|
Efforts continue
to reduce census at Vermont
State Hospital
(June
2005 Issue)
By Sean Smith
Vermont Health Commissioner Paul Jarris, M.D., M.B.A., last month
expressed confidence in ongoing efforts to reduce the patient census
at Vermont State Hospital (VSH), as a prelude to closing the troubled
psychiatric facility.
The hospital, which twice in the past 20 months has lost its federal
certification because of safety concerns, is essentially under a
death sentence. As state officials and legislators continued to
work on plans to replace the nearly 115-year-old hospital, Vermont
Gov. James Douglas announced in February that he wants to expedite
the facility's closing and set a goal of reducing the VSH patient
census from 50 to about 35 by late March.
That same month, the Douglas administration announced a proposal
to replace the hospital with a 28-bed facility at an academic medical
center and a series of short-term-stay programs at community hospitals.
But Jarris acknowledged in March that the reduction would not take
place on schedule, and as of May 4, the state Department of Health
reported the hospital census stood at 48.
The VSH situation has been further complicated by job transitions
among members of the Douglas administration during the past several
months. Deputy Health Commissioner for Mental Health, Susan Wehry,
M.D., left to take the post of medical director in the Vermont Corrections
Department and Human Services Secretary Charles Smith announced
he would be swapping jobs with Administration Secretary Michael
Smith.
Jarris discussed aspects of the VSH controversy in an e-mail interview
with New England Psychologist last month.
Regarding the hospital's patient census, Jarris says that currently,
some 40 percent of the VSH population consists of forensic patients,
a group that had increased by 100 percent in the previous six weeks.
He says that Vermont State Hospital is currently the only hospital
designated in statute to receive court-ordered patients for forensic
evaluations.
Jarris says the Department of Health is "strongly promoting passage
of legislation this session to allow for the Commissioner of Health
to transfer a patient to another hospital for forensic evaluation
when clinically appropriate. "This would greatly assist in managing
the census at the hospital," according to Jarris.
Even as efforts continue to reduce the census and work toward closing
the hospital, Jarris says his department is mindful of ensuring
that patients' care does not suffer as a result. Some mental health
professionals and advocates have expressed concern about plans to
transfer patients to facilities like Brattleboro Retreat, general
hospitals and community mental health agencies, because they say
these places will not adequately serve the complicated needs of
severely mentally ill adults.
"We have made it clear that, in each case of a potential transfer,
clinical considerations will come first," says Jarris. "We also
have made it clear that no hospital will be asked to accept individuals
for whom they cannot provide appropriate services. In fact, relatively
few transfers have taken place in recent months, although a lot
of cooperative work is being done to break down the barriers to
such transfers."
Also, according to a Department of Health newsletter, the department's
Mental Health Acute Care Team recently implemented a new method
of tracking the care and services provided to patients who are discharged
from the Vermont State Hospital and patients who are on Orders of
Non-hospitalization (ONH). The new process sets specific deadlines
and guidelines for contact and follow-up on VSH patient discharges
between the Acute Care Team, VSH and designated agencies or other
appropriate authorities.
Jarris downplayed the impact of the transitions within the Douglas
administration. Wehry's departure "caused a management hiatus, as
all such departures do, but we have a capable and experienced acting
deputy in Division of Mental Health Director Paul Blake, and we
are actively recruiting a new deputy. Our plans for developing capacity
at the community level are proceeding quickly and have not been
affected by the deputy vacancy."
Jarris says he and his colleagues are very concerned about the
problems at VSH - which included three patient suicides in a span
of 14 months and two patient escapes on consecutive days earlier
this year - and understand the strong reaction the hospital's woes
have elicited among families, advocates and others. But the VSH
situation reflects a major transition in the state's mental health
system, one that he believes will be a beneficial one in the long
run.
"The positive side of all this is that everyone in state government,
including legislators who are apportioning limited revenues, fully
understand that major changes are required," he adds. "There is
no debate about whether something must be done. We are faced with
the obligation to change, but we also are faced with the opportunity
of building a system of care modeled on the 2003 report of the President's
New Freedom Commission on Mental Health.
"We're in a state of flux, but there certainly is an underlying
excitement on the part of our department and the mental health community
that we are on the verge of creating an exemplary system that will
endure for generations. "This is our big chance," he notes.
|
