Disability Rights Vermont urges narrow expansion to allow ED physician assistants to make initial psychiatric certifications
Loading...
Summary
Disability Rights Vermont told the House Health Committee it supports H 573 to let physician assistants in emergency departments perform the initial certification for involuntary psychiatric holds, but urged narrowing the language and adding reporting and automatic preliminary-hearing safeguards.
BURLINGTON, Vt. — Disability Rights Vermont told the House Health Committee on Feb. 26 that it supports H 573’s effort to expand who may perform the initial certification for involuntary psychiatric holds, provided the change is narrowly limited to physician assistants working in hospital emergency departments and accompanied by procedural safeguards.
"I am Lindsay St. Amour, formerly Owen. I am the executive director at Disability Rights Vermont," said St. Amour, who testified as the group’s executive director and a practicing attorney. She argued that allowing emergency-department physician assistants to perform the first certification would often move people through the statutory timelines faster and reduce the period in which patients can be held in limbo in emergency departments.
The proposal addresses a recurring problem St. Amour described: individuals in psychiatric crisis presenting to emergency departments without a qualified professional available to perform the first certification are often left waiting in settings that are not equipped to provide psychiatric emergency care. She said this situation places emergency departments between obligations under the federal Emergency Medical Treatment and Labor Act (EMTALA) and the practical need to provide psychiatric evaluation and care.
St. Amour explained that a timely first certification triggers subsequent steps in statute — a 24-hour second certification and then a 72-hour window before potential inpatient placement — so earlier certification can reduce reliance on seclusion, restraint and involuntary medication while people wait for placement.
Her written testimony and oral recommendations asked the committee to consider three specific changes: add the phrase "emergency department" before "physician assistant" in the bill language so the expansion is limited to ED settings; require that the first-certification form be filed with the Department of Mental Health or the Mental Health Care Ombudsman to ensure oversight; and make the preliminary hearing automatic rather than dependent on a person in crisis requesting it within the existing five-day window.
"So we are supportive of this bill for physician assistants in emergency department settings," St. Amour said, while noting the additional reporting and hearing changes would improve due process.
Committee members pressed for clarification on the filing recommendation and on who would assist people in pursuing the five-day preliminary hearing. St. Amour said that, before a certification is filed, no one is automatically appointed to represent the person during the emergency examination; the Mental Health Law Project is automatically appointed only after an application is filed, and expanding filing or automatic hearings could strain that project's capacity.
Ranking Member Daisy cautioned that the committee had deliberately kept the bill narrowly focused and that adding the filing and hearing changes would require additional testimony and work. A committee member also raised a broader concern that codifying emergency-department-based certification might lock in a suboptimal system and make future redesigns harder; St. Amour replied that while improved alternatives to routing psychiatric emergencies through EDs are desirable, such system redesign is unlikely soon and a narrowly tailored statutory change is a pragmatic step now.
The hearing did not record any formal vote. The committee thanked St. Amour and paused the witness portion of the hearing until other witnesses return later in the morning.
