Tag Archives: Morgan True

And now, the next phase of the “Get Rid of Norm” campaign begins

Yesterday, prosecutors and defense in the Senator Norm McAllister Incredibly Gross and Offensive Sexual Exploitation case got together and released the “discovery stipulation,” or in English, the projected timeline for a trial.

And as VTDigger’s Morgan True reports, it’s scheduled to take place “smack in the middle of the 2016 legislative session.”

Bwahahahahaha.

Wouldn’t that be fun? If McAllister remains determined to hold on to his seat, he’d have cameras following him everywhere he goes in the Statehouse, and following him back and forth to the courthouse, and reporters asking all sorts of embarrassing questions of fellow lawmakers (“Hey, Senator Mullin, got a minute? I want to ask about your old roomie.”), especially Republicans, and especially Franklin County Republicans.

Of course, legal experts say that delays are virtually inevitable, so the likely outcome is that the trial will happen sometime later next year. Buzzkill. Even so, the cameras and reporters will be swarming.

But with the legal schedule set, Republicans will redouble their efforts to convince McAllister to deliver the face-saving resignation they all desperately want. As Senate Minority Leader Joe Benning told me last month, once the discovery stipulation is revealed, “the process will be clear and Norm will have to face it.”

That is the hope, anyway.

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The downside of subcontracting human services

We had an unintended confluence on the Thursday edition of the Mark Johnson Show, hosted by Yours Truly. Back-to-back interviews with VTDigger’s Morgan True and State Auditor Doug Hoffer turned out to cover some common themes.

True had reported on problems at Rutland Mental Health Services, one of the state’s “designated agencies” for providing social services. Hoffer had just released a very critical performance audit of the Corrections Department’s transitional housing program. I was in the middle of the show when the light bulb went off. Both interviews were kind of about the same thing: Inadequate oversight of human services contractors.

In both cases, an Agency of Human Services program is contracted out to nonprofit agencies that get virtually all their funding from the state. In a way, it’s a mutually captive relationship: the agencies are completely dependent on the state, and the state effectively has no options for replacing a poorly-performing contractor.

In their own way, True and Hoffer found similar problems in different areas of AHS: lack of consistent oversight, gaps in service provision, and inadequate methods for tracking performance. (In the case of RMHS, the situation boiled over into scandal.) The result is a system that looks good from a distance, not so good up close. Its failures are partly due to lax oversight; but we should also consider whether poor contractor performance may also be due, at least in part, to bare-bones funding by the state.

After the show was over, I pondered another issue: What does the Rutland situation have to say, if anything, about the Shumlin administration’s community-based mental health care system? Because those designated agencies are the front-line troops in that effort.

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It’s not that simple

One of my readers posted a comment basically wondering why, if women were being routinely victimized by soon-to-be-former Sen. Norm McAllister, they didn’t go to the authorities? Why put up with the abuse? Why not stay away from the guy?

It’s an understandable reaction. I’ve never been in that situation, and it’s almost impossible to imagine being in that situation. But many people are — more than it’s comfortable to think about — and they feel powerless to resist, evade, or report.

For one great example of this phenomenon, see Morgan Trus’s fine piece on VTDigger regarding “survival sex” — in which victims feel their well-being is dependent on their abuser’s approval. It’s a surprisingly common occurrence, especially in a society where many women are financially dependent on a man.

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Vermont’s new mental health system will have more inpatient beds than the old one

I wouldn’t blame Jay Batra if he felt personally vindicated today. Maybe even a little bit smug. VTDigger’s Morgan True: 

The state wants to replace a temporary psychiatric facility in Middlesex with a permanent structure twice the size, officials told lawmakers last week.

… Last June Vermont opened the doors of the Vermont Psychiatric Care Hospital in Berlin, but the system still lacks the capacity to keep people with acute psychiatric needs out of emergency departments.

How about that. “…the system still lacks the capacity…”

Vermont’s new, decentralized, community-oriented system currently has 45 beds: 25 at VPCH, 14 at the struggling Brattleboro Retreat, and six at Rutland Regional Medical Center. If/when the Middlesex facility is built, the system will have 59 beds.

Before Tropical Storm Irene, the Vermont State Hospital had 54 beds. After Irene, the Shumlin administration insisted, repeatedly, that if we had a more robust community-based system, we wouldn’t need that many inpatient beds. In the process, it ignored the counsel of psychiatric professionals, who said that 50 was the bare minimum.

