Controversy brews over mental health as Senate preps for vote

Senate lawmakers this morning are frenetically preparing for a floor session this afternoon during which leaders aim to pass out, at long last, the mental-health bill that Gov. Peter Shumlin says will alleviate the “crisis” unfolding in hospitals across Vermont.

It’s been a long road for the legislation, which lays out a replacement plan for the 54-bed psychiatric hospital flooded out in Tropical Storm Irene. Seven weeks of legislative debate have done little to quell dissent over the administration’s plan. And a spate of amendments on the Senate calendar today spotlights the major areas of disagreement.

The size of the replacement hospital remains the biggest sticking point. Shumlin has demanded a bill that calls for a facility, to be located somewhere in central Vermont, with no greater than 16 beds. Exceeding that number, Shumlin says, will cost taxpayers nearly $10 million in foregone federal revenue annually. That’s because new rules in place at the Center for Medicaid and State Operations, he says, prohibit federal Medicaid matches for facilities with greater than 16 beds.

In a letter sent yesterday to Senate President John Campbell and House Speaker Shap Smith, Shumlin recalls a conversation he had this past Sunday with Human Services Secretary Kathleen Sibelius and Director of CMS and State Operations Cindy Mann.

“I asked them directly if there are any circumstances in which, if Vermont builds more than 16 beds, we could qualify for federal reimbursement,” Shumlin wrote. “The answer was no.”

The House passed a bill that calls for a 25-bed facility. The Senate Committee on Health and Welfare has since whittled the figure back down to 16. But amendments to be introduced on the floor today would increase the number to as many as 50 beds.

Those amendments come largely at the behest of the Vermont State Employees Association, which represents the 280 workers formerly staffing the Waterbury psychiatric hospital. Delivering proper care to acutely ill patients, hospital doctors have said, requires a facility of at least 25 beds, and preferably more.

Shumlin’s plan replaces the lost capacity in Waterbury with a combination of the 16-bed facility in central Vermont, and by ramping up in-patient capacity at the Brattleboro Retreat and Rutland Regional Medical Center.

Critics say those facilities won’t be capable of delivering the specialized, dedicated care of a facility designed specifically for mental health patients.

The VSEA also stands to lose scores of jobs under the administration plan. Last Friday, the administration sent pink slips to 80 state hospital workers, many of whom have been idle since the flood. Others have been performing their jobs in hospitals, which have been forced to absorb patients that would have otherwise gone toWaterbury.

The fate of those workers is the subject of at least two amendments today. Sen. Tim Ashe, a Progressive/Democrat from Chittenden County, has offered language that would force the hospitals handling new in-patient capacity to give former state workers preference in the hiring process.

Sen. Vince Illuzzi, and Essex County Republican, goes a step further, saying those workers should not only be given the new jobs created at hospitals, but shall retain their status as state workers, and retain the wages and benefits negotiated in the VSEA’s collective bargaining process.

Shumlin said he can’t abide either amendment. While he’ll cheerlead for the former state workers seeking new jobs in Brattelboro or Rutland, Shumlin says, the state can’t dictate hiring protocols to independent entities.

“We are encouraging all our private providers to hire our qualified workforce,” Shumlin said at a press conference Tuesday. “I’m saying there is a difference between encouraging, urging, begging, and requiring them (to hire former state workers). And I will not require them.”

Shumlin had until recently taken a diplomatic tone when discussing publicly the disagreements over the bill. Even after Feb. 17 – the date on which Shumlin had said he wanted a bill on his desk – administration officials were praising the Legislature for their diligence on the legislation.

With town meeting break just around the corner, however, Shumlin has taken a more aggressive tack.

As if to heighten the drama, he underscored the urgency by issuing a dire warning to lawmakers Tuesday:

“We got flooded out of our state hospital. We have people right now, health care providers, who are in danger because we don’t have a sate hospital anymore,” Shumlin said. “I am hoping there will be no loss of life because of this. But I can’t guarantee it.”

The Senate is schedule to head to floor at 3:30 this afternoon.

9 Responses to Controversy brews over mental health as Senate preps for vote

  1. I’d argue the assertion that calls for a larger state hospital “come largely at the behest of the Vermont State Employees Association.” Most of the psychiatrists in the state feel the same way, including Dr. Jay Batra, the director of the Vermont State Hospital. They aren’t trying to preserve union jobs; they honestly believe, from their own professional expertise, that a larger hospital is necessary for quality care. 

    •  @johnswalters They have status quo bias.
      People who harbor vested interests (financial or otherwise) in maintaining the status quo resist change, even if it is for the good of society. Hospital workers strongly resisted deinstitutionalization in the 1970s. If someone did not advocate for change the mentally ill would still be warehoused in large squalid institutions. Society has made a lot of progress since then, but we have not yet attained an ideal way of treating the mentally ill. We should continue moving forward to a less restrictive way of treating mental illness instead of going back to the same old way of doing things that was not working.

      •  @exvshguy Some of them may have status quo bias, but a lot of them have nothing to do with VSH and have never practiced in a state hospital anywyere. They’re psychiatric professionals who operate in a variety of settings around the state. And they have a great deal of expertise on these questions. I’m sorry they don’t agree with you. 

        • The so called expert psychiatrists used to classify homosexuality as a mental illness.  In 1973 they voted by a small majority (58%) to remove it as an illness category from the DSM, replacing it with a category of “sexual orientation disturbance” and then “ego-dystonic homosexuality,” which was deleted in 1987.
          Psychiatry is more of a pseudoscience than a real science. You should take everything they say with a large grain of salt.

  2. The Senate is scheduled to be on the floor at 3:30 PM this afternoon. View the proposed amendments via the following:
    Senate Calendar for Wednesday, February 29, 2012:
    View House passed version of H. 630 as well as Senate Health and Welfare Committee “strike all” amendment:
    Listen to audio of senate proceedings (beginning at 3:30 PM this afternoon): 
    via Vermont Public Radio (VPR)

  3. Pingback: Controversy brews over mental health as Senate preps for vote | Vt Today

  4. Governor Peter Shumlin’s Executive Order regarding Vermont State Hospital (VSH) Employees who have been subject to the recent Reduction In Force (RIF):

  5. Governor Peter Shumlin’s Executive Order regarding Vermont State Hospital (VSH) Employees who have been subject to the recent Reduction In Force (RIF):

  6. (redo; had problems with the link in earlier posting attempts)
    Governor Peter Shumlin’s Executive Order regarding Vermont State Hospital (VSH) Employees who have been subject to the recent Reduction In Force (RIF) is now available online (via PDF): 
    also available via Google Docs: