by the firm, there should be an additional bed capacity of 10 for erratic changes in patient population.
“What we don’t know is how many community services have to go into place to absorb unmet need to reduce inpatient beds,” Donahue said.
The question, Donahue said, is what happens on each side of the gamble.
“If you build it too big, you have the potential of filling it with people who didn’t need that level of care,” Donahue said. “The risk of making it too small is catastrophic. Making it too small means death. Sometime along the line more than once. We will have many days when we will not have the capacity.”
Most of the committee members also agreed that the Brattleboro Retreat and Rutland Regional Medical Center contracts should be for four years, rather than 10 years, as originally proposed. Committee members said the Legislature should have an opportunity to evaluate the effectiveness of care provided by the facilities at that juncture.
“We can’t have any of those (short-term contracts) without evaluations, without being clear about what it is we’re looking for,” Pugh said.
Pugh said the state will be covering capital improvements for the two facilities to accommodate psychiatric patients and these permanent structural improvements will continue to be an asset into the future. “I don’t think it’s a loss for them,” she said.
The draft legislation (as of Wednesday) would also shore up community-based treatment programs ($1 million, for example, would be set aside for peer services; $8 million for regional nonprofit mental health centers; and $600,000 for housing subsidies); and funding to support patient care in treatment centers in Brattleboro, Rutland and Windsor.
House Human Services also debated a set of principles that would be used as a framework for reforming the mental health care system in Vermont. A few of those tenets: Protecting the legal rights of patients; a commitment to oversight, accountability and transparency; alignment with future health care reforms; geographic and financial accessibility; long-term planning; high standards of care; and coordination of a continuum of care within the most integrated and least restrictive settings available.
Editor’s note: This story was updated at 6:15 a.m. and again at 6:34 a.m. on Jan. 26. Correction: Seven members, not eight, supported the 25 bed or more option.
I don’t think the state could even properly run a 16 bed hospital. Now the legislature wants it to be 25 beds that will cost millions more. That’s millions of dollars that won’t be available for the community based services that are required by the Americans with Disabilities Act. The Vermont State Hospital has been decertified by CMS since 2003. The VSH administration was not doing anything to deal with some problems brought up by CMS. I know because I worked in food service there. One example is that CMS found that the Director of Dietary Services failed to ensure all dietary staff adhered to accepted standards of safe food handling practices. The VSH administration did nothing to address that issue. The hospital dietician came in at noon every day for four years even though she was a full time employee. When I reported that to the administration they claimed they had no idea it had been going on. The food service was inadequate and they never checked to see that the dietician was doing anything for four years.
That was just one of many examples of incompetence at VSH. Anyone can read the CMS reports and see that many of the problems were not caused simply by an old building. Staff were not documenting incidents properly and were often not aware of what was going on. Patients had been using beds to barricade themselves in rooms since at least 1995. When CMS surveyor questioned the VSH Executive Director and Staff Educator in 2010 they both stated that the beds in patient rooms were not movable. The CMS surveyor checked and saw there were wooden framed beds in each room that could be easily moved about the room and pushed up against the door.
Patients were also using broken light bulbs to harm themselves. CMS found that Quality Assessment Performance Improvement staff were aware of a previous event involving the use of floor lamps but failed to assess the circumstances concerning the event or implement preventative corrective actions.
As recently as early 2011 the working conditions at VSH got so dangerous that some staff talked to the press about it. Staff were being forced to work 16 hour double shifts. I recall a letter to the Times Argus by a staff person asking for an investigation. I wasn’t working there then but it didn’t surprise me at all. It was the due to the same administrative incompetence that I had observed in over a decade at VSH. The hard working staff at VSH were overworked while the poorly performing staff got a free ride by the hospital administration. What makes the legislature believe that the new 25 bed state hospital won’t be mismanaged also?
