Public Hearing on Regional Centers of Excellence

1 NEW YORK STATE LEGISLATURE JOINT HEARING BEFORE

THE NEW YORK STATE ASSEMBLY STANDING COMMITTEE ON 2 MENTAL HEALTH AND ENVIRONMENTAL DISABILITIES,

AND 3 THE SENATE STANDING COMMITTEE ON MENTAL HEALTH AND

ENVIRONMENTAL DISABILITIES, 4 AND

THE SENATE STANDING COMMITTEE ON HEALTH 5 ----------------------------------------------------- 6 PUBLIC HEARING 7 ON REGIONAL CENTERS OF EXCELLENCE 8 ----------------------------------------------------- 9 Ogdensburg City Hall

City Council Chambers 10 330 Ford Street

Ogdensburg, New York 13669-1626 11

September 17, 2013 12 10:00 a.m. to 2:00 p.m. 13

PRESIDING:14

Senator David Carlucci 15 Senate Committee on Mental Health and

Environmental Disabilities 16

Assemblywoman Aileen M. Gunther 17 Assembly Committee on Mental Health and

Environmental Disabilities 18 19 SENATE MEMBERS PRESENT: 20 Senator Elizabeth Little 21 Senator Patricia Ritchie 22

ASSEMBLY MEMBERS PRESENT:23

Assemblyman Ken Blankenbush 24

Assemblywoman Addie J. Russell 25 1 SPEAKERS: PAGE QUESTIONS 2 Andrea Smyth 11 22

Executive Director 3 NYS Coalition for Children's

Mental Health Services 4

Karen Richmond 11 22 5 Executive Director of Children's

Home of Jefferson County, and also 6 Member of the Board of Directors,

NYS Coalition for Children's 7 Mental Health Services 8 H. Theodore Klaudt, M.D., FACEP 43 58

Chief of Emergency Medicine 9 Pakkam Rajasekaran, M.D.

Claxton-Hepburn Medical Center 10

James Scordo 70 91 11 Executive Director

CREDO Community Center 12

Holly White Armstrong 70 91 13 Co-President

North Country Council of Social Agencies 14

John Pinkerton 96 119 15 City Manager

Ogdensburg, New York 16

Donald Peck 96 119 17 Vice Chair

St. Lawrence County Legislature 18

Vernon Sam" Burns 96 119 19 St. Lawrence County Legislator

District 1, St. Lawrence County 20

Storm Cilley 96 119 21 Ogdensburg City Council Member

Ogdensburg Volunteer Rescue Squad 22

Angela Doe 126 133 23 Director of Community Services

Karen St. Hilaire 24 St. Lawrence County Administrator

St. Lawrence County 25 1 SPEAKERS (Continued): PAGE QUESTIONS 2 Ronnie Freeman, Jr. 147 161

President, CSEA Local 423 at SLPC 3 Colleen Wheaton

President, CSEA Central Region 5 4 Joseph Cosentino

CSEA Retiree President 5 St. Lawrence County, New York 6 Laurie Zweifel, Ph.D. 165 208

Licensed Psychologist, 7 Children/Youth Services

Michael Lumley 8 Licensed Master Social Worker II,

Children's Collaborative Day 9 Treatment Program

Andrea Randle 10 Licensed Clinical Social Worker

Elizabeth Chadwick Burns 11 Psychologist

Terri Langenmayer 12 Family Care

Michael Spellman 13 Patient

St. Lawrence Psychiatric Center 14

Susan Kent 229 249 15 President

Virginia E. Davey 16 Division 249 Council Leader

Public Employees Federation 17

Edward Snow 229 249 18 Executive Board Member of PEF,

Also, OPWDD Labor Management Chair 19

Charles Thorpe 260 264 20 Sr. Vice President and Provost

Clarkson University 21

Patrick Kelly 267 281 22 Member of the St. Lawrence

Psychiatric Task Force 23 CEO of St. Lawrence County Industrial

Development Agency 24 25 1 SPEAKERS (Continued): PAGE QUESTIONS 2 Richard Halpin 295 325

