- Associated Press - Sunday, May 25, 2014

BERLIN, Vt. (AP) - With Vermont’s new state psychiatric hospital preparing to receive its first patients in July, some lawmakers are questioning its costs, including a staff-to-patient ratio nearly twice that of the closed Vermont State Hospital.

Jeff Rothenberg, CEO of the Vermont Psychiatric Care Hospital in Berlin, said the new facility’s state-of-the-art design - with four separate units - will require a lot of staff to provide top-notch psychiatric care.

It will be a big change from the Vermont State Hospital in Waterbury, a 19th-century facility that lost its federal certification and funding about eight years before flooding from Tropical Storm Irene forced it to close in 2011.

“We will no longer rely on a decrepit hospital to house those patients, but instead provide all levels of care in a variety of settings closer to their homes and communities,” Gov. Peter Shumlin said in April 2012 as he signed a law to revamp the mental health system, in part by placing patients in smaller settings.

But openings of two facilities that were to be part of that decentralized system - in Burlington and St. Albans - have been delayed, and lawmakers say that’s at least partly due to the higher-than-expected costs of the Berlin facility.

“I think we are spending more than we anticipated,” said Rep. Mary Hooper, a member of the House Corrections and Institutions Committee and a Democrat representing Montpelier. “There’s no doubt in my mind that we have not created parts of the system that we said we were going to.”

Lawmakers budgeted $19.3 million to run the Berlin hospital for the 2015 fiscal year. That’s less than the $22 million spent at the Waterbury hospital the year before it closed, but Waterbury was more than double the size.

In the newly designed mental health system, Berlin’s 25 beds for the most acutely ill patients will be supplemented by 14 at the Brattleboro Retreat and six at the Rutland Regional Medical Center.

The Berlin facility will have a direct-care staff-to-patient ratio of 5-to-1, according to a chart prepared by Rep. Anne Donahue, R-Northfield, a member of the House Human Services Committee, with a daily cost per patient of $2,247.

That compares to a staff-to-patient ratio of 3.4-to-1 at Brattleboro, with a daily cost per patient of $1,468, and a staff-to patient ratio in Rutland of 4-to-1, with a daily per patient cost of $1,444. Waterbury had a direct-care staff-to-patient ratio of 2.7-1. Donahue said she based her chart on numbers from the Department of Mental Health.

Rothenberg defended the new facility’s planned staffing levels. “The facility design was focused on creating as positive a patient experience as possible, recognizing that the majority of admissions would be involuntary in nature,” he said in an email.

The idea was that some patients housed at the Waterbury hospital - a locked, acute-care psychiatric ward - might be better off in less intrusive and less restrictive settings. Several such facilities have opened around the state, but they haven’t shrunk the acute-care population by much.

Donahue noted that Berlin, Brattleboro and Rutland would have a combined total of 45 beds, not much less than the 54 beds that Waterbury had. In addition, Middlesex has a seven-bed facility that houses forensic patients, or those referred to the mental health system by Vermont’s criminal courts, she said. That brings the total of beds to 52, just shy of Waterbury’s capacity.