[A] key legislative committee has come out against the administration’s attempt to use the budget as a vehicle for changing the state’s policy on medicating Vermonters in severe mental health crisis against their will.
In its fiscal 2017 budget proposal, the administration of Gov. Peter Shumlin sought to streamline the state’s process for involuntary medication, cutting the time it takes to about two weeks, rather than the current average of 60 days.
The administration said the change would be more effective and ethical. Officials also said it could save about $5 million total, including $2.25 million in state funds.
The proposal met staunch opposition in the Statehouse.
In a memo to the House Appropriations Committee, members of the House Human Services Committee said they were “very surprised” that the administration had included in the budget “the proposed wholesale repeal of a law that the General Assembly carefully revised just two years ago.”
The memo questions whether the policy change really would save as much as the administration expects. The memo also rebukes the Shumlin administration for proposing such a policy change in the budget, saying a proposal that significant “has no place” in the money bill.
The committee may still consider it as a standalone bill, according to the memo.
Committee Chair Ann Pugh, D-South Burlington, called the inclusion of the proposal in the budget bill “abhorrent.”
“It’s a very charged issue that takes a delicate balancing of competing rights and competing needs,” Pugh said.
Lawmakers revised the state’s policy in 2014 after heated and rigorous debate. The administration says the new law still does not do enough to bring Vermont into line with medical best practices.
Pugh contested the assertion that the administration’s proposal is the best way to treat patients in acute mental health crisis. “Whether it is the best practice, people are mixed,” Pugh said.
But she raised concerns that the law has not been in place very long and hasn’t been fully implemented because of other outside factors. Vermont’s court system is backed up, and there’s a shortage of mental health treatment beds, she said.
Pugh said the committee did not propose an alternate way to save the anticipated $2.25 million in the budget. She has reached out to members of the administration to find alternatives, she said.
Some mental health advocates agreed with Pugh’s assessment. Jack McCullough, of Vermont Legal Aid, said it was “outrageous” to propose the change in the budget.
“I don’t think that the savings claims are believable,” McCullough said, “and I do not think that the state should be trying to balance the budget on the back of the most vulnerable people in the state.”
The savings were proposed under the budget for the Department of Vermont Health Access, which processes the payments — though the policy is under the umbrella of the Department of Mental Health.
Emails from within the Shumlin administration the evening of Jan. 21 — the day the governor unveiled his budget — indicate it was not widely known ahead of the publication of the budget proposal that the involuntary medication policy would be included.
Mental Health Commissioner Frank Reed wrote to Human Services Secretary Hal Cohen that he was surprised the involuntary medication proposal was in the budget. Reed also raised concerns that his department hadn’t had a chance to vet the idea with key stakeholders, likening it to throwing DMH “under the bus.”
Cohen responded that he also did not know the proposal was going to be publicized.
“As you know, I’ve been waiting to hear if this was in or out. Apparently it’s in. Which really isn’t a surprise,” Cohen wrote. He added that communication from the fifth floor “could have been better.”
He went on: “DVHA may have initiated it but both you and me believe that this is the right thing to do.”
“You now need to get 100% behind this and do everything possible to make it happen. We’ll support you wherever you can,” Cohen wrote, before signing off.
Reed acknowledged last month in testimony to the House Human Services Committee that he was caught by surprise by the governor’s decision to include the change in involuntary medication policy in his budget.
Reed said Monday that had he known ahead of time that the proposal would be in the budget, “We would have at least had this conversation with stakeholders.” The department would have consulted care providers, as well as advocates opposed to the proposal, he said.
The department did follow up on the proposal with stakeholders after it became public, holding a hearing in February. Meanwhile, lawmakers have heard from people with various views on the proposal.
But Reed said that, regardless of whether his department had more thoroughly reviewed the proposal ahead of time, it’s likely it would have been a tough sell in the Legislature. It’s a controversial subject, and lawmakers spent quite a bit of time on the issue only two years ago.
“Bringing this up again this quickly probably would not have been received that much better anyway,” Reed said.
The department head has remained firm that he and his colleagues believe a swifter involuntary medication procedure would be to the benefit of Vermonters in need of care. People in mental health crisis should be given timely medical treatments in the same way that people are if they are hospitalized with physical ailments, he said.
Reed said if the Legislature decides not to move ahead with the proposed policy change, the department will continue to monitor and collect data on involuntary treatment.
“We’re going to keep raising this issue if we feel that the statute may not be giving that person … the best possible outcome,” Reed said.
Cohen, the human services secretary, said he disagrees with the characterization by the House Human Services Committee that the administration proposed a “wholesale repeal” of the law. He said the agency’s proposal is “adjusting the statute” to streamline the judicial process of involuntarily treating patients and involuntarily medicating them.
Cohen said the policy has been under discussion within the agency for about a year and had been thoroughly vetted within state government before it went into the budget.
He had been speaking about the idea with members of the governor’s staff on the fifth floor before the budget came out, he said. He knew it was on the table as a proposal, but was not sure if it would be a standalone initiative, a part of the budget, or be left out.
“We think this is in the best interest of the patients going to the hospital,” Cohen said.
Administration Secretary Justin Johnson said Friday that he had heard Reed’s comments to the House Human Services Committee about being unaware the proposal was in the budget and “was surprised that he was surprised.”
“(The Department of) Finance and Management doesn’t make this stuff up, and doesn’t tell them what to do,” Johnson said. “It’s something that was proposed from AHS.”
Johnson defended the decision to put the proposal into the governor’s budget. He said he believes it’s reasonable to include policy changes that will have budget impacts in the big bill.
“There’s always the challenges of what is standalone and what goes into the budget,” Johnson said.
Because the administration anticipates that the policy change would have a significant budget impact, the change would have been incorporated into the budget at some point, he said.
Department of Vermont Health Access Commissioner Steven Costantino, who heads the department where the budget savings are booked, said the decision to include the proposal in the budget reflected the anticipated savings — but did not take away from the meat of the policy proposal.
“While this policy proposal is driven by nationally recognized best practices, the fact is that the state can save money by decreasing the number of days between depriving someone of their personal liberty and deciding whether or not to treat them,” Costantino said.