Parent, and Board Member of 3 Jefferson County Community Services

Watertown, New York, Resident 4

Karin E. Riches 295 325 5 Parent

Buffalo, New York Resident 6

Roberta Hagerty 295 325 7 Parent Member

Watertown, New York, Resident 8

Barbara Ward 295 325 9 Parent

Member of the SLPC Board of Visitors 10

John Burke 327 342 11 Retired Director of Inpatient Services

Frank Spotswood 12 Retired Employee

St. Lawrence Psychiatric Center 13

Connie Shannon Harrel 346 14 Counselor

Step By Step, Inc. 15

Kevin Wells 353 369 16 Department Head

St. Lawrence County Sheriff's Office 17

Iggy Gillette-Ferguson 372 18 Assistant Professor of Biology

Clarkson University 19

Daniel Harradine 381 20 Community Member

Laura Farr 21 Community Member

St. Lawrence County, New York 22

Samuel Lamacchia 397 23 Chairman

Ogdensburg Bridge and Port Authority 24

Kevin Hammond [ph.] 411 25 (Impromptu. Not on list of speakers) 1 SENATOR CARLUCCI: Good morning. 2 I'm Senator David Carlucci, Chairman of the 3 Mental Health Committee in the New York State 4 Senate. 5 I would like to welcome everyone here today. 6 We're here today, as everyone knows, for the 7 Regional Centers of Excellence, to hear the concerns 8 of the community, for people that are working at the 9 center, working in the community, families that have 10 been living with consumers, and just to hear the 11 concerns, to make sure that everything is taken into 12 consideration, to make sure that we continue to 13 provide the best level of care to people living in 14 North Country. 15 Yesterday, I had the opportunity, along with 16 Senator Patty Ritchie, to tour the facility. I was 17 with Imogene Raeger [ph.], who is on the board of 18 visitors, so we got to see the facility, and meet 19 some of the staff. 20 And, I thank you for allowing me to do that. 21 With that, I would like to turn it over to my 22 counterpart in the Assembly, Chairwoman of the 23 Assembly Mental Health and Developmental 24 Disabilities Committee. 25 Assemblywoman. 1 ASSEMBLYWOMAN GUNTHER: Hi, I'm 2 Assemblywoman Aileen Gunther. 3 And, first of all, I wanted to thank you for 4 inviting me here. 5 And with me today I have my colleague 6 Addie Russell, Ken Blankenbush. 7 And Janet Duprey wanted to be here today, but 8 she had a medical issue and she wasn't able to come, 9 but I know she'll be watching today, and watching 10 the tapes. 11 So I want to say good morning to all of you. 12 And this is my third [unintelligible] 13 statewide hearings on the Regional Centers of 14 Excellence Plan by the New York State Office of 15 Mental Health. 16 In July, OMH published the plan which calls 17 for the redesign of state-operated inpatient 18 services. 19 The plan also provides for the establishment 20 of 15 Regional Centers of Excellence. That will 21 serve specific populations, and call for closure and 22 re-purposing of several state-operated facilities, 23 many of which have played an integral role in the 24 regional mental-health systems of care for decades. 25 We are at a crossroads. 1 Our understanding of mental illness has 2 changed dramatically since the development of our 3 current system, but our delivery of service has only 4 marginally kept pace with these changes. 5 Now with the move to managed care, a 6 directive from the federal government, and the 7 absolute necessity for states to provide quality 8 care cost-effectively, we have an opportunity to 9 reimagine our system. 10 But in the process of redesign, we cannot 11 skirt, shirk, or otherwise overlook the 12 responsibility we have as a state, as a community, 13 and as human beings to ensure that every person who 14 needs care has convenient access to it, and that 15 will take reinvestment. 16 In New York State, we are fortunate to have 17 so many people dedicated to ensuring the people 18 living with mental illness have every tool, 19 opportunity, to work towards recovery and live 20 healthy productive lives, from the tireless family 21 advocates to our union brothers and sisters 22 providing care, as well as the clinicians who work 23 hand in hand with direct-care workers, family, 24 friends, and those suffering from mental health. 25 We are all here to listen today, to work with 1 you, and I want to thank you for having us today. 2 SENATOR CARLUCCI: Senator Patty Ritchie. 3 SENATOR RITCHIE: I would like to start off, 4 first, by thanking Senator Carlucci and 5 Assemblywoman Gunther for making the long trip up 6 here. 7 I know myself, along with the community, was 8 very concerned when the OMH plan first came out. 9 And in their presentation, they were setting 10 up listening tours across the state, and first and 11 foremost, Ogdensburg was not even listed. 12 So, we were able to get OMH to come up for a 13 listening tour, and many of the people that are here 14 today came out. We had the most speakers across the 15 state. 16 We presented them with a petition that 17 actually had personal accounts from people the 18 centers helped, and we actually thought that it was 19 very productive. 20 I think all of us were disheartened when the 21 results came out, and this center was not listed as 22 a Center of Excellence. 23 And from OMH's own plan and presentation, 24 they actually put up this map, and all of you have 25 it here, and I know everyone in this room is 1 familiar. 2 Just looking at this map indicates that the 3 North Country is left without critical services, 4 especially services -- inpatient services for our 5 most vulnerable: our children. 6 And somebody who represents just below the 7 city of Syracuse and has to travel to Albany on a 8 regular basis, and has to traverse these roads, 9 I can tell you, this is a truly big hardship for 10 those families who would have to have someone in 11 their family either in Syracuse or Utica. And 12 that's on a good day. 13 During the winter, you're driving through the 14 Tug Hill Plateau, hours added on. A very 15 treacherous trip. 16 And so, first and foremost, for all of us 17 here, we want to say that we appreciate you being 18 here, but we are really concerned about having 19 access, adequate access, to mental-health services 20 for the people who live in the North Country, in the 21 five-county area. 22 And on top of that, also, we're concerned 23 about the jobs. There are over 500 jobs here in a 24 county that currently posts one of the highest 25 unemployment rates. 1 Even though OMH has told us that those jobs 2 would stay in the area, the plan, you know, does not 3 give many details. 4 And for all of us, we're concerned about 5 having access to quality mental-health care 6 inpatient, and we're also concerned about the jobs 7 and what the impact would be on the area. 8 So, once again, thank you for coming up, 9 thank you for listening to all of us, and we really 10 appreciate the opportunity to have this vetted in 11 the open again. 12 ASSEMBLYWOMAN GUNTHER: I also forgot to 13 mention that Senator Tkaczyk's staff is here. 14 She couldn't be here today; she had another 15 meeting. 16 So we have Joe Glazer, and [unintelligible] 17 listening for Senator Tkaczyk. 18 ASSEMBLYWOMAN RUSSELL: I'll keep it short, 19 because I think we all want to hear from you. 20 As many of you know, I'm 21 Assemblywoman Addie Russell. I represent the 22 116th Assembly District that includes the wonderful 23 city here of Ogdensburg and the St. Lawrence 24 Psychiatric Center. 25 I'm excited to hear what all of you have to 1 say. 2 I'm very happy that my colleagues are here, 3 the Chair of the Mental Health committees in both 4 the Senate and the Assembly. 5 Your travel here probably demonstrates the 6 most of what most people are going to talk about 7 here, and that's accessibility to appropriate 8 mental-health services. 9 So thank you for coming. 10 And I know Ken would probably like to say a 11 couple of word as well. 12 ASSEMBLYMAN FLATBUSH: I'm just -- I'm not 13 going say a few words, just a little bit of a few 14 words. 15 But, I want to just say that the Senator and 16 the Assemblywoman and everyone that has spoken so 17 far, I can't repeat anything that they have said, 18 but the most important thing is, that you are here 19 to let the committees know how you feel. 20 And, so, I'm just going to shut up and 21 listen. 22 SENATOR CARLUCCI: Thank you. 23 So our first speaker is Andrea Smyth. She's 24 the executive director of the New York State 25 Coalition for Children's Mental Health Services. 1 And, we do have written testimony from all 2 the speakers today. 3 So, if you'd like to summarize it, so we can 4 get through all of the speakers, that would be 5 great, but you're also welcome to read the testimony 6 as well. 7 ANDREA SMYTH: Thank you. 8 I'm Andrea Smyth, the executive director of 9 the New York State Coalition for Children's Mental 10 Health Services. 11 I'm joined with Karen Richmond, who is a 12 member of my board of directors, and the executive 13 director of the Children's Home of Jefferson County. 14 Chairpersons Carlucci, Gunther; 15 Senator Ritchie; Assembly Members Russell and 16 Blankenbush; and all of the staff members of 17 Speaker Silver's staff; Senator DeFrancisco's 18 staff; Senator Tkaczyk's staff; we really appreciate 19 the opportunity to come to you and talk about our 20 first impressions of what OMH has put out. 21 The coalition has developed a position 22 statement that we think captures what we hope the 23 planning process will result in. 24 I'm going read that, and then I'll just go 25 through the testimony quickly. 1 The New York State Coalition for Children's 2 Mental Health Services believes that children and 3 families will have access to a stronger, more 4 responsive child and adolescent behavioral-health 5 service array as a result of the work of the 6 five Regional Centers of Excellence planning teams. 7 The coalition supports the planning process 8 as an effective vehicle for families and community 9 representatives to play a significant role in 10 identifying strategic investment and well-designed 11 expansion of both state-operated and state-licensed 12 children's behavioral-health services. 13 Currently, the existing safety net of 14 behavioral-health services for children and 15 adolescents includes both state-operated and 16 state-licensed services; it's not just 17 state-operated services, even in this region. 18 Establishing better coordination and 19 integration of all available services will be 20 required to achieve a modernized, more responsive, 21 and more effective service-delivery system. 22 First, I would like to comment on the 23 developmental alternative services. 24 We think state-operated inpatient services 25 are a valued component of the existing safety net 1 for children and adolescents with serious emotional 2 disturbances; however, the majority of 3 behavioral-health services provided in the region 4 are offered by state-licensed non-profit 5 organizations. 6 While hundreds of children and families are 7 accessing state-operated inpatient services, 8 thousands are receiving intensive therapeutic 9 services either out of home in residential treatment 10 facilities, or avoiding hospitalization with 11 intensive in-home services through the home and 12 community-based waiver program. 13 Changing the location of or the focus of 14 state-operated inpatient services doesn't 15 automatically mean that children will not have to 16 travel further for alternative services if the right 17 alternative services are developed in this 18 community. 19 It's up to the planning process to expand the 20 already-existing alternative services in each 21 community. 22 The coalition has urged modernization of many 23 child and adolescent services, including residential 24 treatment facilities. 25 We released a report entitled 1 "Redesigning Residential Treatment Facilities" in 2 January 2013. 3 I don't have copies with me. It's rather 4 bulky paper. I'll send electronically, and the 5 staff can distribute it. 6 I think I already have, but they can 7 distribute it to you. 8 Children's RTFs are a subclass of hospital 9 that operate at half the per diem cost of 10 state-operated inpatient beds. 11 We urge distribution of the report to each of 12 the five regional planning teams so each region can 13 determine which safe out-of-home alternatives are 14 necessary. 15 In fact, the communities that rely upon 16 state-operated inpatient services may be the 17 communities that lack a robust array of services 18 because they haven't been developed in lieu of those 19 state-operated services. 20 The coalition's proud to include the family 21 voice in our policy development. We have long 22 advocated for the development of crisis services, 23 respite services, and family-support services. 24 These are the types of services that families 25 say they need to support resiliency for their 1 children's -- their children while their children 2 are at home. 3 The planning process will not have to look 4 very far to identify alternatives like our RTF 5 report. Many, many stakeholders have offered 6 modernization suggestions, and we think the planning 7 process will bring those forward. 8 A few words about Medicaid-managed care. 9 By January 2016, all the currently exempt 10 populations for Medicaid-eligible will be moved into 11 a managed systems of care, about the time the 12 Regional Center of Excellence Plan concludes. 13 So they are concurrent. 14 The services offered by the four 15 state-operated children's hospitals and six child 16 and adolescent units represent a very high-cost 17 service, with the average daily cost of over 18 1400 per day. 19 OMH reports that children with -- who need 20 hospitalization, but who have commercial insurance, 21 already don't have access to those state-operated 22 beds because the insurers will not approve the 23 higher-cost service. 24 Having a service close is not accessible when 25 the cost is not allowing you to access it. 1 And under Medicaid-managed care, there may be 2 rejection of the state high-cost inpatient beds. 3 That's why OMH wants to modernize their 4 inpatient services to something that is viable in 5 the new market managed-care marketplace. 6 When exempt children services are 7 transitioned to Medicaid-managed care by January of 8 2016, the cost of service and the length of stay in 9 any particular service is going to influence the 10 decision to approve admissions. 11 If state-operated inpatient services cannot 12 craft a service that's affordable and effective, it 13 will not be accessible to the kids that need the 14 treatment. 15 We strongly support a planning process that 16 uses the information about existing treatment 17 scenarios to define the appropriate role for 18 state-operated services. 19 We're opposed to a scenario, under 20 Medicaid-managed care, under which taxpayer funds 21 are used to subsidize state-operated children's 22 services to keep those services competitive. 23 Our concern is not only based on market 24 share, it's a practical matter, because the State 25 subsidy will be at the expense of funding more 1 geographically-accessible evidence-based child and 2 adolescent services, either provided by OMH or 3 provided by non-profits. 4 That's not an acceptable tradeoff to this 5 organization. 6 We do feel strongly that the preservation of 7 the FTE-equivalence for the state -- child 8 psychiatrists who currently work for the State in 9 each region is imperative in the planning process. 10 The shortage of child psychiatry is a crisis, 11 especially in regions like this. 12 The state FTEs must be obtained regardless of 13 where the inpatient services are located. 14 I want to comment briefly before I talk to -- 15 have Karen talk about the planning process, 16 regarding education for kids who are in-state 17 inpatient services. 18 Many parents feel strongly that their kids' 19 education is often interrupted when they're 20 hospitalized, and we know this to be true, because 21 it's very difficult to integrate children upon 22 discharge back into their school setting. 23 But, last year, the Legislature agreed with a 24 proposal from OMH to turn the education of kids, 25 while they're in psych centers, over to the BOCES of 1 the child's residence. 2 So, the psych centers were acknowledging that 3 they weren't doing an adequate job of keeping the 4 kid's education linked with the child while they 5 were out of the home. 6 And that has already changed. 7 And, so, it makes the case even further for 8 there to be services for the children in the area in 9 which they reside, including at specialty education 10 services, like day treatment, and others provided, 11 that could be more mobile and located in -- closer 12 to the children. 13 So, now, Karen will comment on the planning 14 process. 15 KAREN ST. HILAIRE RICHMOND: Good morning, 16 and thank you, everyone, for coming. 17 My purpose is to really talk about the RCE 18 process, and that if we're really going to look at 19 how we deliver services, that we focus on the 20 importance of them, and what we really need to do 21 when we come back with reports, that we listen to 22 the outcomes. 23 So I really want to thank you all for coming, 24 and for visiting our region, and your interest in 25 better understanding our unique challenges. 1 The Central New York RCE team will make 2 decisions about services for 20 counties with a 3 combined population of nearly 2 million people. 4 Our region is bordered by Lake Champlain, on 5 the Vermont, on the east; and Canada and 6 St. Lawrence River on the north; Lake Ontario on the 7 west; and state of Pennsylvania to the south. 8 17 of the counties are considered rural, and 9 14 have populations of fewer than 100,000 residents. 10 Our region is also home to three 11 Native American nations, and a very active and 12 growing military base. 13 Addressing the needs of all the citizens in 14 this 20-county region will not be easy, but 15 I believe the planning process laid out by the 16 Office of Mental Health makes sense. 17 The Central New York team includes a complete 18 cross-section of family members, children's service 19 providers, and stakeholders. 20 Andrea and I, along with five of our 21 coalition board members, have been asked to 22 participate in the statewide planning process. 23 The coalition urged that at least one of the 24 tri-chairs of the five regional teams have expertise 25 in child and adolescent services. 1 We are pleased that every team has one. 2 One of the coalition board members, who 3 directs family-support services at a community-based 4 agency, has a very personal connection. She herself 5 has a family member who is a mental-health client. 6 The board member will serve on the western region 7 team. 8 In short, inclusion of children's-services 9 providers and other stakeholders is a good first 10 step towards success. 11 My organization provides OMH services, as 12 well as Office of Children and Family Services, and 13 we also provide in-home and out-of-home services, 14 and we provide services for children and adults. 15 The need for safe out-of-home services for 16 children and adolescents cannot always be avoided, 17 but hospitalization of children is never a benign 18 incident. 19 An important result of this planning process 20 must include the development of services that can 21 support hospital diversion and adolescent step-down 22 services. 23 Our region is currently developing a respite 24 program for children who do not need hospitalization 25 placement. 1 What happens before and after a child is 2 hospitalized should be discussed more thoroughly 3 than where a child is hospitalized, especially if 4 hospital stays are to become brief, intermittent 5 occurrences under managed care. 6 While we agree that the planning process is 7 compressed, as Andrea pointed out, the coalition has 8 already identified steps that can be taken to 9 modernize RTFs and waiver services. 10 Many other advocacy groups have completed 11 similar efforts and made similar recommendations. 12 I am confident that my familiarity with the 13 existing service gaps and the input from the other 14 community appointees will greatly impact the 15 development of a streamlined, yet more responsive 16 children's behavioral-health system. 17 I am proud to participate in the RCE planning 18 process, and believe it will be successful. 19 And thank you for your time. 20 SENATOR CARLUCCI: Senator Patty Ritchie. 21 SENATOR RITCHIE: Just a couple questions. 22 I am assuming, since you say you support the 23 five centers, that you believe that there still has 24 to be some inpatient services; is that correct? 25 ANDREA SMYTH: I believe that there can be 1 inpatient-like services or out-of-home services that 2 are therapeutic in nature, that our residential 3 treatment facilities are a subclass of hospital for 4 children, and we believe that the existing 18 RTFs 5 could operate satellite; RTFs in this region, either 6 at campuses that already have other residential 7 services in the area, or, on the state property as a 8 privatized service. 9 SENATOR RITCHIE: So you're advocating on 10 behalf of the children, in particular, going to the 11 children's home instead of being at this facility? 12 I guess I'm just trying to understand where 13 you're coming from. 14 KAREN ST. HILAIRE RICHMOND: I don't think 15 that's what we're advocating for, Patty. 16 I think really what we're looking for, is 17 that we look at all of the options that are out 18 there and available for children. 19 And I think that the way that we have done 20 services and the way that we've provided them may be 21 the best way, but maybe not. 22 And I think this is a unique opportunity for 23 us to all sit at the same table and look at the 24 best, most cost-effective method to be able to take 25 care of children and family. 1 There are children that go to St. Lawrence 2 now, that it's not any more convenient for their 3 parents to get there than it's going to be for our 4 children in Utica. 5 So I think that it's very important that we 6 have -- take this opportunity to look at everything. 7 And, in fact, St. Lawrence may be the 8 better option as we come through all of this, but 9 I think it's an opportunity to look at it. 10 And certainly not the children's home. 11 I think we're looking at, What is going to be 12 a best regional plan? 13 SENATOR RITCHIE: So I guess I would ask 14 then: 15 I'm assuming that you believe family being 16 part of this, considering that's what you're talking 17 about, is really important. 18 So from where I'm sitting, what does that 19 mean for the families of these five counties? 20 That, Jefferson is in a little bit different 21 situation because they're not so far out. 22 But, St. Lawrence, Franklin, Clinton, Essex, 23 what does that mean for those that would be -- would 24 have to travel to Utica or Syracuse? 25 What does that mean for those families; if 1 they're supposed to be such a big part of the 2 healing process, what does that mean for those 3 families that are that far away from their family 4 members? 5 ANDREA SMYTH: I guess I would observe that 6 the state-operated beds aren't the only beds 7 available to those families in those regions, and 8 that we certainly hope that the identification of 9 alternatives that might even be closer to families 10 in Essex County could be developed. 11 And that's -- that's what we think the 12 regional planning process can bring, are the ideas 13 about where there are gaps already, large geographic 14 gaps. 15 SENATOR RITCHIE: I guess, at this point, 16 just for clarification: You're advocating for 17 inpatient beds in other places in the five-county 18 area, versus at the psych center. 19 And, you know, that's a real concern for me, 20 because you came out saying that, you know, cost was 21 one of the mitigating factors here. 22 And I understand, listen, I want to do what 23 I can to protect the taxpayers' monies also, but 24 I also want to make sure that those that 25 I represent, and those from the North Country, are 1 given the same access to critical mental-health 2 services that everyone else in the state is. 3 And I guess I'm thrown back a little bit on 4 this plan that says, there will be other inpatient 5 services, but not at the psych center. 6 And I guess that is, in itself, part of the 7 plan -- 8 KAREN ST. HILAIRE RICHMOND: [Unintelligible] 9 know if it's determined. 10 SENATOR RITCHIE: -- because there is no 11 plan. 12 So, I mean, for me personally, it's hard to 13 advocate on behalf of this new plan. 14 Everyone in here wants to make sure that 15 those who need services have services in their own 16 home, but we all know, at some point, that's not 17 possible. 18 So, you know, this is a real concern, because 19 the plan is not transparent to the rest of us. 20 Maybe sitting on the committee you have 21 insight, but this is the first time that I've heard 22 that some of these people who need services would 23 have inpatient services somewhere else in this area 24 besides the psych center. 25 KAREN ST. HILAIRE RICHMOND: And I think, for 1 clarification, from our perspective, is that, you 2 know, we provide services for over 150 children in 3 St. Lawrence and the northern region, and those 4 families travel a long ways. 5 And I think that the percentage of children 6 that are hospitalized probably are less than the 7 percentage of children who need services in the 8 community. 9 So I look at this as, not an opportunity to 10 maybe close Ogdensburg, but maybe an opportunity to 11 look at how to enhance it for our region. It may 12 not be as big as it is, but it may be a smaller 13 venue that could serve children in the 14 North Country. 15 But I think that what it does give us, 16 Senator, is an opportunity to look at things; to 17 really come back and talk about the strengths that 18 we have in our community, and in our region. 19 I mean, I think our-seven county region is 20 unique to the state, and I think it's an opportunity 21 that we can all look at it, and talk about it, and 22 then kind of bring it back to -- for -- I don't know 23 that I would say I favor Ogdensburg closing. I like 24 having the fact that our children can get services 25 at St. Lawrence, but if we're posed with a change, 1 I think we have to look at all options, and figure 2 out how we can better serve the children and 3 families that we have to serve. 4 And in my perspective, we have adults through 5 the mental-health clinic that are going to be up 6 against the same issue. 7 So, I think it's certainly an opportunity 8 that we need to look at across the systems. 9 SENATOR CARLUCCI: Karen, just for 10 clarification, can you say your name and title and 11 organization. 12 KAREN ST. HILAIRE RICHMOND: Sure. 13 Karen Richmond, and I'm the executive 14 director of the Children's Home of Jefferson County, 15 but we also run an Article 31 community-based 16 mental-health clinic in Watertown. 17 SENATOR CARLUCCI: Thank you. 18 ASSEMBLYWOMAN GUNTHER: Can you tell me what 19 the Children's Home is? 20 KAREN ST. HILAIRE RICHMOND: The Children's 21 Home, by original design, is a residential 22 child-care center that serves children with -- out 23 of the court system; so, they're juveniles, they 24 come through that system. 25 But we have contracts that we serve for case 1 management. ICM, SCM, and mental-health clients 2 that we serve on another aspect in the county, and, 3 actually, in the tri-county, Jeffs, Lewis, and 4 St. Lawrence. 5 ASSEMBLYWOMAN GUNTHER: It will take a lot of 6 reinvestment. 7 You know, I think some of the fears that 8 I have is that, there's a lot of talk about the 9 plan, or -- but, you know, to me, it's going to take 10 people that are not only families. 11 Like, who's involved? 12 I understand, like, there's some regional 13 task force, but, you know, are we from the ground 14 up, or the top bottom? 15 Like, you're an executive, or -- but, there 16 are people that, you know, you look at statistics, 17 and I'm not hearing about the statistics that we 18 have from places like Sagamore, or, the one in 19 St. Lawrence. 20 But, what is the readmission rate? 21 And what is the after-care? 22 And are they keeping those children back in 23 the community? 24 You know, I think that -- you know, when we 25 talk about centers for excellence, you know, we have 1 data that we can look at right now, to say: How 2 great of a job are they doing? 3 Number two, my other concern is, as far as 4 the reinvestment, is that, you know, no parent, and 5 we all know, there's parents in the audience, wants 6 to have their child committed to a psychiatric 7 center. 8 That's like the last resort for any parent. 9 Or even having to put them in respite. It's a 10 terrible resort. 11 You know, we love our children, we want to 12 keep them at home, and that's very important. 13 You know, you're talking about BOCES with the 14 education component. 15 Absolutely. That's part of recovery. 16 You want that child to go from in a crisis 17 situation, and progressively go back to the school 18 that they came from. 19 But my apprehension is, that, are we looking 20 at statistics? 21 And I was in Sagamore on -- and, I'm sorry 22 that I don't know, Patty, what the readmission rate 23 is in St. Lawrence, you know, at your children's 24 facility, or, Trinity also, but I think that we have 25 to look at all of those in order to make a good 1 decision. 2 You know, I'm a big person about flow charts, 3 and I want to see how the system -- like, I want you 4 to frame it for me. 5 And, you know, I'm not -- I don't do it for a 6 living, but frame it. 7 A child in crisis goes, where? 8 How far away? 9 How do you bring those children to the 10 parents? 11 And it's not therapeutic, not to have those 12 parents involved. 13 And I would -- I drove all last night, and -- 14 with Allison [ph.] and my staff, and, you know, 15 there is poverty in this area, and there are people 16 without transportation that can't spend $25 for a 17 car to go down to Utica. 18 I drove from Syracuse yesterday, up. And 19 I just feel like that -- 20 [Applause.] 21 ASSEMBLYWOMAN GUNTHER: -- [inaudible]. 22 [Applause.] 23 KAREN ST. HILAIRE RICHMOND: But I would 24 agree with you -- 25 ASSEMBLYWOMAN GUNTHER: I'm not saying that 1 I don't believe in change. I understand the managed 2 care. 3 But you know what? I just don't understand 4 where we're going. 5 I represent Middletown, New York. 6 Middletown psych center closed, the big 7 reinvestment in area. 8 They did have a crisis-management team that 9 was created, but, honestly, as pediatric beds in 10 Orange and Sullivan, I think we got 8 beds -- 11 Allison? -- six or eight beds, what happened was, 12 that we were spending a lot more in acute care. We 13 were, you know, putting those kids in the emergency 14 room, 24 hours, which is against state regulations 15 at this point. Eight hours, and you have to make a 16 decision with -- admit -- you admit the child or 17 discharge her. 18 And, then, put them upstairs on constant 19 awareness, for as many as four days, with somebody 20 that does not have the expertise to deal with the 21 child in psychiatric crisis. 22 So, I see the whole thing, but I want to -- 23 I want a level of comfort. 24 And I'm hearing that "we," "we," "we," but 25 who is the "we"? 1 There are a few -- 2 KAREN ST. HILAIRE RICHMOND: But the "we" is 3 the RCE team that's going to come through. That's 4 got a diverse population from all across the state, 5 or our region, that's going to be sitting there. 6 And I think what you're saying is absolutely 7 correct, we have children that sit in our emergency 8 room in Watertown for 10 or 12 days, even with 9 St. Lawrence here, that they don't meet the criteria 10 to be able to be hospitalized; however, they're not 11 stable enough to return back home to their families. 12 So I applaud you when you say parents don't 13 want to commit their children to institutions, but 14 they need to be able to have services to 15 substain [sic] them in their home and in their 16 community. 17 And I think this is what's going to give us 18 an opportunity to look at how we can take the 19 funding that we've been funding for in-care 20 provided. 21 I mean, I did the same tour about two weeks 22 ago. I did seven counties in two days. 23 I commend you. 24 It's a long ways, there's a ton of poverty, 25 and a lot of nothing between one spot and another. 1 ASSEMBLYWOMAN GUNTHER: Absolutely. 2 KAREN ST. HILAIRE RICHMOND: And then you can 3 go into Hamilton who has nothing in their whole 4 county. No pharmacy, no psychiatry, nothing, in a 5 whole county. 6 So I think for us not to look at a way to be 7 able to deliver these services regionally, and more 8 effective, this is the best time that we've ever 9 had. 10 So, I'm not saying that anything is off the 11 table or on the table. 12 ASSEMBLYWOMAN GUNTHER: Right. 13 KAREN ST. HILAIRE RICHMOND: I'm saying that 14 we have to come back. 15 We've looked at it in the child-welfare 16 system, in the Close To Home project, and we are 17 requiring children to stay in their home district 18 when they're placed. 19 This is, mental-health children deserve -- 20 and by the way, children aren't any different, 21 whether they're in the mental-health system or the 22 child-welfare system or the juvenile justice system, 23 they cross -- they cross paths. 24 We have to stop separating services, and look 25 at the child and the family, because no child -- no 1 family ever wants their child pulled out of their 2 home. 3 ASSEMBLYWOMAN GUNTHER: Absolutely. 4 KAREN ST. HILAIRE RICHMOND: And the longer 5 you pull a child out of the home, the harder it is 6 to reunite them, so we need to be able to look at 7 all of those services. 8 I think there's expertise at Ogdensburg that 9 we need to draw on, and I think that's what we need 10 to do, to look at the way we deliver services. 11 ASSEMBLYWOMAN RUSSELL: You spoke about -- 12 Ms. Smyth, you spoke about a subclass of 13 hospitalization that cost half the per diem cost of 14 current state-operated inpatient facilities. 15 Is that something that would be classified as 16 a partial hospitalization program? 17 Or, can you give me a little bit more 18 information about that? 19 ANDREA SMYTH: No, they're licensed 20 residential treatment facilities. They're 21 OMH-licensed facilities. They're a subclass of 22 Article 1 hospitals, so they are -- operate along 23 some of the same regulations as regular hospitals. 24 It's not a partial hospitalization program; 25 it's an inpatient. 1 At the federal level, it's called 2 "inpatient psychiatric rehab facilities." 3 But in New York, we've converted that to a 4 next higher level and put in hospital regulations. 5 So, that's why the subclass of hospital comes 6 along. 7 ASSEMBLYWOMAN RUSSELL: Would there be 8 anything preventing the State from operating such a 9 facility? 10 ANDREA SMYTH: The State currently doesn't. 11 There are 17 licensed RTFs. 12 Funding has been frozen for five years under 13 the Medicaid cap. 14 One of them went out of business in 15 Putnam County. 16 There were eighteen, until last year. 17 There's been a moratorium on RTF beds since 18 1994, so, there are 518 RTF beds, and 405 children 19 inpatient state-operated psychiatric beds, and 20 that's for it entire state. 21 So, it's really -- 22 KAREN ST. HILAIRE RICHMOND: And none of them 23 are closer than Utica. 24 ANDREA SMYTH: Right. 25 KAREN ST. HILAIRE RICHMOND: So now we don't 1 even have -- 2 ANDREA SMYTH: So the geographic region 3 doesn't even have an RTF, but that's one of the 4 things that we think should be considered, because 5 the residential treatment facilities are 6 therapeutic, and they have the intensive 24-hour 7 supervision. 8 The report, when you see it, it has a very 9 onerous admissions process, just like the state 10 psych centers. 11 We spend a lot of time trying to keep kids 12 out of these places. 13 ASSEMBLYWOMAN RUSSELL: Given that these 14 facilities are under financial strain, you said that 15 one had to close, likely because of the cap, would 16 that be an area that the State should look at 17 providing, instead of -- you know, if it requires 18 some sort of, I guess, additional funding for them 19 to be able to -- 20 ANDREA SMYTH: We've requested a meeting with 21 the Department of Health, to say, now that they've 22 moved the deadline for moving kids into managed care 23 to 2016, they have to revisit the Medicaid cap, 24 because the Medicaid cap was until the programs 25 moved to managed care. 1 But the date to move the programs keeps 2 moving up, but the funds have been frozen for 3 significant periods of time. 4 ASSEMBLYWOMAN RUSSELL: A lot of your 5 testimony appears to be from a -- as one of my 6 predecessors used to say, a 30,000-foot view. 7 Did you have the opportunity to kind of come 8 back down to the area that's, you know, 9 traditionally been served by the St. Lawrence 10 Psychiatric Center, and the actual center itself, to 11 look at issues, such as, its lengths of stays, its 12 continuity with the home school district? 13 You know, you talk about the fact that they 14 need to be, really, just intermittent inpatient 15 admissions. 16 You know, I believe that the Ogdensburg -- 17 or, the St. Lawrence Psychiatric Center here in 18 Ogdensburg actually has some of the best statistics, 19 when you look at the length of stay, and the 20 education handoffs, and the close contact with home 21 school districts. 22 Were you able to, or did you have the time to 23 do that type of -- 24 ANDREA SMYTH: The member agencies that we 25 represent work closely with all of the state 1 psychiatric centers. 2 We have a actually worked to develop 3 emergency readmission policies, so that when kids 4 are discharged, we can turn them back to the psych 5 center, if necessary, rather than have them 6 recidivism and go through the whole process of 7 admission through lower levels of care. 8 ASSEMBLYWOMAN RUSSELL: I guess my question 9 is: Did you actually look at the statistics for the 10 St. Lawrence Psychiatric Center in terms of -- 11 ANDREA SMYTH: Length of stay? 12 ASSEMBLYWOMAN RUSSELL: -- those markers, 13 like, lengths of stay, and the education component, 14 and readmission? 15 ANDREA SMYTH: We look a them quarterly with 16 the Office of Mental Health. 17 ASSEMBLYWOMAN RUSSELL: Is it included in 18 your testimony? 19 ANDREA SMYTH: No. 20 ASSEMBLYWOMAN RUSSELL: Okay. 21 And can you tell me what an appropriate 22 amount of family involvement would be, when you're 23 talking about a placement outside of the home, 24 whether it's inpatient hospital, whether it's in one 25 of these RTFs, whether, you know, it is in a 1 partial hospitalization setting? 2 What should -- how involved should the family 3 be in recovery? 4 ANDREA SMYTH: We think completely involved. 5 Our organization has established protocols 6 for treatment-team involvement, so that families are 7 scheduled, so that the treatment team, the families 8 are asked to participate in the treatment team. 9 We have transition coordinators who go out to 10 the community, to prepare for discharge. 11 We have family-support services, where we 12 hire professional parents who work with the family, 13 to prepare, and do in-home work for return. 14 ASSEMBLYWOMAN RUSSELL: So how -- how -- what 15 type of length of stay should we be looking at, or 16 would you anticipate is probably, on average, what 17 someone should -- should need to be in on an 18 inpatient level? 19 ANDREA SMYTH: You know, we are not -- 20 I mean, this is one of our biggest fears about 21 managed care. 22 I mean, if a managed-care organization is 23 going to say that a typical length of stay for a 24 child with a severe emotional disturbance is 25 seven days, then we're all in a lot of trouble, 1 because the average length of stay at most of the 2 inpatient children and adolescent psychiatric 3 centers is 125 days, I think. 4 I don't know, I can't recall off the top of 5 my head, what St. Lawrence's is, but, 125 days, 6 which is three months, you know. 7 And the average length of stay at an RTF is 8 six months. 9 So, in a managed care environment, you know, 10 we are not -- we are not going to be able to meet 11 standards that someone else say are acceptable. We 12 have to meet the standards of the children and the 13 families we see. 14 ASSEMBLYWOMAN RUSSELL: Okay, I guess -- so 15 of an average of three months, how many days should 16 the parents be involved in the treatment meetings? 17 Is it once a month? Is it once a day? Is it 18 every two weeks? 19 You said parent involvement is paramount, so 20 I'm just trying to gauge how many times a parent 21 would have to drive to Utica, a week, in order to be 22 involved at a level that we -- 23 ANDREA SMYTH: We use a lot of -- we use a 24 lot of, you know, telecommunication for our parent 25 involvement. 1 I mean, it's almost impossible for families 2 to take whole days off to travel. None of these -- 3 none of these placements are close enough for 4 families to be involved personally every single time 5 the treatment team meets. 6 ASSEMBLYWOMAN RUSSELL: And how often is 7 that? How much -- how often -- 8 ANDREA SMYTH: It depends on the child. It's 9 all individualized. 10 I mean, by regulation, the treatment team has 11 to meet, I think, once every 14 days. 12 But, I -- I don't know that that's -- you 13 know -- 14 ASSEMBLYWOMAN RUSSELL: Okay. 15 ANDREA SMYTH: -- there may be one every 16 three days if the treatment needs to be changed. 17 ASSEMBLYWOMAN RUSSELL: Thank you. 18 ANDREA SMYTH: Yep. 19 SENATOR CARLUCCI: Senator Ritchie. 