|
Suicide likely
to delay plans to revamp Vermont State Hospital
(December
2004 Issue)
By Sean Smith
Efforts aimed at mapping out the future of the Vermont State Hospital
were overshadowed early last month by the suicide of a patient,
the third in 14 months at the embattled psychiatric facility.
According to hospital officials, the patient was on a day's leave
from the hospital when she took her life on Oct. 31. Vermont Health
Commissioner Paul Jarris ordered a complete administrative and clinical
review of the patient's case, while representatives from the Centers
for Medicare and Medicaid Services (CMS) carried out their own investigation.
The tragedy comes at a time of impending transitions for the hospital,
which is seeking recertification and restored funding from the CMS.
The federal agency had withdrawn both in September of 2003, citing
the two previous patient suicides and other problems in the hospital
staffing and operation.
Meanwhile, state officials and legislators are seeking to come
up with a plan in January for replacing the 113-year-old hospital
in the next few years.
One of the state's most active mental health advocates, State Rep.
Anne Donahue (R-Northfield), interviewed days after the most recent
suicide was announced, says it is too early to say how, or if, either
process would be affected by the patient's death.
"At this point, there is no indication on the surface that suggests
this suicide was due to systemic failure," says Donahue, a member
of the Mental Health Oversight Committee. "But if you are under
review, you're going to hold off on the recertification until at
least a routine check is completed. It's just a guess on my part,
but I think this tragedy will probably delay things for a bit."
Less than two weeks before the suicide, CMS officials conducted
an unannounced two-day inspection of the hospital, reviewing both
safety and treatment protocol. The visit was to be the final step
in the hospital's recertification, and Vermont Human Services Secretary
Charles Smith told the Associated Press he believed CMS would complete
the process by Thanksgiving.
Vermont officials estimate the hospital has lost some $4 million
in federal funds since it was decertified. Even as CMS continued
its assessment of the hospital's progress, earlier this fall the
advisory committee authorized by the Vermont legislature to explore
replacing the VSH presented three options: a 50- to 70-bed psychiatric
hospital that would offer a full range of intensive treatment and
rehabilitation services; a 32-bed inpatient unit affiliated with
a general hospital, with separate rehabilitation and secure residential
programs; or two or more 16-bed inpatient units spread around the
state, plus separate rehabilitation and secure residential units.
A final recommendation to the legislature is due Jan. 15.
Legislators and others have expressed concern that the administration
of Governor Jim Douglas is moving too slowly on the hospital planning
initiative. "I suggest we have lost a year," says Mental Health
Oversight Committee co-chair State Sen. Jim Leddy (D-Chittenden)
in remarks before the annual meeting of the Association for Mental
Health. "I can't imagine that for another population, another disability,
we would take so long to figure out what we should do." But Smith,
who authored the interim report on the hospital, told the Associated
Press that "This administration has been absolutely unflinching
in facing up to the issues of the state hospital."
Donahue says the VSH replacement plan is "simultaneously behind
and ahead of where it should be." She says there are insufficient
details on cost projections, for example, and no suggestions on
which care providers might partner with the VSH successor.
"By now, if you're going to have a plan for January, you should
know which preferred model, from a clinical perspective, you're
going to use and who's going to work on the model with you," she
says." At the same time, it is a good thing [the advisory committee]
didn't jump the gun and make a recommendation when they didn't have
enough information on these important areas."
One other issue to be addressed, Donahue says, is the physical
state of VHS and its effect on patient care during the development
of a new facility. "A number of people are not satisfied with the
status quo for the interim during the implementation of the new
hospital plan," she says. "Some critical plant improvements are
needed, and if patients are going to be staying in the building
for three or four years, it's just not good enough as is."
|
