Health Care

Bourgoin case raises questions about mental health screening

UVM Medical Center
UVM Medical Center emergency room entrance. Photo by Andrew Kutches/VTDigger
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.

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Elizabeth Hewitt

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  • pat harman

    Thanks for continuing to follow up on the mental health issues involved in the terrible Vermont crash. The man went in and out of the ER three times. He was seeking help and he didn’t get it. Someone dropped the ball. Pat Harman RN

  • Dave Bellini

    Vermont doesn’t believe in mental hospitals. The advocates want everyone treated in the community. The result is that many mentally ill persons wind up dead, homeless or in prison. They kill themselves. They commit suicide by cop. They kill other people. It’s probably more expensive pretending Vermont has a functional community mental health system. It’s working great. All is well.

    • Curtis Sinclair

      A civilized society doesn’t believe in mass incarceration of people with disabilities. In 1999 the US Supreme Court held that under the Americans with Disabilities Act, individuals with mental disabilities have the right to live in the community rather than in institutions. (Olmstead v. L.C., 527 U.S. 581).

      Before deinstitutionalization people with disabilities lived in horrid conditions. Many people with disabilities ended up in institutions being neglected, abused or even being subjected to experimentation without consent. But it was mostly out of sight out of mind.

    • Rich Lachapelle

      The private, contracted, “non-profits” with the top brass making 6-figure incomes have become the norm in Vermont. Their lobbying investments in Montpelier have paid off handsomely. These agencies have found that providing the full array of services for opioid addicts have become a much bigger cash cow than dealing with people with legitimate mental incapacitations so that is where their attention has been focused in the past few years.
      These “social service” agencies have found Vermont’s “let’s create as many victims as possible” philosophy a very lucrative endeavor. We have another opportunity next month to maintain this mindset in Montpelier, folks, so let’s all get out there and vote for those democrats!

  • Linda Wulff

    They need to have mental health screeners present in the ER at all times! Why should a psychiatric emergency receive less immediate attention than a heart attack? One is just as crucial as the other!

  • Linda Wulff

    They need to have mental health screeners in the ER at all times 24/7 ! Why is a psychiatric emergency deemed less urgent than a heart attack? They are equally important in my view.

  • Ann greer

    As a former employee of the hospital, I suggest that Mr. Noble may have misspoken when he indicated that medical provider responses “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”. I have never known a provider to do nothing when faced with a patient in distress. At the very least, a patient would be offered a listing of resources and presented with a plan to follow should the problem persist or worsen. Additionally, it was not uncommon to, with permission, contact a family member/friend on their behalf, or a provider from whom they were currently receiving care.

    I also wonder about whether at the time of Mr. Bourgoin’s arrest in May 2016 for threatening and aggressive behavior, if he was referred for a mental health assessment and recommendations as part of his release prior to his trial?

  • Barbie Alsop

    It’s a shame that it takes a tragedy of this magnitude to start the discussion about appropriate psychiatric evaluation and care. Prognosticating harm isn’t easy or reliable, but a person in need of services should likely see more than a nurse practitioner. It’s too late to wonder “what if?”