20 SENATOR RITCHIE: Just a follow-up comment, 21 I think. 22 Karen, you said that no parent wants to pull 23 their child out of their home or -- and be 24 institutionalized for care. 25 But the thing is, as hard as everyone tries, 1 there always are those select cases that we're 2 talking about, and the Assemblywoman just talked 3 about, what the length of stay is. 4 And I know, as a parent, I'm not going leave 5 my child in Utica or Syracuse for three months. 6 And I think that is the main reason that this 7 area should be classified as a Center of Excellence. 8 It's not that we don't have the opportunities 9 to make that happen. We have wonderful colleges to 10 partner with, there's already some programs there, 11 to help make that happen. 12 And once again, I just think, for the record, 13 it's truly unfair that anyone who lives above the 14 thruway will not have this kind of access to 15 inpatient services, if they're adult family member 16 or their child needs those kind of services. 17 And I just kind of find it ironic that you're 18 advocating how much family involvement there needs 19 to be, but at the same time, you're advocating that 20 it's okay for those services to be moved downstate. 21 They don't really line up. 22 So, they don't really line up. 23 [Applause.] 24 SENATOR CARLUCCI: Thank you. 25 Next we're going to hear from a panel of 1 speakers. 2 We have Mark Webster, Vicki Perrine, 3 Dr. Theodore Klaudt, and Dr. Pakkam Rajasekaran. 4 Good morning. 5 Please introduce yourself, and then you can 6 start right up. 7 ASSEMBLYWOMAN GUNTHER: [Inaudible.] 8 H. THEODORE KLAUDT, M.D., FACEP: My name is 9 Ted Klaudt. I'm the medical director of the 10 emergency department at Claxton-Hepburn Medical 11 Center. 12 SENATOR CARLUCCI: [Inaudible.] 13 H. THEODORE KLAUDT, M.D., FACEP: Thank you. 14 I'm really here to speak about the concerns 15 I have regarding the closing of SLPC, from my 16 perspective as a -- as an ED physician, as the 17 medical director the emergency department, and not 18 because I can speak to psychiatric long-term care, 19 and so forth. 20 Just a little bit of background: 21 I've been an emergency physician since 22 completing my training in Ottawa 34 years ago. 23 I've been in this part of the world now for 24 22 years. 25 I was the medical director of emergency 1 department at CDPH in Plattsburgh for 11 years, 2 where we had both an adult and children's 3 mental-health unit. 4 And, I've been here now for the last 5 two years. 6 A little context about "CHMC"; 7 Claxton-Hepburn Medical Center: 8 Our ED sees 19,000 visits per year. This is 9 mental-health patients as well as medical and 10 surgical patients. 11 Of those, 1765, or just about 10 percent, are 12 patients who present for psychiatric evaluations 13 annually. That was our -- those were our figures 14 for last year. 15 We're pretty much on course to see the same 16 number of patients. 17 The job of the emergency department really is 18 to provide medical clearance for these patients, and 19 once they're medically cleared, to facilitate the 20 assessment by psychiatric evaluation, or, 21 psychiatric evaluators, and this occurs in a 22 separate but contiguous three-bed safe area. 23 And I want to be clear about that: we have 24 3 rooms for this out of a total of 18 rooms in our 25 department. 1 And this is going to become important as I go 2 on, because I'd like to weave in the impact that 3 I believe this may have, or probably will have, on 4 our medical and surgical patients as well. 5 We admit 54 percent of the patients for whom 6 we provide psychiatric evaluations, and last year, 7 that was 975; or just somewhere under 3 a day. 8 SENATOR CARLUCCI: Is that all to the 9 St. Lawrence Psychiatric Center? 10 H. THEODORE KLAUDT, M.D., FACEP: No, this is 11 to our mental-health unit, as well as to 12 St. Lawrence Psychiatric Center. 13 Last year we admitted 210 patients to 14 St. Lawrence Psychiatric Center, mostly -- and these 15 were all children, I should say. Only 50 adults. 16 And the reason for that is, we have an 17 inpatient adult mental-health unit, and most of the 18 patients -- most of the adult patients that are 19 going to be admitted from the ED will be admitted to 20 our adult mental-health unit. 21 There are reasons for which they may be 22 admitted directly to St. Lawrence Psychiatric 23 Center: 24 If they were recently admitted there; 25 If there are, for some reason, conflicts as 1 to why they should not be admitted to our adult 2 mental-health unit. 3 The vast majority of children, however, who 4 are admitted through our facility to a mental-health 5 unit will be admitted to St. Lawrence Psychiatric 6 Center. 7 And, again, I have some concerns about those 8 children whom we cannot admit there, and the impact 9 that that's having already while this is still open. 10 I'd like to say that, over the past 3 years, 11 on 80 percent of the days that we've been operating, 12 which is every day, 24/7, we have had 5 or more 13 mental-health patients within our department. 14 The length of stay for mental-health patients 15 is, for a multitude of reasons that I won't bore you 16 with, much longer than it is for the general medical 17 patient. 18 We generally will discharge a general medical 19 patient in about 2 1/2 hours, those that are going 20 to be admitted in about 4 hours; whereas, the 21 mental-health patient will spend 7 or 8 hours, on 22 average, in our department. 23 So this has a significant impact, in that, 24 when we only have three secure rooms, when we have 25 an average of five patients a day coming through, 1 those patients spill over into the general medical 2 area. 3 And we have, in the past year, one day out of 4 seven, evaluated ten or more mental-health patients 5 per day. 6 And I can tell you that I remember very well 7 days when we've had eight and nine patients at any 8 given time in our department, which means that half 9 our department at that point is occupied by 10 mental-health patients. The other half then is 11 available for medical and surgical patients. 12 And this also comes into my area of concern. 13 We believe that the ED volumes of 14 mental-health patients that we're going to be asked 15 to evaluate and maintain in our department are only 16 going to increase, and this is going -- this is 17 going to exceed our capacity to do so safely. 18 I think that the patients who present with 19 mental-health distress should not be mixed in with 20 the general medical, surgical, patients who are 21 there for totally other reasons. 22 I think there's nothing more agitating, if 23 you've spent any time in an emergency department, 24 than being in that very, very intense area. 25 By the same token, mental-health patients are 1 occasionally brought in to us by police, because we 2 are the 939 facility for the area, who are agitated 3 and can't be placed in our secure area because, it's 4 full, and some of our medical patients are not well 5 served by being made aware of this, for, again, a 6 variety of reasons I'm sure you can imagine. 7 So, we feel that there will be an increased 8 boarding of patients -- of mental-health patients in 9 our emergency department as a result of the closure 10 of SLPC. And this is going to negatively impact 11 both, their care, they're gonna be there for longer, 12 and will impact the flow of the medical and surgical 13 patients in our department. 14 There's been lots written in the last 15 10 years or so about ED crowding. 16 Some of you may be aware of excellent 17 scientific papers that show that this has a negative 18 impact on the outcomes for those medical and 19 surgical patients. Mortality increases, and 20 certainly morbidity, length of stay, costs, and so 21 forth, increase. 22 And we've seen in our department, I've only 23 been here two years now, we've certainly seen an 24 increase of length of stay over that period of time 25 for, both, the mental-health patients, as it already 1 stands without these increased numbers, and for our 2 medical patients. 3 There are safety concerns. 4 Again, there's lots written about violence in 5 emergency departments that the staff are subjected 6 to. 7 There isn't a nurse in our department who 8 hasn't been kicked, punched, spat on, and whatnot, 9 and I think as things become more congested and more 10 tense, this will only intensify. 11 If we have to transfer patients, and it 12 sounds like this would be part of the plan, anywhere 13 from two to four hours away, that is going to 14 increase, certainly, length of stay in our 15 department to be able effect that transfer. It is 16 certainly going to increase costs. 17 And it's not unusual that I'll have to deal 18 with a family member when I tell them that their 19 child is going to be going to Utica or to CBPH or to 20 Syracuse, as to how they're going to be impacted 21 negatively by that decision. 22 "How am I going to get there? I don't have a 23 car." 24 This is not a high income area as most of you 25 know. 1 So, I think that is a major concern for me as 2 well. 3 There are weather, obviously, and road 4 conditions to be taken into consideration. We have 5 long winters here, bad roads, and things do happen. 6 Ambulances do crash. 7 And I think, overall, to kind of put this 8 into, and to encapsulate this, into a summary, 9 I feel that closing the services at SLPC will put an 10 undue burden, an increased burden, on our emergency 11 department that's going to negatively impact, both, 12 those psychiatric patients that we see and care for, 13 and the mental health -- or, rather, and the medical 14 and surgical patients that we're dealing with as 15 well. 16 ASSEMBLYWOMAN GUNTHER: Thank you very much. 17 Dr. Raj. 18 PAKKAM RAJASEKARAN, M.D.: Yes, ma'am. 19 First of all, my -- well, my name is 20 Pakkam Rajasekaran, and I go by the name "Raj" to 21 make it easy to pronounce. 22 I thank you all -- 23 ASSEMBLYWOMAN GUNTHER: Thank you for that. 24 PAKKAM RAJASEKARAN, M.D.: I thank you all, 25 Senators and Assembly Members, to give me the 1 opportunity to present my case. 2 I am -- I've been a practicing psychiatrist 3 for 32 years, and I have practiced in similar 4 communities. 5 And I came from Cooperstown area in Bassett. 6 I was working in Bassett Medical Center. And then 7 moved here about two years ago to the North Country. 8 And I am -- I am going to talk about my 9 experience, from the gut level, from the trenches, 10 and that is what I'm here for. 11 I'm the medical director for the 12 mental-health center here at the Claxton-Hepburn 13 Medical Center. I'm also the chairman of the 14 department of psychiatry. 15 And, I work very closely with Dr. Klaudt for 16 the emergencies. 17 I wanted to spend a minute or two about the 18 role of Claxton-Hepburn versus SLPC. 19 We both serve very unique roles. 20 Claxton-Hepburn is what we call 21 "Article 29, 939 facility." 22 We are designated to receive mentally ill 23 patients, and of many of them are brought in by 24 police officers on a pick-up order. They can pick 25 up a patient if they find it necessary, and we 1 evaluate them. And if we find them to be necessary, 2 they meet the inpatient criteria, we hospitalize 3 them. 4 We hospitalize, again, our unique role, is to 5 provide the acute emergency care locally first, and 6 not necessarily go for long-term care. 7 In that role, we hospitalize about an average 8 of 975 patients a year to our unit here, and we do 9 have a wonderful 28-bed unit. 10 But, there are going to be patients who are 11 going to be needing long-term care. 12 Generally speaking, if they are not going to 13 get well in 30 days, for a lot of other reasons, we 14 do have to transfer them to the SLPC, and that's 15 what we do. 16 And, our average length of stay is 9.8 days. 17 We have a 92 percent occupancy rate. 18 Now, between Claxton inpatient services to 19 the hospital, SLPC, we transfer about 68 patients 20 annualized, but those are our patients who were 21 already hospitalized or have been in the SLP -- in 22 the Claxton for a month or two, and then they need 23 to be getting longer-term care, and they go there. 24 And this does not include admissions directly from 25 the emergency room. 1 And that is the background I wanted to give. 2 And the other statistics I wanted to present 3 is, this year alone, for the last 8 months, we have 4 evaluated 1177 patients, out of which 252 are 5 children. 6 And we transferred 123 children to SLPC 7 directly, and mainly because they are in the 8 catchment area, and there are various other reasons. 9 And when they have a bed, they are wonderful, 10 they will take the patients right away. 11 And that leads to the next part: What will 12 happen if the SLPC is shut, and how that affects 13 this community, and the way we provide services 14 locally to our mentally ill population and the 15 families? 16 Now, my understanding is, the SLPC has about 17 100 beds, and about 70 them, I believe, are adult 18 beds. 19 I may be wrong, but I'm just giving what 20 I read. 21 And if they are shut, and they are 22 transferred to Utica and Syracuse, and I have a lot 23 of concerns how that affects our patients and our 24 community, and how we provide services. 25 There is a lot of burden and hardship on our 1 families. 2 For example, when we transfer -- I'm going to 3 talk about the children now -- when we transfer 4 children, they are not as simple as transferring an 5 adult. 6 Children have to be signed in because, 7 normally, the parents are the guardian, or, they 8 have a different guardian, the DSS is the guardian. 9 And many hospitals will insist, especially 10 the private hospitals, generally demand the parents 11 have to come with them. And that is a daily 12 entrance, and the parents have to consent for the 13 treatment. And then they have to go for the family 14 meetings, and so many other meetings, meeting with 15 the teachers, counselors. 16 Our families, especially my experience in 17 North Country, they really don't have that kind of 18 resources to put gas in their car and go 130 miles 19 to some hospital somewhere else. Coming from 20 Massena to Syracuse or Utica, that's a 4-hour drive, 21 and then to come back. 22 And this is to be done on a weekly basis, 23 I don't know how they are going to afford. 24 Now, the children need continuity of care, 25 and they need a good treatment, the best treatment 1 available in the world. And these are our children, 2 and I'm concerned about that. 3 And the other issue Dr. Klaudt pointed out, 4 the weather conditions. 5 You know, these roads are not exactly 6 wonderful in wintertimes, as you all know. 7 And, how are we going to transport all these 8 patients? 9 And what about the transportation costs; who 10 is going to pay for them? 11 You know, you're talking about transferring, 12 the numbers I gave you, 123 children alone from the 13 emergency room to SLPC. 14 And that's a great problem. 15 You know, again, as a psychiatrist, I wanted 16 to -- and from the community, I wanted to address 17 another issue. 18 It's a very well-established fact, when the 19 people don't receive proper services in the 20 inpatient and they don't have services in the 21 community, that leads to more recidivism, more 22 readmissions. That increases the cost of care. 23 And, you know, the -- already the systems are 24 burdened. 25 And not to mention, how many of our patients 1 end up in the legal system. And we all know a lot 2 of mentally ill people are homeless, and they end up 3 in the legal system, they are incarcerated. The 4 jails are filled. 5 I read the other day our -- I believe the 6 County is paying $1,700 a day to house somebody from 7 a local county to some other county, if the 8 prisoners are transferred from this county to 9 Malone, or some other county, and I'm concerned 10 about that as a citizen. 11 And, so, that's why I wanted to present my 12 case, and I want the legislators to be aware of what 13 the impacts are. 14 And I also, in a closing note, I wanted to 15 mention my experience working with the SLPC staff 16 and the medical staff. 17 That's a fine hospital. 18 I have worked in state hospitals before, I've 19 known many state systems, and they are wonderful to 20 the unique needs of our people, both adult and 21 children, and, they make the process as easy as 22 possible. 23 It will be a terrible tragedy to see that 24 hospital close. 25 Thank you very much. 1 [Applause.] 2 SENATOR CARLUCCI: Thank you, 3 Dr. Rajasekaran. 4 We are joined by Senator Betty Little, who 5 was able to join us. 6 So, thank you for being here. 7 SENATOR LITTLE: Thank you. 8 Just a quick question. 9 Dr. Klaudt, in the beginning of your 10 testimony, you had talked about the time frame it 11 took to discharge some of the patients that come 12 into the emergency room to psychiatric center, and 13 you talk about the children, and you had some 14 concerns about that. 15 And, I thought you were going to talk about 16 that further? 17 H. THEODORE KLAUDT, M.D., FACEP: Certainly, 18 I can. 19 SENATOR CARLUCCI: Well, in terms of looking 20 for, maybe there are strategies or suggestions that 21 you have in terms of how to make that process 22 quicker, smoother? 23 H. THEODORE KLAUDT, M.D., FACEP: Well, in 24 general, if the patient is going to be -- we're 25 talking about children now, if they're going to be 1 admitted to SLPC, this will flow fairly quickly; 2 about as quickly as one can make these things 3 happen. 4 Again, there is this dual evaluation of a 5 medical-screening process first, to make sure that 6 there are no medical issues that are causing the 7 psychiatric symptoms. It's more common, obviously, 8 in adults than in children. 9 But, nevertheless, once that's done, they 10 then have to be evaluated by one of our psychiatric 11 crisis counselors. 12 So that dual -- and it typically doesn't flow 13 in parallel, if you will. It's sort of a stepwise. 14 That, in and of itself, will certainly 15 lengthen the stay for a patient presenting with 16 psychiatric or mental-health behavioral issues, as 17 compared to the medical patient, where we will see 18 them typically, and then move them along. 19 The children that are not going to be 20 admitted to St. Lawrence Psychiatric Center, because 21 of an absence of beds, or for some other reason, 22 there may be some other very legitimate reasons why 23 they can't be admitted here, these are children who 24 occasionally will spend days in our department while 25 we're trying to find placement for them. 1 For whatever reason, it seems, when 2 St. Lawrence Psychiatric Center is full, when their 3 children's unit is full, most other children's units 4 in the state are full as well, or in the immediate 5 area, if you will, CBPH, Utica. And it's not 6 unusual then for these kids to spend long periods of 7 time. 8 I don't know how one would shortcut that, 9 other than to say, let's have more beds. 10 That's always our solution: let's make more 11 beds. 12 Obviously, that's not practical in this day 13 and age of cost constraints, and so forth. 14 SENATOR CARLUCCI: But, no, you're not really 15 talking about beds at the psychiatric center; you're 16 talking about beds where they wouldn't fit the 17 criteria to go to the psychiatric center? 18 H. THEODORE KLAUDT, M.D., FACEP: Not -- 19 SENATOR CARLUCCI: Because, have you 20 experienced a wait with the psychiatric center now 21 for children's beds? 22 H. THEODORE KLAUDT, M.D., FACEP: No. If 23 there are beds available, there's not -- there's not 24 a huge issue. 25 There are procedures, if you will, that have 1 to be gone through. 2 I think it takes a little longer to get a 3 patient, a child, admitted to SLPC from our 4 department than it takes for an adult to be admitted 5 to our adult mental-health unit, obviously, within 6 the same institution, that flows more easily, more 7 quickly. There's another group of people to be 8 talked to, there's a transport to be arranged, and 9 so forth. 10 But other than that, if they have beds 11 available, I can't say that there have been 12 significant issues in moving that patient who needs 13 to be admitted, once they've been accepted. 14 Did I answer your question? 15 SENATOR CARLUCCI: Yeah, thank you. 16 I appreciate it. 17 PAKKAM RAJASEKARAN, M.D.: Senator, if I may 18 elaborate on that? 19 I think it's wonderful if we have a bed 20 available. I'm talking about the children, and if 21 the SLPC accepts them, and the transition is very 22 smooth. 23 There are occasions, for various reasons, 24 either beds are not available, or for some reason, 25 those children are not admitted to SLPC, it's not 1 unusual for them to sit in the emergency room in the 2 crisis bed for days, and without getting any 3 specialized services. 4 And, in the meantime, we cannot find a bed 5 for them anywhere in the state. There are no places 6 for them to go to. The parents cannot take them, or 7 there are no parents. 8 We encounter such situations. 9 In my opinion, I think it's not acceptable 10 for children to not receive specialized treatment 11 services, sit in an emergency room for days on end. 12 That is what I would like not to see. 13 Thank you. 14 SENATOR CARLUCCI: And I guess that's really 15 what I was trying to get at, is what is that wait 16 happening from? 17 Because, we're really not talking about a 18 lack of beds, in terms of, there are beds available. 19 So where are the beds not available, in terms 20 of -- 21 PAKKAM RAJASEKARAN, M.D.: The -- what 22 happens in the system, Senator, is, if for some 23 reason SLPC will not take the patient -- 24 And they have good reasons, we know. They 25 have to meet the criteria to go there. 1 -- that invariably means no other hospital in 2 the state will take the patient. 3 And that does happen to us many times, and 4 that is a problem with the system. 5 You know, I don't know what the answer is, 6 but that is the truth, and that is a problem with 7 the system. 8 SENATOR CARLUCCI: So that sounds like a 9 major problem -- 10 PAKKAM RAJASEKARAN, M.D.: Yes. 11 SENATOR CARLUCCI: -- that we should be 12 working with the Regional Centers of Excellence to 13 try to cope with it, in terms of, there's not -- 14 they're not fitting the criteria, but there's a 15 need. 16 PAKKAM RAJASEKARAN, M.D.: Exactly. 17 And, now, the other concern I have is, when 18 Binghamton closes, I think, I believe, they are 19 going -- they have been serving several counties -- 20 Broome County, Oswego County, and Chenango, Oneida, 21 and so on -- now SLPC serves about six counties. 22 Now, if these two places close, then we're 23 going to be competing with -- along with the 24 10 other counties, and that is our concern. 25 You know, there are times, I hate to see the 1 children in the emergency room for seven days. 2 Now, what's going to happen, we'll be one of 3 the ten. You know, we'll be competing with all the 4 beds, with 10 other counties, and that's my concern. 5 H. THEODORE KLAUDT, M.D., FACEP: If I may? 6 SENATOR CARLUCCI: Please. 7 H. THEODORE KLAUDT, M.D., FACEP: I'd like to 8 add on to that. 9 I think there clearly are times, and this 10 goes back to my experience at CDPH, and I'm not here 11 to speak to that per se, but as well as here, both 12 facilities refer children for admission to SLPC. 13 So, there are times when SLPC, when that 14 children's unit is full, when that's the reason for 15 which we can't transfer that child, and they may 16 linger in our departments because no one else has 17 any beds. They may linger in our department for 18 long periods of time, or a significant amount of 19 time, to find another facility that does have a bed. 20 My concern is, that with SLPC closing, 21 that'll just reduce the number of beds that we have 22 locally, possibly reduce the number of beds 23 statewide, but that problem is only going to get 24 worse. 25 SENATOR CARLUCCI: I guess what I'm really 1 trying to get at, is that it sounds like conflicting 2 answers here, in terms of, is it that the children 3 are waiting around because there's a lack of beds in 4 the state system, or is it because they don't fit 5 the criteria to be in the state system? 6 H. THEODORE KLAUDT, M.D., FACEP: Both. 7 SENATOR CARLUCCI: Okay. 8 PAKKAM RAJASEKARAN, M.D.: Both. 9 SENATOR CARLUCCI: And both, okay. 10 And what would you say the percentage is, in 11 terms of your experience? 12 H. THEODORE KLAUDT, M.D., FACEP: I'll take a 13 stab at it, and I'll say that, probably, half and 14 half. 15 SENATOR CARLUCCI: Okay. 16 Okay, great. 17 Senator Ritchie. 18 SENATOR RITCHIE: Just a clarification for 19 the record: Last week I was able to go to Claxton 20 and tour the hospital, and during that visit, was 21 told that 123 children were transferred to the 22 center since the beginning of the year. Yesterday 23 I had the opportunity, with Senator Carlucci, to 24 stop at Trinity and at the children's building, and 25 when I asked that question, I was told that that 1 information was not correct. That there were only 2 50 children. 3 That's a big difference. 4 So for the record, could you tell me, because 5 I see it's in your written testimony, how many 6 children have been transferred from January until 7 present this year? 8 H. THEODORE KLAUDT, M.D., FACEP: I didn't 9 pull these numbers out of our system myself, but 10 I will say, I believe these numbers. 11 The person who pulled them is reliable, and 12 we have an electronic medical-record system, wherein 13 it's easy to find disposition of where people go to. 14 I believe the 123. And that would really be 15 in keeping with the 210 who we transferred to SLPC 16 children's unit last year. 17 SENATOR RITCHIE: So that, in itself, is a 18 huge difference in the numbers. And I know the 19 individual did not have a sheet in front of them, so 20 there -- you know, there may be just an innocent 21 reason, because the adult number is fifty. 22 But that makes a big difference, when you 23 have number-crunchers trying to make a decision on 24 whether the facility -- the inpatient facility is 25 going to close. 1 So for the record, I just wanted it said 2 that, last year, it shows 210 children, and this 3 year, to present, 123, just from Claxton that were 4 transferred to the center. 5 H. THEODORE KLAUDT, M.D., FACEP: That's 6 correct. 7 SENATOR CARLUCCI: Go ahead. 8 ASSEMBLYWOMAN RUSSELL: Sure. 9 Can you tell me, kind of, what the longest 10 length of stay for a patient, you know, has been? 11 I'm sure that there's some sort of -- 12 sometimes you guys keep track of, Boy, that child 13 was here for 15 days. 14 Can you give me an idea? 15 H. THEODORE KLAUDT, M.D., FACEP: In recent 16 memory, it was just short of eight days. 17 ASSEMBLYWOMAN RUSSELL: Okay, so eight days. 18 And why are they not receiving specialized 19 care in the ED for eight days? 20 H. THEODORE KLAUDT, M.D., FACEP: It's 21 difficult. I think we find it difficult to provide. 22 I mean, I see our role, if you will, in the 23 ED as evaluating them, making a disposition 24 decision, and then trying to make that disposition 25 happen. 1 If those children are on medications, we'll 2 certainly provide those medications, but they've 3 been on medication before, so that's not any great 4 help. 5 We -- 6 ASSEMBLYWOMAN RUSSELL: Would you be 7 reimbursed for youth psychiatric services if you 8 provided them in the ED? 9 H. THEODORE KLAUDT, M.D., FACEP: I don't 10 have the answer to that question. 11 ASSEMBLYWOMAN RUSSELL: Okay. 12 And where are the -- we know St. Lawrence 13 Psychiatric Center is a location where you're 14 transferring these children out to. 15 I've also heard testimony today about an 16 alternative level of care, a residential treatment 17 facility. 18 Can you give me an idea of the children that 19 do not go to the local psychiatric center, what 20 percentage is going to residential treatment versus 21 inpatient hospitalization? 22 H. THEODORE KLAUDT, M.D., FACEP: I can't 23 give you -- I cannot give you a percentage. 24 I would not even hazard a guess. 25 ASSEMBLYWOMAN RUSSELL: Okay, so you're just 1 not sure where they're being discharged to? 2 H. THEODORE KLAUDT, M.D., FACEP: Uhm -- 3 ASSEMBLYWOMAN RUSSELL: Not discharged to, 4 but transferred to. 5 H. THEODORE KLAUDT, M.D., FACEP: Correct, 6 yes. 7 ASSEMBLYWOMAN RUSSELL: Is it an option for 8 you to transfer someone to a residential treatment 9 facility, or would you need to transfer to a 10 hospital? 11 H. THEODORE KLAUDT, M.D., FACEP: No, 12 I believe that a transfer to a residential treatment 13 facility can be effective, if that's appropriate. 14 ASSEMBLYWOMAN RUSSELL: Okay. 15 And, so, that the capacity of residential 16 treatment facilities, or the lower level down from 17 an inpatient hospital setting, is also problematic? 18 H. THEODORE KLAUDT, M.D., FACEP: I can't -- 19 I can't speak to that as a -- with any degree of 20 authority, if you will. 21 ASSEMBLYWOMAN RUSSELL: Okay. 22 Perhaps someone else who testifies will be 23 able to later on. 24 And can you tell me how you transfer a child 25 to a different facility? 1 Do you know the mechanics of how that 2 happens, whether it requires additional staff? 3 Can you release the child to the parents and 4 have the parent transport? 5 And is it in a car, or do you -- does it 6 require an ambulance? 7 H. THEODORE KLAUDT, M.D., FACEP: The -- we 8 do not transfer patients by private automobile, the 9 care of their parents or anyone else. 10 If they need to be admitted, we think that 11 that's significant, and they should be secure, and 12 that means competent staff need to accompany them. 13 They're transferred either by ambulance with 14 the appropriate staff, or by ambulance. 15 ASSEMBLYWOMAN RUSSELL: Okay. 16 Thank you very much. 17 SENATOR CARLUCCI: Dr. Rajasekaran, 18 Dr. Klaudt, thank you. 19 H. THEODORE KLAUDT, M.D., FACEP: Thank you. 20 [Applause.] 21 SENATOR CARLUCCI: Next we have another 22 panel. 23 We're going to hear from, Jim Scordo, who's 24 the executive director of CREDO; 25 Sister Donna Franklin, the executive director 1 of Catholic Charities & Diocese of Ogdensburg; 2 Holly White Armstrong, who's the co-president 3 of North Country Council of Social Agencies. 4 If you can just state your name and title, 5 and then start. 6 JAMES SCORDO: Sure. 7 Good morning, and thank you, Senate and 8 Assembly Members, for gathering here today to hear 9 us, and hear our concerns here in the North Country. 10 My name is Jim Scordo, and I'm the executive 11 director of CREDO Community Center. 12 We're the substance-abuse provider in 13 Jefferson County, and most recently, and now into 14 Lewis County as well, providing outpatient services 15 there. 16 CREDO provides treatment services to, on any 17 given day, 240 individuals on an outpatient basis, 18 and 72 individuals in residential programming. 19 You know, we're somewhat connected with the 20 mental health, although, we're indirectly, as we see 21 more and more individuals that come into our system 22 with a co-occurring disorder; meaning, substance 23 abuse in addition to their mental illness. 24 In 2012, we had 40 percent of our outpatient 25 clients who had a co-occurring disorder. 70 percent 1 of our residential clients have co-occurring 2 disorders. 3 As a result of that, we are exploring the 4 feasibility of obtaining an outpatient mental-health 5 license so that we can treat the needs of our 6 individuals who are under our care. 7 We see many individuals that get referred to 8 our programs that -- particularly on the residential 9 side, that are not appropriate for a level of care 10 in our residential treatment programs. They need a 11 higher level of care. 12 And as our previous speakers attested to, 13 that some individuals do not fit into another system 14 because there's a gap in services, perhaps; whether 15 it's that inpatient is at capacity, the 16 hospitalization is at capacity, or it's just 17 difficult to find the right setting for that 18 individual. 19 When we're talking about individuals, their 20 needs are so unique, and it's hard to categorize 21 them all and put them all in this nice little box, 22 and say, Here's what we're going to do for you, 23 here's what we're going to do for adults. 24 The same thing is true when we start looking 25 at: 1 What are our options? 2 What are we going to try to do to provide 3 better care for our individuals? 4 There's not an easy answer to that. 5 And as Karen Richmond and, let's see here, it 6 was Andrea Smyth were talking about, there's 7 different committees that are meeting, to try to 8 take a look at this and how we're going to move 9 forward with this. 10 And, there's a lot of different viewpoints, a 11 lot of different thoughts, on how we should proceed 12 with this. 13 So it's -- it's -- I'll say what some of my 14 thoughts are about this. 15 I think, when we did the 16 deinstitutionalization in the 1980s, we did a 17 disservice to individuals. 18 [Applause.] 19 JAMES SCORDO: I began to wonder whether 20 I was the only one who felt that way; that I looked 21 at it, that we had individuals we were putting out 22 onto the streets, and saying, You know what? Let's 23 do this in an outpatient, with case-management 24 services, and you're going to be okay. 25 How many laws do we need to see created after 1 somebody who's death occurred as a result of 2 untreated mental illness? 3 And I don't believe everybody can be treated 4 on an outpatient basis, whether it's a mental-health 5 problem or substance-abuse problem. 6 We need to have different options for 7 individuals that increase in intensity based on 8 their individual needs. 9 As I started reading different pieces, former 10 commissioner of OMH, Mike Hogan, and I believe it 11 was in one of the "SAGE" reports; the State and 12 Government Efficiency Reports, he was talking about 13 that, as we look at the future of OASAS, OMH, what's 14 that going to look like? and how are we going to -- 15 as we look at the centers of excellence, what are we 16 going to do? he referenced, we dropped the ball when 17 we -- in the deinstitutionalization that occurred in 18 the '80s. 19 And he said that we dropped the ball because 20 we left some communities with little or no services. 21 So, as we revisit this here in 2013, and soon 22 2014, let's not drop the ball again. 23 And I don't claim to have all the answers. 24 You have Commissioner Hogan who's speaking, 25 who has years of experience, talking about that, 1 that we dropped the ball. 2 So I would say that we need to listen to what 3 somebody like Commissioner Hogan has to say, and pay 4 attention. And pay attention to the needs in our 5 respective communities. 6 I'm afraid that we're heading in that 7 direction again, as we look at closing St. Lawrence 8 Psychiatric Center. 9 Is this really all about saving dollars? Is 10 that what it comes down to? 11 And if so, what about those people; what 12 about those people who are impacted by that? 13 And we can talk about managed care is going 14 to do this, and managed care is going to do that. 15 Well, are we letting managed care drive this 16 train, or are we going to have some influence on 17 what some of the care that are needed for 18 individuals? 19 I don't believe insurance companies and 20 payers should be the ones dictating what the 21 behavioral-health needs are of our individuals. 22 [Applause.] 23 JAMES SCORDO: And that's not going to be an 24 easy task by any means, but we have individuals, 25 that we can go forward and carry our message to 1 Albany; the fact that you're here listening to us 2 today. 3 The fact that manage care has been postponed 4 because we're not quite ready to roll that out, is a 5 good thing. 6 Let's give that a little more time to 7 develop, until we have all our ducks in order, 8 before we roll out a system that is going to impact 9 many, many people. 10 People need variable lengths of stay, people 11 need different levels of care. 12 I'm -- we need to look at inpatient, you need 13 to look at residential, and you need to look at 14 hospitalization, in addition to the outpatient and 15 case-management services. 16 Everybody is unique, and everybody is 17 different. We can't just put them all into one 18 category and say we're going to treat them all in 19 one setting. 20 People need different levels of care, and we 21 need to be able to offer options to them. 22 If we don't, if we think we're going to go 23 about doing this, and we're going to do what we did 24 with the deinstitutionalization, and we're going to 25 close down facilities, and think we're going to 1 treat these people on outpatient and case 2 management, all you're going to do is shift your 3 costs. 4 You're shifting them to the substance-abuse 5 providers, that they're going to come into our 6 system. 7 And, fortunately, we still are able to offer 8 residential care and -- at the substance-abuse end. 9 You're going to shift them to the RTF 10 facilities that were talked about previously, that 11 are already at capacity, that there's not enough of 12 them in the state. 13 And most importantly, you're going to shift 14 these people to the New York State Department of 15 Corrections and our local jails. 16 Prior to treatment being available in the 17 '70s, where did people go? 18 People with mental illness, people with 19 substance abuse, there was very few providers that 20 existed prior to 1970. 21 Many of those people ended up in jails, or 22 they ended up in institutions for long, extended 23 periods of time. 24 I'm not saying that we need to go back to 25 that, but I mean to say that if you do not offer 1 some different options for people as far as care, 2 they're going to be end up filling up our 3 correctional facilities, and that's not where 4 somebody belongs with mental illness and substance 5 abuse, both treatable diseases. 6 If it was your family member -- 7 [Applause.] 8 JAMES SCORDO: If it was your family member 9 who had the unfortunate, that addiction touched 10 their life or mental illness touched their life, you 11 would want to fight every step that you could to 12 make sure that they were given the most appropriate 13 opportunity for care, and you would want to see as 14 many options available to them as possible before we 15 said, Well, I'm sorry. 16 And you would want to have as much services 17 as you possibly could available locally. 18 We need services in the North Country. 19 If we move everything to -- as planned, we, 20 in essence, have cut off the North Country. 21 That's a barrier. 22 That's a barrier for treatment, for families, 23 for individuals, and I don't think it's a good idea. 24 There are other committees. As 25 Karen Richmond talked about, there's other 1 committees that are looking at this. 2 That's a new committee that's in formation. 3 It's going to take a some time to get that up in 4 operation, and to get everybody on the same page as 5 you involve multiple providers from multiple 6 counties. 7 That's a great idea, and I'm part of that 8 group. 9 I missed a few of the meetings, but I'm 10 engaged and a part of that, and we'll anxiously work 11 towards that. 12 But we need to be thinking about what's going 13 on here, and how this is impacting today. 14 And by having St. Lawrence Psychiatric 15 Center, what does that mean; what does that mean if 16 that were to close? 17 So I'll close in saying: 18 That this is not an easy battle, by any 19 means, and New York State is looking to, How can we 20 save dollars? 21 Let's not be shortsighted in how we go about 22 doing that. 23 Let's not just shift the cost to another area 24 that's going to end up costing you more as you put 25 them in our correctional facilities, and you'll just 1 end up building more prisons. 2 I think we've been down that road. 3 Let's work at meeting the behavioral-health 4 needs of our individuals, and treating them as you 5 would want your family members treated if they had 6 mental illness or substance abuse. 7 Thank you. 8 [Applause.] 9 SENATOR CARLUCCI: Holly Armstrong. 10 HOLLY WHITE ARMSTRONG: I'm Holly Armstrong. 11 I'm retired JCC professor of human services, and I'm 12 currently co-president of the North Country Council 13 of Social Agencies. 14 The unique part, both, as a professor, I got 15 to set up interns with a lot of the agencies, and so 16 I got to know them really well; 17 And then the council of social agencies meets 18 every month, and puts on a luncheon, to try to meet 19 some of the educational needs of the providers. 20 So, we have a lot of contact. 21 And so, the council itself, we've really 22 tried to look at, What are the needs of the 23 residents in our community, and how can we help meet 24 those needs, through either education, through 25 advocacy, whatever? 1 And we've been doing it for 70 years. 2 I'm getting old -- no. 3 Because there are so many needs, a couple of 4 you mentioned, there's poverty; homelessness; 5 there's veterans, there's domestic violence; there's 6 lack of food; the housing issues. 7 I mean, we went on with a whole list, to try 8 to make up our survey. 9 And to be quite honest, I had trouble not 10 putting all of them as "very important." 11 It was on a scale of low priority to high 12 priority, and we sent it out to our providers, to 13 help kind of lead, of all the things, what is 14 something that we should tackle and really work on 15 and understand? 16 And, surprising -- it really wasn't that 17 surprising. 18 I gave you the survey. 19 And on the second page, I blocked out, 20 "Access to mental-health care and mental-health 21 services," was the number one need. 22 It was the highest priority, of 51.5 percent. 23 The high priority, was 27.3 percent. 