"The workers insisted they are not just out to save their jobs, but to preserve a high quality of care for people who need it. The alternative is likely to be an increase in Vermont’s mentally ill residents showing up in its prisons, as has happened in other states that close psychiatric hospitals, they said. ‘Corrections actually will be where many of these people will go,’ Malloy said. ‘The Los Angeles County Jail is the largest psychiatric facility in the country.’"
Article published Nov 21, 2011
Vermont State Hospital Workers at closed facility speaking out
By DAVE GRAM
THE ASSOCIATED PRESS
With Vermont nearing the end of the third month of a storm-imposed experiment in getting along without a central state psychiatric hospital, workers at the closed Waterbury facility gathered this past week to issue a warning: You can’t get along without us.
“There is no other state in the country (that) successfully closed down all state hospital beds. There is no evidence to support that this can work successfully without a safety net of some kind in place,” said Tommie Murray, who was chief quality officer at the Waterbury hospital before flooding triggered by Tropical Storm Irene forced it to close in late August.
Murray was among a dozen psychiatrists, nurses, social workers and others who sat around a conference table and shared their concerns about a state mental health system without the Vermont State Hospital in Waterbury as its centerpiece.
All 51 patients at the Waterbury hospital were evacuated when 8 feet of water from the Winooski River flowed through the 120-year-old hospital campus. They were spread to less-secure psychiatric facilities, to the mental health units of hospitals, a private psychiatric hospital in Brattleboro and a quickly converted wing of the state prison in Springfield.
Since the storm, senior officials in the administration of Gov. Peter Shumlin have had numerous meetings and conference calls with one another, legislators, mental health advocates, hospital administrators and others trying to chart a course forward for Vermont’s mental health system. One group not included enough in the discussions, the workers said, was them — the people with front-line experience in caring for the state’s most mentally ill.
Shumlin took one option off the table last month, saying patients and staff would not return to Waterbury. Built in the early 1890s, the facility was widely regarded as outdated and in need of replacement before the flood. It was decertified by federal authorities in 2003, meaning the state lost eligibility for federal aid in caring for Medicaid- and Medicare-eligible patients there, an annual cost of about $8 million.
State officials have been talking about the long-term future, but have been focused mainly on the immediate need. “Building a replacement facility is years away at best, and we need to put services in place now to ensure all Vermonters have access to the care they need,” Shumlin said last month.
Administrators at Vermont’s other hospitals have been raising an alarm that they are not equipped to deal with Vermont’s most mentally ill patients. Emergency room staff have been assaulted, hospitals have had to step up their use of restraints; some have complained that less ill patients are being scared off by the most acutely psychotic.
On Thursday, the former Waterbury workers said they are not surprised by these developments. The hospital provided a unique and needed range of services, they said. With patients and staff scattered around the state, economies of scale have been lost. More importantly, they said, the cohesiveness of the Waterbury team has been lost.
Many of the 240 people who worked at Waterbury have followed their patients to the other places where they’ve been housed since Irene. But the transitions have been far from seamless.
Bev Ordway, a psychiatric technician, said she had been commuting more than two hours each way from her home in West Topsham to do 12-hour shifts at the Brattleboro Retreat. But she said her certification was different from the staff’s there, so until she recently completed training similar to theirs, she was limited to “standing there and watching” the Brattleboro staff interact with patients she had been working with weeks earlier.
Administrators at Waterbury have been working out of former Vermont Lottery offices in Barre, traveling a few days a week to Brattleboro or other locations where patients are being housed.
The workers urged that the two of three floors at Waterbury be reopened on a temporary basis — “temporary with a capital T,” one said — and that the state move as quickly as possible to build a new hospital similar in size to the 54-bed Waterbury facility somewhere in north-central Vermont. The largest psychiatric unit the state is using now is the 14 beds at the Brattleboro Retreat in Vermont’s southeast corner. But the bulk of Vermont’s population is in the northern part of the state, where two-thirds of patients at Waterbury came from, the workers said.
Dr. John Malloy, a psychiatrist who worked at Waterbury, agreed with others that the hospital building needed to be replaced. But he said a distinction needs to be drawn between “the physical hospital and the human hospital.”
What he called the “human hospital” delivered care others can’t, staff members said, in part because patients who went to Waterbury typically stayed longer than those who go to multipurpose hospitals.
“Other hospitals cannot afford to sit with these people for weeks and weeks and weeks,” said Dr. Robert Duncan, another psychiatrist. “After about two weeks hospitals lose money, in the way that the insurance reimbursement systems are designed.”
The Waterbury staffers said they are also unique in being highly trained and long practiced in calming patients in crisis. At the psychiatric unit at the Fletcher Allen Health Care hospital in Burlington, staff are quicker to call in security when patients are misbehaving, they said.
The workers insisted they are not just out to save their jobs, but to preserve a high quality of care for people who need it. The alternative is likely to be an increase in Vermont’s mentally ill residents showing up in its prisons, as has happened in other states that close psychiatric hospitals, they said.
“Corrections actually will be where many of these people will go,” Malloy said. “The Los Angeles County Jail is the largest psychiatric facility in the country.”