What’s happened since then? The administration has slowly, quietly, built the system back up. And it has found that, yes indeed, those professionals knew what they were talking about.

Let’s take a trip in the Wayback Machine to Tuesday, December 13, 2011

Gov. Peter Shumlin announced on Tuesday that his administration plans to replace the Vermont State Hospital in Waterbury with a decentralized, “community-based” plan with 40 inpatient beds in four locations around the state. …

The unveiling of Shumlin’s proposal came on the same day a top mental health psychiatrist called for almost the exact opposite of what the governor proposed. Dr. Jay Batra, medical director of the state hospital since 2009 and a professor at UVM, told lawmakers at a hearing on Tuesday that the state should have one central mental health facility serving 48 to 50 patients in order to provide the best clinical treatment and best staffing model.

That, from a lengthy VTDigger account of Shumlin’s announcement, which was made in the conspicuous absence of Dr. Batra. At the time, Shumlin was planning on a central hospital with as few as 16 beds. It was a well-intentioned effort to avoid the serious problems that had plagued VSH in the past. But it was a misdirected effort, pursued against the advice of those actually in the field.

At the time, I wrote some highly critical stuff about the administration’s plan, and I got some active pushback from administration officials who basically accused the psychiatric community of professional puffery — overstating the need for their own expertise.

Now, it’s safe to say that the administration was wrong.

Assuming the Legislature approves the $11.4 million Middlesex facility, the mental health system will have more beds than before Irene, and those beds will cost more than a similar number at a single, central State Hospital. How much more, I don’t know. But the system has had persistent problems hiring and maintaining the staff it needs for the specialized care its patients require. Those problems are exacerbated when the beds are spread among four separate facilities.

Also unknown is how much money was [mis]spent on the long and winding road to get exactly where the experts thought we should go in the first place. Plus, we are left with a system that’s almost certainly more expensive to operate and harder to administer because of its geographic spread.

One of Governor Shumlin’s great strengths is his decisiveness. He can assess a situation quickly, make a decision, and carry it through. Well, it’s a strength when he’s right. When he’s wrong, and he stubbornly insists on staying the course, that same decisiveness is one of his great weaknesses.

Don’t expect the Vermont Workers’ Center to go away anytime soon

Those dirty hippies who made Joe Benning walk the gauntlet on Inauguration Day are most likely in this for the long haul. I say this because the Vermont Workers’ Center is a rapidly-growing organization with surprising financial muscle.

According to the nonprofit’s most recent IRS filing, VWC had revenue of nearly $680,000 in the year 2013. VWC head James Haslam told VTDigger’s Morgan True that this year, the figure will be around $800,000. As recently as 2009, its intake was less than $200,000; you do the math.

That’s pocket change in Koch World, but in Vermont it makes VWC a power to be reckoned with, beyond its ability to draw a crowd to the Statehouse.

Aside from money, it’s also tapped into a deep vein of dissatisfaction with/alienation from politics as usual. Its members are committed enough to turn out large numbers for a demonstration or flood the Statehouse hallways when needed. They are also willing to financially commit: VWC charges membership dues, and pulls in about 30% of its budget from members without much apparent effort.

My big question, when I saw VWC revenues in the high six figures, was: where is it all coming from?  Haslam:

That work is supported by a combination of foundations which, typically, is about half of our support or maybe a little bit more. The other half is from our base, which is individuals and trade unions. I think it’s something like 20% unions, 30% individuals. It fluctuates year to year, but that’s about right.

I didn’t ask him for a list of foundations; as a nonprofit, VWC is not obligated to release donor information. VTDigger’s Morgan True reports that the Ben & Jerry’s Foundation is its largest nonprofit donor, having given $50,000 this year and a total of $160,000 since 2010. True also reports that VWC has strong ties to a national network of progressive organizations; “We’re part of a broader people’s movement to turn things around for working people,” Haslam told him. Well, if its largest foundation gift was 50K and they’re pulling in 400K from foundations, then they’re drawing from a large donor pool.

One other note from Thursday’s protest. It’s been reported that five of the 29 people arrested that day were paid by VWC, which has raised some hackles. Haslam says the five are members of VWC’s ten-person staff. He says they did not receive any remuneration beyond their regular pay for taking part in the protest or for being arrested.

