State hospital employees feel squeeze, fear future

All Vermont State Hospital employees are facing an uncertain future.

This week, the Legislature is debating plans to replace the state hospital in Waterbury, which was flooded by Tropical Storm Irene. 

But workers living in and around Waterbury are also struggling with their commute. Many are driving long distances each day to work in Rutland, Springfield or Brattleboro, or staying overnight there during the week. 

Depending on what the Legislature decides, these temporary arrangements may become their permanent options for employment. 

Gov. Peter Shumlin has proposed establishing three or four centers for acute and secure psychiatric care across the state, including a 16-bed state-managed facility close to Central Vermont Medical Center in Berlin. 

The plan also includes a 14-bed unit within the Brattleboro Retreat, a six-bed unit in Rutland, and up to 12 beds at Fletcher Allen Health Center in Burlington until the central Vermont facility is built.

The administration is committed to helping Vermont State Hospital employees make the transition to the new system, Shumlin said in an interview with the Waterbury Record.

“We are going to do everything in our power to help reassign this hard-working and incredibly competent workforce,” Shumlin said. “We are going to give them as many options as we can.”

Mental-health workers and advocates gathered at the Statehouse Tuesday to tell legislators that Shumlin’s proposal would not provide the best care for patients with the most severe mental illness. They believe a larger central Vermont facility, with at least 30 to 40 beds, is needed.

But a replacement hospital in central Vermont, no matter its size, is not likely to be located in Waterbury. Draft legislation points to a proposed location “contiguous to the Central Vermont Medical Center.”

The Federal Emergency Management Agency would probably not pay for new hospital construction at the State Office Complex because it is in a flood plain, Mike Kuhn, project manager for the Buildings and General Services Department, told the Legislature last week. Elsewhere in Waterbury would not make sense because of the administration’s desire to locate the new units in or near existing hospitals.

Medicaid Rule

An obscure federal rule about reimbursements for mental-health care hangs over the debate about the future of the hospital.

The federal government will not fund care for adults through Medicaid that occurs in what the law calls an “institution for mental disease.” That is defined as any freestanding psychiatric facility with more than 16 beds. 

Under particular circumstances, the government sees a psychiatric unit that’s part of a general acute-care hospital through a different lens, according to an analysis done in 2006 by the Vermont Legislative Council, which advises the Legislature.

However, the 54-bed Vermont State Hospital did receive Medicaid reimbursements until the federal government stopped paying because of deteriorating conditions at the hospital. Those payments occurred because Vermont has an agreement with the federal government to receive its reimbursements as a block of funds, which does not distinguish between mental-health care and other care. 

Without the agreement, the difference between operating a new 16-bed facility in Berlin versus a new 25-bed facility would be about $9 million a year, according to the Joint Fiscal Office, which issued an analysis of Shumlin’s proposal last week. 

The Vermont State Employees Association wants to see a replacement hospital with 54 beds, the same number that were in Waterbury. 

“Any decisions about how Vermont’s mental-health system operates in the next 50 years should be based on need, as opposed to whether or not federal assistance will be available,” the association said in a flyer for legislators.