Psychiatrists and Activists Make Big Difference in Vermont

Administrators at Fletcher Allen Health Care in Burlington, Vt., knew Anne Donahue well. She had played an important role in coordinating opposition to their controversial plan to move the hospital’s inpatient psychiatric unit off site (Psychiatric News, June 7). They never expected, however, that four of their own senior psychiatrists would be their undoing before a critical state regulatory panel.

For a little over a year, Donahue devoted most of her time to the mission of blocking the Burlington hospital’s plan to move its inpatient psychiatric unit from its main campus to a remote site, isolated from the rest of the medical and surgical services. She doesn’t even want to estimate how many letters and e-mails she sent out on the issue as she informed everyone she thought should know that the Fletcher Allen plan would decrease the standard of care, put psychiatric patients at increased risk, and dramatically increase the stigma associated with mental illness.

For Donahue, a Georgetown University–trained attorney, this fight was more than just what is good for patients or what is “right.” This fight was a bit closer to home. Donahue herself has struggled with recurrent major depression, now in remission.

“I am, by definition, a consumer,” Donahue told Psychiatric News. As such she is an integral part of a statewide patient advocacy group called Vermont Psychiatric Survivors and is editor of the group’s newspaper, Counterpoint.

It has been in that role as editor that she “played investigative journalist,” she told Psychiatric News, gathering substantial amounts of information on the Fletcher Allen project and coordinating its dissemination to a vast array of interested parties.

Donahue’s history with depression goes back 15 years. She was working in New York for a charity that helped homeless children and teens when her illness first struck. With treatment, she returned to her vibrant, workaholic self. She was instrumental in exposing the plight of homeless children in New York City and soon moved to Los Angeles to establish a similar program. In 1990 she received the Jefferson Award for her efforts in public service. She then “came home” to Vermont to build a house on family land and “take a sabbatical.”

In Vermont Donahue felt as though she’d left behind the depression that had previously plagued her, but she soon discovered that was not the case. Over the ensuing few years, Donahue would come to know Fletcher Allen Health Care’s psychiatric unit firsthand, spending six days there in 1994. It would be the first of several stays in Vermont and New Hampshire hospitals. Over the last few years, however, she has been free of depression.

Early on in Fletcher Allen’s plans to relocate the mental health inpatient unit, Donahue did not pay much attention to the local debate. But then she heard that the psychiatric patients were the only ones that would be moved off the main campus in the hospital’s massive renovation project.

Donahue began pouring all of her legal expertise into discovering documentation and finding appropriate legal ways to stop the plan. She was instrumental, state regulators confirmed to Psychiatric News, in uncovering and providing to the state “significant input that we otherwise would not have been privy to.” She helped to expose a little-known lease restriction on the scope and type of care that could be offered at the off-site location for the proposed new inpatient unit after it was discovered by another patient advocate. This restriction was based on religious restrictions imposed by the Catholic Church, which indirectly owns the proposed site. In addition, Donahue helped pursue alternative architectural plans that showed that contrary to hospital administrators’ testimony, there were viable options for keeping the unit on the main campus.

When the state of Vermont held hearings before the Public Oversight Commission (POC) to develop a recommendation for or against the project to state regulators, Donahue helped coordinate testimony on many of these issues, as well as the personal aspects of mental health patient care.

Psychiatrists Step Forward

According to nearly everyone involved, including Donahue, it seems that the real turning point in the fight against Fletcher Allen took place during the second day of hearings before the state POC.

Several people at the hearing told Psychiatric News it was the unexpected and dramatic testimony of four University of Vermont College of Medicine (UVM) senior psychiatrists that convinced the POC commissioners to vote against Fletcher Allen’s plans. (Fletcher Allen serves as the primary inpatient clinical site for UVM.)

Rumors had been rampant within the community that the silence of the UVM psychiatry faculty was largely due to hospital administrators’ veiled threats of retaliation if the faculty spoke out against the proposal. Several faculty members confirmed to Psychiatric News that they feared for their jobs if they spoke out.

At the start of the public comment period of the POC hearing, UVM faculty members Richard Bernstein, M.D., director of inpatient services; Paul Newhouse, M.D., director of the Clinical Neuroscience Research Unit and the geriatric psychiatry service; Terry Rabinowitz, M.D., director of the consultation-liaison service; and G. Scott Waterman, M.D., director of medical student education, approached the witness table together.

Waterman and Rabinowitz both said the faculty’s appearance was the result of an 11th-hour decision the evening before the hearing to break their silence and, in spite of any real or perceived risk, go on record as being clearly opposed to the hospital’s plan. Waterman began by telling the POC that “we do not relish the task of coming before you in opposition to the administration of our hospital, but we ultimately realized that we owe it to our colleagues, our patients, our students, our residents, the community, and ourselves.” Newhouse testified to the “antiquated” nature of the proposal, calling it a “significant degradation of care.” Rabinowitz highlighted the difficulties that would arise in achieving timely consultations with other services, and Bernstein said that he and the previous four unit directors had concluded, with their combined 30 years of experience, that the proposal was “simply wrong.”

Following the faculty’s testimony, the POC voted unanimously to recommend that the state deny the necessary permits and approvals for Fletcher Allen’s proposal. Before the state took action, however, Fletcher Allen withdrew the proposal.

Immediately, praise began flowing to the four faculty members, from fellow psychiatrists, from patient advocates—indeed, from every member of the coalition fighting the proposal.

At a meeting of the Vermont Psychiatric Association, the four were jointly nominated for the APA Assembly’s Profile of Courage Award. The award is given during the fall Assembly meeting, which will be held this year from November 8 to 10 in Washington, D.C.

“Sounds to me,” outgoing APA President Richard Harding, M.D., told Psychiatric News, “that [the four] are prime candidates for the award. They made a clear, principled stand, at some professional risk, for the good of their patients.”

Harding added that “when Bill Weitzel and I proposed the Profile of Courage Award in 1994, we had in mind just this kind of stand by regular members that would make a difference.”

Newhouse addressed the outpouring of gratitude the four have received in a recent e-mail message to supporters in which he acknowledged that “while we did not realize that the public expression of our views would have as much impact as it may have, I am glad that the effect was positive.”

Newhouse noted in his e-mail what the British prime minister said after the battle of El Alamein: “Now this is not the end, this is not even the beginning of the end. But it is, perhaps, the end of the beginning.”

Most of those involved in the dispute with Fletcher Allen, including Donahue, agree that the fight is not over. Significant work remains to make sure a viable, high-quality unit is included on the main campus in Burlington. ▪