By PAULA TRACY, InDepthNH.org
CONCORD – To address the state’s adult mental health emergency room boarding crisis following a state Supreme Court ruling, the Department of Health and Human Services sought a bill to allow professionals more time to evaluate people before making an involuntary emergency admission, but the amendment itself ran out of time in the legislative year and was recommended to be killed unanimously by a Senate committee Tuesday.
This week marked the first time in more than a year that there were no adults waiting for more than three days for a mental health evaluation in a hospital emergency room, but Lori Shibinette, the commissioner of Health and Human Services, said long-term issues need to be addressed.
However, the number of children waiting in emergency rooms increased to 33 as of Tuesday, according to the state’s Department of Health and Human Services’ website. Children are not covered in the Jane Doe case.
She floated a concept that would allow for medical protective custody to be extended in cases where a decision needs to be made before an Involuntary Emergency Admission is made.
But during a public hearing on the amendment to a tabled and non-germane bill, the idea was criticized as an attempted end-run around the Supreme Court’s Jane Doe decision three weeks ago which holds that the state must provide a hearing for individuals within 72 hours of being admitted to an emergency room to allow for due process rights.
Sen. Jeb Bradley, R-Wolfeboro, who was recently asked by Health and Human Services officials to place the amendment on to the biennial budget bill, but refused, and instead put the amendment in House Bill 565 to allow for a public hearing.
But with little time left in the legislative year, he said the time in this session had simply run out to come up with an adequate legislative solution and urged the Senate Health and Human Services Committee to kill the amendment to allow for working groups to spend more time coming up with a solution this summer.
The committee unanimously agreed and will recommend to the Senate that the bill be retained so that it can immediately be addressed if a solution comes in that study by November.
The bill also had a provision that would allow for private care providers to also come into the state to help with the crisis but it was criticized for a lack of definition and concern that it would impact existing care providers.
The Senate may still act but the rules would need to be suspended and it would require a two-thirds vote of the Senate to continue on.
Shibinette said many of the people who receive an initial IEA are dropped following more scrutiny of their situation and that impacts the intake numbers at the state hospital for the mentally ill.
Dr. Jonathan Ballard, chief medical officer for the department, said doctors “need time to assess” and this could be a tool to help them with that determination.
The patients could be high on drugs, schizophrenic, an Alzheimer’s patient or having other afflictions which would not require them to be admitted to the state hospital yet currently, they are placed on a list.
Shibinette said nothing in the provision would preclude an immediate IEA but it would give time for other cases that are unclear to be evaluated.
She said the bill would allow for three days “to get them to the right path” for treatment.
But opponents said that would effectively allow people to be held in a windowless room without any treatment for as much as seven days without due process and that it would add to suffering in addition to being an end-run around the recent court order.
Opposing aspects of the amendment as written were Ken Norton of NAMI NH, Gilles Bissonnette, of the ACLU-NH and the class counsel for the Jane Doe case, and Lisa Madden, president of Riverbend Counselling along with a host of state representatives, former mental health care patients and rights advocates.
No one outside Health and Human Services spoke in support of the amendment.
Most of the speakers, however, agreed that the state has made great strides in addressing the adult boarding crisis in the past weeks since the ruling and the governor’s emergency orders have helped to get money and resources and barriers dropped to providing emergency care.
Shibinnette said in the past two weeks the state has been compliant with the Jane Doe court order though she noted that there still needs to be a community solution at the back door, as the state opens up more beds at the State Hospital at the front door.
The state has recently completed a 10-year mental health plan and a number of measures are moving through the legislature to provide services and funding to address this crisis.
But opponents of the amendment said due process rights of the individual cannot be pushed aside while evaluations continue.