In the ongoing struggle to recover from Tropical Storm Irene, Governor Shumlin has done a lot of things very well. Top marks virtually across the board — handling a catastrophe so smoothly that I don’t think he gets enough credit for it. The Republicans are ignoring Irene because they can’t find anything to take issue with.

But there’s one big exception: treatment for the mentally ill. The entire system is severely overtaxed. Mental health staff are working as hard as they possibly can just to keep the system functioning — barely. Patients aren’t getting the treatment they need, and are often in unsafe situations. There have been attacks on staffers. A major incident could happen at any moment — one that would catapult this issue onto the front pages and into the center of this year’s political debate, and call into question Governor Shumlin’s carefully manicured reputation for good management.

I’m not talking about the plans for long-term reform or the debate over the size and configuration of a state hospital replacement. I’m talking about the jury-rigged, bailing-wire-and-duct-tape mess we’ve got today. And will continue to be stuck with for quite a while.

The Governor and the Legislature deserve credit for moving quickly to craft a long-term plan. But the short-term plan seems to consist of “keep costs down and hope it doesn’t blow up.”

Well, even without a real blow-up, the mental health care system is starting to become a major issue in the media.

Exhibit A: In a Bloomberg News article about mental health care nationwide, Vermont is the poster child for inadequacy and neglect. The story, entitled “Sleeping in Vermont Dumpster Shows Psychiatric Cuts’ Cost,” begins with the sad case of a Burlington woman who clearly needs some kind of inpatient care, but in the wake of Irene, there simply isn’t any space.

…private-hospital emergency rooms have been backed up with mentally ill patients — some handcuffed to ER beds for as long as two days. Dozens of people are turned away each month without being admitted, and calls to Burlington police about mental-health issues increased 32 percent over the prior year.

The article includes this cheery observation from Dr. Robert Pierattini, chair of psychiatry at UVM: “I think we may see a rise in suicide.”

There has been talk of an 8-bed temporary inpatient facility in Morrisville, or possibly a similar arrangement in Waterbury. That would not come anywhere near solving the problems, although it would ease the pressure a bit. But when will something happen? In a couple of months, we’ll be commemorating the first anniversary of the Irene disaster. It’s taking an awfully damn long time to create a “short-term” fix.  

“I worry every day,” Patrick Flood, the state’s mental health commissioner, said in a telephone interview last month. “I have on my screen right now the case of somebody we have to find a bed for tonight and there’s no apparent bed.”

Your anxiety is duly noted, Mr. Flood. It would be more compelling if you were one of the front-line people in health care or law enforcement, or the friends and family of people who need treatment; they’re the ones who actually deal with the consequences, the danger and the fear on an everyday basis. You’re the one in your office, looking at your screen.

Exhibit B: Another thing Patrick Flood is probably worrying about. A big story posted yesterday on VTDigger by Anne Galloway entitled “Brattleboro Retreat faced regulatory violations over drug overdose as lawmakers approved plan for mental health system.” (A plan that put the Retreat in a very central role and gave it a bunch of state money.)

In January, a patient named Jared Fitzpatrick grabbed some methadone off a nurse’s cart, overdosed, and died. His death triggered intensive reviews by state and federal regulators. The Retreat must implement a corrective action plan or face the loss of federal funding for some patients.

The problems at the Retreat occurred just weeks before the Legislature approved plans to rely on the psychiatric facility as part of its complex plan to replace the Vermont State Hospital with a new decentralized community mental health system.

And yet, officials from the Retreat and the Administration did not inform lawmakers of the nature of the incident or the investigations. In fact, if you read the exchange between Retreat CEO Rob Simpson and a Senate committee about Fitzpatrick’s death, it’s obvious that Simpson carefully framed his responses in a deceptive manner. Example:

“…we have not heard back from the medical examiner with any clarity on this death,” Simpson told lawmakers. “It’s unclear …”

Sen. Kevin Mullin interrupted: “But it was from natural causes, right?”

Simpson said,”Well, we don’t know, the medical examiner’s preliminary report is that, indeterminate cause of death.”

…Yet, the medical examiner’s office had preliminarily determined the cause two weeks prior. On Jan. 23, Steven Shapiro, M.D., noted the pending cause of Fitzpatrick’s death as an overdose of prescribed and non-prescribed medications.

It’s only one incident, but (a) it might have made a difference in how the Legislature viewed plans to give the Retreat a larger role in the mental health care system and give them $5.3 million to upgrade its facilities… and (b) as Jim Croce put it, “you don’t tug on Superman’s cape” by omitting key information from your testimony at such a crucial stage. Or, as Digger put it:

Though Fitzpatrick was not a ward of the state – he was a private patient – lawmakers and advocates say his death raises questions about the reliability of care offered at the Retreat and the ability of the Legislature to adequately monitor private hospital facilities receiving taxpayer dollars.

…Ironically, given the concerns about proper levels of oversight, the Legislature approved the reforms without knowing that the Retreat was in trouble with state and federal regulators.

And that’s a huge issue with Governor Shumlin’s future plans. They depend on private facilities to largely replace a state hospital. Are we going to be able to trust the Retreat to hold up its end of the bargain? And can we trust the Retreat — and the Administration — to be transparent when things don’t go according to plan?