"We hold these truths to be self-evident: that all men are created equal."

- United States Declaration of Independence

Monday, October 25, 2010

The Trouble With Fresh Air (?!)

People are constantly asking me, “why on Earth would anyone oppose fresh air as a basic right?” After which, I often tell them they’d be surprised! However, I often don’t have the time to explain the many reasons (and excuses) our opponents offer. Enter the brave new world of blogging, however, and I can share them, in their own words.

So, I have typed up the testimony submitted by the two large lobbying firms for Mass. hospitals AGAINST adding “access to fresh air and the outdoors” as a basic human right, and I present them to you. I apologize in advance if they produce mild feelings of nausea!

Testimony By The Massachusetts Hospital Association (MHA) and the Massachusetts Association for Behavioral Health Systems (MABHS) In Opposition to the “Five Fundamental Rights enforcement/fresh air rights” bill (House Bill #1945/Senate Bill #743)

Submitted for September 23, 2009 Hearing of the [MA] Joint Committee on Mental Health and Substance Abuse, State House, Boston.

  • Enforcement of existing “Five Fundamental Rights” law was a major part of the bill, but this testimony ignores that part entirely – for BOTH lobbyist groups testifying in opposition! A guilty conscience, perhaps?
  • MABHS’ testimony was the first presented at the hearing – the rest was in favor - but after reading this testimony, MABHS’ Executive Director left the hearing room, and so was unable to listen to our testimony, despite repeated statements in the past expressing willingness to work with us and listen to our concerns.
  • The MABHS testimony is nearly a word-for-word, carbon copy of the previous session’s testimony, given in June 2007.

Massachusetts Hospital Association (MHA) Testimony

MHA opposes HB1945/SB743. This bill would mandate hospitals and other facilities that treat mentally ill patients to provide daily access to fresh air and the outdoors. Although our member hospitals believe that the ability of patients to have daily access to the outdoors is desirable, we are unable to support these bills. MHA believes these bills pose significant safety and operational concerns that would be untenable. Clinical staff shortages, often exacerbated by cuts in state funding, are a primary hindrance to the effective implementation of these proposals. Patient clinical presentation and safety must be the key determinants in any decision process. Potential physical plant and logistic barriers must also be taken into account. As these considerations are not part of the provisions set forth in HB1945/SB743, MHA is unable to support either bill.

Massachusetts Association for Behavioral Health Systems (MABHS) Testimony

On behalf of the Massachusetts Association for Behavioral Health Systems (MABHS), I [Executive Director David Matteodo] appreciate the opportunity to testify before the Committee on Mental Health and Substance Abuse on S.743 and H.1945. The MABHS represents 47 inpatient facilities throughout Massachusetts that collectively admit over 45,000 patients annually for behavioral health treatment. Our facilities provide the overwhelming majority of acute inpatient psychiatric and substance abuse services in the Commonwealth.

Although our hospitals believe that the ability of patients to have daily access to the outdoors is desirable, we are unable to support these bills. It would make the right to “daily access to fresh air and the outdoors” one of the Fundamental Rights of patients, which could only be revoked if certain criteria were met. In the past, we have met with the main proponents of this Legislation to review our concerns, and are willing to continue to meet with them to see if there are alternative ways the hospitals can address the issue. However, we hope that the Committee does not report these bills Favorably for a number of reasons, as summarized below.

  • S. 743 and H. 1945, by adding the right to go outside to the Patients’ Rights law, would create real safety issues for hospitals. Many of the patients who are admitted to our facilities come to us because they are a danger to themselves or others. Many of these patients would like to leave; they do not think they should be in the hospital. However, our hospitals are entrusted by families, loved ones, and the communities to keep the patients safe. Since many hospitals in Massachusetts do not have enclosed outdoor areas, escorting every patient outside is not possible. We cannot allow unsafe situations for our patients or for the communities our hospitals are in. How would families react if patients were eloping [escaping] because we were unable to contain them safely? The families and communities entrust the hospitals to keep the patients and the communities safe. If these bills were to pass, that safety could be jeopardized.
  • Our hospitals provide short term acute treatment. People come to our hospitals for treatment of acute psychiatric illnesses and stay for approximately 9 days. This is much different from the DMH State Hospitals where patients can stay for many months. Our major priorities are safety and treatment and stabilization of the patient’s symptoms. We are trying to treat patients so they can rapidly go back out to the communities as productive members of society. We are not trying to penalize or restrict patients. Just as acute hospitals seek to stabilize general medical conditions and discharge patients back to the community, so do mental health facilities – the difference is our hospitals are treating psychiatric illnesses, and in many cases, patients with both a psychiatric and medical illness. We treat our patients with respect, care, and dignity. The restrictions on patients going outside are not for punitive reasons, but rather for the safety of the patient, the unit, and the community. We do not believe our patients or hospitals should in any way be compared to prisoners or prisons, where the length of stay may be years.
  • If these bills were to pass, it would require either additional Capital or Staffing costs for many hospitals. Hospitals would have to either build fenced-in areas; or if unable to do that, hire many new staff to escort patients outside. Already the inpatient mental health units are under extreme financial pressures, both externally and internally within their own hospital systems. Additional added costs will raise questions about the ongoing viability of many units, as hospitals struggle to find resources to fund a new mandate. Access to mental health services could suffer if the mandate forced hospitals to close their units. It is impractical for certain urban hospitals with no secure outdoor areas to allow every patient who asks to go outside.
  • Our hospitals in no way would endorse the idea of Outdoor privileges being taken away because of a punishment. We agree that going outside can often be beneficial for patients, and try to allow it when possible and safe. Many of our hospitals already allow patients outdoor access where they can safely provide it. However, unfortunately due to physical plant and safety reasons, not all facilities can allow it, especially units in acute general hospitals. Hospitals are also concerned with the movement towards Smoke Free Campuses and how a mandate such as called for in these bills could be complied with safely.
  • In the last Legislative Session, there was suggested Re-Drafted language that took into consideration patient clinical presentation and safety. That language was an improvement over these versions and could be further improved by adding “and the ability of the facility to provide this right safely” as a criteria for providing outdoor access. This would clarify the situations where because of physical plant and logistical issues, a unit simply could not safely allow patients broad access to outdoors.

In conclusion, we urge the Committee to not refer these bills favorably in their current forms. Our facilities are committed to providing as safe and humane environments for our patients as possible. We are willing to work with the advocates of this bill, or with the Committee if it so desires. However due to the above reasons, especially the safety concerns, we are not able to support these bills. Please do not report these bills Favorably.