The fight over laws governing involuntary medication has turned into an emotional debate, as quickly became evident at a public hearing Thursday night in Montpelier.
Deb Ward-Lyons was among the parents of mentally ill children to speak out in favor of legislation that would expedite the forced medication process. And when it was her turn to speak, she recited words written by her son in the midst of a psychotic break.
“I’m Satan. I’m going to cut your head off. I’m Satan. I’m going to cut your head off,” Ward-Lyons said. “How about I kill you? Don’t repeat yourself. Don’t repeat yourself. Don’t repeat yourself.”
Ward-Lyons’ son lives successfully now with the schizophrenia that previously landed him in the hospital. But the Burlington mother said it wasn’t until his doctors won a court order to administer involuntary medication that her son could begin to heal. And like other parents of mentally ill children who testified, she says that the court process took far too long.
“Sometimes, my son's mind didn't realize it needed help, help imposed from others," Ward-Lyons said. "Our laws need to do a better job supporting those who are challenged with mental health issues. These individuals deserve a speedy court process."
"Sometimes, my son's mind didn't realize it needed help, help imposed from others. Our laws need to do a better job supporting those who are challenged with mental health issues. These individuals deserve a speedy court process." - Parent Deb Ward-Lyons, speaking in support of forced medication bill.
Hospitals, doctors and parents like Ward-Lyons want lawmakers to speed up the process used to determine whether mentally ill patients should be medicated against their will. But advocates say the proposal threatens the civil rights of vulnerable Vermonters.
Lawmakers will have to weigh testimony like Ward-Lyons against the stories of former patients like Laura Sisson, who told lawmakers that in her case, forced medication only made her condition worse.
“Forced medication for me set into motion a vicious cycle of re-traumatization and crisis that ate up six years of my life that I’ll never get back,” Sisson said.
At issue isn’t whether doctors should be able to seek a judge’s order to administer involuntary medication. Rather, lawmakers are mulling changes to the process used to determine whether that involuntary medication can take place.
Tom Huebner, executive director of the Rutland Regional Medical Center, said it takes his hospital 80 days on average to secure the involuntary treatment order. Huebner said the delay is bad for patients, from a clinical perspective. And he said the inability to treat violent patients has created dangerous conditions for staff.
Huebner also said ailing patients are stuck in psychiatric wards longer than they need to be there. He said that has exacerbated the shortage of mental health beds that Vermont has been struggling with since Tropical Storm Irene.
“When the system’s clogged up, and someone’s waiting 80 days for treatment, you need an awful lot of beds to fill that demand,” Huebner says.
"Forced medication for me set into motion a vicious cycle of re-traumatization and crisis that ate up six years of my life that I'll never get back." -Laura Sisson, testifying against the bill.
The proposed legislation would expedite the hearing process, and allow hospitals to make their cases before a judge 10 days after a patient is committed. The bill would also allow for involuntary commitment and involuntary medication proceedings to occur simultaneously. Currently, hospitals can’t seek forced medication orders until the involuntary commitment process is complete.
Jack McCullough, director of the Mental Health Law Project run by Vermont Legal Aid, said the legislation would erode the due process rights of patients.
McCullough said patients sometimes need time, not medicine, to emerge from crisis. And he said many patients targeted for involuntary medication by doctors when they first arrive in the hospital enjoy a successful recovery without pharmaceutical intervention.
By speeding up the involuntary medication process, McCullough said Vermont will force substances upon patients who in many cases would have done better without them.
McCullough points to data from 2013 as evidence. Of the 445 involuntary commitment cases filed with courts last year, only 66 went on to involuntary medication hearings. If involuntary commitment and involuntary treatment proceedings are not only sped up, but undertaken simultaneously, as is being proposed, than McCullough says far more of those 445 patients would have had medication forced upon them.
McCullough said he sympathizes with the plight of parents like Ward Lyons. But he said the Legislature needs to consider the interests of the population as a whole.
“I think they’re looking at it in the short term when they should be looking at it in the long term,” McCullough said. “If people are forcibly medicated, that does lasting damage to their relationship with the treating sources, their relationship potentially with the family, and their relationship with the mental health system.”
Luke Shalen is so opposed the involuntary medication proposal that he revealed publicly for the first time Thursday that he has schizophrenia. Shalen, a Winooski resident who works at the Department of State’s Attorneys and Sheriffs in Montpelier, has been hospitalized three times, most recently in 2008. And he said he fared much better as a patient when he had the time to decide for himself whether medication was right for him.
Shalen said he’s particularly concerned about the shortage of mental health beds being cited as a motive for the changes.
“I find it incredible that part of the response to the 2011 closure of the Vermont State Hospital is to compensate for the lack of adequate hospital facilities for patients by making it easier to forcibly medicate them,” Shalen said.
Dr. William Frankle, a medical doctor who works on the psychiatry wards at Rutland Regional Medical Center, said that for some psychotic patients, medication is imperative. He said the issue isn’t whether or not the patient needs medication, but how long it will take before doctors are cleared to administer it.
“They’re very disconnected from reality,” Frankle said. “And it is impossible to interact with them in a reality-based manner when those delusions or those paranoid thoughts are present.”
McCullough said that under current law, people who need medication eventually get it. And he said the time between involuntary admission and court hearing is key to protecting the rights of people who don’t.
“If cases are rushed to trial on the timelines that they’re talking about, the attorneys representing the patient will not have adequate time to prepare the cases, prepare to defend against the claims that are made, prepare to cross-examine the state’s witnesses,” McCullough said. “And the fairness of the process is definitely in question.”
The bill is currently in the Senate Judiciary Committee, where it has the support of that committee’s powerful chairman, Bennington Sen. Dick Sears. And the Shumlin Administration has given its strong backing to the legislation. Hospital executive Huebner said the bill is the single biggest priority for his organization this year.
“The decision of whether the state of Vermont should in some instances involuntarily medicate and involuntarily commit people to an institution was made years ago,” Sears said. “The issue here is what is the court process that one goes through that can ensure their rights ... but at the same time do it in such a way that it doesn’t take six to 10 weeks, or in some cases 10 months.”