24 So you put those two together and you've got 25 78.8 percent of the providers in Jefferson, Lewis, 1 and St. Lawrence counties said that accessing 2 mental-health care was their greatest concern. 3 Now, when we got this information, some of my 4 board were saying, But, geez, there's still 5 transportation issues, there's poverty issues, 6 there's drug-abuse issues. 7 Yeah, and why? 8 Because people are not getting the 9 mental-health care that they need. 10 Now, when we look at the next one, "Assessing 11 health care without insurance," you know, we heard 12 from some -- a couple of people, that people 13 couldn't get into some of these facilities. 14 That may be part of the problem: the families 15 that cannot afford privately to pay and they don't 16 have insurance to cover. 17 And we do know there are many instances 18 that -- for all kinds of health needs, that Medicaid 19 and Medicare are not covered by certain providers, 20 so people already have to go to Syracuse and Utica 21 to some doctors to get assistance. 22 And that was the third: Finding primary-care 23 providers that accept Medicaid and Medicare. 24 So what I wanted to show, kind of reiterate a 25 little bit, on the second thing I handed you: 1 Access to mental-health services. 2 We are -- these are just some of the things 3 that came up. 4 We are in a crisis situation in terms of 5 accessibility to mental-health services. 6 Waiting six weeks to address a mental-health 7 issue is absurd. If we broke an ankle, we would get 8 immediate care. 9 The delay also may lead to misuse of legal or 10 illegal substance, which is what Jim referred to. 11 And that really happens, because they do not get the 12 care they need. 13 I mean, just imagine, if you were in a 14 situation where, you have already talked to your 15 family, your pastor, whoever, your coach, to help 16 you out, and, finally, We're going to get you some 17 good mental-health care. You know, you go talk to 18 somebody who's a professional. 19 Oh, yeah, maybe we can squeeze you in in 20 eight weeks. 21 You know, what is that like? 22 And what do you do in-between time? 23 You drink. 24 You self-medicate. 25 Well, oh, you don't have -- you can't afford 1 it, so then you go out and you commit a crime. You 2 steal from your family, you steal from your 3 neighbors, you steal from a store, so you can get 4 the money to substain [sic] your habit. 5 You know, so what we're talking about -- 6 well, and the federal government dumped 7 mental-health services for our military into local 8 communities. 9 Military does offer some services, but not 10 enough for the volume of people in the population on 11 base. 12 There's also the situation, if you use the 13 base facilities, you may lose your job. 14 Okay? 15 So a lot of the people with mental-health and 16 substance-abuse issues, domestic-violence issues, 17 will come into the community for the resources that 18 are there, that are already overwhelmed, period. 19 You know, they can't meet what they already have. 20 So these are real issues that I am concerned 21 about. 22 Jim mentioned costs. That's a huge thing for 23 me. 24 All of our non-profits have been cut. 25 Yes, they can write grants, but there's state 1 and federal budgets that have cut them drastically 2 over the years. 3 The needs have increased, so they're running 4 with less personnel and less money to offer the 5 services, and yet the needs for those services have 6 increased. 7 With this survey, that I wanted to make 8 important to you, we will be having an analysis of 9 it in the future. 10 We're going to have a November luncheon that 11 will review all of it, but we're going to include 12 some of the information from the Center for 13 Community Studies. 14 This is just kind of raw data that you've 15 gotten right now, hot off the press. 16 And there's also Jefferson County Community 17 Services, of course, who are making their plan. 18 So, with everything combined, we should 19 probably be able to come up with some more ideas, 20 some recommendations, how to move forward. Giving 21 us an idea, as a board, of how to help the community 22 move forward. What are some of those action steps? 23 We're not there yet, but we will be. 24 This access to mental-health care, I just 25 don't know how to describe how awful it is, because 1 what we have is very good, but getting to it is 2 hard, both, transportation-wise, financially, and, 3 the long waits, the absurd waits, that people have 4 to deal with. 5 So the increase in services in 6 Jefferson County, if people are released from 7 Ogdensburg, is going to really cripple, I think, us 8 financially, because then you're demanding what 9 services we do have to increase. 10 Where does the money come to do that? 11 It would also have increased ripple effect 12 because, waiting 8 weeks, now people will wait 13 10 or 12 weeks, and you're still going to have that 14 increase in crime, and alcohol, and all of the other 15 things that occur in the meantime. 16 Some of the patients here in Ogdensburg also 17 have been living here for a long time. They're not 18 ready to be put back in the community. They need 19 the inpatient care that they have here. 20 When -- the '70s, that Jim referred to, when 21 everyone was released, people were on the streets. 22 They had nowhere to go. 23 Transitional housing formed out of that. 24 There was a crisis, "What do we do to try and 25 meet this need?" 1 But it wasn't preplanned. You know, it 2 wasn't, let's get all of the housing ready and 3 transfer someone so it's done effectively. It was 4 just the response. 5 And that's what our counties are going to 6 have to deal with, is: 7 What happens afterwards? 8 What do we have to do to try to deal with 9 this influx? 10 And I can only support, the Syracuse, Utica, 11 routes, just like everyone else has, this is very 12 difficult for families with a child to -- and really 13 one of the strongest child facilities, and those 14 with disabilities, is Saratoga. 15 So, we're really talking a long way. 16 Ogdensburg seems to be fighting a real uphill 17 battle. 18 And I know, politically, it's been divided 19 into three sections, so that makes it difficult to 20 have, like, that one muscle to kind of move on. 21 There have been ideas brought across, and 22 you've mentioned some of those, to try to deal with 23 this: partial hospitalization. 24 Our River Hospital is doing that with 25 posttraumatic stress. 1 The telepsych, our Family Health Center, 2 formerly North Country Children's Clinic, is doing 3 that; because someone mentioned, you know, the 4 Skypeing, and those kinds of things. 5 Those are options, and certainly things that 6 need to be considered, and certainly are helping 7 people, but, we do need inpatient. 8 I have to say that CREDO is one of the best 9 facilities I've ever known, but they look at the 10 person and what they need. And if you -- you just 11 go down the route: You can have intensive 12 inpatient, and you can get right up to, you know, 13 down to, you're in your own apartment. 14 But, there's different phases along the way 15 to help a person recover. 16 We do not want people thrown back in the 17 community that are not ready for the community, and 18 we don't have the resources to help them as much as 19 they should be helped. 20 And so that increase, it just shifts that 21 burden from the state to the counties, and I'm not 22 sure that that's what we should be doing. 23 My father always used to say, "If it isn't 24 broke, don't fix it." 25 Okay? 1 I know that's old-timey, but it's true: we 2 have an excellent center which this region has tried 3 to incorporate. 4 And with our ER's and our facilities, 5 community agencies, tapping into St. Lawrence, I -- 6 I just don't know how effective it's going to be if 7 we don't have that option. 8 I'm not saying to close some of the newer 9 options and ideas. 10 I would enhance community service in every 11 single county. I mean, certainly, that would really 12 help. 13 But our high poverty, our high unemployment, 14 our lack of services, it's devastating at times. 15 One of the things I've gotten from my 16 providers this year, we're running a workshop, is 17 provider compassion. It's called 18 "compassion fatigue." 19 It's sort of, like, you're dealing -- it 20 isn't the kind of job that you turn off at 5:00. 21 It's a 9-to-5 job. 22 You're working with these people; you're 23 short-staffed, you're overworked, and, you really 24 care, but you get tired. You get worn out. 25 And I just see, if this is affecting the 1 providers in Jefferson County at this point, why -- 2 how are they going handle the huge increase with the 3 closing of the psych center; and, mainly, not having 4 the option for inpatient treatment? 5 We need that. 6 Our Samaritan, you know, we have an inpatient 7 treatment for adults there, but it doesn't hold 8 enough. And a lot of them are, well, geez, the last 9 half year was synthetic drugs. 10 You know, most of the people, you know, we 11 weren't dealing with some of the other mental-health 12 issues. Synthetic drugs, there's such a problem in 13 our area. 14 So, to have that option of the psych center 15 for inpatient was really necessary. 16 So, with everything -- and I'm not minimizing 17 the jobs. I'm really -- I do want the full 18 employment. 19 All of you know how hard it is to access 20 anyone with a professional background, and 21 psychiatrists. It's terribly hard. 22 They have everyone here in place, and that's 23 working well. 24 But, we need to focus on the person, and 25 maybe think of it as yourself or a family member. 1 If you need mental-health care, you need a 2 quality of care, and you can get that locally, okay, 3 but you may have to use other facilities to enhance 4 that quality of care, to help someone come back in 5 the community and be a productive, healthy person in 6 our community. 7 So it's the quality of the person and the 8 quality of the community, and I'm advocating we keep 9 St. Lawrence Psych Center here for that. 10 I also am not closed to newer options of 11 helping deliver better mental-health services, like 12 with some of the new things, but closing this, 13 I don't see as an option. 14 SENATOR CARLUCCI: Thank you. 15 HOLLY WHITE ARMSTRONG: Thank you. 16 [Applause.] 17 ASSEMBLYWOMAN RUSSELL: Mr. Scordo, I'm going 18 to maybe put you on the spot a little bit, because 19 I think you might be the only representative 20 testifying that works in the OASAS system as well. 21 Now, can you tell me, do you know anything 22 about the OASAS facility that's located at 23 St. Lawrence Psychiatric Center grounds here in 24 Ogdensburg? 25 JAMES SCORDO: Yes, I have -- that we refer a 1 number of individuals who need inpatient care. 2 Since we do not have inpatient care in 3 Jefferson County, we use that regional concept, and 4 St. Lawrence Alcohol and Treatment Center is one of 5 our treatment options where we send folks who need 6 inpatient care. 7 ASSEMBLYWOMAN RUSSELL: Okay, so that's 8 inpatient facility. 9 And do they -- I mean, they're on an OMH 10 site. 11 Do -- are they able to provide any 12 mental-health services there, by virtue of being 13 co-located on the same campus? 14 JAMES SCORDO: I don't know if they have any 15 sharing of staff that they do, but anybody who's 16 been treating either the mental health or the 17 substance abuse, you have to be prepared that you're 18 going to have a fair number of folks who have 19 co-occurring disorders, so you better get some folks 20 with mental illness -- or, mental-health background 21 on your staff. 22 If you're treating the substance abuse, and 23 the same holds true. 24 So they probably have some on staff, but 25 I would guess that they may have some close 1 collaborations with the mental-health services here 2 on site. 3 ASSEMBLYWOMAN RUSSELL: Okay, so -- so you 4 think that, potentially, they've already broken down 5 some of the silos that you testified were somewhat 6 problematic for the population that you serve? 7 That they are oft -- they're funneled to you 8 because they have substance-abuse problems, but 9 maybe the underlying issue is a mental-health 10 problem? 11 And -- I mean -- so, I guess, would you say 12 that that is a good practice to have, maybe, OASAS 13 treatment facilities, you know, working more 14 closely, or collaborating more, with the 15 mental-health system? 16 JAMES SCORDO: I think that we're heading to 17 a time when we're really going to take a look at, 18 What's the future of OASAS and OMH? 19 And, we've done more integrated care. 20 Are we going to bring those two agencies 21 together at some point? 22 Or, they have collaborative agreements that 23 go back and forth, that allow each of the providers 24 to provide services, as long as you bring in some of 25 the staff? 1 And I think that's what, for the most part, 2 providers have done. 3 We also do work closely with each other in 4 referring back and forth. 5 You know, in our county, in Jefferson County, 6 we rank referrals to the children's home for 7 mental-health services and for services for youth; 8 Based on some of their folks that have 9 substance abuse, particularly their youth, to our 10 program. 11 So, that collaboration can happen without 12 having to be right in, you know, a stone's throw of 13 each other, but you got to have those working 14 relationships. 15 ASSEMBLYWOMAN RUSSELL: Do you know if any 16 other state mental-health facilities have OASAS 17 services or programs on their campus? 18 JAMES SCORDO: I am not aware if there are or 19 not. 20 ASSEMBLYWOMAN RUSSELL: Okay. 21 It would just seem to me, that as we're 22 creating centers of excellence, and we're talking 23 about the future of OASAS and mental-health 24 services, that if that collaboration already exists, 25 why wouldn't, you know, the St. Lawrence Psychiatric 1 Center -- I guess I'm testifying at this point -- be 2 seen as a center of excellence, because they already 3 have that ability, and, likely, there's some sort of 4 collaboration. 5 And in a rural area, where we have heard so 6 many times that there's a lack of providers, you 7 know, you kind of get a certain amount of synergy, 8 and ability to bring the professionals together that 9 need to address all of these issues. 10 JAMES SCORDO: Yeah, that's a secondary 11 concern on our part, that if the St. Lawrence 12 Psychiatric Center were to close, what is that going 13 to do on the alcohol and drug treatment center? 14 You know, I understand there's underground 15 heat systems that come from the main OMH, over to 16 the alcohol and drug treatment center. 17 Are they going to be able to continue to 18 exist if the psych center is closed? 19 Hard to say what impact that will -- ripple 20 effect that will have on the inpatient treatment 21 program that the state-run facility operates. 22 ASSEMBLYWOMAN RUSSELL: Thank you. 23 Concern of mine as well. 24 SENATOR CARLUCCI: All right, thank you. 25 [Applause.] 1 JAMES SCORDO: I will close and say that, 2 take your time. Let's not rush into this, and, this 3 involves way too many people's lives. 4 Just take your time, and do this right. 5 SENATOR CARLUCCI: Thank you. 6 JAMES SCORDO: Thank you very much. 7 [Applause.] 8 SENATOR CARLUCCI: Next we're going to hear 9 from our host, our city manager of Ogdensburg, 10 John Pinkerton; 11 Council Member Storm Cilley; 12 Donald Peck, county legislator; 13 And, Vernon "Sam" Burns, county legislator. 14 So just introduce yourselves and your title, 15 and start into it, please. 16 STORM CILLEY: My name is Storm Cilley. 17 I am a member of the Ogdensburg City Council; 18 I'm a life-support provider for the 19 Ogdensburg Volunteer Rescue Squad; 20 And I'm a recently retired teacher of the 21 Ogdensburg City School System. 22 For the past 32 years, I have had almost 23 daily contact with individuals receiving psychiatric 24 services within the community, as well as those 25 desperately in need of such services, who, for one 1 reason or another, are not receiving them. 2 Instead of cutting mental-health services and 3 putting more obstacles in the path of individuals 4 and families attempting to obtain those services, 5 the State of New York needs to increase and improve 6 the services available to the neediest, most 7 vulnerable members of our society, including more 8 readily-accessible inpatient beds. 9 The 1980s saw a drastic reduction of patients 10 receiving inpatient care at the SLPC, and we as a 11 community are still waiting for the State of 12 New York to fulfill their promises of improved 13 outpatient care that were made at that time. 14 You need only to spend a few hours in 15 Ogdensburg to get a sense of how many mentally ill 16 individuals are present in our city, and how they 17 wander from place to place in search of meaningful 18 activities. 19 The lack of those activities is a major 20 source of concern for all of us who interact with 21 them. 22 And for the past 123 years, these individuals 23 and the caring, dedicated professionals who care for 24 them have made up the fabric of the city of 25 Ogdensburg. 1 The idea of moving inpatient beds from 2 Ogdensburg to Syracuse and Utica is a poorly 3 thought-out and ill-conceived plan by career 4 bureaucrats who have been ordered to cut expenses at 5 any cost, with very little regard as to how it will 6 actually affect the patients and families that 7 desperately need this care, and no concrete plans to 8 help those who are having enough trouble dealing 9 with the system now. 10 By moving those inpatient beds an 11 unreasonable distance away, the OMH is making it 12 even more difficult for patients to obtain care and 13 for their families to provide the support that is so 14 necessary to the successful treatment of this 15 vulnerable population. 16 When developing this plan, much more 17 consideration needs to be given to the travel 18 distances and times involved for those seeking care, 19 not simply the population or the political power of 20 the areas involved. 21 I have personal experience making the 22 2 1/2-hour trips to Syracuse and Utica in the winter 23 months when those trips have lasted four, five, and 24 even six hours one way. 25 In a manner, I believe that the Albany 1 bureaucrats understand this, because it is almost 2 impossible to get them to travel to the 3 North Country between November and May. 4 [Applause.] 5 STORM CILLEY: The St. Lawrence Psychiatric 6 Center is already a center of excellence doing all 7 of the things that the new centers are supposed to 8 do. 9 Historically, it has been a leader in 10 providing care and improving the lives of the 11 mentally ill. 12 It enjoys tremendous support from the 13 citizens that it serves, local governments, 14 industries, educational institutions, and numerous 15 other organizations. 16 It provides top-notch quality care. 17 It is one of the most professionally 18 operated, highly rated and respected facilities 19 within the Office of Mental Health. 20 It has an extremely dedicated and 21 professional workforce, whose jobs are vital to the 22 economy, of not only Ogdensburg, but the entire 23 North Country. 24 Provided with, essentially, free heat, it is 25 one of the most economical facilities to operate in 1 the entire state. 2 Unlike other facilities downstate and in the 3 Southern Tier, the ability of these facilities to be 4 re-purposed is nonexistent. 5 The grand and historical buildings that the 6 State abandoned in the 1980s continue to sit idle 7 and deteriorate while nothing is being done to 8 maintain, preserve, or market them. 9 The promises made by OMH and Albany 10 bureaucrats that no jobs will be lost with this 11 restructuring is dishonest. 12 Offering current staff another position in 13 facilities downstate does nothing to preserve badly 14 needed jobs in the North Country. 15 Based on past experience, it is highly 16 unlikely that New York State will ever follow 17 through on its promise to create more outpatient 18 services in the community. 19 Even if it does, those services will demand a 20 different set of skills than those possessed by 21 current employees, probably at much lower pay 22 grades. 23 The SLPC is already seeing employees flee in 24 search for other jobs even though the plan has not 25 yet been implemented. They cannot afford to wait 1 until the last minute to secure the future of 2 themselves and their families. 3 In conclusion: 4 This plan is not providing -- about providing 5 more or better care for the mentally ill of 6 New York State. 7 Pure and simple, it is about cutting the cost 8 of running the Office of Mental Health. 9 It is being done at the expense of and 10 without regard to the needs of the mentally ill and 11 the residents of the economically-depressed rural 12 areas of the state. 13 It is an unconscionable, poorly conceived 14 plan that will do irreversible harm to those that it 15 purports to serve. 16 I am asking you, as responsible members of 17 the New York State Legislature, to evaluate this 18 plan honestly, and force the Office of Mental Health 19 to do the right thing for the mentally ill in 20 northern New York. 21 Keep the St. Lawrence Psychiatric Center, 22 already a center of excellence, open as a 23 full-service inpatient facility. 24 [Applause.] 25 JOHN PINKERTON: Good morning. 1 My name is John Pinkerton. I'm the city 2 manager, and welcome to my hometown. 3 I'd like to come from a historical viewpoint. 4 I'd like to know where we've been before 5 I know where I'm going; therefore, I'm going to 6 delve into a little bit of the history of the psych 7 center. 8 The St. Lawrence State Hospital was 9 championed by Congressional Medal of Honor recipient 10 General Newton Martin Curtis, a resident of 11 Ogdensburg, and a member of the New York State 12 Assembly. 13 On April 29, 1886, the New York State 14 Legislature approved the bill of General Curtis, 15 authorizing the appointment of five commissioners to 16 locate a mental hospital in northern New York. 17 Several psychiatric hospitals were already 18 built in New York, but none north of what is the 19 present-date thruway. 20 The State Commission on Mental Health, at 21 this time, decided the psychiatric needs of the 22 state would be best served by locating a mental 23 hospital in northern New York. 24 We will show that history validates that 25 decision. 1 On May 18, 1887, Chapter 375 of 2 New York State law was passed, which ratified the 3 selection of Ogdensburg as the site of the mental 4 hospital. 5 Built in 1890, the state hospital soon became 6 a national leader in the treatment of the mentally 7 ill and the training of nurses in psychiatric care. 8 Dr. Peter Weiss, the first director, 9 initiated the training of local residents to staff 10 the nursing components of that hospital. 11 The St. Lawrence Psychiatric Center was the 12 first to have a school of nursing; 13 Was the first to have entrance exams for 14 nurses, which was replicated by all the other 15 schools of nursing thereafter; 16 Was the first to assign all patients to 17 employment in various occupations, for the purpose 18 of reeducating the facilities of attention and 19 volition. 20 This program was initiated by state hospitals 21 all over the country afterwards. 22 The programs of purposeful activity enabled 23 the St. Lawrence State Hospital to become a 24 self-supporting institution. 25 It was the first to establish a set of 1 standards to help in the cure of patients; 2 It was the first state hospital to open a 3 beauty salon, and offer other amenities, which 4 improved patients' feeling of self-worth. 5 This format has been duplicated in 6 assisted-living centers to this day. 7 It was the first to allow voluntary admission 8 of patients; 9 It was the first state institution to have an 10 outpatient clinic; 11 It was the first in New York State to 12 initiate the open-door policy; 13 It was the first to have a children's unit 14 north of Syracuse. 15 In 1966, the New York State Department of 16 Mental Hygiene commissioner of that time, 17 Dr. Alan D. Miller, remarked, "The St. Lawrence 18 State Hospital is world-renowned for the care and 19 treatment of the mentally ill." 20 No Willowbrook here, but we are concerned 21 about what could happen to our most vulnerable 22 citizens should they be placed in an urban center 23 like that. 24 It appears that the OMH plan for 25 mental-health care is this: If you live along the 1 thruway or New York City, you will get the 2 mental-health care you deserve. 3 If you don't, then you don't have enough 4 votes to warrant concern. 5 Often I hear that the North Country is too 6 reliant on New York State jobs, jobs which, by the 7 way, are deemed necessary to promote the general 8 welfare of the citizens of New York. 9 I do not hear any complaints about the 10 monetization of the electric power generated by the 11 St. Lawrence Seaway that goes into the coffers of 12 the New York Power Authority. 13 I do not hear the Governor complaining 14 because St. Lawrence County does not receive any 15 monetization of electricity like they do in Niagara. 16 I do hear the Governor say that the 17 North Country needs to pull itself up by its 18 bootstraps, but, when the small village of 19 Waddington and other communities in St. Lawrence 20 County banded together to break attendance records 21 at the elite Bassmaster's Fishing Tournament in 22 August of this year, without State aid, the Governor 23 took the time out of his busy schedule to come and 24 promote an elite series event for the Finger Lakes 25 next year, not the St. Lawrence River Valley. 1 I want to highlight just one significant 2 metric that demonstrates a glaring weakness in the 3 OMH redevelopment plan. 4 The population of the six-county catchment 5 area of the St. Lawrence Psychiatric Center is less 6 than the population of Onondaga County, and yet the 7 suicide rate for this catchment area is greater than 8 that are for Onondaga County for 2008, 2009, and 9 2010. 10 How can OMH release a report, "Suicide as a 11 Never Event in New York State"? 12 I applaud that goal; however, I am concerned. 13 The State for that period, as a whole, had a 14 suicide rate of 6.6 per 100,000 people. 15 In St. Lawrence County, that rate was 10.8. 16 We are currently underresourced in this 17 critical area. 18 What happens when our services are reduced? 19 I think we all know the answer. 20 Currently, New York State receives free steam 21 from what was once a cogeneration plant. 22 This plant loses between 2 and 3 million 23 dollars a year supplying the steam to the Ogdensburg 24 campus of prisons and mental-health facilities. 25 The plant officials have offered to supply 1 steam heat at cost, and electricity at a 22 percent 2 discount over the rate currently being paid by OMH 3 and DOCS, thus reducing the overall operating costs 4 at the Ogdensburg campus, but State officials have 5 been nonresponsive to the proposed negotiations. 6 Such an agreement would improve the economic 7 viability of the St. Lawrence Psychiatric Center and 8 the Ogdensburg Correctional Facility. 9 Over the years, the State Office of Mental 10 Health has developed plans to reduce inpatient care 11 at the St. Lawrence Psychiatric Center, and today, 12 there are over 30 vacant, once magnificent buildings 13 left to rot and decay. 14 Now there is no economically viable solution 15 to use that 500,000 square feet of space. 16 Are we about to add buildings to this 17 inventory? 18 Rather than talking about reducing or 19 eliminating inpatient services for our people, we 20 have no choice but to loudly protest. 21 We cannot stand by while needed services are 22 being taken away. 23 We need to expand the excellence exhibited by 24 the staff of the St. Lawrence Psychiatric Center in 25 caring for the mentally ill. 1 I learned a long time ago, the best 2 predictors of future of outcomes are past results. 3 Based on the past, the St. Lawrence 4 Psychiatric Center needs to be recognized as a 5 center of excellence. 6 Let me conclude with this chilling thought: 7 Within weeks of announcing the State's plan, 8 Kristin Woodlock resigned her position as acting 9 commissioner, for personal reasons. 10 Now she says, one of her biggest worries 11 about the reform plan is that the State won't be 12 able to follow through. 13 We share Commissioner Woodlock's concern. 14 Thank you. 15 [Applause.] 16 DONALD PECK: My name is Donald Peck. I'm 17 the vice chair of the St. Lawrence County Board of 18 Legislators. 19 I also believe you have a copy of the 20 testimony from Chairman Putney in your list of 21 testimony, who couldn't be here today due to work 22 commitments. 23 And I have a brief statement I'd like to read 24 on behalf of St. Lawrence County. 25 St. Lawrence County is the largest county in 1 New York State, comprising of 2822 square miles. 2 We're larger in land area than Rhode Island 3 and Delaware, yet our largest municipality has fewer 4 than 15,000 people. 5 St. Lawrence County has some of the most 6 poorest communities in the state. 7 During the past three decades, manufacturing 8 employment has declined and has -- as has the number 9 of farms. 10 Economic barriers facing St. Lawrence County 11 have led to high employment [sic] and poverty rates. 12 We have one of the highest unemployment rates 13 in New York State and one of the lowest per capita 14 income levels. 15 It seems that, every day, we find ourselves 16 in some type of struggle just to maintain our 17 quality of life for our citizens. 18 The Office of Mental Health's proposed plan 19 to remove inpatient services for adults and children 20 at the St. Lawrence Psychiatric Center will impair 21 the quality of life in the North Country. 22 The removal of services and care from a vast 23 impoverished area will force our citizens to travel 24 excessive distances to access other facilities 25 outside of this region; thereby, creating serious 1 hardships for the patients and their families. 2 The removal of the St. Lawrence Psychiatric 3 Center will also put additional stress on the county 4 budget, already stretched to the maximum, as 5 St. Lawrence County will most likely have to 6 shoulder one more unfunded mandate: the additional 7 associated with transporting Medicaid-eligible 8 patients. 9 Despite the barriers we face, 10 St. Lawrence County has always provided an excellent 11 workforce, but we struggle every day to keep jobs 12 here. 13 Approximately 500 employees at the 14 St. Lawrence Psychiatric Center will be affected 15 under the Office of Mental Health's proposed plan. 16 Despite the OMH's public-relations hype, the 17 reality is, that many of these employees will be 18 required to move out of the North Country to retain 19 their jobs. 20 This will have a serious effect on population 21 demographics and economy of the region, and will add 22 additional stress to an already overburdened 23 social-, health-, and mental-service system in this 24 region. 25 New York State has the responsibility to 1 protect its citizens. 2 It is bound by its Constitution to provide 3 for care and treatment of persons in need of 4 mental-health services. 5 The State can assert it is not taking these 6 services away from North Country residents, but 7 making the services so inaccessible to North Country 8 residents is doing just that. 9 Thank you. 10 [Applause.] 11 VERNON "SAM" BURNS: Good morning, and 12 welcome. 13 My name is Sam Burns. I'm a county 14 legislator of St. Lawrence County, and I represent 15 the city of Ogdensburg. 16 Welcome to my legislative district. 17 Senator Carlucci, thank you for coming all 18 the way you have. 19 Senator Ritchie, it's always nice to see you. 20 Senator Little, thank you for coming from the 21 eastern part of the North Country. 22 Chair Gunther, as a nurse, and someone who's 23 worked with people with disabilities, I'm sure you 24 understand what we're going through and what we're 25 facing. 1 Assemblywoman Russell, it's good to see you 2 cleaned up from the spaghetti dinner on Saturday. 3 [Laughter.] 4 VERNON "SAM" BURNS: And, 5 Assemblyman Blankenbush, thank you for coming. 6 I've heard that one in four people in our 7 nation will suffer some form of mental illness in 8 their lifetime. 9 I think we can all agree that every family in 10 our state will, sooner or later, deal with a family 11 member that has a mental disorder. 12 My wife and I have an autistic son. 13 We are thankful that other disorders have not 14 surfaced, but the possibility is always there. 15 If he ever had to be hospitalized for a 16 disorder, he would not survive away from us. 17 My son walks all over Ogdensburg. Most 18 people in this room will tell you that he can be 19 seen in all parts of the city. 20 Ogdensburg is not Syracuse. 21 Why, if the mission of OMH is to provide 22 hope, would placing him in such an urban setting as 23 Syracuse be more therapeutic than a rural setting 24 like this? 25 Some of you have already visited the grounds 1 of the St. Lawrence Psychiatric Center. 2 Thank you. 3 If you would have had more time, I would have 4 asked you to stand on the banks of the 5 St. Lawrence River and watch a sunset. 6 Bring along any psychiatrist or psychologist 7 and let them judge what setting is more conducive to 8 working with those with disorders: the St. Lawrence; 9 or downtown Syracuse, with I-81 and I-690 10 crisscrossing outside your window? 11 Others have already told you, or will provide 12 you, statistics -- 13 [Technical difficulties.] 14 VERNON "SAM" BURNS: We're not proud of this 15 fact, but it is a reality. 16 A large percentage of families in our region 17 would not be able to travel to Utica or Syracuse to 18 be with their loved ones. 19 OMH can tell you and us that 20 videoconferencing is a great alternative. 21 How stupid do they think we are? 22 Videoconferencing will never take the place 23 of a parent's hug or the soft touch of a sister or 24 brother. 25 [Applause.] 1 VERNON "SAM" BURNS: This plan is not in the 2 best interests of those in need of mental-health 3 treatment, and certainly does not provide hope to 4 their families in the North Country. 5 The North Country is not like Long Island or 6 Western New York. 7 We do not have a passenger rail system or 8 interstate highways that can get us from the western 9 part of our region to the eastern. 10 There's 136 miles from Ogdensburg to Utica. 11 There is no direct route. 12 Use MapQuest, then actually see how long it 13 takes to get from here to there in the winter. Some 14 days, it just will not happen. 15 I have been a St. Lawrence County legislator 16 for seven years now, and it has been my honor to 17 represent the city of Ogdensburg. 18 I've lived in the North Country my entire 19 life, and my family roots go very deep here. 20 I take my responsibility to provide needed 21 services to the residents of St. Lawrence County at 22 the least cost to be of utmost importance, as each 23 of you do on the state level. 24 I am concerned, that as this plan goes 25 forward, then the cost of providing transportation 1 to Medicaid patients that will have to be 2 transported to Syracuse and Utica will fall back on 3 St. Lawrence County. 4 This cost should not be borne by the county 5 because of such an unfunded mandate from Albany. 6 At an operations committee last night, the 7 county sheriff was asked about the daily census of 8 the county jail. 9 Not only are we full, but we now must board 10 out inmates to other counties. 11 Our county jail is only five years old. 12 It was built on time and under budget, thank 13 God, in a PLA, but, recently, we have had to board 14 out inmates because of overcrowding. 15 If the sheriff has the opportunity to provide 16 figures, he would explain to each of you the problem 17 all county jails now face for those inmates coming 18 into the system needing mental-health services that 19 they do not receive in their communities. 20 This plan will only make matters worse, 21 because we all know, but don't want to talk about, 22 the local jails becoming a dumping ground for more 23 and more people that have mental disorders. 24 There have been multiple times this year when 25 the sheriff has come to the board of legislators 1 asking for more money to provide for the mental and 2 physical health of incoming inmates. 3 Again, due to the lack of state-operated 4 mental-health services in the North Country, 5 St. Lawrence County and all counties north of the 6 thruway will see higher and higher medical costs for 7 our jails. 8 Remember earlier, when I mentioned how poor 9 St. Lawrence County is? 10 How do we pay for this additional cost? 11 It is a fact that a large percentage of the 12 residents of the North Country have served our 13 country in the many branches of the armed forces. 14 We are a deeply patriotic people in the 15 North Country, and take great pride in the fact that 16 the 10th Mountain Division of Fort Drum is our army 17 base. 18 We are proud of the heros that have been 19 deployed from the base, and thank them for their 20 service. 21 I question if this plan has taken into 22 consideration the fact that research has shown that 23 mental-health disorders suffered by our troops is at 24 an all-time high. 25 Does this plan provide the services that 1 those we have asked to defend our freedom, and their 2 family members that they have left behind, will be 3 taken care of? 4 We owe them at least that much. 5 [Applause.] 6 VERNON "SAM" BURNS: Finally, allow me to 7 talk about the cost of this plan in terms of the 8 personal effect it will have on my friends and 9 neighbors, and how it has already affected them. 10 Former-acting Commissioner Woodlock wrote a 11 letter to Senator Ritchie, explaining that nearly 12 half, 260, of the current employees will continue 13 under the RCE plan. 14 Are you kidding me? 15 She goes on to say, that the remaining staff 16 will have the opportunity to work for RCE, in the 17 North Country, with the expansion in the 18 state-operated community mental-health services. 19 However, within the same letter, she offers 20 voluntary reassignment to go somewhere else. 21 More double-speak and hogwash from a person 22 that no longer has any say in implementing the 23 RCE plan. 24 Why can't someone from Albany be honest with 25 state employees and tell us, what jobs will be open, 1 where they will be, and how soon a decision needs to 2 be made? 3 Why is it okay for those in Albany to put 4 state employees' lives on hold for years while they 5 develop a new method of reducing the state workforce 6 and privatizing as much as possible? 7 Why is it okay to tell us on Monday, that 8 Albany is doing everything they can to bring back 9 upstate; and on Tuesday, tell us that they have a 10 great new plan to provide needed services, but, it 11 also means that half of the employees that finally 12 enjoy a decent standard of living could be thrown 13 out on the streets in a few years? 14 Why does Albany focus on every community on 15 the thruway or south of the thruway, and tell us in 16 the North Country, "We will work with you," and then 17 dump us into a pit of despair? 18 One of our young presidents, John F. Kennedy, 19 once said, "Efforts encouraged are not enough 20 without purpose and direction." 21 I ask each of you to join with the people of 22 the North Country, and other parts of New York State 23 that face the same downsizing and cutback in 24 services that we do, to fight against this RCE plan. 25 Stand up on the floor of the Assembly and 1 State Senate and tell the administration that this 2 plan will not work, and does an injustice to those 3 New York State residents that require mental-health 4 services across our state. 5 Their families deserve to be close to their 6 loved ones, and the dedicated state workforce 7 deserve respect for what they do. 8 Thank you. 9 [Applause.] 10 SENATOR CARLUCCI: Senator Little. 11 SENATOR LITTLE: Thank you. 12 I really want to thank you for your 13 testimony. 14 Certainly, each of you hit the nail on the 15 head with each of the issues that you talked about. 16 And I will tell you, that one of the first 17 questions I had of the acting commissioner, when 18 this was announced, is, "Why isn't St. Lawrence a 19 center of excellence?" 20 And I was told, it's the numbers. 21 And I will tell you that I have a 22 colleague -- former colleague in Albany who coined 23 the term "geographic discrimination." 24 And that's exactly what we see here. 25 [Applause.] 1 SENATOR LITTLE: We have so many issues -- no 2 public transportation, higher cost of gas, 3 everything -- but to look and see, that when you 4 look at a map of the state of New York, north of the 5 thruway is larger than several states. And to say 6 that we won't have a center of excellence here is 7 just mind-boggling. 8 And the other thing is, that when we talk 9 about and we read about the savings, it's my 10 understanding that 100 percent of all the savings 11 must go into "community reinvestment," which is a 12 term we heard before, when they closed the 13 developmentally-disabled facilities. 14 And then you have to fight for that 15 reinvestment funds and be competitive with other 16 areas that have the numbers. 17 So, it just doesn't make any sense, this 18 entire thing. 19 And, your presentation was excellent. 20 The other thing is, I thought, with all of 21 the tragedies that we've seen happening in Colorado 22 and Connecticut, and last night in Washington, D.C., 23 and all over, that our focus is supposed to be on 24 the mental health, and those with mental issues. 25 [Applause.] 