Dr. Jay Batra, medical director for the Department of Mental Health, will leave his position at the end of this month to take over as Vermont Health CO-OP’s chief medical officer.
There he will join his former boss Christine Oliver, who ran the department when Tropical Storm Irene heavily damaged the Vermont State Hospital in Waterbury. At that time, Batra was the hospital’s medical director. A few months later, Oliver switched positions with Patrick Flood, then deputy secretary of the Agency of Human Services.
Batra’s departure comes at a difficult time for the department. In the last month, both he and Flood resigned. Oliver left the agency in August to become CEO of the Vermont Health CO-OP, which is a new Vermont-based, member-owned insurance company that is seeking state licensure. While Flood’s departure was a surprise — he stepped down without giving colleagues notice — Batra says he told Flood well in advance that he was considering joining the CO-OP.
Batra clashed with the governor’s office over the state’s new regionalized mental health care system, which will replace the 54-bed Vermont State Hospital. Batra supported the construction of a centralized facility for a larger number of patients than the plans for the 25-bed hospital the state ultimately settled on. Batra said he put aside his personal opinions and helped the department get new facilities on line as quickly as possible.
In an interview with VTDigger reporter Andrew Stein, Batra talked about his decision to leave state government, the condition of the department and the major challenges facing Vermont’s mental health system.
Batra said contrary to statements made by top officials, the opening of the new Green Mountain Psychiatric Care Center in Morrisville should not be delayed because of his departure. There are capable psychiatrists in place that can handle the opening of the facility, he said.
As he reflected on his six years working for the state as a University of Vermont contractor, he said he is excited to move into a position where he is not at the whims of political posturing.
Below is an edited version of that conversation.
Andrew Stein: Why are you taking this position at the Vermont Health CO-OP?
Jay Batra: After I became medical director for the state hospital, I really became interested in how an entire system works. It’s an expansion of skills to look at an entire population. It started at the Vermont State Hospital with 54 patients. And, as you know, Christine Oliver was the commissioner of the Department of Mental Health in 2011, and I worked closely with her as the VSH medical director and immediately after the flood. She literally stood by our side during the evacuation from the flood. She is by far the best boss I’ve ever had. She knows exactly when to use a person’s creative autonomy to give them freedom, and she knows when to set limits. So she was a very influential factor in me picking the health care co-op.
Stein: How long had you considered leaving the department?
Batra: Around this time last year, Christine Oliver and Patrick Flood, who was deputy secretary of the Agency of Human Services, switched positions. I had Christine’s ear the entire time, but not really anyone else’s at the agency. I wasn’t sure if they’d have much use for me, so I did interview for jobs then. But Patrick Flood, to give him credit, even though we had different opinions on how to go forward wanted me there, asked me to stay, and I agreed to stay and took the post as medical director for the department.
It was more (that I was for) the concentration of expertise rather than the idea I was against regionalization.
Stein: When you say you two had different views, do you mean Patrick was a more ardent supporter of the regionalized, decentralized mental health system and you were a bigger proponent of a centralized system with a large state hospital?
Batra: I’m not opposed to decentralization, but the state is so small you can’t actually support a group (of experts when they’re spread out). Even the 54-bed hospital was a little too small at times. It was more (that I was for) the concentration of expertise rather than the idea I was against regionalization.
Stein: Speaking of size, Vermont is going from a 54-bed state psychiatric hospital to a 25-bed state hospital planned for Berlin. There will be 20 acute care beds between facilities in Rutland and Brattleboro, but will those 45 beds be enough to make up for an already small facility?
Batra: It really isn’t an exact math of the number of beds. My approach to this in a scientific way is you want to test out certain things before making them broad-scope or policy to see if these projects actually work. Now, this is nobody’s fault, but we had no chance to do this because we had a catastrophe and we had to do what we had to do. So, it’s hard for me to predict whether new services will reduce the need for hospitalization or if they will change the nature of hospitalization
My concern, mostly, is about developing the expertise to sustain (care). Just providing 24-hour psychiatric coverage is going to be a massive challenge at three different units instead of one. There just simply aren’t enough trained people in the state or people that would want to do that kind of thing.
Stein: What would happen if the 25-bed facility were a 40- or 50-bed facility?
Batra: That whole discussion feels like water under the bridge now. The legislators got to hear my thoughts many times on it, and it’s settled. I’m not going to live in the past, so the goal now is to do the best you can for the people.
Stein: Do you think the new system will be able to provide for the state’s psychiatric care demand?
Batra: Many of the hospitals have taken the brunt of the services provided by the state hospital. Fletcher Allen, the Brattleboro Retreat and Rutland all have competently skilled, dedicated staff. That’s not to say there are not actual logistical problems despite that, but it’s not due to a lack of skill or effort. I do have confidence things will get better, even though we’re still in a crisis.
Stein: From your perspective, could things be much worse?
Batra: Most definitely, even without a crisis circumstances in other states are much worse. If the attitude was, ‘This is not what we signed up for, this is what we’re doing,’ I can guarantee you we’d be in such deep trouble. I think people have really pushed themselves, and it’s probably because Vermont is such a tight-knit community. You are your brother’s keeper here, and we help each other out in tough times.
