Liam Gannon, MD is the Medical Director of Copley Hospital’s Emergency Services. On February 7, 2017, he testified at the Statehouse to members of the House Health Care and Senate Health and Welfare committees. He spoke about challenges patients and hospital staff faced regarding treatment of the mentally ill in hospital emergency rooms throughout the state. His testimony, in full, follows:
Thank you for allowing me the opportunity to speak on the challenges we continue to face regarding the treatment of the severely mentally ill in Vermont. My name is Liam Gannon and I am the Emergency Room Medical Director and a practicing physician at Copley Hospital in Morrisville, Vermont. Copley Hospital is what is termed a critical access hospital. These hospitals are in areas which are geographically critical and also resource limited. We are your local, small, community hospital.
I would like you to indulge me for a moment and consider the following: you’re visiting Hardwick, Vermont with your family and are out having a nice meal. You suddenly experience crushing chest pain are quickly transported to Copley Emergency Room by Hardwick Rescue.
We rapidly diagnose a heart attack and give you the appropriate immediate medical treatments. We then arrange for your rapid and immediate transport to the University of Vermont where a cardiac team is waiting and a stent is placed in your coronary artery opening the blood flow back to your heart, after which you achieve a full recovery.
Now, imagine you are at the Mountain at Stowe enjoying a family ski vacation. Your son, daughter, wife, or husband catches an edge in the snow and goes off trail, hitting a piece of machinery parked on the side. Again, you are treated by an elaborate and well-designed system of care. The ski patrol get you off the hill. Emergency Medical Services transports you safely to the local community hospital. Again, you arrive, or your family member arrives at our emergency room for stabilization. You’re provided with diagnostic x-rays, intravenous fluids, blood products if needed, and the all-important pain relief that you need. Due to the severity of your injuries, you’re quickly helicoptered to the University of Vermont where a trauma team is awaiting your arrival. Your local community ER physician will have had a detailed discussion with the trauma team outlining your situation and the next needed steps. Although your recovery is long, due to the rapid evaluation and hierarchical system of care, you achieve a full recovery.
Critical access hospitals like mine are designed to diagnose, stabilize, recognize our resource limitations, and quickly involve the specialty centers where appropriate. Of course we admit and operate on patients that are within our scope of practice, and do so quite well.
I want you to take a moment now to imagine that you or your family member begins to have a psychotic break. They begin hearing voices, experience paranoia, and extreme fear that results in violence. Or, perhaps they’re experiencing such a profound depression that suicide becomes preferable to living, despite their close family support. Our current system again lands you in the closest facility, at Copley Hospital’s Emergency Room. You have a potentially life threatening condition, the expertise is not available to you or your loved one, you sit and wait and wait and wait. The hospital is compassionate and tries their best but the bare room, lack of therapeutic environment, and specialty care actually cause worsening of this medical situation.
Prior to the 1950s little, if any, treatments for the severely mentally ill were available. However, we have come a long way in both diagnostic and treatment options since then. Yet, although we publicly acknowledge that mental illness is an organic, medical problem (just as medical as diabetes, heart disease or trauma), we continue to treat it often as a social or legal problem. Treatment of acute, severe mentally ill patients deserves the same prioritization as heart attack, stroke, or trauma.
Facilitating proper care will take resources, commitment, and possibly courage.
I sit before you as a physician, a husband, and father. I sit before you as one of your constituents. If we approach this situation with the same passion and urgency that we would advocate for our own family member, we will not go astray. We must always ask ourselves: What is the best care for this patient? Many of us, including myself, stand before you tonight ready to assist with revolutionizing our current system of psychiatric care for the acute, severe, mentally ill in the State of Vermont. We are here to advocate for change but we are also here to assist in that endeavor. Thank you for your time.
– Liam Gannon M.D.