From January 2010 Story In VSEA “Week In Action”

Vermont Association For Mental Health Publicly Supports VSEA Plan To Build New State Hospital In Central Vermont!

Association’s Director expresses frustration with State’s “Futures Project” and ongoing budget cuts. Warns of consequences of inaction.

After five long years of sitting on the State’s mental health system “Futures Project” and patiently watching the wheels slowly turn, the executive director of the Vermont Association for Mental Health (VAMH) held a press conference on February 12 at the State House to announce that his organization was throwing up it hands and parting ways with the Futures Project. VAMH Director Ken Liebertoff said his organization now supports a VSEA plan introduced years ago to build a new state hospital in central Vermont.

“One of the reasons the VAMH is standing here today is because the mental health system is near or approaching gridlock,” said Liebertoff. “Despite the introduction of some valuable small components of the Futures Project…the State Hospital census is no lower today than it was when this initiative started five years [ago]. The fact is that funding for Vermont’s community mental health system is decreasing at an alarming rate and we would project and predict that if in fact the designated treatment system does indeed have a cumulative ten percent reduction in support over the course of both last year and this year, we will see an increased need for beds within hospital settings.” He continued: "It is the recommendation of the VAMH that Vermont consider building a new, state-of-the-art State Hospital in central Vermont; one that is clinically solid, comfortable for patients and with an environment that promotes both quality treatment and recovery."

Following Liebertoff, VSEA Legislative Coordinator Conor Casey spoke briefly at the press conference. He thanked the VAMH for its support to build a new state hospital in central Vermont and for the organization’s willingness to break with an obviously flawed process in order to try and create some forward momentum; something Casey reminded VSH employees are waiting for as well.

“What the VAMH is saying today is true,” said Casey. “The VSH census is not going down like people said it would. Instead, the VSH is now full again on a consistent basis—and the need and numbers are not going to go down in the foreseeable future.” Casey added that VSEA’s DOC members are telling the union they are concerned the State is adopting an unwritten policy to just warehouse certain mentally ill Vermont offenders in the State’s prison system, where they are being “stabilized but not treated.”  He also offered that VSEA is ready to work with advocates in the Vermont mental health community to reach a consensus on a plan to move forward.  

 No Room At The VSH Begins To Impact Community Hospitals

The February 7 Times Argus reports that Central Vermont Medical Center’s (CVMC) top administrator is complaining about an increasing number of violent and aggressive patients coming through the hospital’s doors. In fiscal year 2009, the hospital experienced 52 “Code Greens,” which are usually non-medical emergencies involving violent or aggressive patients. In the four years prior to 2009, CVMC had experienced just 32 of these incidents on average.

CVMC CEO Judy Tarr blamed part of the increase on problems with Vermont’s mental health system, saying the hospital has a 14-bed psychiatric ward, but it’s not meant for the “most unstable, violent and acute mental-health patients,” which she says is what the VSH is for. But Tarr quickly adds that the VSH is always full, which means CVMC must sometimes house certain patients longer than it should. “I think that the mental health crisis has been discussed a lot in recent years,” explains Tarr. “This is an issue for the entire state: the appropriate placement of psychiatric patients.”

Tarr explained that this is an issue confronting hospitals not only in Vermont but also across the nation, adding that she “doesn’t see this issue going away.”          

Fair Warning!

In early January 2010, retired VSEA member Dr. Larry Thomson shared a letter with VSEA that he had penned to every legislator upon their return to work. Thomson, who served as the VSH’s Director of Psychology for 31 of his 36 years at VSH, has been an outspoken advocate to ensure that any new state hospital is State-run and employs seasoned state employees. He is also a strong voice in sounding the alarm about the need for the State to plan for more acute beds and not less. Given the new complaints from regional hospitals and the ongoing debate about the future of the VSH, WIA shares this excerpt from Dr. Thomson’s letter:

“In recent months VSH has been at capacity, with 53 or 54 patients in the hospital. I have been arguing, in recent years, that we would see exactly that: increased demand for in-patient treatment due to: rising population, current economic distress, and the intense emotional issues of returning veterans.