Mental health professionals say certain patients with vastly different psychiatric disorders shouldn’t be placed together in a hospital. With a 25-bed hospital and the other smaller facilities, will there be adequate room to separate different types of patients?
I’ve been very, very closely involved with the design of the 25-bed hospital. We’ve been very conscious of that aspect of things to the point where architects had to look at European models because hospitals here are much larger scale. The design of the new hospital is three units: eight-, eight- and nine-bed units. That nine-bed unit is separable if you need it to be. The retreat has a different mechanism for doing it, and Rutland will have the ability to do that with their three sub-units.
Stein: What do you see as the big goals that your successor will need to accomplish?
Batra: There are so many. The biggest crisis of the moment is to have people be able to access the care that they need. The part of the system that is most strained is the in-patient system, and I don’t want to pretend it’s the only part of the system because the majority of patients are getting care in outpatient settings. That part of the system is also strained.
How long people are having to wait in emergency rooms and the forensic part of the examination system are also issues. Those folks are not getting the care they did before the crisis.
Stein: On the issue of people not getting the mental health care they need it: Is this only due to the remnants of Tropical Storm Irene, or is this due to a larger issue?
Batra: It’s an intense systemic problem. It’s simply that most family physicians even though they deal with mental health problems all the time, didn’t get much training during their residency. So, they’re picking it up along the way, and there’s a huge shortage of doctors they can refer people to. Chittenden County has more psychiatrists than the rest of the state combined, and even then you can’t get an appointment very quickly. Certainly psychiatry is only one aspect of it, and the one that I’m most familiar with. Services exist at all levels, and all of those levels need more people.
The focus on bureaucracy versus care is one reason why people are either closing down practices or moving on. People don’t want to deal with insurance companies, and I’ll tell you I’m included in that.
Stein: Do the state or insurance companies play a role here? And is there anything you might do to improve this situation working for the Vermont Health CO-OP?
Batra: The focus on bureaucracy versus care is one reason why people are either closing down practices or moving on. People don’t want to deal with insurance companies, and I’ll tell you I’m included in that. One reason the public sector appealed to me is that I really can’t stand the idea of having to call insurance companies for every little thing I’ve done. It’s a nuisance for patients. It’s a nuisance for providers, and it makes everybody unhappy in the middle.
I hope not to repeat that. It’s the challenge I have to myself. We’ve got to do things differently. By doing the right things, I’m convinced we can actually reduce costs. There’s a huge amount of waste in the system and that’s where health care cost savings will come from, not from squeezing patients and what they can access. Every obstacle you set up for people, people are going to lose access to care that much more quickly.
Stein: On the state level, you’re leaving in the middle of a major overhaul. So, why leave now? Why not wait another year until many of these new facilities come on line?
Batra: The biggest reason is that there’s this opportunity to get in on the ground level on this thing that is so fundamentally different and have an opportunity to work with a group people as phenomenal as Christine Oliver is.
Does it break my heart? Absolutely it does. But that opportunity you just can’t recreate. Although I’ll deeply miss the incredibly competent people at the Green Mountain Psychiatric Care Center in Morrisville, and I have tremendous confidence in what they do, I do believe that work can continue. They are in very good hands. Mary Moulton is a wonderful commissioner, and she knows every aspect of the system.
I really wouldn’t have left if it was falling apart and their weren’t competent people in place. I have great confidence in the people who are there to take this on.
Stein: About that, there is a lot of talk about the new mental health facility in Morrisville being delayed now that you’re leaving. What do you have to say about that?
Batra: There’s a lot of paraphrasing about what’s happened, but as of today we don’t actually have a license to open. The Board of Health has issued us a license on certain things being completed. The majority of them are done, but they have to come back to do a survey. They will be doing that next week.
There are two very capable psychiatrists ready and waiting. They are actually sitting at their desks in Morrisville right now. They can start accepting patients even as we search for a new medical director.
I’m not saying I didn’t cause any disruption, but certainly I don’t feel like the hospital couldn’t open without me. I really wouldn’t have left if it was falling apart and their weren’t competent people in place. I have great confidence in the people who are there to take this on.
Stein: But there has to be frustrations at the department, right?
Batra: It’s a very intense period. None of us can get things accomplished quickly enough because there’s so much to do.
Stein: Patrick just left and now you’re leaving. Two of the department’s top officials are leaving. What’s going on here? Is the department falling apart during this chaotic period?
Batra: I don’t know the circumstances behind Patrick leaving. But I had talked to him very early on when this opportunity came around, right at the outset, that I was interested and was talking to them because I didn’t want any sudden transitions. I wanted to make sure Patrick knew about it, but I didn’t know he was leaving. That was just as abrupt for me as most other people. I’m not sure what happened there.
But why am I leaving in the middle of this? I will continue to be in the same framework of public work because I will be working for a member-owned co-op, which is accountable to the people who keep us operating. This is similar to state government except I don’t have to worry about my energy being used for some politician to get re-elected. That’s not the motivation. The motivation is to do right by people. It’s unobstructed in that way.
Stein: Did you ever feel that you were being used in that way?
Batra: You can’t be in a political system and not feel that.
