Daily Archives: July 2, 2014

The new state hospital: A milestone, but not the end of the road

Yesterday’s happy-smiley ribbon cutting at the new State Hospital in Berlin was, indeed, a happy occasion. The post-Irene period — almost three years — has been extremely tough on seriously ill patients, their caregivers, and the entire mental health care system. Long waits, days spent in emergency rooms, endless shuffling of patients from one facility to another, constant searching for even a single empty bed. It’s been damn tough, and the interregnum has been longer than it should have been.

But nobody should confuse this milestone with the finish line. There are still a lot of questions to answer and issues to address. (Many of these were covered in Pete “Mr. Microphone” Hirschfeld’s fine piece for VPR, which went above and beyond the pro forma coverage of a ceremonial event and actually addressed the meat of the issue.) First and foremost: is this new hospital big enough?

After Irene, the experts were insisting that a new hospital needed to be at least as large as the old one. Instead, it’s half as big. I realize we’re trying to deemphasize hospitalization and move to a multifaceted, community-based system. But we’re talking about the sickest of the sick: even at 54 beds, that’s one bed per 11,593 residents. A central hospital isn’t for patients who might be better served in outpatient or community settings; it’s for the very, very small number of people who are too ill to function, too dangerous to themselves or others.

It remains to be seen whether 25 beds are really enough. It’ll definitely ease some of the intense pressure on the system, and it should prevent the widespread warehousing of patients in ERs or other unsuitable locations.

And there’s still widespread legislative dissatisfaction with the cost of the new facility, which makes me fear that the hospital will be nickel-and-dimed by lawmakers more concerned with the bottom line than with adequate patient care. Sen. Jane Kitchel, for one: she was more than pleased to take part in the ribbon-cutting, but she’d really like to see the hospital run more cheaply. 

Many lawmakers are complaining that the new hospital’s per-patient costs are substantially higher than the old one’s. That’s true, but I’d point out a couple of obvious items:

The old hospital was inadequate. Everyone says so. It lost its federal certification, which meant it did not qualify for Medicaid funding. If the old hospital wasn’t up to snuff, well, of course the new hospital will cost more.

Many of the costs are fixed. So when the Legislature happily signed off on a smaller facility, it tacitly agreed to much higher per-patient costs. A brand-new 54-bed state hospital would have had higher operating costs than the old one, but it would have cost a lot less per patient than the new 25-bed facility. This shouldn’t be a surprise to anyone in the legislature.

Many of the costs of the old state hospital are now redistributed across multiple locations, and helping to fund new community-based programs. (Or at least that’s the way it’s supposed to work.) This very intensive kind of psychiatric care requires staffers with special training and expertise; in a single central facility, you can have a more concentrated level of expertise. In the new system, we’ll have to spread those people around. And almost certainly hire more of them.

So I don’t want to hear any whingeing from the legislature about the new hospital’s cost. This was their idea.

But it must raise serious questions about the legislature’s willingness to fund the community-based facilities that are supposed to undergird the whole system and prevent a whole lot of hospitalizations. <a href=”http://digital.vpr.net/post/after-long-wait-mental-health-hospital-ready-first-patients”>Via Hirschfeld: </a>

Northfield Rep. Ann Donahue is a mental health advocate who has spent years advocating for a new state mental hospital. Impressive as the new facility is, Donahue says the system won’t function properly unless the community-based facilities are actually built. And she said much of the bed space and treatment capacity called for in the reform plan have yet to be constructed.

“Some of them are still in development, some of them are on budget hold. And we need to really enhance that aspect or we won’t reduce the need for inpatient care,” Donahue said.

At the ribbon-cutting, Human Services Secretary Doug Racine trumpeted the claim that Vermont “has the best mental health services in the U.S.” As of today, that claim is one step closer to reality but, fundamentally, it remains in the realm of political blather. The truth is, Vermont may well have the best mental health care system in the country ON PAPER. But a long struggle remains to turn it into reality. And penny-pinching Democrats are, sad to say, the biggest obstacle in our path.

 

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There’s no need to fear. WonderBoy is here!

Semi-random thoughts upon the hiring of former Douglas Administration stalwart Neale Lunderville, who served as Governor Shumlin’s Irene Recovery Czar, as the interim GM of the Burlington Electric Department… 

— When did Lunderville become Mr. Fix-It for Democratic administrations? Is there not a single Democrat with administrative chops who could be called upon to fill a leadership void in the public sector?

— Between his two government gigs, Lunderville was co-founder of NG Advantage, a firm that deals in compressed natural gas. He was there for less than two years. When and why did he leave?

— Since the Douglas Administration came to its merciful end, Lunderville has held (if I’m counting correctly) at least four jobs. Coincidence, or is there a reason he keeps moving around? (Yes, I know the Irene gig was a short-termer from the gitgo. But even so, there seems to be a pattern here.)

— Lunderville was one of the more notable head-crackers in the Douglas Administration. How committed is he to the ideals of a publicly-owned utility? Especially one with a strong commitment to renewable energy?

— The above question is even more crucial when, according to the Burlington Free Press, “Lunderville will conduct a strategic review of BED operations.” Will his ideological bent inform his strategic review, and shape his conclusions? Hard to see how it wouldn’t.

— He is said to be BED’s interim head, with a six-to-nine-month appointment. At the same time, though, Mayor Weinberger “temporarily suspended” the search for a permanent GM. Seems an odd decision; it often takes more than nine months to fill a top administrative position. Why wait? It seems likely that either Lunderville will stay longer than expected, or BED will soon be searching for another interim GM. Are the skids being greased for Lunderville’s permanent appointment?

Just askin’. Maybe some enterprising member of our paid political media could seek answers to some of these fairly obvious questions.

One further observation. The thing I don’t like about Shumlin and Weinberger hiring a Republican for a tough management task is the same reason I don’t like it when a Democratic President hires a Republican for Defense Secretary, or a military man for a non-military administrative post. It feeds into the stereotype that liberals can’t be effective, tough-minded leaders, and can’t be trusted with critical security and military issues.

Which is nonsense on both sides: there’s no guarantee a Republican will be a good manager, there’s no guarantee a general without the protections of rank and uniform will be an effective leader, and there’s no reason to think a Democrat, or even a Progressive, couldn’t handle a critical managerial challenge or keep our country safe. When Democratic officeholders hire somone like Lunderville, leaving aside the question of his qualifications, it feeds into those stereotypes. And that, in itself, is not a good thing.