February 1st, 2012

Flooding impacts VT facilities

Legislature ponders plan

Since flooding from Tropical Storm Irene forced the closure of the 54-bed Vermont State Hospital (VHS) last August, community care facilities have stepped up to fill the void. Staff members are gamely coping with their new reality, while hoping for quick action from the state.

Among facilities that have stepped up are the Brattleboro Retreat, which originally took in 15 state hospital patients and Fletcher Allen Health Care, which took in seven.

Both facilities are now admitting patients who in the past would have been sent to the state hospital, meaning they are seeing patients with higher acuity and in a more crowded environment.

Fletcher Allen had to lock a previously unlocked unit. “Since the emergency, we have had a different kind of patient on that floor than we would have had historically,” says Robert Pierattini, M.D., Fletcher Allen’s physician leader of psychiatry.

“We have a level of aggression and violence that we would not have accepted before because we can’t. It’s disruptive to the other patients to have people like this on the unit. It wasn’t that kind of unit.”

Staff assaults skyrocketed. Pierattini reports 14 in September (previously, a typical month would have zero or one). “There were also assaults on other patients,” he says.

Also, instances of patient restraint and seclusion rose – as many in the first three months following the storm as in the previous 12-months.

Programs and staffing have had to change. “It’s changed everything,” he says.

“We don’t have enough beds to take care of everybody who needs to be admitted. There are people who are waiting for a long time to get into a hospital; there are people who are doing without hospital care. We are turning people away we normally would have admitted, so we are patching together programs to try to manage because we don’t have any beds.

“We are worried that bad things are happening that we may not even know about. People who can’t get access to hospital care are doing without appropriate care,” Pierattini says.

Despite the added stress, Pierattini praises staff. “People are doing what they need to do and they are doing it cheerfully. They are managing just fine. The attitudes are amazing.”

Still, he worries that if the situation doesn’t look like it has an end, staff will leave.

“People have choices and I don’t think they’ll stay if they don’t have confidence in the system.”

The state has since presented a plan to the legislature, which resumed Jan. 3. The governor’s plan would replace VSH with a new 15-bed facility in central Vermont, a refurbished 14-bed unit at the Brattleboro Retreat and a six-bed expansion at Rutland Regional Medical Center. It would also enhance community services and specialized programs throughout the state, such as step down beds, improved emergency and individualized services and housing vouchers and peer services.

After the closing of VSH, the influx of new patients at Brattleboro Retreat required the temporary suspension of admission to its Lesbian, Gay, Bisexual and Transgender Inpatient Program.

“It wasn’t what we planned to do, but given the emergency, everybody stepped up,” says Brattleboro Retreat’s President and CEO Robert E. Simpson, Jr., MPH, DSW. He notes a new LGBT unit will re-open in February.

The governor’s plan would provide funding for Brattleboro Retreat to renovate space for the high-acuity patients, who typically have a longer stay.

“The renovation dollars would allow us to go back into that unit and create a space that would be more vibrant for that population,” and would also create an outdoor secure space contiguous to the building, according to Simpson.

Since the flooding, on any given day, the facility has 25 patients who might have normally been admitted to VSH. Because they are higher acuity, many resist medication and treatment. “It just changes the composition of the unit and it changes the way you do care,” he says.

Simpson feels things are going well although stress has increased. “The Retreat has been here 177 years so we’ve been in the business a long time. Many of our staff has been here 20, 30 years. I would say overall it’s gone well, but it’s not without adjustment.”

He says the state doesn’t have enough capacity bed-wise and the governor’s plan would create residential programs in a more rapid way, so that people can get out of hospitals more quickly. He’s supportive of that solution but emphasizes that it needs to happen quickly.

After the governor’s plan was announced, Rep. Anne Donahue, (R-Washington 2), chairwoman of the Legislature’s Mental Health Oversight Committee, says she would like to see some revisions.

She says the committee wants to see the new psychiatric hospital not only centrally located, but also integrated with a medical center or hospital and located on the same campus.

“It’s one thing if you’ve got a 200-bed program that can sustain its own full medical complement, but when you are talking about 15 or even 25-30 beds, if it’s not sufficiently connected to a medical hospital you’re really going to have a big gap of care, with the degree of recognition of co morbidity of medical and psychiatric issues and all of the crossover needs,” she says.

Donahue adds that the plan includes a majority of beds in the southern part of the state – when a majority of the population lives in the north.

“I think there’s some massaging of the numbers that needs to happen,” she says. “There are a lot of creative ways to do that and really stay with the same basic elements of the plan but remedy some of that disparity in access.”

She said she is enthusiastic about what she sees as a rapid planning and response in terms of enhancing community services. “Given the extreme shortage of inpatient beds right now, it’s sort of the next best thing we can do is really get community resources out there and in some cases provide alternatives to inpatient care.”

Donahue adds the urgency caused by the flood should help the legislation move quickly. “We just have to be careful that the tradeoff of moving faster isn’t that we end up with a loss in quality, because it is a very long-term outcome.”

By Pamela Berard

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