[G]ov. Peter Shumlin wants to save $5 million by expediting the court process for involuntary medication of mental health patients.
But that proposal is meeting resistance from key House lawmakers.
Rep. Ann Pugh, D-South Burlington, chair of the House Human Services Committee, staunchly opposes the proposal.
“I’ll be very straightforward with you guys,” Pugh told a representative from the Shumlin administration Thursday. “The recommendation to (House) Appropriations will be to take this out of the budget bill.”
An average of 70 to 75 applications for court-ordered medication are made each year in Vermont. There are even fewer applications for expedited involuntary medication — just 16 since September 2014.
An average application for involuntary medication takes 128 days to complete. An expedited application takes 47 days.
Frank Reed, the commissioner of the Department of Mental Health, explained that the administration’s proposal would shorten the process significantly by requiring court hearings to take place within a week of when a request is filed. The revamped system would shorten the wait time to about two weeks.
By changing the policy, the administration says the state could save about $2.3 million in general fund dollars in the budget for the Department of Vermont Health Access by moving patients through state care more quickly. Reed and other members of the administration say it’s a change that would make Vermont’s policy more effective and ethical.
Reed told the committee that he had not expected the administration to make involuntary medication a budget priority. But he said he stands by the proposal as an important policy matter the state needs to address.
“We were somewhat surprised that (Shumlin) had decided to prioritize this issue for this session,” Reed told the committee.
The department believes a swifter involuntary medication process will be good for patients “because it generally tends to improve their outcomes, reduce the amount of time that they spend in the hospital, and allow them to return to the community rapidly so they can then take advantage of the services that are right for them,” he said.
He added that the department had not had time to vet the proposal with members of the judicial branch, Vermont Legal Aid and other entities that would be affected.
The department will hold a public hearing on the matter at 9 a.m. Tuesday at the Waterbury State Office Complex.
The Legislature passed a bill two years ago making changes to the system in a bid to streamline the judicial review process for medicating patients against their will. Pugh said she is not opposed to reviewing the proposal again, but she put her foot down on including it in the budget.
“We will deal with this as a policy issue, not as a money issue,” Pugh said.
Pugh questioned why the administration proposed the policy change in the budget, especially without engaging many of the other players in the system.
“To do it to find $5 million is not OK,” Pugh said. “To propose it in a way without having involved any of the stakeholders, whether they be patients, family members, legislators, members of the judiciary and providers … is a travesty.”
But the administration defended its decision to propose the policy change in the budget. Scott Coriell, spokesman for Shumlin, said in an email that the Agency of Human Services has been looking into the policy suggestion since the fall and that it addresses “clear problems” with the system as it currently works.
“Despite the hard work the Legislature did when it addressed this issue two years ago, it takes longer in Vermont than any other state to adjudicate these cases,” Coriell said. “This fails our duty of care.”
Coriell said the proposal was written into the budget because it affects state spending.
Rep. Anne Donahue, R-Northfield, a mental health advocate, said the administration’s policy proposal is “stunning.”
Donahue said she is not convinced the administration can book “hypothetical and very, very questionable savings” from the policy change. She also questioned Mental Health Department’s clinical arguments for changing the system.
“We talk about patient-centered care in every other part of medicine,” Donahue said. “Patient-driven, patient-centered. This is about as far away as you can get from that.”
Rep. Mitzi Johnson, D-South Hero, who chairs the House Appropriations Committee, has asked the heads of all policy committees to include alternative cost-saving suggestions in their budget recommendations.
“For major policy changes, we need to rely really heavily on policy committees,” Johnson said.
Johnson said that across state government, Vermont spends some $400 million on mental health services every year. If the Human Services Committee decides that maintaining the current involuntary medication policy is a priority, then lawmakers need to figure out “which initiatives aren’t quite as high on the priority list,” Johnson said.
The House Human Services Committee will review the involuntary medication process in the coming weeks, Pugh said.
Meanwhile, Pugh’s committee is delving into different areas of the Agency of Human Services. She plans to have a conversation in the next few weeks about what investments should be priorities in the budget.