There were numerous quality improvements made over time, including changes in the administration. Just as at any place of business, there were those who were exceptional employees and those who were not. Lamps were used in the hall on night shift for many years as the halls were very dark when overhead lights were turned off. When this was deemed a safety risk, new safety lighting was installed (just one of the many improvements made with the money put into the facility). Also, some of the beds were not moveable and some were wooden, moveable beds. It depends on which unit one was asking about, and perhaps it was unclear. Also, another improvement that could be made with a new facility.
There were many improvements made over the years at the Vermont State Hospital that needed to be made. I find it unfortunate that CMS isn’t requiring other inpatient facilities to meet the same standards that they required VSH to meet. I also find it very unfortunate that a disgruntled ex-employee would go to such extremes to sway public opinion that could result in someone not receiving the care that they need when they are in crisis. The community should absolutely receive the funding they need to improve services so people can remain in the community instead of requiring hospitalization. But when those that are in crisis are not able to remain safe in those settings, they should at least have access to the services they need rather than be in emergency rooms for days at a time (usually in restraints or receiving a lot of emergency medications). I know the hospital used to have a lot of practices such as this, but practices have changed significantly over the years.
Remember how beneficial it was for patients to be able to work in the canteen? To socialize with each other there? To spend time off the unit while gaining work experience? The other inpatient settings don’t offer those programs. They discharge people as soon as possible, often before they are ready, whether they have a place to go or not. They are businesses. They will and do turn people out onto the streets. Curtis, I know you care about people more than that.
Mr. Sinclair has a jaundiced view of the staff, the programs and the many achievments we had at VSH in the past 3-5 years. My own experience as a Nursing Service Supervisor was very different and much more positive. While I think there is always room to do better, the fact that we were given good grades by the Department of Justice and JCAHO accreditation is testimony to our work and our ability to learn from past mistakes. I am pr4oud of the work I did and the staff I supervised.
Again with the food service issues…
I find it difficult to hear “former employees” complain about the conditions, even when they worked outside the actual hospital. The former canteen was not the hospital. The problems in the Brooks building were in the past and, at the time of the flood, a product of an ancient and untherapeutic facility. If these “former employees” set foot inside the actual hospital, then they would see state of the art care and amazingly dedicated staff. Anyone that says otherwise is misinformed.
It is the hospital staff who have distorted views. I hope the people reading these responses realize that it is the current VSH hospital staff who are the ones arguing for the rebuilding of the hospital. Their interest is in keeping their jobs, not serving the state’s mentally ill. Community services are the best way to treat mental illness, not involuntary incarceration at a state hospital.
Soteria houses, home based crisis intervention, assertive community treatment, and peer run respite houses are all good alternatives to psychiatric hospitals, but they need funding. Instead of sinking more and more money into a failed hospital Vermont should be looking into those alternatives. A peer run respite house was set up in Massachusetts by Dr. Daniel Fisher. According to their deputy commissioner of mental health the only opposition to peer respites that the department encountered came from traditional mental health providers, who saw peer respites as “cutting into their business.” http://commonhealth.wbur.org/2010/10/peer-run-respite/
The story of the hospital’s canteen was covered here in VTDigger. It was part of the hospital until administrative incompetence and corruption drove it into a $100,000 deficit. The Douglas administration then had the canteen shut down. The legislature saw to it that the canteen would be reopened, but it was not to be under the hospital’s jurisdiction. It seems they had no confidence that the hospital could run its own food service. That is probably because the same administrator who oversaw the canteen was still at VSH.
Before I ran the canteen I was an involuntary patient at VSH for two years, so I know what kind of things happen on the wards. In 2005 the US Department of Justice found that VSH had been violating patient’s civil rights for over 10 years. Yet during that period the hospital staff and administration were calling VSH one of the best psychiatric hospitals in the US. One of the problems DOJ cited was the inappropriate diagnoses of patients. That’s the one that kept me unjustly incarcerated. Many of the same psychiatrists that were there then are still there now, so why should I believe things have changed? I also remember staff ‘joking’ about keeping people locked up to protect their job security. I keep hearing from staff how things have improved, but I don’t believe it. CMS certainly didn’t believe that. They refused to certify VSH for the past eight years.