1 SENATOR LITTLE: So, I appreciate 2 Senator Carlucci coming up here, and Aileen Gunther, 3 for the hearing. 4 And, you know, I only represent six small 5 towns in St. Lawrence County, but, Clinton County, 6 Franklin County, Essex County, and even parts of 7 Warren County, depend upon St. Lawrence. 8 I've had people call my office and ask me to 9 try to help them, because they needed a loved one 10 that they wanted to see get into St. Lawrence. 11 The other thing is being close, because part 12 of a cure program or a rehabilitation program is 13 family, and family involvement. 14 Unfortunately, there are some that have no 15 family, but for those that do, that's what's going 16 to help them heal, and be able to be healthy 17 citizens again, if they can. 18 So, so many things here just be don't make 19 sense, but I think we should be a center of 20 excellence here. 21 ASSEMBLYWOMAN GUNTHER: I also wanted to 22 thank you for your testimony. 23 You know, I was out in Farmingdale. And if 24 you think about, and the whole plan, Farmingdale, 25 you see the people on Long Island traveling to 1 Queens and the Bronx, and then you go to Binghamton. 2 And, you know, I kind of made this thing 3 about where people are going, because it was so 4 confusing to me, to where children go, where adults 5 go. And you can see, you know, there's a lot of 6 movement going on. 7 And you're right, a lot of times, those folks 8 that, you know, we're caring for, if you have a lot 9 of money, there are, like, places you can go and be 10 self-pay, and, you know, really see -- receive 11 great, you know, care. 12 Not that, we receive great care in Sagamore, 13 in St. Lawrence. 14 And, you know, I -- it is -- it also is 15 sometimes economic discrimination because, if you 16 can't afford, and, you know, to let your child be 17 admitted in a time of crises, it's not only that 18 that child needs treatment, but it's a family thing. 19 And you just can't heal, or you can't -- and, 20 also, you want the school district to be part of 21 that, so you can go from treatment, to school, to go 22 back to, you know, the best life possible. 23 And there are certain degrees. 24 And then, you know, you read statistics, 25 like, by the time our adolescents reach 18, 1 50 percent will have a mental-health crisis. 2 And then, when Addie, who is a tremendous 3 advocate to the veterans, PTSD, you know, we see 4 more and more from Vietnam, to Afghanistan, and the 5 treatment is so much different. 6 Flashback, it's so much different than any 7 other mental illness or mental-illness disease. 8 And, you know, we can't treat mental illness 9 any different than we treat diabetes. 10 And you know what? 11 [Applause.] 12 ASSEMBLYWOMAN GUNTHER: I think that, you 13 know, we all -- listen, we're all taxpayers in this 14 room. We all want to save money, but, we want to 15 save money by providing care that will rehabilitate 16 people to return to their community, to return to 17 their schools, that they won't have to be in an 18 inpatient setting. 19 So I think that we still have to, you know, 20 go back in and look at, How can we provide the best 21 care in the most cost-effective way? 22 And that way is, to bring that child back 23 home, to bring that husband -- we're talking about 24 children, but we're also talking about husbands and 25 wives, we're talking about that kind of dynamic 1 also, that requires a lot of therapy. People get 2 frightened and people act out, and there has to be a 3 lot of healing before you can return home. 4 But getting them home is cost-effective. 5 ASSEMBLYWOMAN RUSSELL: We've heard some 6 testimony earlier that children, in particular, are 7 being boarded in our emergency departments at our 8 939 facilities. 9 And you county legislators mentioned, as well 10 as some of the previous speakers, that a large 11 amount of the jail population, you know, have 12 psychiatric disorders. 13 Do you have any sort of idea, maybe it can 14 be, you know, how many inmates are on, like, you 15 know, drugs to treat psychiatric disorders? 16 Do you have any idea of -- of, roughly, how 17 many folks in your jail, or that are under the 18 custody of your sheriff, have psychiatric disorders? 19 VERNON "SAM" BURNS: I don't know. 20 We don't have a number for you, 21 Assemblywoman. 22 But as I mentioned earlier, the sheriff has 23 had to come back to us and ask for more funding 24 because of drugs needed for them. 25 And, hopefully, if he doesn't testify -- 1 UNNKOWN MALE SPEAKER: He is. 2 DONALD PECK: He's back. 3 VERNON "SAM" BURNS: He is? 4 DONALD PECK: Yes. 5 ASSEMBLYWOMAN RUSSELL: Okay. 6 SENATOR CARLUCCI: He can answer that 7 question. 8 DONALD PECK: He can answer that question. 9 UNNKOWN MALE SPEAKER: Addie, the sheriff's 10 going to speak. 11 DONALD PECK: Yes. 12 ASSEMBLYWOMAN RUSSELL: Oh, okay. I just -- 13 I didn't see his -- there he is. Okay. 14 I know he's going to speak later -- well, 15 I'll -- okay, I can ask the specific jail questions 16 to him, because I think that's a very striking 17 issue. 18 Thank you, all of you, for coming -- oh, and, 19 actually, I have one question for Mr. Pinkerton. 20 You talked a lot about the history of this 21 community, and providing mental-health services 22 here. 23 It seems to me that -- do you know how many 24 residents, or how many folks, receive outpatient 25 care here in the Ogdensburg area? 1 JOHN PINKERTON: I don't. 2 I know that someone will be giving you 3 statistics on the children. 4 I don't -- I take that back. 5 They won't because they weren't here. 6 But, it's 115 children are receiving 7 outpatient from Ogdensburg. I believe it is 45 from 8 Gouverneur, and 37 from Massena. 9 I don't know about adults, Assemblywoman. 10 ASSEMBLYWOMAN RUSSELL: Okay. 11 JOHN PINKERTON: But I'm sure we'll have 12 speakers that will know that number. 13 ASSEMBLYWOMAN RUSSELL: Thank you. 14 SENATOR CARLUCCI: Thank you. 15 [Applause.] 16 SENATOR CARLUCCI: Next we'll hear from 17 Angela Doe, who's the director of community services 18 for St. Lawrence County. 19 ANGELA DOE: Good morning. 20 Thank you for this opportunity to provide 21 comment today. 22 My name is Angela Doe, and I am most proud to 23 serve as the director of community services for 24 St. Lawrence County. 25 And while I understand the New York State 1 Office of Mental Health, like many other agencies 2 contained within government, is under significant 3 financial pressure to reduce costs while 4 implementing the necessary changes in our 5 service-delivery system, I would be remiss if 6 I didn't include in my comments today the very 7 center of our controversy: the Regional Center of 8 Excellence. 9 While the Regional Center of Excellence Plan, 10 as proposed by the New York State Office of Mental 11 Health, provides an opportunity for a structured 12 approach to improving its service-delivery system, 13 currently, it lacks substantial details, as well as 14 analysis, of the true clinical and financial 15 implications it will have in the states, our 16 communities, and most importantly, on our clients, 17 consumers, and their families. 18 And while I agree the overutilization of 19 long-term psychiatric beds when other 20 community-based services are not available serves as 21 an expensive approach to addressing 22 psychiatric-treatment needs, St. Lawrence County 23 simply can't afford to lose inpatient beds from its 24 current service-delivery system. 25 It is important to emphasize to the State of 1 New York the potential negative impact a regional 2 approach may have, as well, the significant gaps in 3 our already existing community-based service system. 4 Simply put, St. Lawrence County families, our 5 jail, our service providers, and our local hospitals 6 will incur increased costs, as ambulances, for 7 example, necessary for safe transports to Syracuse 8 and Utica, typically cost up to $595 for those with 9 Medicaid, $1,193 for those with Medicare, and in 10 upwards of $2,495 for those clients and families 11 without insurance, most often known as "self-pay." 12 Should the State of New York continue its 13 mission to downsize inpatient beds using a regional 14 approach to access intermediate care, it is then 15 important to note, that while it may result in a 16 reduction in state expenditures, it most 17 specifically will be at the cost of quality care. 18 I thank you so much for this opportunity to 19 share my brief comments with you today, and I look 20 forward to working and serving as a Regional Center 21 of Excellence team member to help facilitate and 22 resolve this most valued issue. 23 SENATOR CARLUCCI: Thank you. 24 [Applause.] 25 ASSEMBLYWOMAN GUNTHER: You name and title? 1 KAREN ST. HILAIRE: My name is 2 Karen St. Hilaire. I am the St. Lawrence County 3 Administrator. 4 I was not on your list to speak today 5 because, frankly, I should be back at the office, 6 building the budget, to deal with the increased 7 costs that I have from many of the decisions that 8 have been made in Albany, this being one that will 9 add another cost to us. 10 However, I felt this issue was so critical 11 that I should come, and Angela has asked me to crash 12 her time, so I'm going to do that. 13 I'm going to take the opportunity to tell you 14 that this issue is critical from many perspectives 15 for this county. 16 Our legislators, I think, have done an 17 excellent job. 18 My staff, Angela, our sheriff will explain 19 some of the specifics to you, but, holistically, 20 when you look at it from a budgetary perspective, 21 which is one of the issues that drove you as a state 22 to look at this issue, I have to say there have been 23 increasing mandates placed on local governments, and 24 you hear this all the time from county 25 administrators just like myself, that we pick up the 1 cost because it's not cost-effective for you to do 2 something. 3 So, you put a plan together and you pass it 4 on down to us, re-tweak your plan, and redo how 5 you're going to do business, and we pick up the 6 cost. 7 We have, and I believe the sheriff will tell 8 you, over 50 percent of our people get psychotropic 9 drugs. They should not be in jail. They need to be 10 in mental-health facilities. 11 But, we don't have the capacity for them 12 because the decision was made in the 1980s to put 13 those people out on the street. 14 We had over 2,000 people who had inpatient 15 psychiatric care in the '80s. 16 We have fewer than 100, or 200 at this point. 17 Have all of those people gotten well? 18 We sent them out on the street and, all of a 19 sudden, they're miraculously well? I don't think 20 so. 21 They still have many of the same issues, but 22 they're not being treated. 23 We're treating them, but we're not treating 24 them. We're housing them, so that they're not a 25 hazard to the community, so that things like what 1 happened yesterday in D.C. do not happen here. 2 But that is not the way to deal with 3 mental-health issues. I think we all know that. 4 So I would implore you to, please, look at 5 this, not just from a budgetary matter, but from a 6 human perspective of the individual who needs 7 treatment; from the community perspective, 8 a holistic community perspective, first of all, not 9 burdening us with an economic cost that we can't 10 have, but more to the point, making communities 11 safer. 12 And we're not safer by saying, We deem you to 13 be well. We're going to put this back in the 14 community. 15 They're not well. They need care, and not 16 everybody can be treated by outpatient care. Many 17 need inpatient care. 18 So I would please ask you to look at that. 19 I will tell you just two examples I know of 20 in the last year and a half. 21 I -- actually, one is a personal one. 22 I have a niece. 23 My brother-in-law was killed by an individual 24 who failed to stop at a stop sign. 25 He was on his way to work one morning, 1 killed. 2 His daughter, who was 14, became very 3 depressed, to the point of attempting suicide. 4 She, thank God, was able to get into the 5 St. Lawrence Psychiatric Center. 6 The treatment she got there for three months 7 really helped her to turn her life around. She's 8 now back in school. She's productive, she's doing 9 very well. 10 My sister, who was struggling, first of all, 11 with the death her husband, then her daughter, had 12 no resources. She didn't have a car, because the 13 car was totaled in the accident. She had to get 14 here from about 40 miles away, every day, to be with 15 her daughter, because she was not going leave her 16 here. 17 And in doing so, other family members helped 18 with that. 19 But if she had to go Utica or Syracuse, 20 I don't imagine how she would have done that. 21 Another case: 22 A woman who lost her husband after 30 years, 23 she was ill-equipped to handle many things that he 24 had always taken care of. 25 His first family decided that they were going 1 come in and take the home over that she had been in, 2 and he had never turned over to her. 3 She ended up with no home, no ability to deal 4 with things. 5 She also attempted suicide. 6 Thank God, one of our firemen stopped her 7 from finishing that act. 8 She ended up in the psychiatric hospital for 9 six months. 10 She's now out, she's a productive citizen. 11 But we need to take care of people when they 12 need that, and saying, "You're well," and leaving 13 them on their own, is not the way to do it. 14 So thank you for letting me crash your time. 15 Thank you for listening. 16 [Applause.] 17 ASSEMBLYWOMAN GUNTHER: I just want you to -- 18 50 percent of those that are in jail right now -- 19 KAREN ST. HILAIRE: Yes. 20 ASSEMBLYWOMAN GUNTHER: -- are on 21 psychotropic drugs? 22 KAREN ST. HILAIRE: Yes, more than that. 23 And the sheriff will give you the exact 24 number, but more than that. And that's costly to 25 us. 1 Our bill for drugs goes up every year. The 2 sheriff comes and begs me to find more money in 3 contingency. 4 We have this battle: I say, "I don't have 5 it." He says, "I have to have." 6 We go through this whole thing, and we find 7 money. 8 It's over $100,000-and-some that we've had to 9 transfer in the last year to cover these costs. 10 We also have had additional costs to send 11 people who have psychiatric needs to other places. 12 Because, they're in jail and they should be 13 here, but we have to send them now to a correctional 14 facility with a mental-health facility attached. 15 And that costs an enormous amount of money; again, 16 hundreds of thousands of dollars. 17 ASSEMBLYWOMAN GUNTHER: Do you have a 18 psychiatrist that comes to the jail? 19 KAREN ST. HILAIRE: Kevin? 20 KEVIN WELLS: Yes, [unintelligible]. 21 ANGELA DOE: Yes, we do. 22 KAREN ST. HILAIRE: Okay. 23 ANGELA DOE: Psychiatric nurse practitioner. 24 KAREN ST. HILAIRE: Yes, we closely are 25 aligned with the mental-health clinic, but Kevin 1 will tell you exactly how that functions. 2 ASSEMBLYWOMAN GUNTHER: A lot of them 3 probably have the history of dual diagnosis -- 4 KAREN ST. HILAIRE: Absolutely. 5 ASSEMBLYWOMAN GUNTHER: -- both of addiction 6 and -- 7 KAREN ST. HILAIRE: Absolutely. 8 ASSEMBLYWOMAN GUNTHER: [Unintelligible.] 9 KAREN ST. HILAIRE: And mental health 10 [unintelligible]. 11 Yeah. 12 ASSEMBLYWOMAN RUSSELL: Ms. Doe, I have a 13 couple of questions for you. 14 How long have you been, I guess, in contact 15 with the mental-health system? 16 ANGELA DOE: Well, interestingly enough, 17 I returned home, here to St. Lawrence County, after 18 being gone shortly after graduating high school in 19 1987, so I guess I'll age myself by birth date then. 20 [Laughter.] 21 ANGELA DOE: After being away from the 22 North Country for about 18 years, I've been back now 23 for, about, maybe 18 months, to serve in the 24 capacity of the director of community service. 25 I've spent my entire career working in 1 mental-health, substance abuse, and in particular, 2 working with folks who suffer from co-occurring 3 disorders and medical comorbidities. 4 ASSEMBLYWOMAN RUSSELL: Okay. 5 Is there any specific reason that you chose 6 this career path? 7 ANGELA DOE: Sure. 8 I am a second-generation mental-hygiene 9 worker. My parents both retired from the 10 St. Lawrence Psychiatric Center. 11 Quite frankly, I have spent most of my life 12 in a family system, where working in substance abuse 13 and mental health has most identifiably been a noble 14 career. 15 But I think, more importantly, I grew up in a 16 house where getting paid for doing something that 17 was very positive, that contributed to society and 18 healing, was a good thing. 19 ASSEMBLYWOMAN RUSSELL: Okay. 20 You grew up in a family that really -- in 21 a -- that provided mental-health services. 22 ANGELA DOE: Sure. 23 ASSEMBLYWOMAN RUSSELL: Having lived here for 24 most of your childhood -- 25 ANGELA DOE: All of my childhood. 1 ASSEMBLYWOMAN RUSSELL: -- and -- I don't 2 know, where do you live now? 3 ANGELA DOE: I live in -- I'm a taxpayer in 4 Ogdensburg. 5 ASSEMBLYWOMAN RUSSELL: Okay. 6 I guess -- 7 ANGELA DOE: I think Addie is putting me on 8 the spot here. 9 ASSEMBLYWOMAN RUSSELL: I'm giving you some 10 leading questions. 11 [Laughter.] 12 KAREN ST. HILAIRE: You can handle it. 13 ASSEMBLYWOMAN RUSSELL: You know, there was 14 talk before, some testimony, about what happened in 15 the 1980s. 16 ANGELA DOE: Sure. 17 ASSEMBLYWOMAN RUSSELL: You're probably 18 familiar with the facility back in the 1980s? 19 ANGELA DOE: Sure. 20 ASSEMBLYWOMAN RUSSELL: And what happened to 21 that population here in the Ogdensburg area? 22 ANGELA DOE: Well, I think that there are 23 two ways for us to look at this. 24 We can rewind this tape, and we can all go 25 all the way back to what is noted in our 1 human-services books and academia, and then we can 2 look at how those two areas, between theory and 3 practice, interface. 4 And, certainly, in the '80s, I was -- my 5 family was lucky enough to be able to stay here, 6 but, eventually, as we deinstitutionalized, as you 7 know, a functioning psychiatric center that offered 8 a number of services, whether -- I mean, I remember 9 when the farm was there, I certainly remember when 10 the greenhouses were there. 11 I remember that my parents would have ongoing 12 conversations about the productivity in the 13 involvement of clients in levels of care that were 14 contained within this psychiatric center, and how 15 there was a notable decrease sometimes in 16 psychiatric medications. 17 But I have to tell you that, for me, leaving 18 the area, and coming back, was a choice to come back 19 home and bring all of the skills that I had the 20 opportunity to develop outside of the area in best 21 practices, to come home to a place where there was a 22 positive psychiatric center who had a history and a 23 track record of implementing best practices, as a 24 rather attractive thing to come back home. 25 It is -- it is -- openly, I believe, if we 1 are the most candid here, it is a saddening place 2 for some of us who understand the need for inpatient 3 intermediate psychiatric care. 4 I think if we are most honest, as a 5 mental-health practitioner, I understand the fiscal 6 responsibility of taking care of folks in 7 community-based services. 8 But I also know, that when we think about 9 levels of care, and we think about the 10 Central New York region, in particular 11 St. Lawrence County in Ogdensburg, our levels of 12 care look like this. 13 In most instances, you have the most 14 restrictive level of care, which is inpatient 15 psychiatric stabilization, and SLPC providing 16 longer-term intermediate care, and then you have 17 community-based outpatient services. 18 In addition to being the director of 19 community service, I also have the largest 20 community-based outpatient OMH-licensed facility in 21 St. Lawrence County as well. 22 And having the differentiation between levels 23 of care is a wonderful thing, but, if we're going to 24 look a levels of care, and we're going the utilize 25 the RCE, and the way in which I believe it was 1 intended, although, when I read, that's not what I'm 2 seeing, the expectation I have as a director of 3 community service, is that we're going to not only 4 look at our need to continue having intermediate 5 levels of care, because they're necessary and 6 they're needed, but we're also going to look at 7 reinvestment, and we're going to look at the 8 continuum to include in our counties, be here or 9 regionally, a number of services that are 10 potentially needed, be it day treatment, partial 11 hospitalizations, crisis respite, to ensure that 12 those services can be utilized effectively in all of 13 our communities across the central region, and in 14 New York State, to ensure that we don't overutilize 15 intermediate levels of care. 16 But, please hear me say: 17 Let us not make any mistake, that because 18 we're identifying that it's not always 19 cost-effective to keep individuals in treatment for 20 long periods of care, it doesn't disqualify the fact 21 that we still need an intermediate level of care. 22 ASSEMBLYWOMAN RUSSELL: Okay. 23 Where did -- what types of services are the 24 vast majority of folks that maybe were in -- 25 institute -- you know, institutionalized in the 1 1980s, or those that would have been, you know, 2 moving forward, are they living in the community of 3 receiving community treatment? 4 Or -- I mean, somebody said they haven't 5 gotten well. 6 So I guess, is -- what -- I guess -- 7 I've heard, anecdotally, that there is a large 8 number of folks receiving community treatment, say, 9 here in the city of Ogdensburg. 10 Is that a fair assessment? 11 ANGELA DOE: Sure. 12 There's a number of people in 13 St. Lawrence County. But, in particular in 14 Ogdensburg, it's a relatively high number. 15 ASSEMBLYWOMAN RUSSELL: Okay. 16 And the community must have been tasked at a 17 certain point during deinstitutionalization to, 18 maybe, provide homes for -- 19 ANGELA DOE: Sure. 20 ASSEMBLYWOMAN RUSSELL: -- residents to 21 transition to? Residential placements, so to speak? 22 Can you tell me a little bit about that? 23 ANGELA DOE: If you're referring to -- if I'm 24 understanding your question correctly, if you're 25 referring to transitional living, and things of that 1 nature, although St. Lawrence County does have some 2 transitional-living providers, we need to be 3 specific about what we offer. 4 We don't have a level of housing that 5 adequately provides safety and security for our 6 clients who are participating in intensive or 7 non-intensive community-based services. 8 [Applause.] 9 ASSEMBLYWOMAN RUSSELL: I guess another 10 dynamic that I guess I want to try to understand, 11 we, later on, will be hearing, I think, from several 12 folks that are retired from the psychiatric center, 13 that used to work there. 14 How does -- you live here in this community, 15 you grew up here in this community. 16 There's a lot of folks that maybe were 17 institutionalized, that continue to reside in this 18 community, some without, maybe, the level of 19 supervision or the safety that they should be 20 provided by, I guess, the mental-health system. 21 But, I guess, how does this community maybe 22 differ from others that maybe haven't had 23 100-and-some years of experience being the host of 24 mental-health services? 25 ANGELA DOE: Well I have to tell you, Addie, 1 if I can be most candid with you -- 2 ASSEMBLYWOMAN RUSSELL: Yes. 3 ANGELA DOE: -- Assemblywoman Russell, one of 4 the things that I've had the opportunity to talk 5 about with Karen, and I've spoken to the legislators 6 about this, and colleagues, and, certainly, across 7 the state, and then, certainly, you know, neighbors 8 and friends, is that the reality for all of us is, 9 that there are a number of communities across the 10 state of New York that have individuals who suffer 11 from persistent mental illness. 12 The uniqueness, though, of 13 St. Lawrence County that sets it apart, and one 14 might say this is anecdotal, because I haven't 15 written anything that shows that it's empirical, so 16 I'll stick with it being anecdotal, but the point 17 being, is that, for me, leaving this community and 18 being involved in very large, more metropolitan 19 areas, the opportunities for additional services 20 certainly are greater. We know this. 21 But the same struggles and the same concerns 22 and the same needs for inpatient psychiatric care 23 for individuals who suffer from persistent mental 24 illness, they too exist there. 25 The interesting thing about 1 St. Lawrence County, is that Ogdensburg in 2 particular, has served as this impetus for an 3 opportunity for our psychiatric center to do 4 something very different than many psychiatric 5 centers across our state, and quite frankly, across 6 our country, if you look at the research. 7 SLPC has, and I -- and one may say that I'm a 8 bit biased, and that probably is true, but from an 9 administrative perspective, one of the things that 10 they have offered that I haven't had the opportunity 11 to work with rather regularly, is that they have 12 taken the steps necessary to implement best 13 practices. 14 If you have an opportunity to walk through 15 children and youth services, one of the things that 16 you will see is that, the folks who work at SLPC, 17 they're not just psychiatric social workers and 18 licensed mental-health clinicians and psychologists 19 and docs. These are individuals who made a 20 conscious effort in their career to specialize in 21 childhood disorders. 22 And specializing in childhood disorders 23 doesn't just mean that we offer an intermediate 24 level of care to children who need inpatient 25 psychiatric hospitalization; rather, what it means, 1 is that we have done to whatever lengths necessary, 2 whether we're a state-operated facility, whether we 3 are a private OMH facility, to implement the 4 practices necessary, the best practices necessary, 5 to decrease our length of stay, and to increase 6 wellness for our individuals and our children. 7 And quite frankly, with integrity, I can say 8 that that is one of the things that certainly played 9 into my decision to return back home after being 10 gone for lots of years. 11 ASSEMBLYWOMAN RUSSELL: Thank you. 12 KAREN ST. HILAIRE: Addie, if I could also 13 add to that? 14 I think John Pinkerton is probably the person 15 who can speak the best to this, and I've heard him 16 speak about this, the fact that there are many, many 17 people who live here in the community, who have been 18 at the psychiatric center as patients, and they are 19 now part of the community, and they are integrated 20 into this community. 21 The community accepts them, they are part of 22 the community, and they work with the -- the people 23 who have those needs, as a very -- and it does make 24 a very different fabric, in that there's a real 25 caring here that you might not find in other places 1 where they're just released out into the population 2 that is much larger, and people aren't watching out 3 and caring for them. 4 But I think John is probably the person who 5 can address that probably better than either myself 6 or Angela. 7 ASSEMBLYWOMAN GUNTHER: Angela, can you 8 provide some of those statistics about readmissions, 9 and all of that, some information, just to show, 10 like, as yours is a center for excellence? 11 ANGELA DOE: Well, I -- respectfully so, 12 I didn't pull a lot of the OMH -- 13 ASSEMBLYWOMAN GUNTHER: Not today, no. 14 ANGELA DOE: -- but I certainly can get you 15 those statistics. 16 ASSEMBLYWOMAN GUNTHER: No, Addie will get it 17 to me. 18 ANGELA DOE: Absolutely. 19 Absolutely, I can get those to you. 20 ASSEMBLYWOMAN GUNTHER: Thank you. 21 Anybody else have any questions? 22 Thank you so much. 23 KAREN ST. HILAIRE: Thank you. 24 And thank you for letting me crash the party. 25 [Laughter.] 1 ASSEMBLYWOMAN GUNTHER: We enjoyed having 2 you. 3 KAREN ST. HILAIRE: Thank you very much. 4 [Applause.] 5 ASSEMBLYWOMAN GUNTHER: Ronnie Freeman, Jr., 6 Colleen Wheaton, and Joseph Cosentino. 7 Now, after this testimony, if we could take 8 just like a 10-minute break, so that we could just 9 get up? 10 And, would that be okay with everybody? 11 Because, you know, I don't want anybody to 12 miss any part of anybody's testimony, because people 13 are waiting, so I think it's important that we do it 14 together. In 10 minutes, we'll come right back. 15 Thank you. 16 COLLEEN WHEATON: Good morning, and thank you 17 for taking the time to hear from me. 18 My name is Colleen Wheaton, and I serve as 19 the CSEA Central Region President, on behalf of the 20 majority of the people who are on the front line -- 21 front-line direct-care workers at the St. Lawrence 22 Psych Center. 23 I will tell you that CSEA is not here to 24 defend the status quo in our mental-health-care 25 delivery, but we will continue to fight for the 1 right approach to redesigning that system, one that 2 better takes into account the needs of those who 3 receive services, and those who we represent who 4 help to deliver those services. 5 We have heard it all across the state, we 6 already have a mental-health-care system that is 7 failing many in our communities. We cannot afford 8 to further allow the system to be cut back due to 9 budgetary reasons. 10 We must remember, that when we talk about 11 this system, it is not about numbers on paper. 12 We are talking about an illness that, when 13 untreated, people's lives are at risk. 14 We, therefore, have a huge mandate to get 15 this right, and not rush into supporting a plan that 16 is not really a plan. 17 I have submitted our official written 18 testimony on behalf of CSEA. 19 What I would like to do right now is, 20 summarize our concerns, and then let you hear from 21 our area representative, to give you a better 22 understanding of the full local impact of this 23 closure. 24 First, I need to state for the record, that 25 when the Office of Mental Health held their 1 listening tours earlier this year, it was obvious to 2 all of us who had a stake in providing mental-health 3 services that no one was really listening. 4 If there -- if they -- they were, they would 5 have realized that the North Country already has a 6 center of excellence right here in Ogdensburg, the 7 only facility north of the thruway that serves 8 thousands of families that so many of us -- so many 9 in our communities. 10 Given our rural coverage area, and a huge 11 distance between these center coverages, we have no 12 business allowing the Governor to close the facility 13 and leave mental-health care in the North Country in 14 a lurch. 15 The Governor's plan to send those in need of 16 inpatient care to facilities along the thruway 17 corridor in Syracuse and Utica is horribly 18 misguided. 19 It will not only displace members of our 20 communities, but will discourage people from seeking 21 treatment; discourage families for participating in 22 their children's treatment, and force them to travel 23 long distance if they do. 24 On that point, I would like to publicly 25 commend Jamie Weber of Gouverneur for starting her 1 petition to fight for SLPC, and sharing her story 2 with the world. 3 Her son Alex began treatment at the psych 4 center when he was just 7 years old. And thanks to 5 the ability of this facility, she and her family 6 were able to visit Alex on a daily basis to take 7 part in his treatment. 8 Because they had the psych center here for 9 them, Alex, now 17, is looking forward to a much 10 brighter future. 11 I don't want to even think what would have 12 happened if the psych center wouldn't have been 13 there for them. If Jamie and her family needed to 14 travel from Gouverneur to Utica or Syracuse to visit 15 their son, those visits would have been far less 16 frequent, and that could have had a severe negative 17 impact on his treatment. 18 Thankfully, the psych center was there for 19 Alex, and we now have to make sure the psych center 20 stays here for other children like Alex, whose 21 family chooses to live in the North Country, but 22 shouldn't have to a sacrifice high-quality local 23 mental-health care because of that choice. 24 Closing the psych center would also shift 25 more of the burden from mental-health care to our 1 local taxpayer, as those who fall through the cracks 2 will end up in our prisons and jails which are not 3 equipped to deal with them and are already full of 4 people in need of mental-health services. 5 This just comes as another unfunded mandate 6 from the State, one that we cannot afford, either 7 for a financial standpoint or from a human 8 standpoint. 9 When we know there is already a lack of 10 needed services for mental health across the state, 11 how can we support the Governor's plan when there is 12 absolutely no evidence that the Regional Centers of 13 Excellence Plan will meet the outstanding needs? 14 The Cuomo Administration is purposely 15 misleading the public about the impact of this 16 policy by packaging it in a nice-sounding name 17 without providing any real details about how 18 services will be provided or supported. 19 There is no evidence that the Governor's plan 20 will meet the needs of real people and communities. 21 We are here today to express our strong 22 disappointment with regards to this plan, and ask 23 for your help in beating back a proposal that will 24 devastate New York's ability to treat the mentally 25 ill. 1 And we can't talk about the impact of these 2 closures without looking at the economy and the 3 impact of job loss to our communities. 4 Sure, the Governor says no one will lose 5 their job, but we can't help but ask, Where would 6 these workers go? 7 Surely, many will face job losses, especially 8 if they choose not to relocate their families to 9 positions far away. 10 The bottom line, is that we will see more 11 good-paying middle-class jobs leaving the 12 North Country, which will further harm our 13 communities already struggling to rebound from the 14 Great Recession. 15 St. Lawrence Psych Center employs about 16 520 people. If these workers earn an average of 17 about $40,000 per year, our North Country 18 communities stand to lose nearly $21 million every 19 year. 20 How can our communities support these losses? 21 Small businesses will go under, our tax base 22 will shrink even more, and the North Country will be 23 one step closer to becoming a ghost town. 24 We cannot let this happen. 25 In summary, the Governor's Center of 1 Excellence Plan is not a well-thought-out plan for 2 delivering mental-health services; instead, it is a 3 continuation of a budget policy with misplaced 4 priorities. 5 CSEA is not simply fighting against change, 6 but we are defending the need to provide better 7 human services to our most vulnerable citizens; to 8 stop the Governor from shifting the burden from the 9 state level to local taxpayers; and to stop the 10 shredding of good middle-class jobs provided by our 11 dedicated and caring state workforce who are 12 providing much-needed mental-health services to our 13 communities throughout the state. 14 I would like to introduce Ronnie Freeman, our 15 local president at the St. Lawrence Psych Center. 16 RONNIE FREEMAN, JR.: Good afternoon. 17 My name is Ronnie, president of the 18 CSEA Local 423 at the St. Lawrence Psychiatric 19 Center. 20 I come to you guys today to explain to you 21 guys the severe impact the St. Lawrence Psychiatric 22 Center closing will have on the community, its 23 patients they serve, and, of course, our members in 24 CSEA. 25 There's a genuine concern that the patients 1 will become a statistic of the future, and let me 2 explain. 3 In 2006, Markowitz published data on 4 81 U.S. cities, looking at correlations between the 5 decreasing availability of psychiatric hospital 6 beds, and the increasing crime arrest rates and 7 homelessness. 8 As expected, he found direct correlations. 9 This is consistent with past studies in 10 Massachusetts and Ohio that reported that 27 and 11 30 percent -- sorry, 36 percent of the discharges 12 from state mental hospitals have become homeless 13 within six months. 14 It is also consistent with the study in 15 New York that found 38 percent of discharges from a 16 state hospital had no known addresses six months 17 later. 18 I found this publication, and correlated it 19 directly with the concerns that our members will, 20 you know, express their opinions, as far as their 21 concerns with their patients becoming a statistic of 22 the future. 23 And this directly had New York City in it, 24 mostly because, in many cities, such as New York, 25 homeless people with severe mental illness are now 1 accepted part of the urban landscape and make up a 2 significant percentage of the homeless who ride 3 subways all night, sleep on sidewalks, or hang out 4 in parks. 5 You can see that here as well. 6 These ill individuals drift into the train 7 and bus stations, and even the airports. 8 Many other homeless people hide from the eyes 9 of the citizens. They shuffle quietly through the 10 streets by day, talking to their voices only when 11 they think nobody is looking, and then in shelters 12 or abandoned buildings at night. 13 Some shelters become known as havens for 14 these ill wanderers and take on the appearance of 15 hospital psychiatric wards. 16 Others who are psychiatrically ill live in 17 the woods on the outskirts of cities, small towns, 18 under bridges, in cemeteries, and even in tunnels 19 that carry subway trains beneath cities. 20 Coming from northern New York, our patients 21 do not know this life. 22 The biggest fears that the patients we now 23 serve, and have served most of their lives, will 24 become part of these future statistics. 25 Where has the Regional Centers of Excellence 1 been for the population of already homeless that 2 suffers from mental illness? It has not had the 3 outpatient resources they need to help in their 4 treatment. 5 The RCE plan calls for fast action to 6 implement supportive community service for recovery 7 to be able to continue; but, yet, in this plan, 8 there is no outline for how this is going to take 9 place. 10 We are asking that you look at how much of an 11 impact the RCE plan truly has on the livelihood of 12 our most sensitive individuals. 13 The time to truly care is now, and to make 14 decisions based on their interests. 15 And I do have a testimony from a 16 highly-respected treatment aide at the 17 St. Lawrence Psychiatric Center. 18 A lot of people's past testimonies have been 19 talking about physicians and doctors and 20 social workers, but, truly, where has the census 21 come from, the people that are directly up front 22 with the patients? 23 So I will read her testimony now. 24 (Testimony of Angela Caufield [ph.] is 25 read into the record, as follows:) 1 RONNIE FREEMAN, JR.: "My name is 2 Angela Caufield. I have worked at SLPC for 3 12 years. 4 "When I was in training for this position of 5 mental-health therapy aide in 2001, I was told that 6 I had a chance to make a real difference in the 7 lives of our patients. I was told that this job 8 would be difficult, and if I truly invested myself 9 in my work, it would the most rewarding thing 10 I could do. 11 "The Education Department couldn't have been 12 more right. 13 "I have worked in adult services for the 14 majority of my years at SLPC. I specialized in the 15 care of geriatric population. 16 "While some may think of the elderly as lost 17 causes, we take their rehabilitation very seriously. 18 "We have patients who have spent the majority 19 of their adult lives at our facility. We take care 20 of their needs emotionally, physically, and 21 spiritually. 22 "I see the difference that our staff makes in 23 the daily lives of our patients. 24 "We share only 8 hours of our day with them; 25 they share their lives with us 24 hours a day. 1 "They depend on us to take care of them, to 2 help them heal, grow, and move forward in their 3 rehabilitation. 4 "When I was informed of changes that are 5 upcoming to our patients, my immediate question was, 6 Who will take care of our guys? 7 "But the real question is, Who will take 8 better care of our guys? 9 "The answer is 'no one.' 10 "The reward that Mr. Peridus [ph.]" -- 11 He was an education and trainer at SLPC for 12 many years. 13 -- "spoke about 12 years ago is apparent to 14 me every day I walk on to my ward. 15 "I see my guys show their independence in 16 their daily living skills. I see them trying, I see 17 them work, I see them grow, and on occasion, fail, 18 and then try again. 19 "They are amazing to me. 20 "I am proud to work with them, and I am sure 21 they are proud of our service. 22 "I understand the Center of Excellence wants 23 us to be the hub of Upstate New York. 24 "We are more than a hub; we are excellence. 25 "We strive to improve the lives of our 1 patients every day, without question. 2 "These men and women do not choose to be ill, 3 but we have chosen this job because we know we can 4 make a difference in their lives, in the lives of 5 those we serve. 6 "Please make decisions best on the" -- 7 "on the best of the interests of our patients. 8 "Thank you for listening. 9 "Angela Caufield." 10 [Applause.] 11 JOSEPH COSENTINO: I'm Joe Cosentino, 12 president of CSEA Retirees, Local 923. 13 If you don't know me, you're lucky. 14 [Laughter.] 15 JOSEPH COSENTINO: I worked for the 16 St. Lawrence Psych Center for 25 years, and 17 retired in 1983. 18 The center was always number one in the state 19 of New York for excellency and long-term employees. 20 Years ago, we had clients come from 21 downstate, transferred, when Governor Cuomo -- 22 Governor Rockefeller was governor. He brought 23 clients from downstate. 