Tag Archives: Tropical Storm Irene

Let’s Not Fix the Mental Health System and Say We Did

Oh, great. The state’s Department of Mental Health is finalizing a ten-year plan to improve the state’s inadequate mental health care system. The highlights, errrrr lowlights, include:

  • It doesn’t appear to address the system’s biggest shortfall, i.e. the lack of resources for the worst cases.
  • It echoes the approach promulgated by the Shumlin administration and legislature after Tropical Storm Irene. Which, for those just joining us, failed to do what it promised.
  • There seems to be nothing about the lack of resources in the prison system.
  • There’s nothing about providing more funding to put the plan into action.

So there’s that.

The report focuses on linking treatment of mental and physical illness, “eliminating stigma around mental health and expanding community-based treatment programs.” That’s nice. But meanwhile, people with profound mental illnesses continue to be stuck in hospital emergency rooms in greater numbers and for longer periods.

That has nothing to do with “stigma” or “community-based treatment programs.” It has everything to do with Vermont’s lack of capacity to treat our severely mentally ill. That’s been a problem since Irene damaged the state hospital at Waterbury.

Continue reading

The Bourgoin reverberations

I imagine Vermont’s psychiatric community is nervously anticipating the fallout from the horrible wrong-way crash on I-89 that killed five high school students. Lawmakers will be looking to assign blame and prevent future tragedies, and they’ve often used the psychiatric community as a whipping boy.

There are things the Legislature and administration could do, but based on past performance, I have little faith they will come to the right conclusions.

A couple of points. First, the Howard Center is in deep shit. Second, here’s the lesson I hope is drawn from this: when you have an under-resourced mental health system with a chronic shortage of inpatient beds, you foster a bias against hospitalization.

Continue reading

Minter airs general election TV spot for the primary, hm.

Following in the footsteps of Matt Dunne, Sue Minter has put out her first TV ad for the gubernatorial primary. And following in the footsteps of Matt Dunne, her ad raises strategic doubts in my mind. (Not counting the missed opportunity to use “Minter Fresh” as the tagline.)

(Gee, why am I not a campaign manager?)

The ad focuses on her work as Irene Recovery Officer, which strikes me as a questionable place to start her TV effort.

First of all, Irene was a traumatic event, but it was five years ago already. It’s been front and center in her campaign since day one. Doesn’t she have anything more recent to brag on?

Second, the ad is misleading on a key point: she was the second Irene Recovery Officer. She succeeded Neale Lunderville, who occupied the post during the critical first few months of the operation. Irene happened in late August 2011; Minter took over in January 2012.

(This is the same convenient omission made on Minter’s Wikipedia page by FourViolas, an editor who’s made 13 changes to the page since mid-March.)

Continue reading

More Wiki-intrigue: Who is “FourViolas”?

Recently, I’ve written a couple of posts about Peter Galbraith’s Wikipedia entry and the extremely assiduous pro-Galbraith editing activity of two anonymous persons — Devotedamerican and Westencivil.

Well, now I’ve got more intrigue to report, and it involves one of Galbraith’s competitors for the Democratic gubernatorial nomination.

Those who’ve been following the Galbraith story way too closely for proper maintenance of mental health will recall that the activity of Devotedamerican was brought to attention by another Wikipedia editor.

The plethora of edits was flagged to VTDigger by FourViolas, a Wikipedia editor from Vermont who reported having stumbled upon Devotedamerican’s work while inserting policy positions on the pages of all the Vermont gubernatorial candidates.

In an email, FourViolas asked to be identified only by Wikipedia username, saying the community appreciates anonymity.

Yeah, well, here’s the thing. FourViolas has been extremely busy editing Sue Minter’s Wikipedia page. FourViolas’ first edit came on March 17; after that, s/he was inactive until May 21. Since then, FV has been responsible for 12 more edits. Most of them add biographical detail fleshing out Minter’s experience and qualifications.

One of FourViolas’ edits conveniently omitted an important fact. See if you can spot it:

Continue reading

The budget mess, again

One of the annual features of the Shumlin Era is the battle to close a budget gap*. There are reasons for this: the rising costs of (1) operating a government (mostly health care), (2) operating public schools (mostly health care), and providing social services (mostly health care).

*To be fair, it was also a feature of the Douglas Era, but the dynamic was different: Republican governor versus Democratic legislature. 

And then there’s the revenue side. Vermont is suffering from a creaky tax system that doesn’t reflect current economic realities, and is bringing in less and less money over time.

The Legislature is now in the throes of dealing with Budget Gap 2016, which has many of the features of past editions. Cries of doom, unexpected revenue upgrades, patently unworkable/unpopular money-raising ideas from Shumlin’s crack policy staff, and lawmakers trying to find alternatives. This year, we also have a significant difference between administration and Legislature over the size of the budget gap; per VTDigger, House budget writers say the administration omitted more than $9 million in basic government operations from its proposed budget…

…including a pay increase for state workers (estimated at $2 million to $6 million, depending on the results of a fact finder’s report and ongoing contract negotiations), pay increases for child care and direct care workers ($1 million each), and funding for the Low Income Home Energy Assistance Program ($4 million).

Shumlin’s modest proposals for new spending have already been killed by the House Appropriations Committee, whose first priority is closing the gap between current obligations and state revenue.

It’s a depressing Rite of Mud Season that has drained the energy of the Democratic caucus, party, and electorate.

Continue reading

Our mental health sandcastle, part 1

And every one that heareth these sayings of mine, and doeth them not, shall be likened unto a foolish man, which built his house upon the sand:

— Matthew 7:26

Here’s something that close observers won’t find surprising at all: fresh signs of trouble in Vermont’s mental health care system. In my next post: staffing shortages and other troubles in the system’s crown jewel, the Vermont Psychiatric Care Hospital. This time: Again with the Brattleboro Retreat.