Yes Curtis, you are correct that community care is good for some levels of mental illness, but not acute Level 1 types. A facility is needed to help these people who are dangerous to themselves or others with properly trained staff to help the clients get back to baseline behaviors. The community services do not have staff trained to deal with Level 1 clients and it has been witnessed by myself and many others since the flood. You are hearing it from these other community services, that they are unable to handle Level 1 clients. Lower level patients are being pushed aside for the lack of Level 1 beds, what do you think will happen to these people being refused? Are they just going to get better? Absolutely not? You can use any Massachusetts reference you want, but the fact down there is they still have 6 State Hospitals with over 600 Level 1 beds, and are finishing up a 320 state of the art CMS approved hospital, and it is being said that is still not enough Level 1 beds. So yes there is a need for a State Hospital to help Level 1 clients get back to their safe baseline. I agree 100% that there needs to be more community services, but the reality is there still needs to be a State Hospital with trained staff to help the most vulnerable. Rhode Island is currently the only state that does not have a state hospital and their system is in shambles and are talking about building a new state of the art hospital. This state needs both, to secure the system and 16-25 beds are just not enough. 40-50 would be the ideal number to make sure that all Vermonters with mental illness recieve the care they deserve.
People would not get to the point where they are in an acute level crisis if there were more community treatment plans. The money for community treatment has all been diverted to a failed hospital.
And crisis treatment does not always have to be in a hospital. The North Islington study showed that crisis resolution teams offer an alternative to hospital admission in mental health crises. Those CRTs target people who would be admitted acutely to a hospital without their intervention, providing intensive home treatment whenever feasible with 24 hour availability, daily or twice daily home visits, control over access to in-patient beds and a range of interventions focused both on symptoms and immediate social problems.
In March of 1994 the three state hospitals operated by the Rhode Island Department of Mental Health Retardation and Hospitals integrated into one hospital system. It is called the Eleanor Slater Unified Hospital System. It has 495 beds. RI has twice the population of VT but almost 10 times more state hospital beds. Maybe that is why it is a mess. Instead of spending more money on community services they are spending more on an outdated method of treatment. Insanity has been defined as doing the same thing over and over and expecting a different result.
I also want to add something else in response to Mr. LeVasseur. His downplaying of VSH food service problems shows that VSH staff still have no respect for hospital patients. The hospital staff don’t care about the food service or think it is part of the hospital because they can always go somewhere else for food. Hospital patients have no choice. But that never seemed to occur to many VSH employees.
Once again, Mr. Sinclair has missed the point. I never said that food service was not a problem. What I said was that the dietician I worked with was a dedicated, caring professional that was in early, met with patients constantly about their concerns and co-facilitated groups to educate.
The food service, like many other institutions was not perfect, although the reviews I received vacillated between ok and actually pretty good. I co-facilitated cooking groups at the hospital and was in the process of planning a spring vegetable garden for the patients.
To say that staff have no respect for patients shows how very pathetically misinformed and out of touch Mr. Sinclair is. I would challenge Mr. Sinclair to find a more caring, dedicated group of people than those that work at the hospital. Does he believe that VSH workers are spending more than half their week away from their family, every week, just for fun? The respect, empathy and caring that I have seen from staff towards people in significant distress and extreme states makes me glad that I work at VSH. I do take offense at the constant attacks on VSH staff by Mr. Sinclair, someone that has not seen the inside of the hospital in years and obviously holds a grudge about being terminated.
To speak to his other comment, crisis response/hospital diversion programs are a necessary piece of the mental health system. That being said, having worked at one, there were often persons in such extreme states and distress that they required a more intensive, safer alternative. That is one of the main purposes of VSH, patient safety.
Studies show that being placed in a mental health institution can actually cause people to become more mentally ill. People who are socially “labeled” as mentally ill suffer stigmatization and alienation that leads to psychological damage and a lessening of self-esteem. Arguing against an unjust, coercive and dehumanizing treatment model is not a grudge.
The incompetence at VSH was documented by CMS inspectors. What possible grudge could they have?