|BILL AS INTRODUCED||2007-2008|
Introduced by Representatives Donahue of Northfield, Andrews of Rutland City, Evans of Essex, Fisher of Lincoln, Frank of Underhill, French of Randolph, Haas of Rochester, Hudson of Lyndon, Jerman of Essex, Martin of Wolcott, McAllister of Highgate, Morrissey of Bennington, Mrowicki of Putney, Pearson of Burlington and Pillsbury of Brattleboro
Subject: Mental health; Vermont state hospital; governing body
Statement of purpose: This bill proposes to codify and revise the existing bylaws of the Vermont state hospital governing body.
AN ACT RELATING TO THE VERMONT STATE HOSPITAL GOVERNING BODY
It is hereby enacted by the General Assembly of the State of Vermont:
Sec. 1. 18 V.S.A. § 7101(26)–(28) are added to read:
(26) “Deputy commissioner” means the deputy commissioner of mental health services within the department of health.
(27) “Governing body” means the Vermont state hospital governing body created in chapter 178 of this title.
(28) “Medical director” means the medical director of mental health services within the department of health.
Sec. 2. 18 V.S.A. chapter 178 is added to read:
Chapter 178. Vermont State Hospital
§ 7451. PURPOSE
The purpose of this chapter is to describe and define the scope of authority for the operation and administration of the Vermont state hospital, the sole public inpatient psychiatric facility for the state of Vermont. The Vermont state hospital operates under Vermont law within the department of health.
§ 7452. VERMONT STATE HO SPITAL
(a) The Vermont state hospital is responsible for caring for Vermont residents with mental health and related problems for whom no adequate, less restrictive alternative can be found.
(b) The Vermont state hospital is part of a comprehensive continuum of care for adults with serious and persistent mental illness in a community mental health system which also includes designated agencies and hospitals.
(c) The Vermont state hospital provides intensive psychiatric treatment and secure observation for individuals who are dangerous to self or others and whose psychiatric disabilities are of high acuity, great complexity, or are difficult to treat.
(d) The Vermont state hospital provides high quality, clinically appropriate treatment in a safe, respectful environment which supports the ability of individuals to return as rapidly as possible to the community or other less restrictive settings. Individualized treatment and other services are based upon the psychiatric diagnoses, multidisciplinary assessments, and needs identified of the individual. Treatment is guided by evidence-based practices where available and directed toward implementing recovery principles, evaluating innovative treatment methods, and sharing outcomes which improve the mental health of the persons served. Community involvement, including outpatient providers and peer and family support, is included to ensure continuity of care. Individual rights are protected in the delivery of involuntary treatment.
(e) The Vermont state hospital provides its staff educational opportunities and supports professional development activities to advance mental health treatment, methods, and the availability of human resources to improve the quality of life of persons served by the hospital.
§ 7453. GOVERNING BODY; COMPOSITION; MEETINGS
(a) The governing body shall be comprised of the secretary, or designee for the governor; the commissioner or designee; the deputy commissioner; the medical director; and three public at-large members appointed by the governor. The executive director of the Vermont state hospital and the medical director of the Vermont state hospital shall be nonvoting members of the governing body.
(b) Appointment of the public at-large members of the governing body shall be at the sole discretion of the governor and shall be for a period of not less than two years. The adult state program standing committee shall be invited to make nominations for any vacancy among the public members on the governing body. Initial terms shall be staggered so that not more than one member’s term expires each year.
(c) The deputy commissioner shall serve as chair at all meetings of the governing body. The governing body shall meet as often as is necessary to fulfill its duties under this chapter but not less frequently than two times a year. Meetings shall be scheduled by the deputy commissioner, who shall be responsible for establishing the agenda and providing notice to its members and invested stakeholders as to the date, time, and place of each meeting.
(d) A quorum of the governing body is a majority of voting and nonvoting members. For purposes of decision-making, a majority of the voting members is required. Minutes of all meetings of the governing body shall be maintained to document deliberations and decisions. Minutes shall not be taken at executive sessions.
§ 7454. GOVERNING BODY; DUTIES
(a) The governing body shall have legal authority and responsibility for the operations of the Vermont state hospital as an institution.
(b) The governing body is responsible for reviewing the effectiveness of management operations of the Vermont state hospital, overseeing institutional planning, and ensuring a consistent level of care throughout the hospital.