The Vermont attorney general’s office is conducting a criminal investigation into the Brattleboro Retreat following a whistleblower’s complaints about alleged Medicaid fraud at the private psychiatric hospital, The Associated Press has learned.

Ruh-roh. The AP’s Dave Gram quotes AG Bill Sorrell as characterizing the probe as “not narrow in scope,” and that it goes beyond the whistleblower’s complaint into other areas.

As for that complaint:

[Former Retreat staffer Thomas] Joseph alleged a yearslong pattern of instances in which, if overcharges showed up in patient accounts, Retreat staff would not make refunds but instead would change the account to reflect a balance of zero.

If the accusations are true, the Retreat would be in deep shit with Medicaid, which (according to Gram) supplies the Retreat with roughly one-fourth of its total funding.

Yeah, that’s not an enemy you want to make.

Continue reading

Shumlin identifies the real culprit: “Anonymous blog sites”

In response to the killing of social worker Lara Sobel and three other women, Governor Shumlin has issued a plea for change. But he’s not calling for tougher gun laws or even better enforcement of the ones we have*. He’s not calling to boost staffing to make the Department of Children and Families more effective. Heck, he’s not even calling for better security arrangements for state workers — although he has “ordered a full review of our security procedures,” so we’ll see where that goes.

*Reportedly, Jody Herring should not have been able to acquire the gun used in the murder spree.

The real problem is “hateful speech” delivered on “anonymous blog sites and unfiltered social media.”

I realize the Internets provide an easy target in times like these, especially for a politico capable of writing “anonymous blog sites” without a trace of irony. But even aside from that inelegant phrase, there’s a real “You kids get off my lawn” feel to the whole piece.

Yes, “anonymous blog sites” can be wretched hives of scum and villainy. But is this our real problem? Was Lara Sobel’s death triggered by “anonymous haters who use vicious language to incite public ill-will toward others,” as Shumlin seems to argue?

Continue reading

The best darn Plan B in state politics (UPDATED)

Update: I don’t know how this escaped my notice (and that of the entire Vermont political media), but WCAX-TV beat me to the punch by about six weeks. See addendum below.

The Democratic race for governor is a three-way (at least) tossup, with no one willing to lay odds on a single contender. The Republican race, on the other hand, appears to pose a stark contrast: if Lt. Gov. Phil Scott runs, he would enter the 2016 gubernatorial race as the favorite. If he doesn’t run, the VTGOP will be left with an unappetizing choice of steam-table leftovers. Or maybe Bruce Lisman, the canned succotash of the Republican buffet.

However… another name is being bandied about the political rumor mill, and it’s one hell of a good one.

Neale Lunderville.

Let me make it clear, he’s not running for governor. He’s not even running for running for governor. If Phil Scott does run, he’ll have Lunderville’s wholehearted support. Or so I hear.

But if Scott chooses not to run? Lunderville could be a formidable candidate. He’s got solid Republican credentials from his service in the Douglas administration. He knows how to run a campaign, dealing the dirt so His Nibs could sail above it all. And, thanks to the generosity of our Democratic leaders, Lunderville has steel-plated credibility as a bipartisan fixer.

Continue reading

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.

Is this the time for business as usual?

It’s an annual rite at this time of year: a changeover in the upper levels of the administration. It usually involves some key departures, a shuffling of the deck, and the elevation of those who have served in a lesser capacity.

The latter began on Wednesday for the Shumlin Administration, with promotions for press liaison Sue Allen, campaign manager Scott Coriell, and education adviser Aly Richards. Loyal servants, rewarded for their work.

But should they be?

I have nothing against these folks. As far as I know, they deserve their promotions. But a broader question is on my mind:

Praise and promotions were freely distributed when Shumlin was riding high. Should the same be true after a poor administrative year and a disastrous campaign?

Further: Are these promotions a sign that Shumlin, at some fundamental level, doesn’t get it? That it’s business as usual on the fifth floor?

The Governor has made the right noises. But the current situation calls for a lot more than that. You can say “The buck stops here” all you want, but if the buck stops and gets tossed in a drawer, it’s a meaningless statement.

After the election, I saw a gleam of hope: Shumlin does his best work in crisis, as we saw after Tropical Storm Irene. This election was the closest thing to a personal Irene for Shumlin. My hope was that he would seize the opportunity, thoroughly evaluate everything he and his people do, and boldly set a new course.

So far, given his frequent deferrals to legislative leadership and his dispensation of Jobs For The Boys (And Girls), I’m having my doubts.

In addition to a personal reckoning by Shumiln, there ought to be a personnel reckoning. During the campaign, I wrote that the continued problems of Vermont Health Connect called for some clear direction and, probably, the rolling of some heads.

In addition to Doug Racine’s, that is. Racine may have had his failings at Human Services, but it wasn’t like he got a lot of help from Shumlin. Plus, he had little to do with Vermont Health Connect. He was expendable, not because he was the biggest problem, but because he wasn’t really part of the team. Mark Larson, who was far more responsible for VHC but was clearly one of the boys, was shunted to the side but kept his title and is still drawing a salary for duties and responsibilities unknown.

Is Governor Shumlin capable of evaluating his staffers and functionaries with the cold eye of reason, and demoting or defenestrating those who’ve contributed to his administration’s malaise?

We’ll see. He promises more personnel changes to come. But I have to say I’m not optimistic. If the changes have more to do with the desires and ambitions of his staff than with a sorely-needed overhaul of the Shumlin Machine, then his third term is off to an inauspicious start.