Editor’s note: Inside the Golden Bubble is an occasional column about the legislative process.
The Shumlin administration has been pressing the Legislature to pass a bill ASAP that will set the stage for the reconfiguration of the mental health system. Gov. Peter Shumlin wanted the legislation on his desk by Feb. 17. When that deadline blew by, Town Meeting Day was the new deadline.
But the former senator from Windham County must have forgotten the phenomenon known as legislative time. The fast paced, smooth sailing that can easily lead to the torpor of the doldrums when legislation hits stormy seas, that is, when senators or representatives ask questions, propose amendments and generally deviate off the course of fast passage.
Such was the case last Thursday, when Senate President John Campbell suspended the usual rules of the Green Room and attempted to put H.630, the mental health system bill that includes a provision for the Vermont State Hospital replacement facility, through all stages of passage — a neat trick whereby, if all parties agree, i.e., the GOP and the Dems, the Senate can go through the second and third readings of a bill in one sitting.
Senate President Pro Tem John Campbell struck a deal with his GOP colleagues. In order to get the rules suspended for fast passage, he needed approval from three-quarters of the senators. In other words, he needed Republicans and his fellow Dems to go along with the idea. He made his pitch: There would be no politics, only substance on this issue.
“I have a very good relationship based on trust, and I asked them if they would go along with voting to suspend the rules and make sure no one would be hanging out there without treatment,” Campbell said. “I promised there’d be no politics, and they agreed (to suspend the rules).
Lo and behold, politics did emerge — from a corner the president pro tem least expected.
Passage looked possible there for a while, until Sens. Vince Illuzzi and Joe Benning, both Republicans, and others effectively routed the proceeding. There were questions about whether Act 250 would be circumvented (there’s a passage about expediting construction), whether a provision to protect state workers was strong enough, and finally whether the legislation would give the state the flexibility to build more than 16 beds if need be.
Questions in the real world sometimes lead to answers; in the Legislature answers come in the form of amendments, political rhetoric and votes.
Hence, the all stages-of-passage agreement hit a wall in a hurry. A flurry of amendments ensued. Delay was inevitable and the Town Meeting Day deadline slipped away.
Later that evening, however, the delay was compounded by new news: Information had been leaked. The Shumlin administration was about to announce the layoffs of 80 state workers from the defunct Vermont State Hospital.
Though the move was anticipated, the timing was unexpected. The news flash took nearly everyone in the Senate by surprise — including Campbell. Suddenly, the fast track passage of H.630 was seen by some in a different light, and Campbell was worried about the perception that he knew about the reductions in force in advance and was trying to push through the legislation on behalf of the Shumlin administration before state employees were notified of the layoffs.
“Not only would I think that was a pretty lousy thing to do, also it was hard to go back and explain to Republican colleagues that this wasn’t about politics,” Campbell said. “I apologized to everyone as soon as I found out. None of them thought I was aware of this when I asked to suspend the rules.”
The senator felt slighted by the administration’s handling of the Senate vote, particularly given his loyal support of the key issue — Campbell has said he supports a 16-bed state psychiatric facility over the 25-bed proposal that came over from the House.
“The administration put me in a very bad place in the sense that I’m push something for what I believe is for the right reasons and of course the administration wants it pushed,” Campbell said.
The plan was to get the bill out on Friday, but the layoffs threw the Green Room into a tizzy and a vote was put off until this week.
Jeb Spaulding, the secretary of the Agency of Administration, blamed the Vermont State Employees Association for the timing. He said the union wanted to “roil the waters and get concessions.”
“Personally, it’s very disappointing that Vermont State Hospital employees who were affected had to hear about this on the news because the VSEA leaked it on their own members,” Spaulding said.
He said the layoffs had nothing to do with the bill in the Senate. “The reason we were pushing bill was because the governor asked for it to be on his desk by Feb.17,” Spaulding said.
“We were on a course to do that,” Spaulding said. “We said look there are things in bill including the budget adjustment act for fiscal year 2012 in this bill. The Budget Adjustment Act is now passed. We can’t we get this done by town meeting, we concluded, unless the bill passed last week — that was the rush.”
That course was detoured. An H.630 bill signing before Town Meeting Day is not going to happen. Senate committees will give the three amendments in the offing a once-over on Tuesday before the bill goes to the floor again on Wednesday. Then the legislation has to go to conference committee. A celebratory gubernatorial signing is at least two weeks away.
And it would likely only be celebratory if the governor got his way — that is if a 16-bed facility is approved. The House bill — and the three Senate amendments in play — all press for more beds.
Sens. Philip Baruth and Tim Ashe, both of Chittenden County, are proposing a 25-bed psychiatric facility; Benning’s legislation gives the state the option of signing up for 25, if needed; and Sen. Vince Illuzzi, R/D-Essex-Orleans, is demanding up to 50 beds. The proposals were reviewed by Senate Health and Welfare on Friday, and they go to the Institutions and Appropriations committees on Tuesday.
Download a copy of H.630 Benning amendment
Benning and Illuzzi are both concerned that the administration has rejected an offer from Fletcher Allen Health Care to take over the responsibility for the hospital and, as Benning put it, “nullify worry about whether Medicaid will cover” operating costs.
The Shumlin administration has said it would not build a larger psychiatric facility because of Medicaid rules that could kick in that would limit the number of beds to no more than 16 that the state would be reimbursed for at a 60/40 match level. Institutes for Mental Disease, under Centers for Medicaid and Medicare rules, cannot be larger than that and receive federal funding without a waiver. Vermont has long had a waiver that enabled the state to operate the old Vermont State Hospital, which had 54 beds. The state’s current waiver expires on Dec. 31, 2013. If a teaching hospital is associated with an institute, no waiver is needed because the rules allow CMS to reimburse the state — regardless of the size of the facility.
The administration has proposed a community-based mental health system for severe psychiatric patients that includes the state-run facility, several regional hospitals, a small secure facility for patients with forensic psychiatric issues and a number of step-down facilities. Officials have said this network of supports could serve 80 patients in all.
Benning says the new system would not provide enough in-patient care for patients in northern Vermont. According to a map he obtained from the state, 68 percent of the patients live in “home counties” north of Middlebury and Randolph.
Download a copy of the 2008 map of patient locations. (Please note: the map contains an error, it should indicate 14 beds at the Brattleboro Retreat, not 15.)
Benning and Illuzzi each said in separate interviews that they are worried that the administration has decided not to retain people who are skilled at handling patients with severe psychiatric problems.
Illuzzi’s amendment cites a 1996 agreement between the VSEA and the Department of Corrections regarding a private-public partnership. The deal allowed state employees to continue to work with a contractor that provided mental health services to prisoners. Illuzzi wants to make sure state employees can stay on at private hospitals. His bill also requires the secretary of the Agency of Administration to contract with Central Vermont Medical Center and Fletcher Allen Health Care. The bill also requires private facilities to report bodily harm incidents and death. Illuzzi said the legislation includes statewide standards for involuntary medication, restraint and seclusion.
