Ken Libertoff’s voice thundered through a hearing room in the Statehouse, where the Senate Health and Welfare Committee and House Health Care Committee had convened a joint hearing.
“To hear what we’ve heard tonight makes me say to you that there needs to be — in this legislative session — zero tolerance for Vermonters’ going to emergency rooms and sitting there for days and for weeks,” said Libertoff, who is retired from a job at the helm of the Vermont Association for Mental Health and Addiction Recovery. “It is unacceptable.”
Even though the hearing topic was how state employees are affected by working at places such as the Vermont Psychiatric Care Hospital in Berlin, most of the roughly two dozen witnesses were from private-sector hospitals and designated mental health agencies.
The workers at the Vermont Psychiatric Care Hospital said they are so understaffed that they are routinely forced to work double shifts. They said patients at the hospital often get so violent that the Vermont State Police need to be called to protect the workers from being assaulted.
Witnesses who work in the private sector said emergency rooms are filling up with psychiatric patients to the point that people are being “warehoused” while nurses struggle to provide quality care. They also said no one experiencing a heart attack would be forced to suffer in such an inappropriate care setting.The situation is not new. Since flooding from Tropical Storm Irene forced the closure of the Vermont State Hospital in 2011, the state has often held psychiatric patients in emergency rooms while they wait for a bed in the hospital in Berlin, the Brattleboro Retreat or Rutland Regional Medical Center.
The number of people being held and the amount of time they waited started going down in 2015, after the Vermont Psychiatric Care Hospital opened. But by 2016, the Department of Mental Health was reporting a record number of involuntary hospitalizations for adults, coupled with some of the longest wait times in years.
The department has given three main reasons for the long wait times: a Vermont Supreme Court decision that providers interpreted as increasing their liability if they release patients; a growing national stigma around psychiatric patients being dangerous; and worry on the part of providers that patients will have negative outcomes if they are released too soon.
Mental Health Commissioner Melissa Bailey did not attend the hearing because she wanted the workers to feel comfortable expressing themselves freely.
She said in a statement Wednesday that the department appreciates “the dedication of direct care staff and other community service providers.”
Struggles in psychiatric care
Doctors and nurses at the University of Vermont Medical Center in Burlington, Central Vermont Medical Center in Berlin, Copley Hospital in Morrisville and Northeastern Vermont Regional Hospital in St. Johnsbury all testified Tuesday and said the situation is not bearable.“We’ve reached the point with the warehousing of psychiatric patients in emergency departments that’s beyond what I would say is a policy issue but perhaps even an ethical issue as a state,” said Dr. Ben Smith, an emergency department doctor at CVMC.
“When I show up to work every day, my heart falls,” Smith said, because he looks at the data on the number of psychiatric patients in the emergency room waiting for a bed. He said they wait for anywhere from 60 to 300 hours.
“Last week, we had two children in our department, age 10. Each was there eight and nine days, respectively,” Smith said. “This is a place where the lights never go off, where there is constant noise often of a very disturbing nature.”
He said: “At the ER we like to roll with the punches, sometimes quite literally, but it seems like it’s become the de facto policy of the state of Vermont, and for those of us who work on the front line, it just doesn’t seem right.”
Raenetta Liberty, a nurse in the emergency department at UVM Medical Center, said she’s experiencing a staffing crisis. “We are hemorrhaging nurses in the emergency room,” she said. “We just lost another nurse to another ED because the conditions are challenging.”
Dr. Justin Knapp, the medical director for inpatient psychiatry at CVMC, said he works daily with the emergency room and Washington County Mental Health Services, and there are patients whose treatment is unreasonably delayed.
“Had I known the stress that would be involved with the boarding of psychiatric patients and not having appropriate resources available, I’m not certain that I would’ve moved to Vermont with my wife” to take this job, Knapp said.“And I’m not certain that our current situation is something that’s durable for a career, and that saddens me because I very much like my life here and I’ve come to really value my local community,” Knapp said.
He called the situation with mental health “discriminatory” in comparison to the rest of the health care system.
“It strikes me that in no other branch of medicine are patients made to choose between adequate inpatient care, adequate rehabilitation services, and adequate outpatient care,” Knapp said.
State workers did not say the situation was any better at the state-funded hospital in Berlin. It has 25 beds for Level 1 patients — who are typically considered a danger to themselves or others and unable to be released into the community — and the hospital has employment vacancies, the workers said.
Peter Bartlett, a mental health specialist at the Vermont Psychiatric Care Hospital, said five or six workers typically are asked to put in overtime each day. “Folks are getting mandated two shifts in a row, three times in a week. It’s not only very disruptive, it’s unsafe for our workers.”
“They get overtired. They don’t get any sleep. They’re not alert on the units. They have to drive home after 16 hours of work, and it’s not fair to the patients either,” he said. “It’s not sustainable. We’ve been staffing an emergency crisis for a year and a half.”
Kristal Westover, a worker at the hospital in Berlin, said she was assaulted by a patient multiple times in the same shift. She is now out on workers’ compensation benefits because she can’t do her job.
“This inadvertently puts more strain on my already exhausted co-workers. This is a huge issue because we are currently down 18 staff and we are often overworked, and we are accountable for filling the empty slots.”
Rep. Bill Lippert, D-Hinesburg, the chair of the House Health Care Committee, told the witnesses: “I’ll be honest to say it’s not easy to hear, but it’s important to hear, and I’m personally impressed, and I want to say thank you for your work and thank you for helping sustain so many Vermonters who are in such need.”
Bailey, the mental health commissioner, said in her statement: “We understand the stressful nature of this work, will thoroughly review all comments offered up from this forum, and will work collaboratively with all partners including all stakeholders and legislative representatives, to continue to build and improve our health care system.”
Libertoff, the mental health advocate, said Vermont needs eight to 10 beds to specifically treat geriatric psychiatry patients. He also said the Green Mountain Care Board, which regulates health care infrastructure and hospital budgets, should push hospitals to invest in additional beds.
Jeffrey Tieman, the chief executive officer of the Vermont Association of Hospitals and Health Systems, said several of his hospitals have renovated their emergency departments to make them more suitable for boarding psychiatric patients, and some might find it too expensive to add beds.“There is no one single solution,” he said. “We have to work with community partners. We have to find capacity. We have to find community-based solutions. None of that is going to happen quickly or easily or without cost. But we have to try, and we have to get together and sit at the same table and make sure we’re paying attention to everything that we heard here tonight.”
Dave Bellini, the president of the Vermont State Employees’ Association, said the issue comes down to money, especially in regard to funding the Vermont Psychiatric Care Hospital and the state-funded designated mental health agencies.
“In the community, you should’ve built a bigger mental hospital, but you didn’t,” Bellini said. “You need to staff it, but you didn’t. I’m saying ‘you’ because I’m blaming everybody. It’s a disaggregated horror show.”
He added: “Community mental health, it’s never going to be funded. You guys are never going to fund it.