24 When they got here, they thought they were in 25 heaven. 1 Why? The food was different. The employees 2 cared for the clients. 3 And, I can truthfully say, after retiring in 4 '83, I can walk down the street and I still have 5 some of any clients, and they come up to me, and, 6 "Thank you, thank you, thank you, thank you." 7 Makes me feel good. 8 Now I feel that the State of New York, if 9 they're going to mandate closing this hospital for 10 the service, they serve six counties, and serving 11 six counties, that's a big area. 12 And if they mandate that, the State of 13 New York should pay for all of their transportation 14 back and forth. 15 Let's not treat these clients like 16 New York State treats its veterans. 17 I am one that's been trying to get the psych 18 center, having a veterans hospital here, and I had 19 people from Albany come down, and all over. 20 And they feel that if the psych center is 21 still here, they need the alcoholic unit, they need 22 the psych center here, close by. It's all within 23 walking distance from where the Pritchard Pavilion 24 is. 25 These buildings are in need, and need to be 1 used, because they should not be left empty. 2 All I can say, the State should be thankful 3 for this hospital in St. Lawrence County. 4 Thank you. 5 I want to thank everybody. 6 [Applause.] 7 ASSEMBLYWOMAN GUNTHER: Ronnie, you talked 8 about the statistics in New York City, that, 9 36 percent, 38 percent, after 6 months are homeless. 10 RONNIE FREEMAN, JR.: Right. 11 ASSEMBLYWOMAN GUNTHER: Can you tell me a 12 little bit about your facility here, Ronnie? 13 RONNIE FREEMAN, JR.: Our facility here -- 14 ASSEMBLYWOMAN GUNTHER: Do you keep those 15 stats? 16 RONNIE FREEMAN, JR.: Do we keep those stats? 17 Well, the stats that we have, is that we're, 18 pretty much -- we're -- we're full, most of the 19 time, you know. 20 ASSEMBLYWOMAN GUNTHER: No, but the "after." 21 Like, you know, when you said, like, after -- 22 in New York City, when you were reading those 23 stats -- 24 RONNIE FREEMAN, JR.: The "after," I do not 25 have, as far as -- that was, uhm -- that was a 1 publication by Freddie Markowitz. He's a professor 2 of sociology out of Northern Illinois. 3 ASSEMBLYWOMAN GUNTHER: You could probably 4 get that information from the folks in your 5 facility. 6 RONNIE FREEMAN, JR.: Yeah, yeah. 7 ASSEMBLYWOMAN GUNTHER: And that would be a 8 good thing to -- for a comparison, from what's 9 happening in New York City, and what's happening -- 10 I'm sure there are great facilities in 11 New York City. I'm not to saying anything 12 disparaging, but, just, that would a great thing. 13 RONNIE FREEMAN, JR.: Yeah, and I think the 14 direct correlation was a percentage of 15 New York State. Even though those were homeless 16 people that were in New York City, they were people 17 that drive from facilities all over New York State. 18 So it wasn't just, like, Manhattan Psych 19 Center or Brooklyn. It was, you know, Buffalo, 20 Rochester, people who drifted and found that it was 21 more -- you know, it was more applicable for them to 22 be in New York City, just because it's, apparently, 23 easier to be homeless in New York City than it is 24 anywhere else. 25 ASSEMBLYWOMAN RUSSELL: Just to, I guess, as 1 the summary, you'd rather that, you know, folks that 2 were released from the psych, say, hang out here at 3 city hall, become part of the community where 4 everyone knows who they are, and is an active member 5 of their independence in the community, and 6 treatment, and, essentially, the community embraces, 7 and tries to accommodate, and be part of their 8 service when they're not in an inpatient setting, 9 versus, shipping our adults to Hutchings, to be 10 discharged to the corner under 81 as you go up the 11 SU hill? 12 RONNIE FREEMAN, JR.: Well, absolutely. 13 And we have a lot of patients here that are 14 from this area -- they're not from Syracuse, they're 15 not from New York City, and they're not from Buffalo 16 or Rochester -- to find it treatment-smart, to put 17 them in an urban setting, where they don't know -- 18 they don't know their way around. 19 And to find it, you know -- to find it 20 deplorable for them to be, you know, put in that 21 situation, where they have to learn how to 22 accommodate this somewhere that they're not familiar 23 with. 24 St. Lawrence Psych Center has, you know, a 25 lot of people that have come in and out. 1 And one thing I hear a lot from my members, 2 is, you know: There's so-and-so. I remember when 3 they were here five years ago, and we helped them 4 through this, and we helped them through that. 5 And they meet each other on the streets, and 6 it's almost like a -- you know, a -- now it's like 7 camaraderie that they have with each other, and it's 8 not just work-related, it's personal-related. 9 ASSEMBLYWOMAN RUSSELL: Okay. 10 I just -- I make that anecdote, because 11 I lived in Syracuse for three years, very close to 12 Hutchings, and -- and drove the intersections around 13 that facility. 14 And for a center that is being told that it's 15 going be our center of excellence, driving around 16 those intersections where, obviously, there are 17 people suffering from homelessness, likely 18 mental-health problems, likely, maybe, on their way 19 to treatment at that facility, that are panhandling 20 on the very busy streets of downtown Syracuse, 21 versus, popping in to see the mayor, or, someone who 22 works here at this building, and, perhaps, the lady 23 at the bank across the street, and -- instead of 24 standing in the middle of traffic, asking for money. 25 I -- I completely agree with that you we 1 don't want the patients here at St. Lawrence to 2 become part of that type of world, and those 3 statistics that you referenced. 4 So thank you for bringing that dynamic to 5 this discussion. 6 ASSEMBLYWOMAN GUNTHER: Patty? 7 SENATOR LITTLE: Not at this time. 8 COLLEEN WHEATON: Thank you. 9 SENATOR CARLUCCI: Thank you. 10 [Applause.] 11 [A recess was taken.] 12 [The hearing proceeded, as follows:] 13 [Technical difficulties.] 14 ASSEMBLYWOMAN GUNTHER: We've gone back and 15 forth, some folks are not here. 16 UNKNOWN FEMALE SPEAKER: We jumped ahead. 17 UNNKOWN MALE SPEAKER: We jumped ahead. 18 UNKNOWN FEMALE SPEAKER: We jumped ahead, 19 because we have to get back to patients. 20 ASSEMBLYWOMAN GUNTHER: Are you Panel 11? 21 UNKNOWN FEMALE SPEAKER: We're eleven, yes. 22 ASSEMBLYWOMAN GUNTHER: Okay. 23 So, Laurie Zweifel, Elizabeth Chadwick Burns, 24 Michael Lumley, Andrea Randle, Scott Blankenship, 25 Elizabeth Barnes, and I have Terri Langenmayer. 1 Okay, is everybody here? 2 Okay, thank you so much for your patience, 3 and, we'll continue. 4 ANDREA RANDLE: Hi, good afternoon. 5 Thank you for coming, and having us. 6 My name is Andrea Randle. I'm a licensed 7 clinical social worker at the St. Lawrence 8 Psychiatric Center; "SLPC." 9 I've been a licensed clinical social worker 10 for 17 years, and I've been working at SLPC for the 11 past 11 years in the children and youth inpatient 12 program. 13 This is not part of my written testimony, but 14 I did have some numbers that might be helpful to 15 clarify what some other things have been said 16 earlier. 17 ASSEMBLYWOMAN GUNTHER: Thank you. 18 ANDREA RANDLE: In the year 2012; so, 19 January 1st through December 31, 2012, we admitted 20 293 children to our inpatient unit at SLPC. 21 The median length of stay was 17 days, not 22 3 months. 17 days. 23 Average length of stay is 21 days; 3 weeks, 24 that's our average length of stay. 25 Certainly, some children stay more, if their 1 mental needs are more pressing, or discharge 2 planning is more complicated. 3 Some kids are there much less, if it's a 4 simpler treatment. 5 So that is the average. 6 90 children were between the ages of 7 5 and 12. 203 children were between the ages of 8 13 and 17. 9 The other thing I wanted to point out is, the 10 readmission rate, within 30 days, was only 11 22 children. 12 So out of 293 children, only 22 were 13 readmitted within a 30-day time period. That's 14 really good. 15 ASSEMBLYWOMAN GUNTHER: So it's, about, under 16 5 percent? 17 ANDREA RANDLE: I'm not sure of the math. 18 [Inaudible.] 19 Yeah, I agree with you. 20 [Laughter.] 21 ANDREA RANDLE: Last quarter; so, for the 22 last three months, our median length of stay was 23 actually 14 days. 24 So, the last quarter of 2013, our median 25 length of stay was actually 14 day. That's number 1 one in the state. Better than Mohawk Valley, which 2 is the proposed center for excellence. 3 We are, typically, either one or two in 4 New York State in terms of length of stay. 5 We work very hard to get the children out as 6 quickly as we can, back to the community, and, you 7 know, back to an outpatient level of care. 8 So, I did want to clarify that, so you'd have 9 them. 10 ASSEMBLYWOMAN GUNTHER: Can you share those 11 stats with us? 12 ANDREA RANDLE: I can. I will make a much 13 neater copy. I've written all over this, but I can 14 absolutely give you, after. 15 I am not in favor of closing the inpatient 16 units at SLPC, as I believe that the closure of the 17 inpatient units will create serious hardships for 18 the patients and the families I serve. 19 I believe the impact of the Regional Centers 20 of Excellence Plan will have far-reaching effects, 21 many of them damaging on my patients and their 22 families. 23 To be admitted to an inpatient psychiatric 24 hospital, you must be having an emotional and/or 25 behavioral crisis, and be at imminent risk of 1 harming yourself or others. 2 This is trying enough, but to couple it with 3 being separated from your family and loved ones 4 seems just plain wrong. 5 All mental-health workers and, frankly, 6 common sense, will tell you that patients need their 7 supports when they are undergoing treatment, and 8 this is especially true of the children and youth 9 that I work with. 10 Parents, caregivers, and guardians are an 11 integral part of a child's mental-health treatment, 12 and I am fearful that this will not be the case if 13 our inpatient units are closed here in Ogdensburg. 14 I believe that most people don't realize how 15 important inpatient units are until you need one. 16 A majority of the children that I work with 17 come from families that have serious financial 18 problems, and a majority of the children that I work 19 with are Medicaid-eligible. 20 Many of these families do not have reliable 21 transportation. 22 And if they do have a working vehicle, they 23 often do not have sufficient funds for gas. 24 As you are probably aware, we live in a very 25 rural part of New York State. We do not have public 1 transportation. 2 I have parents that walk or ride bikes to the 3 inpatient units. 4 I have parents hitchhike to the inpatient 5 unit. 6 I had a parent ride in the ambulance with 7 their child, from the emergency room to our 8 inpatient unit, only to find out they had no way to 9 get home. 10 Medicaid offers transportation reimbursement 11 for those eligible, including volunteer Medicaid 12 drivers and mileage-reimbursement programs, and only 13 for specific reasons, like a scheduled family 14 session or a doctor visit, not to just come and 15 visit their child. 16 And this seems only to work in our local 17 area. 18 It is highly unlikely that a volunteer 19 Medicaid driver will drive you more than one hour, 20 one way. 21 In my 11 years, I've never had a family have 22 a Medicaid driver drive them from Clinton, Essex, or 23 Franklin county, which is over an hour, one way. 24 I wrote testimony all about the Medicaid 25 reimbursement; how much -- how many cents per mile, 1 and what that would do. 2 And that's kind of been covered already, in 3 terms of the extra costs to the county, so I won't 4 go into that. We'll skip over that. 5 A psychiatric emergency can happen at any 6 time, and as with all other emergencies, a 7 mental-health crisis is not planned. 8 If the inpatient children and youth units are 9 closed, that will force people to seek treatment, in 10 an emergency, in Utica. 11 Our outpatient units -- inpatient unit takes 12 children and youth 24 hours a day, 7 days per week, 13 365 days per year. 14 We had nearly 300 children admitted to our 15 facility in 2012 for inpatient psychiatric 16 treatment. "293," actually, was the exact number. 17 Nearly all of the children and youth we serve 18 are between the ages of 5 and 18. 19 All of our patients come to us from an 20 Article 28 hospital emergency room, such as 21 Claxton-Hepburn, Alice Hyde, or Samaritan. 22 What will parents and caregivers do, that 23 have other children that they have to care for? 24 What are parents and caregivers going to do, 25 that don't have the ability to get time off their 1 jobs? 2 What will parents and caregivers do, that are 3 allowed time off their jobs, but as a result, don't 4 get paid for that time off? 5 Imagine a 6-year-old that is deemed by the 6 emergency room to require inpatient psychiatric 7 care, and his parent, who has three other young 8 children in the home, with no means of 9 transportation. The parent may not be able to 10 travel to Utica right away, and the 6-year-old is 11 transported alone to Utica. 12 The admitting staff in Utica will not be able 13 to get a good mental-health status on a 6-year-old 14 without a parent, and it certainly seems traumatic 15 to ship children off in this way. 16 It is hard enough for many of my families to 17 get to SLPC, let alone for them to get to Utica. 18 Why would we want to look to provide such an 19 essential service, inpatient care, so far away from 20 our community? 21 There is a continuity of care between 22 inpatient providers and outpatient providers, and 23 this provides for good mental-health treatment. 24 We have strong working relationships with so 25 many of the community-based providers, including 1 probation, social services, case managers, and 2 school districts. 3 Many community-based providers come to visit 4 the children and youth while they are inpatient, and 5 many are an integral part of our treatment planning 6 and discharge planning. 7 Teachers come to visit their students. 8 Pastors come to visit their parishioners. 9 Travel to Utica will be unbelievably 10 difficult for our Amish families. We do have Amish 11 families that we serve. 12 I cannot imagine what it will be like for the 13 children and families that I serve to lose this 14 piece of their treatment. They will be so alone in 15 Utica, with far less visits and supports, from not 16 only their parents and caregivers, but from all the 17 other supports in our children's lives. 18 OMH talks about potential innovations, such 19 as concierge services; for example, perhaps, travel 20 assistance, and use of the Internet to communicate 21 between the patient and family. 22 Albany may not realize this, but there are 23 still places in St. Lawrence County that don't have 24 high-speed Internet, and do not have reliable cell 25 phone service, and you cannot Skype with dial-up. 1 I relish the idea of expanding our 2 community-based services, and those of us that work 3 in the North Country know how few services we have 4 right now, but I also believe that our community 5 needs some inpatient units as well, as there will 6 always be a need for inpatient psychiatric care no 7 matter how great the outpatient services. 8 Thank you. 9 [Applause.] 10 MICHAEL LUMLEY: Hey. 11 I'm Michael Lumley. I'm a licensed certified 12 social worker. I'm the coordinator of the 13 collaborative day treatment program -- the on-campus 14 collaborative day treatment program for children. 15 I wish to thank all of you for giving me the 16 opportunity to provide testimony today. 17 I'm going to -- my remarks are going to come 18 at, basically, two opposing points. 19 Okay? 20 And what I'm hoping for, is that I can fuse 21 the two together in a way that's going to make sense 22 to everybody. 23 One of the things that we're all talking 24 about is keeping the hospital open; not closing the 25 adult inpatient unit or the children and youth 1 services inpatient unit. 2 I am going to make an assumption that I made 3 when I was putting this together, and the assumption 4 that I've made for a very long time, is that, 5 indeed, that's a runaway train that we may not be 6 able to stop it here. 7 I hate to say that, I hate to be the 8 harbringer [sic] of that potential bad news. 9 I don't think that I am. 10 I think lots of people have said that, and it 11 may come to pass. 12 So, a portion of my discussion will be 13 related to, okay, if that's the case, this is one of 14 the things that we can suggest. 15 I've worked at the facility for 29 years as a 16 children and youth services social worker. I began 17 my career there, and will be ending it November of 18 2014. 19 I'm 54 years old. And next -- my next 20 birthday, will be 55, and I will have 30 years of 21 service. 22 And, I have some other plans, besides 23 providing mental-health services, and that's lots of 24 good stuff. 25 While I am going to be retired from state 1 service, I will still hold out the ideals that I've 2 been carrying with me for the last 29 years. 3 I've been considered a valuable member of the 4 children's team. I have knowledge and expertise 5 related to best practices, and I truly enjoy that 6 our programs and services bring about improved 7 competence and notable positive change. 8 Change is inevitable, but the series we 9 deliver -- or, the services we deliver have 10 consistently prompted positive change in every 11 sphere of functioning. 12 I've been the coordinator of the unit's 13 collaborative day treatment program. 14 And the reason it's collaborative is because 15 we use BOCES, teachers, and teachers assistants, 16 even though the program is housed on campus. 17 I managed a very important component of 18 programming that is available for seriously 19 emotionally-disturbed children, and their families. 20 The program serves 18 school districts with a 21 variety of services which have led to reductions in 22 the use of both inpatient psychiatric 23 hospitalizations and residential treatment. 24 At this time, I do not support the closing of 25 the children's/youth services inpatient unit, or the 1 current plan to decommission the building should the 2 inpatient unit be closed. 3 I would like to make several suggestions to 4 the Committee related to the current plan. 5 First of all, I would like to define 6 "day treatment," to clarify its position in the 7 continuum of care. 8 Children's day treatment programs are highly 9 structured, intensive, non-residential mental-health 10 programs that offer a blend of clinical 11 interventions and special education services to 12 children and adolescents, as well as social and 13 clinical supports to their families. 14 A day treatment program provides services 15 designed to stabilize children's adjustment to 16 educational settings, and to prepare children to 17 return to a regular school-based educational 18 setting. 19 Typically, these programs include special 20 education in the small classroom environment, with 21 emphasis on individualized instruction; individual 22 and group counseling; family services, such as 23 family counseling, crisis intervention, 24 interpersonal skill development, and behavior 25 modification. 1 Children and adolescents receiving day 2 treatment services live at home, or, are in the 3 community, but are identified by the school district 4 as seriously emotionally-disturbed and cannot be 5 maintained in regular classrooms. 6 Day treatment programs occur in a variety of 7 venues, including hospitals and community-based 8 organizations. 9 I'm recommending that the Committee consider 10 maintaining the children and youth services unit in 11 whatever plan is going to be adopted. 12 My colleague Lori Zweifel, Ph.D., who's 13 sitting beside me, will be discussing -- addressing 14 some of the numerous reasons why we need to maintain 15 the inpatient program. And, certainly, Andrea has 16 also spoken to that. 17 Keeping the inpatient unit open will, of 18 course, allow children from the North Country to 19 receive inpatient services relatively close to their 20 homes. 21 At the same time, maintaining the inpatient 22 program allows the campus-based day treatment 23 program to receive the supports that are necessary 24 to continue the program as it is currently set up, 25 and to promote recovery in our students. 1 Placing the day treatment program in a 2 non-hospital setting will eventually change the 3 fabric of the program which, at its core, is a 4 halfway point between inpatient services and 5 residential treatment and outpatient programming. 6 At the same time, because day-treatment 7 students meet the criteria for the New York State 8 classification as seriously emotionally-disturbed; 9 and are, therefore, at a higher risk for 10 demonstrating more severe and potentially dangerous 11 behaviors, the need for a brief inpatient admissions 12 will become more difficult to obtain. 13 Once obtained, there is clearly a reduced 14 likelihood of family participation should there be 15 no local inpatient unit. 16 By not decommissioning the building and 17 keeping the children and youth services open -- 18 And this is where I start to go in the other 19 direction. 20 -- even without the use of inpatient 21 services, I can see the benefits related to outcomes 22 of children's mental-health treatment as it relates 23 to the continuum of care. 24 By keeping the building open, we could allow 25 the continuation of some jobs for our current 1 employees. 2 I would like to have the Committees consider 3 the following: 4 OMH could expand day treatment and outpatient 5 clinic services using a percentage of the current 6 inpatient staff, such as, but not limited to, 7 registered nurses, therapy aides, teachers, 8 social workers, psychologists, psychiatrists, and 9 other support staff. 10 I would like to suggest the possibility of 11 developing a partial hospitalization program -- 12 It's been mentioned several times, but 13 I don't think anybody's actually spoke to it. 14 -- where some of the children would 15 routinely -- where -- wherein, some of the same 16 children that routinely require inpatient 17 hospitalization are treated for a period of time; 18 from days, to weeks, to months, and perhaps even up 19 to 12 hours daily. 20 Currently -- excuse me. 21 The day treatment program could be expanded 22 to provide this type of intervention. 23 Currently, not all children being served in 24 OMH inpatient units are classified as seriously 25 emotionally disturbed; however, once hospitalized, 1 these same children would meet the formal 2 classification. 3 Placing this percentage of the children who 4 might otherwise need further readmissions or 5 referral for residential services in a partial 6 hospital program would clearly reduce the need for 7 an inpatient program in our catchment area or 8 region. 9 A partial hospital program could potentially 10 reduce the number of children that would otherwise 11 require additional inpatient treatment, while 12 providing a pathway for some displaced inpatient 13 staff to continue their employment locally. 14 The reinvestment of monies saved by inpatient 15 unit closures into an expanded day treatment or 16 partial hospitalization program could result in 17 cost-savings, and meet the needs of our mostly rural 18 population. 19 The need for inpatient services can be 20 reduced in a potentially dramatic way via increased 21 alternative non-hospital programming. 22 At the same time, operating both a day 23 treatment program and a partial hospital program 24 located in the children's unit could also reduce the 25 negative impact of placing children far from their 1 homes as -- at the Mohawk Valley Psychiatric Center, 2 in the form of a reduction in admissions, as well as 3 shortened stays. 4 I believe that the Committees are aware of 5 the barriers inherent in moving our inpatient 6 services out of the North Country. 7 Again, I would like to restate that I do not 8 support the closure of the St. Lawrence Psychiatric 9 Center children and youth services inpatient unit or 10 the decommissioning of the building. 11 I want to thank the Committee for their time 12 and attention in this matter, and for allowing me to 13 share my thoughts. 14 [Applause.] 15 ASSEMBLYWOMAN GUNTHER: Thank you. 16 Name and title? 17 LAURIE ZWEIFEL, Ph.D.: Yes. 18 My name is Laurie Zweifel. I am a licensed 19 psychologist, and I work at the St. Lawrence 20 Psychiatric Center, children and youth services, 21 Ogdensburg outpatient clinic. 22 So we've heard from inpatient care, which is 23 our most restrictive; day treatment, which is in the 24 middle; and I will speak on the perspective of the 25 outpatient clinic, which is least restrictive. 1 Although I was not born in the North Country, 2 I have worked at SLPC children and youth services 3 for over 25 years. I have worked on the inpatient 4 unit. I worked in administration, but for the past 5 13 years, I have worked as a licensed psychologist 6 in the outpatient clinic. 7 During my educational and professional 8 career, I have had opportunities to work and 9 interact with other OMH children's inpatient 10 facilities in the New York City area, as well as 11 Central New York. 12 I started at SLPC with my master's, worked 13 for four years, and then returned to get my 14 doctorate in New York City, so, I was fortunate 15 enough to have those experiences, to have a 16 comparison of other state facilities to the 17 St. Lawrence Psychiatric Center. 18 I chose to return to the St. Lawrence 19 Psychiatric Center, and I based this decision, based 20 on the quality of treatment provided by highly 21 experienced and committed staff. These factors have 22 consistently led to positive clinical experiences 23 for the children and families of the North Country. 24 St. Lawrence Psychiatric Center has always 25 been, and continues to be, a center of excellence 1 with clearly demonstrated positive outcomes. 2 That being said, I strongly oppose the 3 RC plan of the Office of Mental Health that includes 4 the closing of the inpatient units at the 5 St. Lawrence Psychiatric Center. 6 I also strongly oppose decommissioning the 7 children and youth services building which houses 8 all of our programs. 9 So we would displaced even as outpatient 10 services and day treatment. 11 I'm going skip around just so I don't repeat. 12 Okay. 13 I would like to speak on behalf of the 14 RC plan from the outpatient perspective. 15 We currently operate three children and youth 16 services outpatient clinics in Massena, Gouverneur, 17 and Ogdensburg. We provide outpatient interventions 18 to 335 children and their families currently. Of 19 those, 173 are in Ogdensburg, 46 in Gouverneur, and 20 115 in Massena. 21 We could definitely provide more services in 22 our Gouverneur clinic, but we are down a 23 social worker, so -- and there's a quite an 24 extensive waiting list in that clinic. 25 So, we definitely could even provide more 1 outpatient services. 2 Our goal is to provide intensive, effective 3 outpatient psychiatric treatment to keep children 4 and adolescents out of the hospital; however, there 5 are times when our children cannot be safely treated 6 in the community and they require an acute inpatient 7 stay. 8 As Andrea had mentioned, in 2012, 9 293 children were admitted to the inpatient unit. 10 Of those, 145 were from St. Lawrence County. 11 Having access to care is extremely important 12 for our North Country families who have a high 13 poverty rate and limited transportation, as well as 14 significant stressors. 15 The reality also, is that the North Country 16 is a culture very different to Central New York. 17 I also grew up in Central New York, so I can 18 speak to that. I grew up near Utica. 19 In addition to our impoverished culture, we 20 also have Amish and Native American patients. 21 Cultural competence is extremely important to 22 quality mental-health care, and we have worked 23 diligently to establish connections and effective 24 interventions. 25 The continuity of care and communication 1 related to the best interests of our patients are 2 significant strengths between the inpatient and 3 outpatient units, and this cannot be understated. 4 We also have professional relationships, as 5 Andrea had spoken, with DSS, probation, and our 6 SPOA. 7 SPOA are our community-based services which 8 include the home- and community-based services 9 waiver, intensive case management, coordinated 10 children's service initiatives, and supportive case 11 management. 12 Again, I stress the need for cultural 13 competence in the North Country, not only for 14 demographic and census information, but for the 15 awareness of the paucity of community support 16 services available. 17 Discharge planning is an integral component 18 of mental-health services, and linking the child and 19 the family with available resources is crucial to 20 safety and recovery. 21 Currently, there are waiting lists for our 22 community support programs. 23 The most intensive program, the waiver 24 program, has 14 children waiting for services, with 25 a referral as old as December of 2012. 1 ICM has a waiting list of three, and, "CSI," 2 the Coordinated Children's Service Initiative, has a 3 waiting list of twenty, with a referral as far back 4 as February of 2013. 5 It is my strong opinion that OMH is putting 6 the cart before the horse, by wanting to close 7 inpatient units before expansion of the outpatient 8 services necessary to keep the children safe in our 9 community settings. 10 Our children and youth services outpatient 11 team consists of a child analyst and psychiatrist, a 12 community mental-health nurse, one licensed 13 social worker, and two licensed psychologists. 14 We have provided some recommendations for 15 expansion, not to replace, but in addition to the 16 services that are already provided inpatient and 17 outpatient. I'll kind of list them, but they are in 18 the packet, so I'm not going go over explaining 19 them. 20 Partial hospitalization; crisis respite; beds 21 to address children who do not need hospitalization, 22 but need a highly structured and supervised 23 time-limited setting; expansion of day treatment, 24 expansion of existing outpatient clinics to expand 25 to wellness centers; expand our clinics to include 1 pervasive developmental-disabilities spectrum 2 comorbidity, increase state-operated SPOA 3 case-management services, school-based wellness 4 mental-health clinics; and transportation to bring 5 children and families to treatment. 6 Finally, I am very concerned that the 7 OMH Regional Centers of Excellence Plan is moving 8 toward privatization of outpatient mental-health 9 services. 10 This is evidenced by membership of the 11 Central New York RCE team. 12 And I have provided a list of membership to 13 you. 14 Most of them are for private agencies. There 15 are some community-services director, but if you 16 notice, there are no members, zero, from SLPC. 17 And we provide extensive outpatient services, 18 and have a huge awareness of the needs, from our 19 perspective. 20 Yes, that is it. Uh-huh. 21 Many of us put our names in for -- to be 22 chosen for this RCE team. 23 Nobody from SLPC was selected. 24 You will see our executive director is on the 25 list, but he is not an active member. 1 It is a well-known fact that not-for-profit 2 and for-profit agencies have a lower pay scale and 3 fewer employee benefits than New York State 4 employees; however, along with these higher expenses 5 come high staff turnover and less-experienced staff. 6 The North Country has a very difficult time 7 recruiting professional staff, and we are designated 8 a national health-services-core underserved area. 9 A plan to privatize expansion of outpatient 10 mental-health services will, in my opinion, result 11 in even less services and less than desirable 12 treatment. 13 In sum, I would like, again, to thank you for 14 your understanding the importance of the 15 St. Lawrence Psychiatric Center inpatient, 16 outpatient, services that we provide in the 17 North Country. 18 We are a center of excellence, but we need a 19 formal designation in order to continue to provide 20 access to quality care that positively impacts the 21 children and their families. 22 Thank you. 23 [Applause.] 24 DR. ELIZABETH BURNS: Hello, I'm 25 Dr. Elizabeth Burns. I also work at the 1 St. Lawrence Psychiatric Center children and youth 2 services, in the inpatient unit. 3 I'm going to be giving testimony in 4 opposition to the closure of the St. Lawrence 5 Psychiatric Center, like most of the people here. 6 Before I give testimony, though, I would like 7 to address some of the things the first presenters 8 brought up regarding residential treatment 9 facilities. 10 It seemed like, from their testimony, they're 11 saying, and I could be perceiving their testimony 12 differently than others, but, that RTFs could 13 replace inpatient services. 14 And I think there's some confusion on how you 15 go about getting placed in an RTF. 16 To get to an RTF level of care, you have to 17 go through an extensive referral process. You can't 18 go to the emergency room, and then go to an RTF. 19 You have to get approval from two different 20 committees. 21 The referral packet requires a psychological 22 evaluation done in the first year -- or, in the last 23 year, a psychiatric evaluation, a recreational 24 therapy evaluation, an educational evaluation, and a 25 summary of background information. 1 So, if all the stars align and your committee 2 meetings fall in the right way, you can get your 3 referral packet in, in two months. 4 Most of the time it's three months. 5 And, then, you may not get approved. Your 6 child may not get approved. 7 To get approval, you have to have an 8 IQ over 70. 9 To get approval for an RTF, you cannot have a 10 developmental disability or get services through 11 OPWDD. 12 If your child has autism and is depressed, 13 you don't qualify for an RTF. You're just not going 14 get a placement. 15 So, two or three months, you may or may not 16 get approval. 17 If you do get the approval, you're not going 18 get a bed right away. 19 You're kind of lucky, if you apply for a 20 child in the summertime, because, usually, they 21 discharge people around the end of the school year. 22 But if you're applying at any other time of 23 the year, you're probably looking, what would you 24 say, Andrea, six months maybe, if you're lucky? 25 ANDREA RANDLE: Average, usually. 1 It's a longer wait time for girls than boys. 2 DR. ELIZABETH BURNS: Oh, definitely. 3 So, that's the RTF process. It's not going 4 to replace inpatient services. 5 And to get approval, also, one of the 6 criteria is frequent hospitalizations. You got to 7 prove that they couldn't make it in the community 8 anywhere else. 9 So if there's no inpatient services, there's 10 going to be longer waits for RTF, but, also, they're 11 not going the meet the criteria for an RTF. 12 It doesn't really make sense. 13 They talk about working with the managed 14 care -- Medicaid-managed care. 15 You know, that has started, we've been 16 working with managed care since January of 2012, 17 with Medicaid. 18 Our hospital, at least children and youth 19 services, because I can only speak from them, is, 20 I think we've had one disagreement the whole time 21 since that started. 22 They've approved all of our lengths of stay, 23 because, like Andrea said, we have one of the lowest 24 in the state. 25 So we've been working with that system very 1 well. 2 The St. Lawrence Psychiatric Center serves 3 approximately 2,000 people, both inpatient and 4 outpatient, adult and children, and I think that 5 we've been doing it rather well. 6 So, that wasn't in my packet, or, in my 7 testimony, but I just wanted to clarify that. 8 ASSEMBLYWOMAN GUNTHER: I'm glad you did. 9 DR. ELIZABETH BURNS: My testimony, like 10 I said, is in opposition to the closure of 11 St. Lawrence Psychiatric Center. 12 I'm going to try not the repeat my 13 colleagues, so, there will be parts of the written 14 testimony that I don't talk about. 15 So the closure of St. Lawrence Psychiatric 16 Center will greatly affect the rural mental-health 17 services in a large portion of the state. 18 It's notable, that outside of the small 19 cities and villages, there are a lot of open fields, 20 farms, and distance between local communities. 21 The unique needs of the rural mental health 22 has been considered, researched, and advocated by 23 the federal government. 24 I'm asking that our state government do the 25 same. 1 The U.S. Department of Health and Human 2 Services has an Office of Rural Health Policy. 3 Their website states: 4 "That the Office of Rural Health Policy has a 5 department-wide responsibility for analyzing the 6 possible effects of policy on 62 million residents 7 of rural communities. 8 "Created by Section 711 of Social Security 9 Act, this office advises the Secretary of health 10 issues within the communities, including the effects 11 of Medicare and Medicaid on rural citizens' access 12 to care, the viability of rural hospitals, and the 13 availability of physicians and other health 14 professionals. 15 "This office analyzes the effect of current 16 policies and proposed statutory, regulatory, 17 administrative, and budgetary changes on rural 18 communities." 19 This website further states: 20 "That it administers three grant programs 21 with Hospital State Division. 22 "The grant programs are Medicare Rural 23 Hospital Flexibility Plan, Small Rural Hospital 24 Improvement Program, and the State Office of Rural 25 Health Grant Program." 1 The reason why I bring this up, is to point 2 out that the U.S., as whole, is acknowledging that, 3 rural health, there are different issues in rural 4 health versus cities that need to be taken into 5 consideration. 6 And if the federal government's doing it, I'm 7 asking that the state government do it as well, as 8 to consider the needs -- the unique needs of living 9 in a rural area, and needing health services, 10 mental health included, in those areas. 11 Unlike other areas of the state, there's more 12 than 100 miles in between state hospitals in 13 northern New York. It is more than a two-hour drive 14 between the St. Lawrence Psychiatric Center and 15 Hutchings or Mohawk Valley. 16 This is a long drive for people in 17 Ogdensburg, but, if you look at the maps people have 18 been talking about, the maps included with my 19 testimony as well, you'll see that many people that 20 come to the St. Lawrence Psychiatric Center come 21 from far north. 22 We're talking, you know, Plattsburgh, there 23 is CVPH, but, usually, the people who go to CVPH 24 stay for seven days, and then they're looking at 25 another state hospital to try to transfer to. They 1 don't stay there long. 2 And even though we're acute care too, a lot 3 of times they send them to us. 4 So, just because there's a private hospital 5 doesn't mean that that -- the needs of the local 6 residents are going to be served. 7 So, any change with the closure of the 8 St. Lawrence Psychiatric Center, you could see some 9 of the people that would come there, when the 10 closure happens, could have to drive up to 11 four hours away, one way, to get services. 12 That isn't as -- acceptable. 13 There's going to be no support, and I don't 14 see how that will facilitate OMH's view or vision 15 for recovery, described by the Regional Centers of 16 Excellence. 17 The Office of Mental Health's testimony 18 submitted on September 9, 2013, stated that, 19 "First and foremost, the redesign of the public 20 mental-health system must be good for children, 21 adults, and families we serve. 22 "OMH knows to how to promote resiliency in 23 young people with serious emotional disturbance, and 24 how to promote recovery from a serious mental 25 illness for adults." 1 How does a four-hour drive, in good weather, 2 separating people we serve from their families help 3 people recover? 4 And I say "in good weather" because, some of 5 the residents, people we serve, that come to the 6 St. Lawrence Psychiatric Center, yes, they have to 7 go through the Tug Hill Plateau, but, also, some of 8 them are coming from the mountains. 9 I don't know if you guys have driven in the 10 mountains in the middle of winter, but it's not 11 safe. 12 Okay. 13 I was going to talk about the problems with 14 transportation, but a lot of people have talked 15 about that already. 16 And the importance of, you know, people are 17 going to have to take off days of work, and need 18 child care, because they can't always bring every 19 child. 20 But, that's been talked about quite a bit, 21 so, I'll skip over that part of my testimony. 22 Okay. 23 The obvious problems with -- you know, 24 difficulty getting family involvement; the problems 25 with not having technology necessarily, or the 1 access to technology, to stay in touch in that way, 2 will result in extra stress on the people who are 3 recovering. 4 And that extra stress could be devastating to 5 the kids and the adults that are hospitalized, but, 6 also, lead to longer hospital stays, which is not 7 budget-conscious, which I know is -- a big part of 8 this plan is to, you know, reduce the costs to the 9 state. And this will just end up with longer 10 hospital stays. 11 I'm never going to advocate against 12 increasing community services. 