(c) The governing body shall delegate responsibility for the effective operation of the grievance process to the Vermont state hospital grievance committee, which shall be comprised of the executive director of the Vermont state hospital, the medical director of the Vermont state hospital, and the quality and risk management chief of the Vermont state hospital.
(d) The governing body shall review the quality of patient care at a minimum through the quality council of the Vermont state hospital and by receiving regular reports of activities from the Vermont state hospital leadership team established in subsection 7458(c) of this chapter. The leadership team shall be responsible for ensuring that there are reports informing the public regarding the quality and effectiveness of services at the Vermont state hospital.
§ 7455. GOVERNING BODY; EXECUTIVE COMMITTEE
(a) There shall be an executive committee of the governing body. The executive committee shall consist of the executive director of the Vermont state hospital; the deputy commissioner; the commissioner or designee; and one public member designated by the governing body.
(b) The executive committee shall conduct the business of the governing body. The executive committee shall meet throughout the year, as necessary, but at least twice in addition to the two meetings of the governing body as a whole.
(c) Meetings shall be scheduled by the deputy commissioner, who shall be responsible for establishing the agenda and providing notification to its members and invested stakeholders as to the date, time, and place of each meeting.
§ 7456. GOVERNING BODY; CONFLICT OF INTEREST
(a) Any member of the governing body who stands to benefit personally from any issue which is brought forward for consideration or whose judgment may be so influenced as to compromise objective evaluation is required under this section to make known that a potential for conflict of interest exists.
(b) The governing body member for whom a conflict of interest exists shall abstain from any consideration surrounding that issue.
§ 7457. ADVISORY COMMITTEE
(a) There shall be an advisory committee established to advise the governing body on the operations of the Vermont state hospital. The existing adult state program standing committee shall serve as the advisory committee. If, however, the adult state program standing committee is unable to fulfill this function, a specific committee shall be created to serve in this role.
(b) If a specific advisory committee is created, representatives shall be appointed by the commissioner for staggered terms of three years. The advisory committee shall be comprised of between 10 and 15 members who represent key stakeholders in the operations of the Vermont state hospital, including: a representative of the designated community mental health agencies or their representative organization; a representative of the designated community hospitals; a member of the adult program standing committee; at least two Vermont state legislators; at least two consumers or their representative organization; at least one family member or their representative organization; at least one staff member of the Vermont state hospital, or their representative organization; and at least one patient rights protection or legal services representative. The advisory committee shall make nominations to the commissioner for vacancies on the committee.
(c) A chair of the advisory committee shall be elected by a majority vote of its members for a period of one year. A quorum shall consist of 50 percent of the advisory committee members.
(d) The advisory committee shall meet periodically as it determines necessary to review information and make recommendations regarding the performance and operation of the Vermont state hospital with respect to hiring key management positions; grievances and appeals (aggregate data) and their resolution; the quality of care provided; and hospital policy development and implementation.
(e) The advisory committee shall report regularly to the governing body on its recommendations, observations, and assessment of Vermont state hospital operations. At least annually, the committee shall report on its operations in a format developed by the governing body.
(f) All proceedings of the advisory committee shall be recorded in minutes approved by its members.
(g) The term of any member of the advisory committee shall terminate upon appointment to the governing body.
(h) A member may be removed from the advisory committee by the commissioner due to nonattendance at 50 or more percent of scheduled meetings in any calendar year.
§ 7458. ADMINISTRATION
(a) Management of the Vermont state hospital is the responsibility of the executive director of the state hospital, who is under the supervision of the deputy commissioner. The executive director of the Vermont state hospital shall serve as the representative of the governing body in assuring that the state hospital operates in accordance with applicable state and federal laws, rules, and regulations.
(b) The executive director of the Vermont state hospital shall oversee all aspects of hospital administration, including management, operations and patient-focused functions, and clinical patient care. The executive director shall organize these functions, delegate responsibilities to enable goals of the hospital to be achieved, and ensure that the services provided meet or exceed generally accepted practices and standards of care. The executive director shall be fully accountable for the overall quality of patient care. Delegation of responsibilities to others under this subsection does not relieve the executive director or the deputy commissioner of accountability for the responsibilities delegated to them by the commissioner.