At a planning meeting before the protest, Haslam told me, people were asked whether they would be willing to be arrested if necessary. “We were hoping that nobody would be arrested,” he said, “but our members felt that it was important for us to take a bold stand.”

Those who volunteered for arrest, he said, “were all people who had had first-hand experience with the health care crisis.” Five of them happened to be VWC staff. “That was a voluntary act for sure,” he says. “We have a number of staff people who didn’t do it.” Including, as it happens, Haslam himself.

With a committed membership and a growing financial base, VWC shows no signs of being a flash in the pan, or some sort of Occupy movement that will burn brightly for a brief time and then flame out. They look to be in this for the long haul, on a broad variety of issues. Whether or not they continue to declare themselves at big political events, they’ll be around, promoting their causes and making it harder to ignore their issues.

Our still-broken inpatient psychiatric system

One of journalism’s highest purposes is to lance the boils of society — to expose unpleasant truths that everybody is doing their best to ignore.

A prime example appears on VTDigger today: a story by Morgan True about the continuing problems in the state’s psychiatric care system, and particularly the brand shiny new state hospital in Berlin.

Among the key points:

— Even after the facility’s opening, some psychiatric patients have found themselves parked in emergency rooms for days or even weeks.

— There have been 59 documented attacks by patients on hospital staff, some resulting in significant injuries.

— The hospital houses a couple dozen of the most severely ill people in Vermont. Many have been convicted of violent felonies. One doctor told True that the hospital is “one of the most dangerous workplaces in Vermont.”

— State law strictly limits the restraint or medication of patients against their will. Even the most violent.

— In part because of this dangerous work environment, the hospital has been consistently understaffed since its opening. As a result, it has yet to operate at full capacity.

Which brings us back to point one: several months after the hospital’s opening, severely mentally ill people are still being warehoused in ERs.

This is a whole lotta bad stuff. It shows a mental health care system that’s still functioning poorly even after the Shumlin Administration’s entire plan has been put in place.

The Department of Mental Health, for its part, seems to be taking a remarkably lax and unforthcoming attitude toward the situation. DMH knows the total number of attacks on staff, but it won’t release any information on staff injuries.

And according to DMH Deputy Commissioner Frank Reed, the department “has not tried to compare the number of violent incidents at VPCH to other psychiatric hospitals.”

Well, why the hell not? I’d think you’d want to know whether our problems are unique, or simply the natural consequence of caring for the most severely mentally ill.

Reed also flunks the transparency test when it comes to waiting times in hospital emergency rooms. He says average wait times have decreased, but…

Reed was unable to provide documentation of average wait times, saying those figures are still being “pulled together.” The numbers will be presented to a legislative oversight committee in January.

Perhaps Mr. True should apologize for inquiring at an inopportune time. But it shouldn’t be that hard to assemble those numbers. Indeed, I’d expect a Department that’s doing its job to compile those figures on an ongoing basis.

In fact, I’d be very surprised if DMH doesn’t have the numbers already. It’s Management 101, isn’t it? Keep track of your most important statistical markers?

True’s report raises all kinds of questions about state law, the Shumlin Administration’s concept of a mental health care system, and how many resources were spent trying to develop a system that was undersized from the start. DMH officials are talking about supplementing the system with a new 14-bed secure residential facility, but acknowledge that it’ll be a tough sell when lawmakers are under the gun to cut the budget. DMH may have already squandered its best opportunity to create a good system.

And please don’t insult me with the “No one could have foreseen” excuse. The people responsible for inpatient care were all saying the same thing after Irene: the Shumlin Administration’s plan was so bare-bones that it was almost doomed to fail. While their advice was ignored, how many millions did the Administration spend on inadequate plans, patchwork facilities, and extra costs? (One example: according to True, the state has paid more than $1 million since 2012 for sheriff’s deputies to monitor psychiatric patients in hospital ERs.)

And it turns out, to the surprise of no one who works in the field, that a 24-bed hospital costs nearly as much to run as the old 50-bed facility, and costs more on a per-bed basis because the foundational staffing needs are so high.

