Hospital replacement details uncertain

Hospital replacement details uncertain
(June 2009 Issue)

By Ami Albernaz

Five years after plans were first announced to replace the aging Vermont State Hospital with a more community-based, geographically distributed system of care, a group of mental health activists has expressed concern about the lack of a definitive closure date for the Waterbury hospital and a clear vision of what will follow.

The shuttering of the 54-bed hospital in Waterbury, which was built in 1939, has looked likely since the facility lost federal certification in 2003, following two patient suicides, and lost it again in 2005. Last month, the Centers for Medicare and Medicaid Services (CMS) denied the facility eligibility for federal matching funds, the first step in recertification. This means the hospital will continue to operate solely on funding by the state, which is already facing budget shortfalls.

Vermont Mental Health Commissioner Michael Hartman, MSW, says the hospital closure is still "definite," but that the pieces of the replacement remain uncertain.

As New England Psychologist went to press, the state legislature looked set to approve $500,000 for a certificate of need for a 15-bed secure residential recovery program, which will likely be located in Waterbury, along with a $250,000 investment in the Rutland Regional Medical Center that would provide 12 beds for specialized, acute care. Minor repairs to Vermont State Hospital for the short term also looked likely to win approval.

"Where we have the question mark is [where to place] 16-20 beds that specialize in acute patient care," Hartman says, adding that institutions including Fletcher Allen Health Care were being considered. "There may be a possibility of a smaller number of beds at a number of facilities."

Community-based and peer-run support services will play a significant role in the replacement of Vermont State Hospital, Hartman adds, citing as an example Second Spring, an 11-bed transition residence in Williamstown that opened in 2007. "What we've tried to do is bring about a mix of beds for people coming in and out of the hospital and bring in peer services," Hartman says. "It looks like we have enough community and partner support to go that route."

A group of mental health activists worry that the plan will not offer enough geographic diversity to optimally serve residents.

"What we really should be doing is having capacity distributed throughout the state," says Ed Paquin, executive director of Vermont Protection and Advocacy, Inc., a mental health rights organization. A letter he and others wrote to state legislators suggested geographically disbursed facilities for bed placements as an alternative to concentrating them in just a few areas.

"The way [the replacement plan] seems to be structured seems to be based on financial requirements rather than what would be best," he says.

Paquin praised the state for steps toward a replacement plan, but said a definitive closure date and more opportunities for input are needed. "There hasn't been clear and consistent leadership from the state," he says. "The state needs to put together a clear plan with a clear timeframe for closure and take the risk that it could face modification and criticism."

Hartman says the capacity to replace Vermont State Hospital should be in place by 2012.

In the meantime, he adds, "it continues to be our hope that we might reach some accord with CMS to allow [federal] participation, but at this point, it seems to be a difficult step to take."

Prior to the CMS decision last month, the state had moved to remedy problems related to the hospital's structure and procedures noted in a CMS report last fall. Inspections by the U.S. Department of Justice and the Joint Commission, a national independent certification organization, shortly before the CMS report did not turn up these problems, the New England Psychologist reported last December.

As New England Psychologist went to press, we learned that the Centers for Medicare and Medicaid Services (CMS) is allowing Vermont State Hospital to address the violations noted in its report. If CMS is satisfied with the corrections, the hospital will receive the federal aid for which it was originally denied eligibility.