(c) The executive director shall meet with senior managers, who shall comprise the state hospital leadership team. Members of the leadership team shall include the executive director, the medical director of the state hospital, the nursing administrator, the operations chief, and the quality and risk management chief. The senior managers shall be responsible and accountable to the executive director for the administrative supervision of the program and service areas to which each is assigned. They shall provide administrative supervision directly or by delegation to all personnel employed or contracted to provide direct patient care in their respective areas.
(d) The medical director of the Vermont state hospital shall report directly to the executive director and shall be administratively responsible and accountable for the clinical operations of the hospital. The medical director shall provide clinical supervision to all clinical components of the hospital and all personnel employed or contracted by the hospital to provide direct care and treatment of patients. The medical director shall be responsible for the scheduling and assignment of medical staff. Through membership in the medical staff organization established under section 7459 of this chapter, the medical director shall be engaged in the development and implementation of the medical staff bylaws.
(e) The executive director shall be responsible for implementing Vermont state hospital policy through the hospital policy committee, in accordance with hospital and medical staff bylaws. The policy committee shall be comprised of the members of the state hospital leadership team and legal counsel for mental health services. All state hospital policies shall be approved by the governing body. In order to conduct the operations of the hospital, the policy committee may generate interim policies. The executive director shall notify the governing body of all new or revised interim policies to be acted upon at the next meeting of the governing body.
(f) Program planning and evaluation shall be conducted on team, departmental, and executive levels. Management information systems shall assist administrative staff in planning, developing, and decision-making regarding patient care, programs, and institutional services.
§ 7459. MEDICAL STAFF ORGANIZATION
(a) There shall be a medical staff organization comprised of physicians who have been granted clinical privileges at the Vermont state hospital. The organization shall adopt bylaws which define its organization and form of governance.
(b) The medical staff organization shall be responsible for the periodic review of its rules and regulations to ensure consistency with Vermont state hospital policy and applicable state and federal laws, rules, and regulations. Such reviews shall occur as often as is necessary. Bylaws shall be formally approved at least every two years.
(c) All bylaws, rules, and regulations developed by the medical staff organization, and any revisions thereto, must be approved by the governing body and are not valid until so approved.
(d) The medical director of the Vermont state hospital shall attend governing body meetings and represent the interests of the medical staff organization.
§ 7460. PERFORMANCE AND RESOURCE MANAGEMENT
(a) The executive director of the Vermont state hospital shall be responsible for ensuring that there are active quality, safety, utilization, and risk management programs within the state hospital. These programs shall review resource needs, the effectiveness of hospital operations, and the quality of patient care services.
(b) The executive director shall be responsible for ensuring that programs for performance and resource management involve activities relative to the identification and resolution of any problems and the identification of opportunities to improve services.
(c) As part of the Vermont state hospital’s performance and resource management programs, the governing body shall require that hospital staff who provide patient care services are competent to perform their responsibilities.
(1) The executive director shall be empowered on behalf of the governing body to authorize or withhold privileges for those employees or consulting staff of the hospital who are subject to the medical staff organization privilege delineation process. Before recommending to the executive director that privileges be granted, the medical staff organization shall ensure, on the basis of verified information, that the applicant’s licensure and certification, training, experience, and current competence are consistent with the privileges requested.
(2) Those professional employees or consulting staff members who are not subject to the medical staff organization privileging process must be approved by the chief of their department and the hospital’s executive director and medical director on the basis of verified education, training, experience, and current competencies consistent with position responsibilities and department protocols.
(3) Paraprofessional and nonprofessional staff providing patient care services who are union-eligible classified service staff and not subject to a privilege delineation process shall work under the clinical supervision of staff privileged in accordance with the medical staff organization or the clinical department requirements. The performance and skill levels of such staff shall be reviewed in writing at least annually. The responsibility for the completion of this evaluation is that of the appropriate clinical department head. These employees shall be evaluated in accordance with the performance evaluation provisions of the existing contract between the state and the Vermont state employee association.
(d) The executive director shall provide the governing body with quarterly reports summarizing the results of Vermont state hospital evaluation and improvement efforts.
§ 7461. GOVERNING BODY PERFORMANCE
(a) The governing body shall evaluate its performance annually and shall use selected criteria as a basis for self-evaluation.
(b) Criteria used for the purposes of self-evaluation shall examine areas including: governing body bylaws; member orientation and education; meetings and member activity; executive management; medical staff organization; strategic planning; professional services planning; human resources; budget; information management; safety and security; risk management; and performance improvement.
The Vermont General Assembly
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