And, given that the new hospital has some of the same kinds of problems as the old one, I have to ask if our laws are out of whack. I mean, look: We’re talking about the two dozen  sickest people in Vermont, many of them violently, dangerously sick. The restrictions on restraint or medication without patient approval may be the best thing for the vast majority of patients; I believe different standards should apply to the very sickest. They are the ones least capable of exercising sound judgment, and most capable of inflicting harm on staff or fellow patients.

One commonality between the old hospital and the new is our strongly patient-centric laws. It seems clear to me that those laws are on point for the vast majority of patients, but that there should be a different standard for patients in the state hospital.

Shumlin waves the white flag

The governor’s number-one public policy goal is no more.

At a news conference today, Governor Shumlin pulled single payer health care off the table, saying the numbers simply don’t add up. Instead, he promised a continued effort to improve access to, and lower the cost of, health care in Vermont.

“This is the greatest disappointment of my political life,” he said, and that nails it. Single payer was one of the foundations of his initial run for governor in 2010. His promise to push for single payer set him apart in a crowded Democratic field and helped overcome doubts about his liberal bona fides.  That promise kept the Progressive Party on the sidelines in 2012 and 2014.

And now, it’s not gonna happen.

Oh, he promised a continued fight for a fairer and more accessible system, starting with the 2015 legislative session. But single payer is out until further notice. When asked, “If not in 2017, when?” he only answered in generalities.

As for the timing of the announcement, only six weeks after the election, Shumlin claimed that his team had just finished working the numbers last Friday and confirmed the bad news on Monday.

The numbers were unacceptably bad. Morgan True of VTDigger had reported that the financing mechanism would be based on an 8% payroll tax and a consumer premium imposed on a sliding scale. But the way the numbers shook out, the actual payroll tax would have to be more like 11.5%, and the premiums would have to be higher than expected. The result could punish the economy and leave many Vermonters with higher health care costs.

He cited several factors that moved single payer out of reach. Federal subsidies were not going to be as generous as hoped. The sluggish economic recovery meant fewer dollars coming into the treasury. That had led to state cuts in Medicaid payments that reduced federal support.

Also, the administration had decided a three-year phase-in for small businesses that don’t currently provide insurance was necessary to cushion the shock of a payroll tax. That phase-in meant substantially lower payroll tax revenue for the first three years.

Shumlin was clearly sensitive to the concerns of the business community. That, and his woodshedding in the November election. He saw single payer as a huge gamble that he was unlikely to win, and now is not the time to stick his neck out.

He also acknowledged that the troubled rollout of Vermont Health Connect cost him credibility on building a new health care system. “We must show we can deliver,” he said. “Vermonters have reason to question us, given the troubles with Vermont Health Connect.”

He emphasized all the hard work that’s been done to create Vermont Health Connect, bend down the cost curve, and lay the groundwork for a better system. And he promised a continued, all-out effort to improve the system. But single payer was his signature deal, and now he’s had to forego it.

Even if the delay is relatively brief — say, two years — single payer is almost certainly unattainable during his tenure in office.  The failure of single payer will be a big part of his legacy, and will significantly hamstring his ability to win back liberal and Progressive voters who’ve been skeptical of him.

Fair or not, today’s announcement confirms that skepticism. Let’s accept that the numbers are honest and the timing was just the way things worked out. Even so, the optics are bad.

There are many liberals who never believed Shumlin was serious about single payer. They will see their cynicism as confirmed.

This retreat will also lend great comfort to the foes of health care reform. A determined Democratic governor, with all the resources he could want, spent three years researching single payer, only to conclude that it wouldn’t work. The revised cost estimate for single payer — $2.6 billion a year — is almost exactly what Wendy Wilton, then-Republican candidate for Treasurer, estimated two years ago.

And the abandonment of single payer strips the governor of his signature issue. Aside from Tropical Storm Irene, his administration has been marked by incremental gains on a number of issues and blocking tax hikes. There haven’t been any high-profile accomplishments — which is why one of Shumlin’s re-election ads focused on GMO labeling, an issue he didn’t support until the last minute. And why a recurring theme in other ads was Irene recovery, something that happened in his first term.

Now we can now look forward to more incremental gains and belt-tightening. His downsized proposals for the 2015 legislature on health care were purely incremental in nature. None will generate headlines or fuel a grassroots movement.

The governor’s gonna have to pull a rabbit out of a hat somewhere to restart his political career. And his biggest hat is now empty.