The [State]’s plan calls for fewer beds, and not in a state run (and less expensive) hospital. Then [the State] would leave us all to pay far more for the treatment programs at these private hospitals than the State now pays at VSH.

I have also stated that these private hospitals cannot work effectively with the typical patient who is admitted to the State Hospital, which gets the most severely disabled and complex clinical cases. In a Free Press article on October 14, 2009, the directors of the psychiatric units at Fletcher Allen and Rutland Regional both make the point that they do not accept many individuals who are admitted to VSH. In addition, Dr. Robert Pierattini, (Director at FAHC) stated that when VSH is full, regional hospitals are less willing to take challenging patients because they cannot count on transferring them to VSH at those times. Yet, [the State] wants to totally depend on these hospitals to replace VSH! If these hospitals cannot admit a typical VSH patient now, and are even more reluctant when VSH is full, how does [the State] expect them to do this when VSH no longer exists?

Another part of the [State]’s plan that is equally unrealistic is the 15-bed Secure Residential Unit in Waterbury. This is an expensive and highly flawed boondoggle. Despite the economic situation that the [State] is always talking about (especially when [it] announces new firings of state workers), [the State] has already spent a half a million dollars just for an architect’s plan for this facility! And the estimate for actually building this 15-bed unit runs to about $17 million! The rumored staffing levels for this Unit are so meager that it is clear it will not provide active treatment. The highly problematic patients sent there will not improve and leave, so we will pay to expand this facility before too long. 

Simply do the math: 15 beds for $17 million or 65 beds (in a fully functional hospital) for $29* million.

Compare the [State]’s plan to spend $85 to $100 million on corporate welfare, and on a 15 bed boondoggle, with the proposal from the Vt. State Employees Association in 2008. The VSEA brought architectural plans for a 65-bed, state-of-the-art, safe and therapeutically designed hospital, which would cost $29* million! This hospital, built on state-owned land in Waterbury or Berlin, would be close to Central Vermont Medical Center, where VSH patients are often seen for medical treatment or imaging. It would provide the most modern design in residential space, safe architecture, and access to treatment areas. It would have enough space to fulfill Vermont’s needs for in-patient care for years to come, including active treatment for those poor individuals that the [State] wants to relegate to the Secure Residential Unit. And it would cost $71 million dollars less than the [State]’s plan.

So, you decide. Spend $100 million tax dollars on private corporations who cannot do the work the [State] wants to entrust to them? Or spend $29 million dollars on a beautiful new State Hospital with enough capacity to safely serve the Vermonters who will be admitted there.

Seems like a no brainer to me.”

State Seeks Opinion On Federal Waiver For New VSH

In testimony on February 10 to the House Institutions Committee, Sen. Patrick Leahy’s Field Director John Tracy was asked to provide the committee with his opinion on whether or not Vermont could apply for a federal CMS waiver that would allow the State to build a new state hospital with more than 16 beds. This is the same kind of waiver that allowed the current VSH to operate as a 50+-bed facility prior to being decertified. Tracey apologized and said his office was declining opinion because it didn’t want to weigh in until after the State and legislators had decided what the future of Vermont’s mental health system is going to be. Tracy also advised that the federal courts have historically ruled more in favor of smaller, community-based care and not larger facilities. Tracy’s questioning sparked committee member Rep. John Rogers to ask to anyone within earshot if they knew why the State couldn’t just build its own facility for the care of Vermonters suffering with acute mental illness. “Is there a reason we have to depend on this federal money,” he asked.

Ed Reminder: A few years back, VSEA had presented the State’s mental health “Futures Committee” with a proposal to build a new 65-bed, State-run state hospital that would cost $29* million to build (read more in Thomson letter above). In the State’s most recent proposal to replace the state hospital, it says $17 million will be needed to build a new 15-bed hospital.

* Denotes 2006 dollar figure. In 2010 dollars, the cost is approximately $46 million.