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Vt. Weighs Change In Patient Restraint

Montpelier — A former mental health patient told an advisory panel Monday that a proposed rule change offered by the state is designed to make it easier for hospitals to drug psychiatric patients against their will and compared patients who will be subjected to such treatment to animals.

“Being treated like a veterinary patient is not going to help the person have buy-in and trust,” Xenia Williams, of Barre, told the meeting of a panel advising the state Department of Mental Health as it considers lifting a requirement that a physician personally observe a patient before psychiatric drugs are administered.

“They want it to be as convenient as possible and as cheap as possible — get ‘em in, drug ‘em and get ‘em out,” said Williams, a former patient who also told the Mental Health Transformation Council, “I’m vehement about this because I’ve been force-drugged.”

The rule was in place at the former Vermont State Hospital in Waterbury, which was closed after being flooded by Tropical Storm Irene in 2011. Since then, the state has moved to a more dispersed mental health system, relying on the emergency departments and mental health wings of Vermont’s other private, nonprofit hospitals.

Hospitals have said they can’t recruit — or afford — enough psychiatrists to have them available 24/7. The new rules would allow nurse practitioners or physicians’ assistants to make the decision to medicate patients, or place them in seclusion or restraints.

A public hearing is scheduled for Wednesday.

Rules drafted by the department and put before the Legislature’s Administrative Rules Committee for review in September were withdrawn in the face of criticism from mental health advocates.

Since then, Mental Health Commissioner Paul Dupre said he and other department officials have been working to reach consensus with the advocates. Another draft is expected to be presented to the committee next month.

Advocates pointed to a provision in a 2012 state law setting up the new mental health system that patients in the private hospitals had to be afforded the same rights they had at the state hospital. Jack McCullough, director of the Mental Health Law Project at Vermont Legal Aid, said this meant a physician needed to meet with a patient before the patient could be medicated against his or her will because that was the practice at the Waterbury facility.

If the department persists with the change, “It’s quite likely there will be a challenge in court,” McCullough said.

But Dupre argued in an interview after Monday’s meeting that health care had changed in recent years to allow nurse practitioners and physicians’ assistants to write prescriptions. He said patients’ rights still can be safeguarded in such an environment.

A.J. Ruben, an attorney with the group Disability Rights Vermont, said the use of seclusion, restraints and forced medication were less matters of medicine than of civil rights.

As the rules changes are contemplated, he urged officials to “ask yourself in each instance: Are we making it easier or harder to use violence against patients?”