13 I think, you know, we would greatly benefit 14 from more funding for outpatient community services, 15 but I think we would be debilitated by the closure 16 of a St. Lawrence Psychiatric Center. 17 Since the closure has been announced, I've 18 heard some parents say, that if their child was 19 rehospitalized, they wouldn't know what they would 20 do if they had to go to Utica. 21 I've also heard other community members say, 22 that if their child had a mental-health problem and 23 the St. Lawrence Psychiatric Center was closed, that 24 they would bring their child -- they wouldn't bring 25 their child to the emergency room to be screened; 1 that they would try to monitor them in their own 2 home. 3 And if that's the belief of the community 4 members in this area, you know, our community is in 5 danger. 6 All I ask, is that you please reconsider the 7 closure of the St. Lawrence Psychiatric Center 8 inpatient services. 9 If the proposed plan for the Regional Centers 10 of Excellence progresses, the Central New York 11 region will be the largest geographical region in 12 the state. 13 This large geographical area will support the 14 need for two hospitals. 15 Whether our hospital is called a "Regional 16 Center of Excellence," or a "satellite hospital," 17 the name doesn't matter; the services do. 18 So thank you for your consideration. 19 [Applause.] 20 ASSEMBLYWOMAN GUNTHER: Thank you. 21 TERRI LANGENMAYER: Hi, my name is 22 Terri Langenmayer. 23 [Pause in the proceeding as speaker 24 approaches the microphone.] 25 TERRI LANGENMAYER: Welcome. 1 ASSEMBLYWOMAN GUNTHER: Name, title? 2 TERRI LANGENMAYER: My name is 3 Terri Langenmayer. I'm a rehab assistant too. 4 I work in family care. 5 I'm also a nurse at Claxton-Hepburn's 6 mental-health clinics, mental-health unit, also. 7 I've worked in the mental-health field in the 8 North Country for 33 years. I've seen many changes 9 which St. Lawrence Psychiatric Center has embraced 10 and worked diligently with to provide optimum 11 services to the mental-health population here in the 12 North Country. 13 St. Lawrence has been a big part of living 14 here in the North Country for everyone. 15 Changing this is going to make it harder for 16 people who live here. 17 Reducing the mental-health services to a poor 18 area is a harsh decision by the State. 19 Mental illness is a lifelong condition only 20 managed, not cured, so, in a sense, it is a terminal 21 illness. 22 Are we closing cancer treatment centers in 23 the state? No, we're building new ones, so that 24 people with cancer can remain close to their 25 families and supports to help them through this 1 illness. 2 People with mental illnesses should be given 3 the same opportunity. 4 Letting St. Lawrence remain open will allow 5 our family members, neighbors, friends, and children 6 to remain close to home while receiving the 7 treatment that they need to remain as mentally and 8 physically healthy as they possibly can, with the 9 family supports that they will need to manage their 10 conditions. 11 Last thing that I would like to say, is that 12 when St. Lawrence has had mandatory inspections, the 13 facility has excelled in every aspect of care. 14 It is already a center of excellence. 15 Why should our families have to travel 16 hundreds of miles to receive the services that are 17 available here now? 18 Why should the families have to share the 19 unfair burden of the distance so that they can 20 remain in contact with those that are suffering? 21 Give us a chance here in the North Country to 22 show New York State that St. Lawrence is still doing 23 a great job, and will continue to embrace the 24 Upstate New York population of people suffering with 25 mental illness. 1 Thank you for your time. 2 [Applause.] 3 ASSEMBLYWOMAN GUNTHER: Thank you. 4 TERRI LANGENMAYER: I was wondering if 5 I could have a friend of mine speak? 6 He needs to return. And I was wondering if a 7 friend of mine could speak very briefly? 8 He's on the speaking docket. 9 Is that okay? 10 Would that be okay? 11 ASSEMBLYWOMAN GUNTHER: I'm just trying to 12 see. 13 TERRI LANGENMAYER: His name is 14 Mike Spellman. 15 UNKNOWN FEMALE SPEAKER: Yes, we have him 16 next. 17 TERRI LANGENMAYER: Michael, can you come up? 18 ASSEMBLYWOMAN GUNTHER: Can I ask a question? 19 TERRI LANGENMAYER: Thank you. 20 ASSEMBLYWOMAN GUNTHER: Tim Farrell, who is 21 he? 22 ANDREA RANDLE: He is our -- 23 MICHAEL LUMLEY: He's the current -- 24 ANDREA RANDLE: -- executive director -- or, 25 acting director? 1 MICHAEL LUMLEY: Acting director. 2 ANDREA RANDLE: But, the ones on the bottom 3 aren't really members. They're ex -- what are they? 4 ASSEMBLYWOMAN GUNTHER: Ex officios. 5 MICHAEL LUMLEY: Ex officios. 6 ANDREA RANDLE: Yes. 7 ASSEMBLYWOMAN GUNTHER: Can you tell us your 8 name? 9 MICHAEL SPELLMAN: My name is 10 Michael Spellman. 11 I would like the thank the Senators and the 12 members of the Assembly for attending this meeting. 13 I would like to thank everybody for giving me 14 this opportunity to present myself as a current 15 "SLPC," St. Lawrence Psychiatric Center, patient. 16 I shall be discharged tomorrow. 17 First of all, I would like to start off with 18 saying that my name is Michael Spellman. 19 I've been coming to St. Lawrence Psychiatric 20 Center since November of 1981. 21 When I first arrived there, I weighed 22 147 pounds. 23 Due to proper nutrition, good therapy, and 24 awareness of my substance-abuse problem, I now weigh 25 175 pounds. 1 Since 1981, I've been mostly 2 substance-abuse-free, thanks to St. Lawrence 3 Psychiatric Center. 4 And St. Lawrence Psychiatric Center has 5 helped me gain employment. It's allowed me to stay 6 [unintelligible], where I have a good standing in 7 the community. 8 I belong to three clubs: 9 Step By Step, Incorporated; Seaway House; and 10 Amvets. 11 As a disabled American veteran, I'm proud to 12 say that, thanks to St. Lawrence Psychiatric Center, 13 and the community allowing me [unintelligible], 14 I feel much more appreciated as a veteran than when 15 I did -- that when I felt in my hometown of 16 Plattsburgh, New York. 17 Not only am I a member of 18 Step By Step, Incorporated, I also serve as 19 president of the board of directors. 20 I believe that my positive experience at 21 St. Lawrence Psychiatric Center, and the connection 22 with Step By Step, has given me the opportunity to 23 be able to give back to this community and 24 St. Lawrence Psychiatric Center by serving as 25 president of the board. 1 I was a volunteer driver for St. Lawrence 2 Alcohol and Substance Abuse Treatment Center in the 3 past. 4 I also volunteered, for many years, at Amvets 5 and Seaway House. 6 I enjoy being a member of this community, and 7 being able to give back to this community that has 8 helped me with my recovery. 9 I feel it would be beneficial for myself and 10 peers and the staff at St. Lawrence Psychiatric 11 Center for the State of New York to keep 12 St. Lawrence Psychiatric Center open. 13 We live in a rural area, and our families are 14 in the same area. 15 If we need a hospitalization and we are in 16 Syracuse, our families may not be able to visit us 17 due to weather, money, and time reasons. 18 The harsh reality is, the streets of 19 Ogdensburg are much safer than the streets of 20 Syracuse, and much more affordable for us to be 21 discharged or live in. 22 I would never survive on South Salina Street 23 in Syracuse. Never. It's a crime area. 24 With any income, that's all I would be able 25 to afford. With my illness, my income, and my age, 1 I would not survive in such an environment. 2 When we get discharged from St. Lawrence 3 Psychiatric Center, we need someone to talk to at 4 the outpatient clinic, the Ogdensburg mental-health 5 clinic. 6 We have therapists, doctors, we've always 7 worked with, and are familiar with. 8 I am worried that if I was to travel to 9 Syracuse and [unintelligible] there, would I be able 10 to get these services? 11 Is there a wait list in such a big area? 12 Would I be able to get a ride back to 13 Ogdensburg, or would I be discharged to the streets 14 of Syracuse? 15 This things concern me -- excuse me -- and my 16 fellow patients. 17 Also, the closing down of the St. Lawrence 18 Psychiatric Center won't just hurt 19 St. Lawrence County, but also the six counties being 20 served by St. Lawrence Psychiatric Center. This is 21 gonna cost people their jobs in all six counties 22 that St. Lawrence Psychiatric Center covers. 23 I, Michael [unintelligible] Spellman feel the 24 obligation [unintelligible] to take a look at what 25 St. Lawrence Psychiatric Center stands for. 1 Not only is it just the only hospital north 2 of Syracuse, it is rated as one of the best in 3 New York State. 4 Close down St. Lawrence Psychiatric Center 5 [unintelligible] on both inpatient and outpatient 6 clinics -- clients, excuse me, outpatient clients, 7 patients, or consumers that St. Lawrence Psychiatric 8 Center serves. 9 I may not have a college degree, or hold a 10 political office, but I have some thoughts, and many 11 years of experience, to which I can help make 12 St. Lawrence Psychiatric Center a little less costly 13 to operate: 14 Having a small self-sufficient farm, 15 employing 10 to 25 people. 16 It doesn't take a rocket scientist to figure 17 out, all you need to start out with is a physical 18 examination, and continue the physical examination. 19 You know, check for diabetes, blood pressure, things 20 like that. 21 And get people from inpatient and outpatient 22 to work on the farm. It would help the hospital be 23 self-sufficient, and -- like it was in the old days, 24 and it would give people self-worth and a feeling of 25 accomplishment. 1 It would employ patients and work and -- 2 employ patient-workers and staff alike, and also cut 3 down on the food costs at the hospital. 4 So you [unintelligible] groups and classes, 5 but you could also teach people that work is 6 therapeutic. 7 I know for myself that work therapy is the 8 best therapy for me. 9 Because of these basic and simple ideas, 10 I feel my voice, and the voice of other patients, 11 should be heard. 12 Also, St. Lawrence Psychiatric Center staff 13 has shown me better care than short-term and 14 long-term facilities I have been in across 15 New York State; therefore, I feel that it's 16 ridiculous and outrageous to shut down St. Lawrence 17 Psychiatric Center and the children and youth. 18 Thank you. 19 [Applause.] 20 ASSEMBLYWOMAN GUNTHER: Thank you. 21 I think you're pretty much of a rocket 22 scientist when you say about the therapeutic 23 community. 24 I represent a place called "The Center for 25 Discovery," and they did just what you said for 1 people with disabilities. 2 So -- and it's really been wonderful. They 3 work on the farm. They -- actually, nine months out 4 of the year. 5 And they have 1400 employees, they have 6 people that are in day program for DD, and it 7 really, really works. 8 So that's number two. 9 And I want you to tell me a little bit about 10 that Step By Step, Michael. 11 MICHAEL SPELLMAN: Step By Step, on a daily 12 basis, has 50 to 60 members attending. 13 It is my thought that you could -- not all of 14 them are able or capable of working, whether it be 15 physical or mental, but, yet, it is a club that 16 keeps people off the streets. 17 I started out as, you know, the first visitor 18 there. It's expanded. 19 The troublemakers have been weeded out. 20 Street people, and things like that, have been 21 weeded out. The people that are just there to take 22 advantage of the members, has been weeded out. 23 It's a sad thing you have to do that, but, at 24 one time, it had 70 to 80 people, and 25 to 30 that 25 were causing a lot of problems. 1 ASSEMBLYWOMAN GUNTHER: Are you a veteran, 2 Michael? 3 MICHAEL SPELLMAN: Yes, I am a veteran. 4 ASSEMBLYWOMAN GUNTHER: You served in, what? 5 MICHAEL SPELLMAN: I served in the 6 United States Army. 7 ASSEMBLYWOMAN GUNTHER: Well, thank you. 8 [Applause.] 9 ASSEMBLYWOMAN GUNTHER: Well, thank you for 10 your testimony. 11 MICHAEL SPELLMAN: You're welcome. 12 SENATOR CARLUCCI: And, Michael, just one 13 question. 14 You talked about, that you're going to be 15 discharged tomorrow? 16 MICHAEL SPELLMAN: Yes. 17 SENATOR CARLUCCI: Can you just -- how long 18 have you been at -- 19 MICHAEL SPELLMAN: Tomorrow will be 20 three weeks. 21 SENATOR CARLUCCI: Okay. 22 MICHAEL SPELLMAN: It's no longer long-term 23 stay. They get people out pretty quick. 24 Not unless they're criminals and they -- you 25 know, the choice is either a correctional facility 1 or inpatient in the psychiatric center; so, those 2 would be staying. 3 I feel St. Lawrence Psychiatric Center can 4 provide much better care to what Hutchings or Utica 5 can. 6 As I said, I've been, you know, in different 7 short-term and long-term facilities across 8 New York State, and I feel that St. Lawrence 9 Psychiatric Center is one of the best, if not the 10 best, in New York State, as far as an inpatient 11 facility. 12 ASSEMBLYWOMAN RUSSELL: Mr. Spellman, can 13 you also explain to us what the Seaway House is? 14 MICHAEL SPELLMAN: Seaway House is a club, 15 also, for people to attend. It's sponsored by 16 Catholic charities, funded by Catholic charities. 17 However, what scares me is the dominoes 18 effect. If they close down the St. Lawrence 19 Psychiatric Center, what's next? The Ogdensburg 20 mental-health clinic? Step By Step? 21 Dominoes, what else are they going to close? 22 The Governor is not here. I wish the 23 Governor was here, really -- 24 LAURIE ZWEIFEL, Ph.D.: So do we. 25 MICHAEL SPELLMAN: -- but, he could not make 1 it. 2 ASSEMBLYWOMAN RUSSELL: And, so, you said 3 that you don't stay for a long period anymore when 4 you have to go inpatient. It's shorter lengths of 5 stay. 6 MICHAEL SPELLMAN: Yes. 7 ASSEMBLYWOMAN RUSSELL: So, I guess, where do 8 you -- where are you discharged to after these short 9 lengths of stay? 10 MICHAEL SPELLMAN: I'm discharged usually to 11 my own apartment. 12 They still have family-care homes, they still 13 have community residents. 14 ASSEMBLYWOMAN RUSSELL: Okay. 15 MICHAEL SPELLMAN: Now, without St. Lawrence 16 Psychiatric Center being open, there would be no 17 social workers in Plattsburgh, Clinton County. 18 There would be no social workers in Malone, 19 Franklin County, or Essex County, or Jefferson 20 County. 21 ASSEMBLYWOMAN RUSSELL: Because they're all 22 tied to this clinic? 23 MICHAEL SPELLMAN: They're all tied to 24 St. Lawrence Psychiatric Center, yes. 25 ASSEMBLYWOMAN RUSSELL: So all those 1 outpatient clinics, you're concerned, will be turned 2 upside down? 3 MICHAEL SPELLMAN: Yes. 4 And there's just not -- you know, if that's 5 the plans, close down St. Lawrence Psychiatric 6 Center, which I don't agree with, like I say, why 7 not turn it into a small self-sufficient farm, like 8 this lady spoke of to you. 9 ASSEMBLYWOMAN RUSSELL: So, you choose to 10 live here, even though you're from -- originally 11 from a different community? 12 MICHAEL SPELLMAN: I'm from Plattsburgh, but 13 I choose to live here. 14 I mean, let's face it, have you ever watched 15 "Channel 7," you know, the news in Syracuse? 16 ASSEMBLYWOMAN RUSSELL: Yeah. 17 MICHAEL SPELLMAN: What goes on there, 18 compared to the streets of Ogdensburg? 19 [Laughter.] 20 [Applause.] 21 ASSEMBLYWOMAN RUSSELL: Well, I guess, one of 22 the things that we've -- you know, that is 23 concerning is, you know, should length of stays be 24 longer? should they be shorter? 25 You know, I guess, if you don't mind 1 sharing -- 2 MICHAEL SPELLMAN: They no longer, as a rule, 3 want you there for a long-term stay anymore. 4 ASSEMBLYWOMAN RUSSELL: But occasionally -- 5 MICHAEL SPELLMAN: Occasionally, in this -- 6 at one time in my life, you know, I was a very sick 7 young man, a very emotionally-disturbed young man, 8 and it was necessary to keep me four to 9 eight months. It was very necessary for me to stay 10 there for four to eight months in my first 11 two admissions. 12 ASSEMBLYWOMAN RUSSELL: But typically, now, 13 you're able to stay in the community that you have 14 chosen -- 15 MICHAEL SPELLMAN: Yes. 16 ASSEMBLYWOMAN RUSSELL: -- for longer periods 17 of time, with just an occasional short readmission 18 as an inpatient? 19 MICHAEL SPELLMAN: Yes, that's correct. 20 ASSEMBLYWOMAN RUSSELL: Okay. 21 ASSEMBLYWOMAN GUNTHER: It's like going to a 22 chiropractor. When your back gets out, at the 23 beginning, you go for a longer period of time. And 24 once in a while, you have to go back for 25 readjustment. 1 MICHAEL SPELLMAN: Yes. 2 I have arthritis, so... 3 [Laughter.] 4 MICHAEL SPELLMAN: There's no cure for that. 5 ASSEMBLYWOMAN RUSSELL: Thank you, 6 Mr. Spellman. 7 SENATOR CARLUCCI: Senator Ritchie. 8 SENATOR RITCHIE: I have a question for Mike. 9 MICHAEL LUMLEY: Yes, Senator. 10 SENATOR RITCHIE: We were told earlier this 11 morning, that one of the reasons that it would be 12 better for those that were at this center to go to 13 the new centers, is because of education. 14 And I know yesterday, when I was there, Ginny 15 showed me the classroom, and talked about it; and 16 you were talking about it. 17 For the record, can you make sure that 18 everyone knows what kind of educational 19 opportunities are there for those who are receiving 20 inpatient treatment? 21 MICHAEL LUMLEY: Well, I haven't done 22 inpatient treatment for the past 12 years, but I can 23 tell you some specifics -- 24 LAURIE ZWEIFEL, Ph.D.: I think Ginny is 25 going to speak to that as well. 1 MICHAEL LUMLEY: Yeah. 2 -- basically, the inpatient program provides 3 educational services for all the children that are 4 hospitalized. 5 Okay? 6 The program starts at 8:30 in the morning, 7 breaks for lunch at about 11:55. 8 Okay? 9 Restarts programming at, I believe, 1:30, and 10 then goes to about 2:30. 11 So, there's about five hours of services, 12 that -- and, again, there's a lot of communication 13 between the inpatient education supervisor and 14 all -- any district that a child comes from within 15 the six-county catchment area. 16 There's usually a telephone call between the 17 education supervisor and a member of the home 18 schools, either administration or clinical staff. 19 A school counselor, for example. 20 Okay? 21 So there's always that kind of process 22 occurring, as well as discharge. Knowing -- 23 identifying, through testing, and through daily 24 participation in the program, being able to 25 identify, "What does this child need upon 1 discharge?" and making sure that those needs are 2 going to be followed up upon. 3 And that requires more communication, more 4 telephone calls, et cetera, at the time of 5 discharge. 6 SENATOR RITCHIE: Well, I think it was 7 implied earlier this morning that maybe that wasn't 8 going on, and that maybe -- 9 MICHAEL LUMLEY: I got that -- 10 SENATOR RITCHIE: -- that was one of the 11 reason that this plan -- 12 MICHAEL LUMLEY: -- that was one of the -- 13 one of the many times that I wanted to actually jump 14 up. 15 The other thing is, the reality -- let me 16 tell you what I believe is the reality there. 17 What you were -- who you were talking to is a 18 non- -- not-for-profit organization, okay, in 19 Jefferson County, which has swept in and picked some 20 of the remains of things, like, the Department of 21 Social Services in St. Lawrence County. 22 Okay? 23 And what you get when you get a private 24 provider, at times, and it's not true all the time, 25 is you get the kind of services that are defined as 1 appropriate, but you get them done by people who 2 don't know the business. 3 Okay? 4 So, you got the children -- some of 5 Jefferson County basically trying to spread out and 6 develop more tentacles, more services, at the same 7 time, not representing what's available, because I'm 8 not sure that they -- and nobody from the children's 9 home has ever talked to me about day treatment 10 services. 11 I don't believe they've talked to my 12 colleague in the Jeff Lewis [ph.], our sister 13 program, in -- in, uhm -- oh, what's the school? 14 DR. ELIZABETH BURNS: Indian River. 15 MICHAEL LUMLEY: -- Indian River. 16 It's, like -- I'm sorry, but that doesn't 17 work. 18 That doesn't work for me anyways. 19 SENATOR RITCHIE: I just have one question 20 for Andrea. 21 Could you just explain, you're talking about 22 the families that come in to those that you're 23 taking care of. 24 Can you just elaborate on how many times the 25 family comes in, or, how important it is, and what 1 would happen if -- you know, I understand that we 2 need to cut costs, but, if you have a child in there 3 and it's going to be a Skype visit versus a parent 4 giving their child a hug, those are two really 5 different things. 6 So, could you just kind of elaborate on? 7 ANDREA RANDLE: Sure. 8 Can everybody hear me? 9 Is it okay if I sit here? 10 ASSEMBLYWOMAN GUNTHER: No, we can't. 11 If you can just stand up. 12 MICHAEL LUMLEY: I will trade with her now. 13 ANDREA RANDLE: You know, to give you an 14 example: Yesterday, for about two hours, I listened 15 to a 6-year-old wail for his blankie. Literally, 16 just wailed, "I want my blankie," for about 17 two hours. 18 You know, we tried every other blanket we 19 had. I ran out and got a stuffed animal. 20 It didn't work. He wanted his blankie. 21 And, you know, those of us with children 22 understand, sometimes they have real attachments to 23 their blankies. 24 So, this was a very emotionally-disturbed 25 6-year-old who wanted his blankie. 1 The parent was able to come in last night. 2 If we were in Utica, I don't know that that 3 6-year-old would have his blankie in any kind of 4 timely fashion. 5 It was heartbreaking to listen to him 6 yesterday. It was absolutely heartbreaking. 7 That's gonna happen more and more and more, 8 because people aren't going to be able to get to 9 their children. 10 We would ask parents to come in daily to 11 visit their children, and a lot of them do that can. 12 Some of them have to space it out more. 13 And as a social worker, and Liz is my 14 co-worker here, a psychologist, families will work 15 with us in terms of, "I can't afford to come every 16 day, so I'm going to try to do every two days." 17 You know, if we have a team meeting, or 18 something, we'll invite them in. "So don't come 19 Tuesday, save your gas money. Come Thursday, 'cause 20 we're gonna meet." 21 But we would welcome families daily if they 22 can get there. Certainly, most families would want 23 to come. 24 The younger the child, the more often, 25 parents, I think, want to come. 1 It's a little different with teenagers. You 2 may be able to go a few more days without seeing 3 your teenager, versus young children. 4 But like I said, there were 90 children under 5 the age of 12 admitted in 2012. That's a lot of 6 kids that are really young. 7 SENATOR RITCHIE: So can you tell me, in your 8 you know, estimation, what would a Skype visit 9 versus a personal visit, what difference would that 10 make to the child? 11 ANDREA RANDLE: I think it would be useless, 12 really, to do Skype. 13 I guess if I was really desperate, I would do 14 it. 15 I do a lot of telephone family sessions with 16 families that can't come, that can't come to the 17 center. 18 I find it to be an exercise in futility. 19 You know, you can't see the people. You 20 can't read the non-verbal cues. 21 The parent doesn't see what's happening with 22 their child during the communication. 23 We do what we have to do, because, you know, 24 I'm a social worker, I'll do just about anything to, 25 improve the lives of the people I work with, but, 1 face-to-face contact, there's no -- there's no 2 question that that is the best practice, in terms of 3 family sessions, in terms of just sheer support. 4 Doctors talking with their patients about 5 medications often want to see the parent. They want 6 to be able to explain to the parent fully about the 7 medications. It's so much harder to do that over 8 the phone. 9 I don't think that's a good solution to use 10 Internet at all, as a way to -- 11 SENATOR RITCHIE: And for me, I think it 12 would just be a teaser. 13 If you have a child there, and you get to see 14 the parent, but you don't get to touch them, I think 15 it would actually make it worse. 16 ANDREA RANDLE: Yeah. 17 ASSEMBLYWOMAN GUNTHER: Senator Little. 18 SENATOR LITTLE: Yeah, if I could. 19 You're the ones that are working with the 20 children and adults in the field, and I just wonder, 21 we talk about levels of service that are necessary, 22 and there's outpatient and day treatment, and all, 23 but that residential level of service is sometimes 24 really necessary. 25 Looking at the people you deal with, how many 1 do you think, or do you think some of them would 2 say, going to Utica, going to Syracuse, going to -- 3 for Plattsburgh, Rouses Point, going to the 4 Capitol District, how many would say, they would 5 just take the child, or the adult would just go 6 home, and not have services? 7 ANDREA RANDLE: I think a substantial number 8 would do that. 9 And I think, you know, as a kind of a 10 tentacle effect, so to speak, of that happening, I'm 11 concerned more about what's going to happen with 12 child protective services. 13 You may have parents in an emergency room 14 situation say, I will not allow my child to go to 15 Utica. I can't get there, it's too far. 16 And if that child requires inpatient care, 17 you're going to wind up hotlining parents, 18 basically, for medical neglect, because you're not 19 allowing the child to get the treatment they need, 20 but the parent sometimes is put in that position 21 where they really can't get long distances. 22 LAURIE ZWEIFEL, Ph.D.: And that has 23 happened. 24 I've had outpatients who, they've been deemed 25 in need of inpatient care and had to go to CVPH. 1 And, parents weren't able to go, and they were 2 hotlined. 3 ASSEMBLYWOMAN RUSSELL: Because they didn't 4 participate in the outpatient treatment? 5 MICHAEL LUMLEY: No, because they -- they 6 refused. Or, they refused to come to sign -- to do 7 the family work while the child was inpatient at 8 CVPH. They hotlined them for medical neglect. 9 ASSEMBLYWOMAN RUSSELL: Did they refuse, or 10 they couldn't come -- 11 LAURIE ZWEIFEL, Ph.D.: They -- well, they -- 12 they refused, because they could not, due to 13 transportation or other family factors. 14 ASSEMBLYWOMAN GUNTHER: I have one more 15 question. 16 SENATOR LITTLE: I said, or the fear would 17 be, that they go home, and the parent is really not 18 capable of dealing with them -- 19 LAURIE ZWEIFEL, Ph.D.: Right. 20 SENATOR LITTLE: -- and all kinds of things 21 happen. 22 LAURIE ZWEIFEL, Ph.D.: Right. 23 SENATOR LITTLE: CVPH is not here, but I did 24 talk to Stevens Monday, yesterday, and they had a 25 patient, that the parents brought a young adult who 1 was having really severe disturbance -- I don't know 2 all the technical terms -- and was quite violent. 3 And it was beyond their level of service. 4 So either these hospitals would have to 5 increase their level of service, take that chance 6 that they won't send them down to Albany, Syracuse, 7 Utica -- 8 [Technical difficulties.] 9 SENATOR LITTLE: -- or, you know, not having 10 St. Lawrence Psychiatric. 11 But what happened there, is they had to keep 12 that child in their unit, which they weren't capable 13 of really dealing with them. 14 There were 12 staff people injured in the 15 time that he was in that unit, before they could get 16 him over here to St. Lawrence Psychiatric. 17 And if they went to -- if you consider 18 Plattsburgh, or even Rouses Point, I mean, from 19 Plattsburgh to Albany, it's got to be 160-some 20 miles, and -- 21 UNKNOWN FEMALE SPEAKER: Albany has no 22 children's unit. 23 It would be Utica. 24 SENATOR LITTLE: All right, so they'd be 25 coming to you, it's even further. 1 He said it's going to have a terrible impact 2 on CVPH to have St. Lawrence Psychiatric closed. 3 MICHAEL LUMLEY: And the other thing is, you 4 the don't know what the magical number is. 5 Let's say that happens five times in a year, 6 and nothing bad occurs. Well, maybe it's going to 7 happen the second time, or the twenty-third time. 8 You know, we don't have those numbers, but 9 the reality is, that any decision made at the time 10 that a child is in crisis has effects on every other 11 decision made 2 days later, or 10 days later. 12 So, if a parent doesn't want to take that 13 child all the way to Mohawk Valley, let's say that 14 it works, say it worked out five times, then, 15 unfortunately, I think some of the bean-counters 16 take that. 17 Okay? 18 But the next situation may be a Sandy Hook 19 situation. 20 SENATOR LITTLE: Could be. Absolutely. 21 DR. ELIZABETH BURNS: And, you know, to add 22 to what people are saying, sometimes, when a child 23 or an adult goes in for a screening, they're not 24 necessarily admitted. 25 So, the family is driving to Utica for a 1 screening, they get turned away, the child goes into 2 further distress, does need hospitalization. 3 Will that family be able to take off, you 4 know, another day of work to bring their child down? 5 And also, the Skypeing? They're going to 6 have to change our policy, because we're not even 7 allowed to send an e-mail to parents, okay, because 8 of confidentiality. 9 So how are we going to Skype? Is that more 10 secure than e-mail? 11 I don't know. 12 It just seems -- 13 ASSEMBLYWOMAN GUNTHER: It's telemedicine. 14 DR. ELIZABETH BURNS: -- kind of disturbing. 15 LAURIE ZWEIFEL, Ph.D.: But then they're 16 going to have to come to us -- 17 DR. ELIZABETH BURNS: Yeah, and we're not be 18 there. 19 LAURIE ZWEIFEL, Ph.D.: -- for telemedicine, 20 because we have the equipment, but that would still 21 require coming to our agency to access it. 22 ASSEMBLYWOMAN GUNTHER: Right. 23 ASSEMBLYWOMAN RUSSELL: If the building is 24 closed, where are they going to access the telemed 25 system? 1 LAURIE ZWEIFEL, Ph.D.: Right. 2 ASSEMBLYWOMAN GUNTHER: That's correct. 3 LAURIE ZWEIFEL, Ph.D.: Thank you. 4 ASSEMBLYWOMAN RUSSELL: I know, the county 5 can pick it up. They're flush. 6 LAURIE ZWEIFEL, Ph.D.: Can I -- I just 7 have -- I know you wanted outpatient statistics, and 8 Mr. Blankenship had to leave, because he had a 9 patient. 10 I don't know if you're still interested, but 11 right now, the SLPC adult outpatient census, as of 12 September 1st, was 1,470 for adults. 13 So, that's a significant number. 14 ASSEMBLYWOMAN GUNTHER: I was also thinking, 15 when Michael was telling his story, that, you know, 16 when they talk about continuity of care, and the 17 fact that Michael, if he does go in for a back 18 adjustment, that -- if you really know the patient 19 that well, that the length of stay is a lot shorter, 20 and there's -- also, there's a level of comfort, and 21 knowing where you're going, and trusting. 22 LAURIE ZWEIFEL, Ph.D.: We do that all the 23 time, inpatient to outpatient. 24 ASSEMBLYWOMAN GUNTHER: [Unintelligible] it's 25 much more cost-effective. 1 LAURIE ZWEIFEL, Ph.D.: Yes. 2 TERRI LANGENMAYER: And we know what baseline 3 is. 4 They're not going to know him from anybody 5 else. 6 We know what Mike's behaviors are, baseline. 7 We know when he's well and ready to leave. 8 They're not going to know him. He's just 9 going to be -- 10 ASSEMBLYWOMAN GUNTHER: That would only 11 increase the anxiety, I think. 12 LAURIE ZWEIFEL, Ph.D.: Right. Yes. 13 ASSEMBLYWOMAN GUNTHER: Well, thank you. 14 MICHAEL SPELLMAN: Thank you. 15 LAURIE ZWEIFEL, Ph.D.: Than you all for 16 coming; thank you all for listening. 17 [Applause.] 18 ASSEMBLYWOMAN GUNTHER: Susan, come on up. 19 SUSAN KENT: So, good afternoon. 20 I'm Susan Kent. I'm president of the 21 Public Employees Federation. 22 I want to thank you very much for your 23 fortitude with these hearings, and the hearings that 24 you're having throughout the state. 25 You see that my face is familiar, because 1 I have committed to come to every hearing. 2 I want to thank you so very much for putting 3 them on. 4 I agree with Michael, that we really should 5 have the Governor and his people here, and they 6 should be doing what you're doing, and should have 7 been doing what you're doing, before they put this 8 announcement for a center for excellence out 9 because, it is not a plan; it is an announcement. 10 I'm joined today with the local union 11 president for Public Employees Federation, 12 Virginia Davey; as well as the executive board 13 member, Edward Snow, who is also the labor 14 management chair for OPWDD. 15 So I just want to introduce, very briefly, 16 that I can't thank you enough for the time and the 17 attention that you're giving to this, and I know 18 that this is not the time within your legislative 19 cycle for you really to have the ability to make 20 change here, and I do understand that the Governor 21 has wide latitude in terms of organizing state 22 services and deploying the state workforce. 23 So, I really do appreciate that you're doing 24 this at this point. 25 And, I don't want to be the bearer of bad 1 news, but I'm sure that this won't be new news to 2 you, I really don't think that we, working together, 3 are going to be able to effect the kind of change we 4 need to with -- in regard to this plan until budget 5 time, because that is really when you wield the 6 power to be able to make changes. 7 And I know that this won't be easy for you, 8 because it is a statewide plan, and because, at 9 budget time, you have many people that are needing 10 you to listen to them, and many people asking you to 11 make budgetary decisions. 12 So I hope that, starting now, throughout the 13 budget cycle, that we will able to convince the 14 Governor and the public that this is really not 15 about saving money, will not result in saving money, 16 but instead, will result in further relinquishment 17 of the State for its responsibility for state 18 services, and will really cost more in terms of both 19 money and social stigma that mental health 20 unfortunately still has with it, and, the social 21 problems that will only exacerbate as a result of 22 this. 23 Ginny is going to talk to you about what she 24 does, and what she sees at the facility, and is here 25 to provide any technical assistance you need. 1 I would like to conclude at the end, and 2 I would like to just point out, that you've done 3 something here: you've afforded an opportunity that, 4 unfortunately, the state government doesn't do. 5 All of those professionals that came before 6 us, they're past members. 7 They're public employees, they're 8 professionals, they're credentialed, and they care 9 about the work they do, but no one's listening to 10 them. 11 No one is giving them an opportunity to talk 12 about how services should be organized, how they 13 should be delivered, and, it isn't that they missed 14 their opportunity either. 15 They were all at what, supposedly, were the 16 listening tours, and they gave this information, but 17 no one listened to them. 18 So, I want to thank you again, because you 19 did listen to them, but we need to partner together 20 to make sure that professionals that come to public 21 service because they care about it, just like you 22 all came to public service because you care about 23 it, they're not denigrated and they're not insulted 24 to the point where their professionalism is not 25 engaged in the active dialogue about how state 1 services should be delivered, and what is good 2 public service and what is bad public service. 3 VIRGINIA E. DAVEY: Welcome to the 4 North Country. 5 You already have a really good feel, I'm 6 sure, of how committed our people are in the 7 North Country. When they believe in something, they 8 stand to voice their opinions, and they not only do 9 that, they try to help us to get there. 10 So, I thank all of you for being here, and 11 I also thank all of the people who spoke today. 12 That's the North Country. 13 I am very pleased to be able to relay my 14 concerns to you regarding the proposed Centers of 15 Excellence Plan put forth by the Office of Mental 16 Health. 17 My name is Virginia Davey, and I have been a 18 teacher at the St. Lawrence Psychiatric Center for 19 over 22 years. 20 I have been proud to work for the Office of 21 Mental Health, and continue to love working to 22 improve the lives of the children with mental-health 23 challenges. 24 Part of the joy in working in the 25 mental-health field is that one is in a position to 1 positively impact the lives of the patients who 2 receive services, the families whose children 3 receive services, and the communities in which the 4 patients and their families reside. 5 My area of expertise at SLPC relates to the 6 delivery of educational services. 7 Please allow me to provide a snapshot of what 8 SLPC has to offer our children. 9 I believe that you will be able to understand 10 how the Regional Center of Excellence Plan will be 11 unable to match the quality of services currently 12 available to children with psychiatric disabilities. 13 You will see that the involvements of 14 parents, schools, families, and communities, and 15 community-based service providers, begins 16 immediately when a child enters the SLPC children 17 and youth program. 18 When a child enters the SLPC children and 19 youth education program, they are provided with a 20 preliminary interview to determine their school of 21 origin, their current courses, the current topic 22 areas being studied in their courses, whether they 23 are attending general track courses, whether they 24 are receiving any special educational services, 25 whether or not they have experienced any behavioral 1 difficulties, whether or not they have attention or 2 concentration challenges, whether or not they have 3 experienced bullying as a perpetrator or a victim, 4 whether or not they have attended classes regularly, 5 what their general feelings are about school, and 6 what they aspire to be in the future. 7 If deemed necessary, children are also 8 administered Woodcock Johnson III tests of academic 9 achievement in order to identify their academic 10 strengths and needs. 11 This information helps to tailor an 12 educational plan that meets the academic, 13 behavioral, emotional, and social needs of patients 14 during hospitalization, but it also helps to 15 reinforce the recommendations made to home school 16 personnel upon discharge. 17 Once consents have been obtained, the 18 education manager has direct phone contact with the 19 guidance counselors assigned to work with the 20 children who enter the educational program. 21 A comprehensive review of a child's school 22 history is obtained, including any information that 23 helps the treatment team to address any stressors 24 that may have negatively impacted upon a child's 25 mental-health status. 1 This information would be included in a 2 comprehensive treatment plan while the child is 3 hospitalized. 4 Schools are given the opportunity to provide 5 assignments and materials so that a child can keep 6 up with the demands of his or her own home school 7 lessons. 8 The education manager, through several years 9 of forging positive relationships with home school 10 personnel, has been able to build a network of 11 contacts -- "a network of contacts" -- to assure 12 that the best possible educational outcomes are 13 achieved during a child's hospitalization. 14 SLPC has invested much time, effort, and 15 financial resources to obtain the latest 16 technologies, textbooks, and teacher materials. 17 These type of investments have helped to 18 assure a smooth transition back to the student's 19 home school programs. 20 Through frequent interaction with area 21 schools, the Education Department has come to know 22 many of the specific textbooks used by the area 23 schools and has purchased those same textbooks for 24 use with the students who enter our education 25 program. 1 When a child is slated to take New York State 2 exams, the coordination with area schools has 3 allowed for schools to send exams so that students 4 are not disadvantaged due to their hospitalization. 5 Ongoing contact is maintained with area 6 schools to assure that once a child is discharged, 7 that opportunity for success in the school 8 environment has increased as a result of their 9 hospitalization. 10 In the process of treatment and discharge 11 planning at SLPC, the teachers regularly participate 12 in Committee on Special Education meetings to share 13 information that may help to address a child's 14 academic, behavioral, emotional, and social needs. 15 Teachers have also regularly participated in 16 conference calls with school personnel, treatment 17 team meetings, and meetings held at the actual area 18 schools. 19 The relationships that have been forged 20 throughout the years greatly, greatly advantage our 21 patients and students in a way that cannot be 22 replicated overnight. 23 And some of us would argue, will never be 24 replicated. 25 These types of contacts take years and years 1 to establish. 2 The students who participate in the children 3 and youth program at SLPC are granted full 4 attendance and course credit once they're discharged 5 from the hospital. 6 A final education report with grades and 7 behavioral, psychiatric, and social recommendations 8 are provided as well. 9 If the Regional Center of Excellence Plan 10 were in place during the 2012-2013 school year, 11 approximately 293 North Country students and 12 patients would have been uprooted from their home 13 communities to receive psychiatric care in Utica, 14 New York. 15 The Regional Center of Excellence would have 16 called for approximately 586 parents to find a way 17 to travel to Utica to participate in the treatment 18 of their loved ones. 19 It would have called upon a number of 20 economically-disadvantaged parents to choose between 21 their jobs, their children at home, and their own 22 safety to participate in the treatment of their 23 hospitalized child. 