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Vt. Groups Tussle Over New Mental Health Regs

Vermont is adopting new regulations for its mental health system, but the process has taken more than a year and the Department of Mental Health is struggling to come up with a proposal hospitals and patient advocates can accept.

The main area of contention surrounds who should tend to mentally ill patients within an hour after they have been involuntarily restrained or secluded.

Representatives of both sides shared testimony for more than two hours before the Legislative Committee on Administrative Rules Wednesday. The committee advised the groups to meet again with the Department of Health and come up with a new proposal by the next meeting on Sept. 19.

The Centers for Medicare and Medicaid Services require that a physician or an independent licensed practitioner, who can be a nurse, make a face-to-face evaluation of the patient within an hour after seclusion or restraint, which can include involuntary medication.

Patient advocates and members of the advocacy group Disability Rights Vermont argued that only physicians should be allowed to perform the evaluations.

But hospital officials said requiring physicians to conduct face-to-face evaluations wastes resources and not always necessary.

“To know an individual, to know what might trigger them and makes them agitated is very important,” said Gordon Frankle, chief of psychiatry at Rutland Regional Medical Center.

A physician called in to a clinic might not know the patient and could make a different, and perhaps less beneficial, judgment than a nurse who has worked with that patient, he said.

The Department of Mental Health wants the two sides to work out the differences, but the two side so far haven’t been able to agree.

The one-hour requirement is still the rule; the argument is over “who is going to do it, what it’s going to cost and how easy it will be to provide the service,” said David Mitchell, director of nursing at the Department of Mental Health.

As of now, requirements vary from hospital to hospital, Mitchell said.