The Senate gave preliminary approval Wednesday to a bill that streamlines the process for judicial review of applications to medicate psychiatric patients against their will.
It passed, 26-4; a final vote is expected Thursday.
The bill, S.287, is designed to decrease the time clinicians wait for courts to rule on applications to medicate a small number of severely mentally ill patients who refuse pharmacological treatment.
Two Senate committees, Judiciary and Health and Welfare, put an enormous amount of work into crafting the legislation. Lawmakers listened to weeks of testimony and in Judiciary senators went through 11 drafts of the legislation.
Sen. Dick Sears, D-Bennington, chair of Judiciary, said he could not recall a bill that went through that many revisions.
The committees heard testimony from close to 30 witnesses, including clinicians, attorneys, patients and members of the judiciary.
In addition, they heard testimony from 34 people at a public hearing, mostly family members of people with mental illness and former psychiatric patients, who gave wrenching testimony about their experiences with the involuntary commitment and treatment process.
Sen. Jeannette White, D-Windham, a primary sponsor, said the bill maintains proper judicial oversight, while giving the court discretion to expedite certain cases if clinicians give a compelling reason.
There are roughly 40,000 Vermonters with some degree of mental illness, White said, but only a small fraction will ever be the subject of legal proceedings over involuntary treatment.
In fiscal year 2013, there were 455 applications for patients to be held against their will for treatment and 42 applications for patients to be involuntary medicated, according to court figures.
Vermont currently has about 50 involuntarily committed patients at four acute psychiatric facilities across the state.
Of those, about 15 are the subjects of petitions by the hospitals for involuntary medication, according to information from the Vermont Department of Mental Health.
Sears, a sponsor of the bill, said the current system is “very cumbersome” and lags behind similar processes in most other states.
The sole purpose of the legislation, he said, is to ensure a timely decision on involuntary medication applications.
Sen. Anthony Pollina, D/P/W-Washington, was one of four senators who cast a no vote. He said that despite the small population affected, the bill is one of the most important decisions the Senate will make.
Pollina, who sits on Health and Welfare, said that while the legislation is crafted to speed up the process, it fails to address the additional resources necessary for quick adjudication.
Court rulings on involuntary treatment and medication affect civil and human rights, Pollina said.
He said the changes in S.287 will lead to more people being injected with drugs they don’t want for the wrong reason.
Recalling the testimony from members of the public, Pollina said, “not one person who experienced the process said it was beneficial.”
Senators who voted for the legislation and those who opposed it said it doesn’t address underlying deficiencies in the mental health system.
“I think this generates a lot of concern from a variety of people because to them it appears this is what we’re doing about the mental health system,” said Sen. Diane Snelling, R-Chittenden.
Snelling voted in favor of the legislation, but urged her colleagues to dedicate themselves to improving the overall system.
“I want everybody to take a solemn vow as a state and as a Senate to examine all possible options of treatment for individuals in mental health crisis,” Snelling said.
The state should continue to examine how to lower the amount of time psychiatric patients spend in emergency rooms, which routinely exceeds statutory limits, and how to provide care in a community setting. In addition, Snelling said the state should assess the long-term impact of powerful psychotropic drugs used to treat the mentally ill on the human brain.
“None of these things are in this bill,” Snelling said.
Jill Olson, a lobbyist for the hospital association, said her organization – a major backer of the bill – was pleased that the Senate gave its preliminary approval and looks forward to the final vote Thursday.
“We think that it really will allow the court system to better respond to the needs of individuals,” Olson said. “Its primary purpose is to give judges more flexibility along the way, and we think that’s really important for our patients.”
Jack McCullough, the lead attorney for the Mental Health Law project, which represents patients in involuntary proceedings, said he hopes the House will give credence to the concerns he’s raised about the bill.
He said the Senate Health and Welfare Committee did not consider several amendments recommended by his office.
Throughout the process, McCullough and Judge Amy Davenport, who hears many of these cases and gave testimony on several occasions, voiced concern it would lead to more applications for involuntary medication.
McCullough said the increased application volume would hurt his office’s ability to present patients’ cases, and result in more people being medicated against their wishes.
Sears said any predictions about the volume of cases or decisions to have patients medicated involuntarily are purely conjecture.
McCullough said the perceived need for the bill makes clear that private hospitals were not prepared to take over care for acute psychiatric patients when the former state hospital closed due to post-Irene flooding in August 2011.
The private hospitals lack “the resources, experience and ability to address the needs of people in psychiatric crisis,” he said.
