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Colorado governor vetoes mental health legislation

Bill would have addressed problem faced by rural hospitals
Gov. John Hickenlooper vetoed legislation that rural hospitals said was necessary to address a problem with sending mental health patients to jail instead of holding them at a hospital.

DENVER – Gov. John Hickenlooper vetoed legislation that rural Colorado hospitals said was necessary to address a conundrum with mental health holds.

The late Thursday afternoon veto killed legislation that would have created a tiered system, where facilities designated for mental health holds would have been the primary location, but if those facilities were unavailable, then the next tier would have been an emergency room.

Rural Colorado hospitals pointed to their difficult position, as there is a lack of “designated facilities” to comply with law and offer patients adequate mental health treatment.

When a designated facility is unavailable, then patients are brought to a jail. Because there is a lack of compliant facilities in rural Colorado, jail is often the only option.

Hickenlooper acknowledged that there is a problem with finding facilities, but his office fears that the bill would have eroded due process.

“No limit is placed for how long an emergency room may detain someone involuntarily while awaiting a free bed in a suitable treatment facility, and, more importantly, no mechanism is made to afford due process to a person held involuntarily in ‘emergency’ custody,” the governor wrote in his veto letter.

Hickenlooper directed the Department of Human Services to create a task force to develop solutions to address the problem. The task force will report by January 2017, so legislation could come in the next legislative session.

Hospitals were irate after the governor’s decision. They even suggested that Hickenlooper did not fully understand the bill.

In his veto letter, Hickenlooper wrote that the bill “allows advanced practice nurses to determine if a person should be committed to a mental health facility longer than 72 hours.”

The Colorado Hospital Association fired back, “In fact, the bill did not allow this, but was exactly the opposite – it would have allowed advanced practice nurses to release patients who were no longer in crisis, consistent with their scope of practice.”

“CHA is exasperated that the governor single-handedly ignored four years’ worth of work and progress and instead chose the status quo, which all stakeholders agreed was a bad idea,” said Steven Summer, CHA chief executive and president.

The bill passed with bipartisan support from 88 of the Legislature’s 100 lawmakers.

Under the bill, hospitals would have been allowed to hold a patient for up to 36 hours while awaiting specialty psychiatric care at a designated facility. It would have emphasized that jails are a last resort.

The closest designated facility to Durango is in Grand Junction. Of the state’s more than 100 hospitals, only about 30 are designated facilities.

To become a designated facility, hospitals must meet certain requirements, including having a 24-hour psychiatrist, which can be too expensive for smaller rural hospitals.

The jam for hospitals is that while they are required by federal law to screen and treat patients who come to an emergency room, including those experiencing a mental health crisis, state law doesn’t allow most of those hospitals to hold patients.

“This bill would have been an important step forward in recognizing and dealing with the problems in our behavioral health system – giving our hospitals the ability to care for patients without breaking the law and reducing the number of people being sent to jail,” said Rep. Tracy Kraft-Tharp, D-Arvada, a sponsor of the bill. “The problem is clear: we are in dire need of more resources for mental health in our state.”