In the aftermath of a deadly crash Oct. 8 involving a wrong-way driver, questions have been raised about how health care providers screen people seeking treatment.
Steven Bourgoin, 36, sought help at the University of Vermont Medical Center in Burlington just hours before he drove at a high rate of speed on Interstate 89 in the wrong direction, ultimately killing five teenagers on the highway in Williston.
Court documents filed in the case suggest that staff at the UVM Medical Center contacted Howard Center, the agency designated to provide mental health services for the region, about Bourgoin on the morning of the day he allegedly crashed into the car of teenagers.
An affidavit filed by Det. Benjamin Katz said that Bourgoin went to the hospital emergency room Saturday morning and was seen entering and exiting the department three times on security video cameras over the course of a few hours.
According to the detective’s sworn statement, Bourgoin saw a nurse practitioner, and the hospital contacted Howard Center about Bourgoin, but did “not screen him.”
Howard Center said in a statement this week that it is “cooperating” with a police investigation.
However, the affidavit was cast into question Friday, shortly after Bourgoin pleaded not guilty five counts of second-degree murder.
Speaking to reporters after the arraignment, Chittenden County State’s Attorney TJ Donovan said “it’s unclear at this point” if Howard Center was in fact contacted about Bourgoin last Saturday.
“We’re trying to get clarity, and once we have it we will answer the questions as best we can,” Donovan said.
Frank Reed, the commissioner of the Vermont Department of Mental Health, said policies and procedures for involving mental health providers varies at hospitals around the state.
If someone poses an imminent risk of harm to themselves or others, a screening can trigger a court process for involuntary hospitalization.
At lower levels of severity, there are many different possible routes, according to Reed.
“Below that, it’s a clinical judgment call,” he said.
If someone experiencing mental health issues comes into an emergency room, medical staff may contact the local designated mental health agency to request a screening, according to Reed.
That screening could happen immediately if the situation is considered urgent. However, the emergency room appointment could result in a referral for a screening at the agency that would be scheduled later, he said.
According to Mike Noble, spokesperson for UVM Medical Center, when a medical provider sees a patient, they try to assess what level of response is most appropriate.
That encompasses “a broad range of responses,” Noble said, from doing nothing, to encouraging the individual to set up an appointment at the agency, to requesting assistance for a crisis intervention.
Noble said that providers at the hospital often contact Howard Center to discuss appropriate next steps for patients in the emergency room.
“It just depends on the level of the situation as to what sort of process would be followed,” Noble said.
Jack McCullough, director of Vermont Legal Aid’s Mental Health Law Project, is often involved with involuntary hospitalization cases.
One of the biggest issues facing Vermont’s mental health treatment system, McCullough says, is a lack of resources at the community level.
A shortage of services in communities means that some people grappling with mental health issues cannot find support until their cases reach a serious level — at which point they are hospitalized, he said.