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Hospitals: Speed Up Involuntary Meds

Vt. Weighs Case For Expedited Care

Montpelier — Vermont hospitals are seeking changes to Senate legislation that would streamline the state’s procedures for involuntary hospitalization and medication of psychiatric patients.

The hospitals hope to further smooth the way for medicating patients against their wishes.

Jill Olson, vice president of policy and legislative affairs for the Vermont Association of Hospitals and Health Systems, asked the Senate Judiciary Committee on Tuesday to allow a petition for involuntary medication of a patient to be filed at any time, rather than just jointly with an application for involuntary hospitalization, as the proposed legislation calls for.

Under current law, an order for involuntary medication cannot be sought until the involuntary commitment process is complete.

Olson said physicians are required to file a petition in court for involuntary hospitalization within 72 hours after a patient is admitted. However, it may not be possible to determine by then if involuntary medication is also needed, she said.

Under the proposed legislation, a hospital could miss the opportunity to apply for medication if the need wasn’t evident right away.

Under the hospitals’ proposal, a petition for involuntary medication could still be submitted before a judge considers the petition for hospitalization, Olson said.

“(Physicians) do want to be able to file a petition for the medication in advance of the full hearing, but they don’t want to have to do it jointly,” she said. Her group represents all Vermont hospitals.

Olson also outlined groups of patients she said should be fast-tracked through the hearing process. Anyone who is demonstrably dangerous to others or themselves, or those for whom a previous petition for involuntary medication has been granted, should be considered by the courts in a faster statutory framework, Olson said.

The hospital association didn’t offer any specifics for a fast-track framework, which isn’t contemplated in the Senate bill.

Finally, Vermont hospitals want to leave it up to judges whether to grant a stay during an appeal of a medication order, rather than having a stay be automatic, as it currently is.

The Department of Mental Health also has no way under current law to petition to have a stay lifted during the appeal process, Olson said.

Appealed cases can take as long as six months to be resolved, she said, and patients are not receiving needed treatment during that time.

“It creates flexibility and discretion for the judge where currently there is none,” Olson said.

The Senate bill includes no changes to the automatic stay.

The legislation, S.287, looks to speed up the process the state uses to determine if psychiatric patients should be given medication against their will. Hospitals and the Mental Health Department say some patients need treatment sooner than the system allows.

“There are some patients for whom time is the enemy and the longer they wait the sicker they get,” Olson said.

But mental health advocates say the proposal to fast-track some patients undermines the rights of Vermonters struggling with mental illness.

Jack McCullough, director of the Mental Health Law Project, said the hospitals have requested the change “in the guise of narrowing the scope of people who could get expedited hearings.”

“But they don’t narrow anything at all,” McCullough said.

Rather, the change requested Tuesday seeks to expand the list of people who qualify for expedited hearings, he said.

“Anyone who’s in the hospital involuntarily should meet criteria for being both mentally ill and dangerous. So they’re saying, ‘Well, we’re only going to apply this to people who are dangerous.’ That’s not any restriction at all. That’s everybody,” McCullough said.