Still No VSH Replacement Plans

Anne B. Donahue

The discussion about replacement of services currently provided to Vermonters with severe psychiatric needs at our state hospital is back in the headlines.

Initial bids for construction or rehabilitation of a 15-bed secure treatment facility at the Waterbury state office complex are now in, and range from $15 to $20 million.

That, however, is not for replacement hospital beds. It is for a replacement of the part of the current state hospital that isn’t providing hospital care at all.

Similar to a long term rehabilitation center where a stroke patient might regain living skills after stabilization, it provides services for persons who need very significant post-hospital support before they can safely return home.

When the Vermont State Hospital was decertified, it was because of grossly inadequate hospital-level care due to under staffing and a building inappropriate for inpatient care. There is no indication that renovations estimated by others at $3 million or less could not create a positive post-hospital environment there.

The concept of providing the acute stabilization function in general hospitals is not a new one. Many states use this model for all inpatient psychiatric care. The confusion arises when states then call their long term rehabilitation centers “state hospitals.”

In Vermont, we have used our “state hospital” for co-mingled long term rehabilitation and acute hospital care: a bad match for any medical discipline.

So what is the progress on moving inpatient care into inpatient hospitals?

After five years, there is still no agreement on how many acute care beds are needed, or where they should be.

The administration put a positive spin on the status of negotiations with Rutland Regional Medical Center for an addition there in its report to the legislature’s Mental Health Oversight Committee a few weeks ago.

It failed to report that initial estimates, received in late April, put the price tag at $20 to $22 million to add somewhere between six to 12 VSH replacement inpatient beds.

One of the biggest barriers for collaboration with the state’s hospitals remains the inability to agree on who should be paying for treatment of individuals who are in the state’s custody, mostly as a result of a preliminary medical assessment (not a court ruling) that indicates they may be a danger to themselves or others.

The debate centers on whether it is a “state responsibility” for the capital and operating costs, or whether it is a “social responsibility” that calls for shared costs and obligations on the part of the state and our community hospitals.

It is a distinction that has only to do with how we pay, rather than whether we pay.

Just as with Medicaid, we don’t escape paying for state care when we only pay half the cost through the state budget. Our non-profit hospitals have no ability to absorb a budget shortfall like that. It is paid by shifting the unpaid state obligation to the prices charged to those who pay for health insurance. It remains a public system, paid partly by taxpayers and partly by those paying health insurance premiums.

Even that analogy, however, has a glitch. A far higher percentage of those with severe psychiatric illnesses are extremely poor, often surviving on disability income. Insurance premium money isn’t there to shift the costs to support inpatient psychiatric units.

This is all data the administration has on hand, as it promotes a “collaboration” plan that makes it impossible for hospitals to collaborate.

Meanwhile, Vermonters continue to receive hospital services in a non-hospital that remains under ongoing supervision by the United States Department of Justice based upon its lawsuit for delivery of care that violates basic constitutional standards.

Rep. Anne Donahue, R-Northfield, is a member of the Joint Legislative Mental Health Oversight Committee.