• A necessary reform
    January 30,2014
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    The recent editorial on S.287 (“Safety vs. rights,” Jan. 24) inaccurately describes the current legal process as well as what the bill proposes to change, so it comes to the wrong conclusions.

    Hospitals and state officials have been concerned about Vermont’s judicial process for psychiatric patients since long before Tropical Storm Irene. Annual Department of Mental Health reports, under many commissioners and several administrations, have called for reform. We applaud the Legislature for taking up these concerns this year.

    We see first-hand what happens to the very small number of patients in severe mental health crisis who refuse treatment and with whom engagement on a therapeutic level is not possible. These patients are very ill. Many behave in ways that are humiliating or violent, for which they often feel remorse when they begin to recover. Their choices about treatment are not “autonomous” because they do not know that they are sick. For these patients, time is the enemy. They become more ill as time passes, and their recoveries take longer than if we’d helped them sooner. It is on behalf of these patients that clinicians petition the court for involuntary medication.

    The piece inaccurately asserts that “authorities must wait at least 40 days after the involuntary commitment of a patient before gaining approval for involuntary medication” and that the bill would “eliminate the 40-day delay.” Under current law, a hospitalization hearing is required no more than 20 days from when the state applies. In reality it often takes longer — sometimes much longer — before a case is reviewed by a judge. In the meantime, the individual remains in a locked hospital unit, absent judicial review, for weeks or months. The bill actually enhances oversight and ensures access to independent judicial review by requiring judges to review the paperwork authorizing hospitalization for “probable cause” shortly after admission. This is in addition to, not in place of the full hospitalization hearing required under current law. Involuntary medication could not be authorized through the probable cause review.

    The bill’s intent is to ensure that individuals in psychiatric crisis who are hospitalized against their wishes have timely access to a judicial review process. It would provide more flexibility for judges to respond to individual cases while leaving the fundamental system intact. A faster time frame could be invoked in cases where patients are very violent, even when hospitalized, or have been through the process and been successfully treated before. Judges would have the option to schedule a medication hearing on the same day as a full hospitalization hearing. The lengthy waiting periods for judicial review are not new since Tropical Storm Irene and will not go away when the new state hospital opens. S.287 represents a thoughtful and targeted approach to some of the long-standing limitations of Vermont’s current judicial process. We strongly support its passage.

    Jeffrey McKee, Ph.D., is director of psychiatric services at Rutland Regional Medical Center. Gordon Frankle, M.D., is chief of psychiatry at RRMC. Thomas Huebner is president of RRMC.
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