24 The Regional Center of Excellence would have 25 required several North Country school districts to 1 develop a working relationship with a center of 2 excellence hospital that serves 90 other 3 psychiatrically-ill patients. 4 It would have called upon schools to provide 5 state tests and Regents exams to students located 6 over 100 miles away from home. 7 It would have called upon home schools to 8 send school materials, lessons, and textbooks to 9 school personnel with whom it had not developed a 10 trusting relationship. 11 As I review the Center of Excellence Plan, 12 I found some good ideas about expanding 13 community-based services. 14 I think most of us can agree that there is a 15 need to expand outpatient mental-health services, 16 and, to build upon opportunities to decrease the 17 reliance on more costly inpatient care. 18 The problem, though, is that we will never be 19 able to fully eliminate the need for inpatient 20 psychiatric care. 21 As noted on Judge D. Bazelon's "Center of 22 Mental Health Law" website, the Olmsted decision, 23 this is paragraph 4 on the website: 24 "In the end, we prevailed. In a 6-3 25 landmark opinion, authored by Justice Ginzburg, the 1 Supreme Court affirmed ADA prohibits the segregation 2 of individuals with disabilities. Needlessly 3 isolating such individuals," the Court wrote, "is a 4 form of discrimination based on disability, 5 discrimination that perpetuates unwanted assumptions 6 about their capabilities and their worthiness to 7 participate in community life. The Court found that 8 institutional confinement deprives people of most of 9 what is valued in life: family relations, social 10 contacts, work, educational advancement, and 11 cultural enrichment." 12 These are thought to be the key things that 13 people who are suffering from mental illness need to 14 do: they need to have their family, they need to 15 have social contacts, they need to have work, they 16 need to have academic and educational advancement, 17 and cultural enrichment. 18 We've talked about a lot of those today. 19 When one focuses on the spirit of the Olmsted 20 decision, one can only conclude that hospitalizing 21 northern New York children and youth in a hospital 22 setting in Utica, New York, does not serve our 23 patients well due to the failure to provide 24 integration to the fullest extent possible. 25 Locating a necessary inpatient hospital far 1 away from home further uproots children and their 2 families from the benefits of active involvement in 3 their community providers -- with their community 4 providers, family support system, home schools, and 5 social networks. 6 It is not in keeping with the 7 least-restrictive setting. 8 If professionals determine that inpatient 9 mental-health care is necessary, it should remain 10 accessible for the patient, their families, their 11 schools, and it should be in reasonable proximity to 12 their homes and places of employment. 13 Many elements of the Regional Centers of 14 Excellence Plan, as it relates to the inpatient 15 treatment component, diminished the quality of 16 services provided to persons suffering with 17 mental-health challenges. 18 What would the general public say if we 19 determined that anyone with a heart condition would 20 not be able to stay in a North Country-based 21 hospital? 22 What if a heart attack patient was advised 23 that they had to make arrangements to go to Utica, 24 New York, because the only center of excellence was 25 located in that city? 1 Would it be acceptable that the family had to 2 travel long distances to visit their loved ones in 3 Utica? 4 Would it be reasonable for them to have to 5 find and pay for child care for extended periods of 6 time? 7 What if the family had to miss work and 8 possibly undergo financial hardships as a result? 9 Do we not yet understand that mental illness 10 deserves a place in our local health-care system? 11 The Regional Center of Excellence Plan 12 crosses the line. 13 The nature of mental-health illness 14 dictates -- 15 [Pause.] 16 [Applause.] 17 The nature of mental-health illness dictates 18 that mental-health services be readily accessible. 19 Remember, people who require inpatient 20 mental-health services are deemed to be of imminent 21 danger to themselves or others. 22 I would not suggest that we delay treatment. 23 We are counting on you, our elected 24 officials, to see the forest through the trees here, 25 and to advocate strongly to keep inpatient care 1 close to home. 2 Please do not allow our patients to be 3 uprooted from their community of support just 4 because they have a mental-health disability 5 requiring inpatient care. 6 This is unacceptable. 7 Those of us who work on the front lines 8 understand how utterly ridiculous this is. 9 I am a union representative, and I care about 10 jobs. 11 I am a union representative, and I understand 12 the value of having good jobs in our communities. 13 But for me, as you can see, this is about 14 patient care. 15 After 22 years of working with mental -- 16 children suffering with mental-health illness, and 17 patients, adults, dealing with mental-health 18 illness, this is about their treatment. 19 And I come to you today to beg you to do 20 whatever is within your power to do to help others 21 to see the forest through the trees. 22 Thank you for your interest in learning more 23 about the mental-health needs of people living in 24 the North Country. 25 [Applause.] 1 SUSAN KENT: As you can see from the 2 testimony, the myths that people that work for a 3 living only care about themselves, are really a 4 terrible disgrace to working people. 5 And public servants have really been bashed 6 again and again and again, to the point that they're 7 not even treated as though they're human, and no one 8 recognizes that they are taxpayers and part of the 9 community. 10 All of my members that came to you today, the 11 CSEA people, the other members of the community, 12 they're not coming here out of self-serving reasons. 13 They're coming here because this 14 announcement, which purports to be a plan, which now 15 is to be, apparently, decided in terms of what the 16 community-based hubs will be, which is the major 17 part of this transition plan, will be decided with 18 only three meetings. 19 That is absolutely impossible. 20 The first meeting is occurring today in 21 Albany. There will be another one on Friday. 22 Each of the teams will have three meetings. 23 This is not thoughtful, thought-out good 24 government. 25 This is not good government. 1 No one is here to say that everything about 2 change is wrong. 3 You heard CSEA say that. 4 They are not against change. 5 We are not against change. 6 The professionals that deliver the services 7 every day, they're not against change. 8 But this isn't about change. 9 This is about "see as we go," and you're 10 talking about people's lives. 11 And, yes, it has a devastating economic 12 impact on this community. 13 Fort Drum was great for the community of 14 Watertown and the surrounding communities, but, 15 also, when you increase a community, and you bring 16 it to life and you invigorate it, you have to have 17 support structures in place. 18 We heard a terrible thing that happened 19 yesterday in Washington, D.C. 20 We hear about terrible things happening all 21 the time. 22 You have a huge employer in terms of 23 Fort Drum, with people that are under constant 24 stress, and I'm pinpointing that because it's so 25 relevant in this time period. 1 They don't need to have no services available 2 for their families. 3 Services need to be available in the 4 community that needs them. 5 I am very concerned that what's going to 6 happen with this plan, once it does become a plan, 7 is that it's going to pit community against 8 community. 9 I've seen a little of it, not too much, but 10 I think that as to get closer to fruition, that that 11 could happen. 12 I'm working as hard as I can not to have that 13 happen. 14 I think that you're probably all working to 15 have that not happen too. 16 But unless we can slow down state government, 17 in terms of what they think is transition, or what 18 they think would be money-savings, we are going to 19 see our communities pitted against community, and no 20 one's going to win. 21 No one's going to win. 22 The two big issues here, just like with 23 Sagamore, just like with Buffalo children's psych, 24 just like in Elmira, issues about children having 25 Skype in terms of having parental involvement in 1 their therapy, or, long visits to hospitals which 2 they can't afford. 3 Or maybe they can't get to, the terrible -- 4 it's beautiful, right, it's beautiful when it snows, 5 but this is really a terrible winter environment, in 6 terms of what could happen during that time of 7 season. And to even think about that kind of a 8 drive at that time, it absolutely is 9 life-threatening. 10 So that's a huge issue. 11 We're talking about children, we're talking 12 about adults, but, you know, let's focus on the 13 children, which I have been throughout by state 14 testimony. 15 Really, we can see the cycle, and I see it, 16 because we represent people in every entity of state 17 government. 18 So I represent people that work in 19 mental-health clinics, as well as administrative 20 offices, as well as prisons, and my people are the 21 psychiatrists, the psychologists, clinical social 22 workers, teachers. 23 They're there, trying to make social problems 24 better. 25 But if we don't start with our children, 1 things will only snowball and escalate, and get 2 worse. 3 Then, the other big problem here, and the big 4 missing link here is, where is the community 5 infrastructure for these services? 6 The acting commissioner, Kristin Woodlock, 7 who seemed to be a very lovely woman, and seemed to 8 believe in everything she was saying, we had a 9 one-on-one, and she really truly believes that 10 inpatient services would not be needed if outpatient 11 and community-based services were being delivered in 12 the way they should. 13 Now, you know, that's a nice thought, but, 14 it's not reality, it's not realistic. 15 And, so, to take away the infrastructure from 16 the community, to take away inpatient services, 17 without a plan to serve that population of people 18 that are not going away, that's just -- it's totally 19 irresponsible, and we can't do state government that 20 way. 21 So, again, I think we're going to be seeing 22 each other during budget time. 23 Unfortunately, I think that's where this is 24 gonna -- you know, this is going to be played out. 25 I am doing what I can, and my people are 1 doing what they can, to try to effect the change 2 now. 3 But, I think we're going to be doing this at 4 budget time, and I'd just ask you to hold strong, 5 and we will do everything we need do to work with 6 you, to make sure that mental-health services in 7 New York are something not to be ashamed of, but 8 will be a hallmark for the nation. 9 I want to thank you for your time. 10 [Applause.] 11 SENATOR CARLUCCI: Senator Ritchie. 12 SENATOR RITCHIE: Ginny, I just wanted to say 13 how much I appreciate your testimony, and the fact 14 that you pretty much countered what we heard earlier 15 this morning about, those that need services need to 16 go to this new facility in order to get what they 17 needed, as far as educationally. 18 And I guess, for the record, I would just 19 like to say, that just shows the quality of service 20 that those who have been to the center have 21 received. 22 I have not received one phone call from a 23 parent, anyone involved, who said anything except 24 for wonderful things about the care they received 25 there. 1 And I think, for the record, your testimony, 2 and those before you, just show, that if we're 3 really trying to do the right thing for these 4 children and these adults, that this is absolutely 5 the wrong plan. 6 SENATOR CARLUCCI: And, Virginia, I just want 7 to thank you for letting us into your classroom 8 yesterday on such short notice. 9 VIRGINIA E. DAVEY: You're welcome. Thank 10 you for coming. 11 SENATOR CARLUCCI: Thank you for your 12 commitment to the community, and to serving people 13 with mental illness. 14 Now, would the plan be that you would have to 15 move your classroom to Utica? Is that what we're 16 talking about? 17 VIRGINIA E. DAVEY: I think they're going to 18 be -- from what I understand of the plan thus far, 19 and I understand that it hasn't really been all 20 worked out, but that we will certainly be offered an 21 opportunity to move to Utica, if we so desire. 22 ASSEMBLYWOMAN RUSSELL: I noticed something 23 in your testimony that I would just like to talk a 24 little bit more. 25 It's been noted several times that 1 293 children have been inpatient here locally. 2 And later on, just in the testimony, you 3 stated that, if the plan had, I think, been in 4 place, "the Regional Center of Excellence would have 5 required several North Country school districts to 6 develop a working relationship with a center of 7 excellence hospital that serves 90 other 8 psychiatrically-ill patients." 9 Are you referring to the Utica center for 10 children? 11 VIRGINIA E. DAVEY: Yes. 12 I think they have a proposal to have 90 beds. 13 Do you remember that, President Kent? 14 SUSAN KENT: No. 15 ASSEMBLYWOMAN RUSSELL: Do we know what their 16 current capacity is in Utica, or how many they have 17 serve? 18 VIRGINIA E. DAVEY: No, I do not know. 19 SUSAN KENT: I can tell you this, 20 Assemblywoman -- 21 ASSEMBLYWOMAN RUSSELL: Yes. 22 SUSAN KENT: -- this plan does not call for 23 any addition of beds, which is also a mathematical 24 puzzlement. 25 ASSEMBLYWOMAN RUSSELL: Well, I guess I'm 1 wondering, what is the size of their child and 2 adolescent facility there? 3 Is it comparable, is it larger, is it 4 smaller, than Ogdensburg? 5 SUSAN KENT: I believe it's smaller, but we 6 can get you those numbers. 7 ASSEMBLYWOMAN RUSSELL: Okay. 8 And, so -- 9 VIRGINIA E. DAVEY: My understanding was, 10 that it was pretty close to what we had, but 11 I really think we should check the numbers, because 12 I don't want to mislead such an important Committee. 13 ASSEMBLYWOMAN RUSSELL: Okay. 14 I mean, it just seems that merging two, kind 15 of, you know, similarly sized, you know, are people 16 going to get lost? 17 How is that going to happen -- 18 SUSAN KENT: Assemblywoman, this is the issue 19 here. The issue is -- 20 That's why I talked about the mindset of the 21 then-acting commissioner. 22 -- the mindset is, that the number of 23 inpatient beds that are currently being used are not 24 needed. And reality does not play that out. 25 So you will not see -- you will not see an 1 addition of inpatient beds, because the plan really 2 is, to make people live in the community without the 3 inpatient services they need at time of their -- you 4 know, their need. 5 So, when they have struggle that requires 6 inpatient -- 7 ASSEMBLYWOMAN RUSSELL: So their plan is, 8 that they don't need any additional staff or 9 capacity, but, that staff is then going to be 10 responsible for forging relationships across 11 three different catchment areas? 12 SUSAN KENT: That's the whole hub concept 13 that none of us can understand. 14 ASSEMBLYWOMAN RUSSELL: That one person is 15 going to be able to forge relationships, especially 16 when it's, children and adolescent services are 17 complicated by educational mandates, that they're 18 going to be able to create relationships with all of 19 the school districts in the six counties? 20 SUSAN KENT: They have not even thought of 21 that, although -- 22 ASSEMBLYWOMAN RUSSELL: Just in 23 North Country, not including the Southern Tier, 24 which is also being planned to be merged in, but 25 that same group of counselors is going to then be 1 able to recall and have personal working 2 relationships, and the educational component is 3 going to get better? -- which is what the first 4 group testified to. 5 SUSAN KENT: There's nothing in that plan 6 that even connects the dots with a child that is in 7 inpatient services and the need to keep them 8 connected to their educational community. 9 No connection. 10 VIRGINIA E. DAVEY: I can tell you that this 11 network that I referenced has been a work in 12 progress, even for us, with inpatient now of 13 28 beds. 14 We have fluctuated in our numbers of beds 15 throughout the years, and twenty-eight, right now, 16 we have been able to forge some very tight contacts, 17 and it's almost seamless in many ways. 18 It's amazing how, in terms of finances, 19 public schools being willing to send their 20 textbooks, sometimes their teachers'-guides lessons, 21 everything, to our hospital, because they know 22 they're going to receive them back. 23 We have accounting procedures that allow them 24 to trust us. 25 That did not happen overnight. 1 And I really think the number, in and of 2 itself, you can always get enough staff members if 3 you have financial resources to make a number work, 4 to make the "90" number work. 5 But we're not seeing in this big scheme that 6 they're gonna -- they're trying to spend money. 7 We see that they're trying to save money. 8 And to that extent, I think that they're -- 9 it's very unlikely that they're going to be able to 10 anywhere near approximate the high level of 11 education that these patients receive. 12 ASSEMBLYWOMAN GUNTHER: The total number of 13 beds for the children, and it would be called 14 "Empire Upstate" or [unintelligible], it would be 15 90; so they'd come from what's already in -- they 16 would be coming from -- 17 Rochester? 18 ASSEMBLYWOMAN RUSSELL: No, Hutchings. 19 ASSEMBLYWOMAN GUNTHER: -- Hutchings, Mohawk, 20 and St. Lawrence. 21 So there wouldn't be any additional beds -- 22 VIRGINIA E. DAVEY: They're just moving the 23 shells. 24 ASSEMBLYWOMAN GUNTHER: Yep. 25 ASSEMBLYWOMAN RUSSELL: And Binghamton. 1 ASSEMBLYWOMAN GUNTHER: Yep. 2 VIRGINIA E. DAVEY: And I don't know how we 3 could ever even conceive that that's going to make 4 things better for their educational component of 5 their treatment. 6 And mind you, we spend a lot of our day, we 7 spend 5 1/2 hours a day, in active treatment in the 8 school setting. 9 So this isn't something to be looked at, that 10 can be -- it's not 2 hours a day tutoring, like what 11 might happen in a general hospital. 12 We spend, five, five and a half. 13 And then there are recreational activities 14 for patients, to help them to learn to get to work 15 together in social settings, to be successful in 16 recreational activities, and so on. 17 This is active programming. This is real 18 programming. It's something that is similar to what 19 they get in the public-school setting, so it's 20 easier to transition them back. 21 ASSEMBLYWOMAN GUNTHER: So five hours of 22 classroom time per day? 23 VIRGINIA E. DAVEY: 5 to 5 1/2 hours. 24 ASSEMBLYWOMAN GUNTHER: How many teachers are 25 there? 1 VIRGINIA E. DAVEY: There are four teachers 2 at our facility. 3 There used to be ten when I first got there. 4 I did a whole report on that, when the 5 State Education Department was reviewing our 6 programs. 7 And we have, still, proudly, been able to 8 maintain what we believe is, under the worst set of 9 circumstances, financially-strapped situations, we 10 have still been able to decide our priorities, and 11 make sure that we provide a good education to 12 these -- 13 ASSEMBLYWOMAN GUNTHER: So how many children 14 are -- four teachers for how many children; what's 15 the ratio? 16 VIRGINIA E. DAVEY: There -- the ratio in the 17 classroom can be about -- we have four different 18 class groupings; and, so, you divide 28 by 4, and 19 you're pretty much around the number. 20 And it fluctuates a lot, from day to day, 21 because we want one -- at one time, we might have 22 mostly high school students, and another time we 23 might have mostly elementary. 24 So all your teachers really flex between 25 elementary classes to high school classes, and we 1 just kind of roll with our -- the population that 2 comes in. 3 So we have areas -- my education is nursery 4 school through 12th grade, with an emphasis in 5 English, 7 through 12. 6 So, we're able to kind of move like a wave in 7 an ocean, back and forth, so that we can carry them 8 to their destination. 9 ASSEMBLYWOMAN GUNTHER: What's a workday for 10 you? 11 VIRGINIA E. DAVEY: Pardon me? 12 ASSEMBLYWOMAN GUNTHER: Is your workday, 13 8 hours? 7 hours? 14 VIRGINIA E. DAVEY: Our work days is 15 8 1/2 hours, with half hour for lunch. 16 ASSEMBLYWOMAN GUNTHER: Okay. 17 VIRGINIA E. DAVEY: So it's similar to any 18 other state. 19 ASSEMBLYWOMAN GUNTHER: Got to pack it in. 20 VIRGINIA E. DAVEY: Yeah, exactly. 21 ASSEMBLYWOMAN RUSSELL: And, of course, like 22 a teacher, I'm sure you take things home to grade, 23 just like every other teacher? 24 VIRGINIA E. DAVEY: Oh, I don't know about 25 that. Confidentiality. 1 We might get stuck at the hospital a little 2 bit after hours. 3 ASSEMBLYWOMAN RUSSELL: To make sure it gets 4 done? 5 VIRGINIA E. DAVEY: [Inaudible.] 6 SENATOR RITCHIE: I've got one. 7 I'm just looking at this OMH proposal that we 8 have here, and, if it's only 90 beds, that means, 9 current capacity, they would already be 15 beds over 10 what they're proposing. 11 So, that's a concern. 12 I mean, all I hear is, that we need more 13 services. 14 And now this already says that there's going 15 to be 15 less than it's at the current capacity 16 right now, if this plan goes forward. 17 So, what happens to the other 15 kids in -- 18 that's in the units right now? 19 What happens to those -- 20 SUSAN KENT: Again, you're dealing with a 21 mindset. 22 You're dealing with a mindset that believes 23 inpatient services are not necessary. 24 And they really need to be held accountable 25 for putting this plan together with no empirical 1 data to back that up. 2 ASSEMBLYWOMAN GUNTHER: Thank you very much. 3 SUSAN KENT: Thank you. 4 VIRGINIA E. DAVEY: Thank you. 5 ASSEMBLYWOMAN GUNTHER: We appreciate it. 6 [Applause.] 7 ASSEMBLYWOMAN GUNTHER: Charles Thorpe? 8 CHARLES THORPE: Good afternoon. 9 I'm going take a very different direction 10 from the directions that we've already been going, 11 and talk about educational connections. 12 SENATOR CARLUCCI: Could you state your name 13 and title. 14 CHARLES THORPE: I'm Chuck Thorpe. I'm the 15 senior vice president and provost, starting my 16 second year at Clarkson University. 17 For those of you who are from the 18 North Country, welcome home. 19 For those of you who are not, welcome to the 20 North Country. 21 Clarkson is in Potsdam, which is about 22 30 miles away from here. That makes a commuting 23 distance. 24 We have faculty and staff who live here and 25 drive to Potsdam every day. 1 I put into the record a letter that my boss, 2 President Tony Collins, wrote for the May hearing, 3 which summarizes these points. 4 Of course, there's been a lot said about 5 jobs. 6 We're a big supporter of jobs. 7 My boss, Tony, is the co-chair of 8 North Country Regional Economic Development Council. 9 Jobs are important. 10 Of course, there's been a lot said about 11 quality of care. 12 We're one of the largest employers in the 13 North Country. We care about the quality of care 14 for our employees. 15 And lest you think that these universities 16 are these bucolic oases that don't need psychiatric 17 care, let me only remind you of final exams. We 18 need psychiatric care as much as anybody else. 19 But here's what I really want to talk to you 20 about today, is the center of excellence concept. 21 When I heard about the potential closing of 22 the psychiatric center, I heard that one of the 23 notions, is to create centers of excellence with 24 close ties to universities. 25 I turned out to be pleasantly embarrassed. 1 I went around to my faculty, I said, We've 2 got the St. Lawrence Psychiatric Center. Don't you 3 think we ought to have some close professional ties? 4 They said, Chuck, we already have close 5 professional ties. 6 The center of excellence is already in 7 operation, we just didn't hold the press conference 8 to announce it. 9 I found out that many of our psychology 10 students already rotate through here. 11 If you really want a career in clinical 12 psychology, our students do their internships at the 13 St. Lawrence Psychiatric Center. 14 Our physician's assistant students, about a 15 third of the class of our PA students rotate through 16 here. 17 If you really want PAs who understand rural 18 health care and who understand mental health, that's 19 one of our advertising strengths; that's what gets 20 students to come to Clarkson to study PA. 21 Our new occupational therapy program will 22 start next summer. Occupational therapists need 23 rotations through psychiatric centers. That's a 24 natural combination. 25 Beyond that, our MBA students, some of our 1 premed students, just finished a summer project 2 working with E.J. Noble Hospital, to see what we 3 could do to streamline the processing, streamline 4 the business processes there. 5 This is good for E.J. Noble Hospital. 6 It is great for these students. They come 7 out of here with a deep insight as to what it takes 8 to have efficiencies in health care. 9 We want to have more of those students 10 rotating through internships up here at the psych 11 center. 12 You add to that all kinds of other things 13 that we would like to do up here: Working with 14 efficient heat, working with efficient lighting, 15 leveraging the strengths our engineering school. 16 This is a natural test ground, a natural 17 classroom, for our students. 18 I'm speaking about Clarkson. 19 My colleague Ben Dixon from St. Lawrence, who 20 had to leave, leaves me an even longer list of 21 St. Lawrence. 22 Their graduate mental-health-counseling 23 students rotate through here. The community-based 24 learning students rotate through here. 25 Ben had to leave to go to a meeting 1 SUNY Canton. Their nursing students rotate through 2 here. 3 The center of excellence exists, the 4 partnerships exist. 5 This is an important part of the educational 6 mission of all of us, and if the center goes away, 7 we lose an important part of our educational 8 mission. 9 Thank you for taking the time and paying the 10 attention to this important issue. 11 ASSEMBLYWOMAN GUNTHER: Well, thank you. 12 [Applause.] 13 ASSEMBLYWOMAN RUSSELL: You just mentioned a 14 couple of other colleges, and Clarkson belongs to a 15 consortium of colleges here in the North Country. 16 Can you just educate the panel as to those 17 colleges? 18 CHARLES THORPE: Sure. 19 There's two different sized consortia. 20 The Associated Colleges of 21 St. Lawrence Valley: Clarkson, St. Lawrence, 22 SUNY Canton, SUNY Potsdam. 23 We're close enough to each other, we 24 cross-register classes, we share some hours, 25 et cetera. 1 The large consortium, the HERC consortium, 2 which stretches from Plattsburgh to -- you probably 3 know better than I do, Assemblywoman -- there's 4 eight of us in that. 5 ASSEMBLYWOMAN RUSSELL: Across the 6 Adirondacks, and then -- 7 CHARLES THORPE: -- across the Adirondacks, 8 Paul Smiths. It includes the Trudeau Institute, 9 which is not an educational institute, but the other 10 major research institute up here. The community 11 college. 12 So eight of us that stretch across there, and 13 this is a catchment area for all eight of us. 14 ASSEMBLYWOMAN RUSSELL: So we have 15 8 institutions of higher education, 4 within 16 30 miles of this facility of, not adolescents, but, 17 18- to 22-year-olds, larger amounts living away from 18 home and experiencing different stressors in their 19 life for the first time? 20 CHARLES THORPE: You said it very eloquently. 21 Now, to be completely honest, if a student is 22 going to be in long-term psychiatric care, we will 23 typically send them home. 24 It is good to have a place that is close by 25 for the shorter-term care. 1 If we know it's going to take months, and 2 they are from -- we have more students from the 3 five boroughs than we do from the North Country, 4 it's better for them to be close to their family. 5 But for our students from around here, or for 6 the shorter-term care, it is definitely a plus to be 7 able to drive here. 8 ASSEMBLYWOMAN RUSSELL: Thank you. 9 CHARLES THORPE: Anyone else? 10 ASSEMBLYWOMAN GUNTHER: As Chairperson, 11 I would love you to write me a letter, and I don't 12 have your written testimony, but, you could put that 13 into a letter form, just forward it to me. 14 CHARLES THORPE: You should have that. 15 I dropped a copy of my boss' letter of 16 May 9th, which summarizes these same facts. 17 ASSEMBLYWOMAN GUNTHER: You know, my daughter 18 attended Cornell University, and there are a lot of 19 foreign-exchange students there, so, their families 20 are very far away from home. 21 And, you know, some of the -- as a parent, 22 some of the statistics were pretty alarming. 23 They used to have to put the nets under the 24 bridges at Cornell. 25 I don't know if you know anything about it. 1 But, you know, you can do crisis intervention 2 on a campus, but you really can't, you know, 3 admit -- there has to be a point where they -- we do 4 get admitted. And, especially, there were tons of 5 foreign students, and kids from all over the 6 United States. 7 So, I think a facility like -- you know, 8 having some -- a facility in a close proximity is 9 very important, especially when you talk about 10 eight different campuses. 11 CHARLES THORPE: Well, you understand this 12 from a parent's viewpoint, as well as from a state 13 viewpoint, as well as from a professional viewpoint. 14 ASSEMBLYWOMAN GUNTHER: Yep. I do. 15 Thank you. 16 Any questions, Patty? 17 SENATOR RITCHIE: No, that's all right. 18 Thanks, Charles. 19 CHARLES THORPE: Thank you very much. 20 [Applause.] 21 ASSEMBLYWOMAN GUNTHER: Patrick Kelly, are 22 you here? 23 PATRICK KELLY: I'm here. 24 ASSEMBLYWOMAN GUNTHER: Laurie Smithers? 25 PATRICK KELLY: Just me. 1 ASSEMBLYWOMAN GUNTHER: Okay, we're happy to 2 have you. 3 PATRICK KELLY: Good evening. 4 ASSEMBLYWOMAN GUNTHER: Thank you for being 5 so patient. 6 PATRICK KELLY: You're welcome. 7 Thanks for coming up here. 8 ASSEMBLYWOMAN GUNTHER: I loved it. 9 PATRICK KELLY: Good. 10 ASSEMBLYWOMAN GUNTHER: I absolutely did. 11 PATRICK KELLY: Beautiful part of the state. 12 ASSEMBLYWOMAN GUNTHER: It certainly is. 13 And I took Route 3 up -- I think it's, 14 Route 3 up, so I could see Lake Ontario. 15 The last time I was here, my husband actually 16 went to St. Lawrence, and his dad did, too. 17 So we came, he was taking a class, and we 18 stayed in the dorms over at St. Lawrence University. 19 So, I've been here before. 20 It's gorgeous. 21 PATRICK KELLY: You are welcomed anytime. 22 I am here as a member of the St. Lawrence 23 Psychiatric Center Task Force. 24 The St. Lawrence Center Psychiatric Task 25 Force, as I'm sure you realized by this point, is 1 disappointed with the New York State Office of 2 Mental Health Regional Centers of Excellence Plan. 3 OMH removing access to inpatient care in the 4 North Country is inconsistent with the goal of 5 providing care in the most integrated setting 6 appropriate for those adults, children, and families 7 requiring access to this key component of the 8 mental-health-care continuum in our region. 9 As a result of this plan, despite 10 demonstrating an unmatched level of support for its 11 center throughout the OMH listening-tour process, 12 the North Country region will see a drastic 13 reduction in access to care for those who need 14 mental-health services. 15 The sheer size, distance, and lack of 16 adequate transportation, infrastructure, and 17 services in the North Country will place undue 18 hardship on local individuals and families requiring 19 quality mental-health services. 20 With the proposed OMH plan, no full service 21 state psychiatric hospital will be located north of 22 the communities along the New York State Thruway. 23 As a result, the distance between the 24 St. Lawrence Psychiatric Center and the nearest 25 proposed center of excellence is significantly 1 further from the same distance between other 2 OMH facilities in all areas of the state. In fact, 3 that distance is roughly four times. 4 The point is, for a Regional Center of 5 Excellence to work, it has to be in the region. 6 When the OMH plan was announced, 7 Senator Carlucci basically confirmed this. 8 I spoke with him in the hallway, he said it 9 was okay if I quoted him. 10 At the time, on July 11th, Senator Carlucci 11 said, "I am absolutely thrilled that OMH has decided 12 to base part of its regional operations right here 13 in Rockland County. This is also a huge win for the 14 people of the Hudson Valley living with mental 15 illness, and their families, who depend upon quality 16 care and treatment." 17 We agree with Senator Carlucci. We think he 18 gets it. 19 And while having a Regional Center of 20 Excellence in your region is, in fact, a huge win, 21 it must then be true that not having one is a huge 22 loss, and the magnitude of that loss is what we're 23 trying to communicate to you. 24 Something else to consider: The Lower Hudson 25 Regional Center of Excellence, which is the facility 1 that the Senator was referring to, is 7 miles from 2 the nearest Regional Center of Excellence within the 3 state system. 4 That's a research center, so to be fair, the 5 distance from that center to the nearest full 6 service Regional Center of Excellence is 23 miles. 7 The distance to our next closest Regional 8 Center of Excellence is 129 miles. 9 The next closest one to that is 132 miles. 10 And these facilities are a distance from us, 11 that is not served by a 4-lane highway, primarily, 12 and, it's through a part of the state that receives 13 25 feet of snow a year. 14 You've heard person after person mention that 15 to you. 16 We know you're aware of our weather patterns, 17 but, we like to be repetitive. 18 The reality is, as a result of the 19 OMH proposal, residents and families in the 20 North Country will be forced to travel to facilities 21 which, in many cases, are well over 100 miles from 22 their home communities. 23 OMH offering that it is considering, and this 24 is a quote, "hospitality housing, discounted hotel 25 arrangements, and web-based videoconferencing as 1 solutions," that was according to OMH Spokesman 2 Benjamin Rosen, "highlights the lack of detail and 3 planning for services for those who are going to be 4 most negatively impacted by the OMH proposal." 5 We have families who can't afford to feed 6 their children. 7 To suggest to them that discounted hotel 8 vouchers are part of the solution, I'd be 9 embarrassed to say that. 10 And as I sit here and I listen to people 11 talking about videoconferencing, that we're put in 12 the position that we have to defend ourselves that 13 videoconferencing is a way to deal with your child's 14 illness is in any way appropriate, is ridiculous. 15 The unfortunate truth is that the OMH plan 16 does not have a lot of answers. 17 We know what the plan doesn't do. 18 It doesn't offer an option for adult and 19 children inpatient services in the North Country, 20 and it doesn't offer a specialized rural location 21 for assisting rural residents. 22 Another concern with the plan is the lack of 23 continuity in the leadership within the 24 New York State Office of Mental Health throughout 25 the Regional Center of Excellence planning and 1 implementation process. 2 The original OMH plan was released on 3 July 10th. 4 On July 20th, Acting Commissioner Woodlock 5 resigned. 6 Acting Commissioner Tauriello will serve 7 until November, at which point 8 Dr. Ann Marie Sullivan is expected to be appointed. 9 This rapid turnover at a time when OMH is 10 drafting and executing plans which will irreparably 11 change the way our residents access mental-health 12 services raises significant concerns regarding the 13 future accountability of OMH during the delivery of 14 the plan. 15 What value do the assurances and promises 16 that have made by OMH hold at a time when they are 17 changing leaders three times a year? 18 The fact that the plan was announced in July, 19 and it's primary architect left OMH three weeks 20 later, is only part of the problem. 21 The Regional Center of Excellence teams were 22 supposed to be appointed by August 1st. 23 The full teams still haven't met, and they 24 were supposed to deliver an implementation plan by 25 October 1st. 1 Again, this is before the next commissioner 2 is even appointed: plans were designed to be created 3 before the next commissioner was even going to be in 4 place. 5 It would be irresponsible to assume that such 6 a hastily-constructed plan with so many different 7 hands on the wheel could be practically implemented 8 in these time frames. 9 In many ways with this plan, it feels like 10 OMH has jumped, and now they're looking for the 11 ground. 12 The lack of information and contradictions 13 with the OMH plan provide even greater uncertainty. 14 Though the OMH proposal highlights continuity 15 of employment, and we were assured it would result 16 in no job losses, three of the five examples of this 17 commitment from OMH involve the transfer of jobs 18 from existing facilities, such as the St. Lawrence 19 Psychiatric Center, to other areas of the state. 20 The removal of any jobs from the 21 North Country, which is, by virtually every measure, 22 already the most economically-challenged region of 23 the state, will have a disproportionately negative 24 impact our communities. 25 There are unique issues in the North Country 1 beyond our great size and disbursed population. 2 We have clearly documented circumstances of 3 social and economic need. 4 For example, St. Lawrence County has one of 5 the highest poverty rates in New York State. It is, 6 in fact, over 20 percent greater than the overall 7 state rate. 8 One in every six persons in 9 St. Lawrence County is living in poverty. 10 Per capita income is just above $20,000, and 11 is more than one-third lower than the New York State 12 average. 13 Franklin County, also in our region, has an 14 even lower per capita income. 15 Veterans, I know we've talked about veterans 16 quite a bit today. 17 Veterans make up 6.6 percent of the state's 18 adult population. 19 Among the counties of the North Country, that 20 percentage ranges from 1 1/2 to 2 times that high; 21 so, in the 9 to 12 percent range. 22 With the occurrence of posttraumatic stress 23 disorder and other mental-health issues becoming 24 more evident in our veteran populations, efforts 25 need to be made to increase, rather than decrease, 1 access to mental-health care and treatment options 2 in the region. 3 We have provide more information and 4 statistics on our socioeconomic circumstances in 5 your binder, copies of which were also provided to 6 OMH and the Governor's Office. 7 Everybody up there is supposed to have a nice 8 powder-blue binder. 9 It's got all of our facts in it; all of our 10 research and all of our claims are held within here, 11 if you want to check them for further information. 12 The most bothersome aspect of this plan is 13 that we have the potential to create an outstanding 14 mental-health-services model in this region, and OMH 15 is not seizing upon it. 16 The St. Lawrence Psychiatric Center currently 17 provides a unique range of children and youth, 18 adult, and sexual-offender treatment programs, and 19 the facility grounds host the New York State Office 20 of Alcohol and Substance Abuse Services treatment 21 facility. 22 Preserving one center in a rural part of the 23 state that already offers this diversity of services 24 would enable OMH to have a center of excellence that 25 adds significant rural and geographic diversity to 1 the OMH Regional Center of Excellence footprint. 2 Another consideration, is that the 3 elimination of catchment areas in the OMH plan may 4 create a greater need for services for those 5 individuals and families who would choose to receive 6 care in a rural setting, such as on the banks of the 7 St. Lawrence River, as opposed to a facility in a 8 congested urban location. 9 In fact, on the their website, OMH proclaims 10 to have, quote, "strategically located the Regional 11 Centers of Excellence across the state, from Buffalo 12 to Long Island." 13 This statement is as insulting as it is 14 misleading. 15 The Regional Centers of Excellence are indeed 16 strategically located. 17 They're located in urban settings along the 18 thruway route, down south to New York City, and out 19 to Long Island. 20 There is no accommodation in this plan for 21 the vast areas north of the thruway, nor is there 22 one for the millions of residents who live in or 23 prefer to receive care in the rural communities of 24 the state. 25 The St. Lawrence Psychiatric Center has taken 1 a leading role in establishing a continuum of care 2 with a number of community-based organizations in 3 the region. 4 The potential and willingness of the 5 universities, hospitals, and community-partner 6 organizations in the region to further collaborate 7 with the St. Lawrence Psychiatric Center has been 8 well demonstrated, both, at the listening-tour 9 visit, and through numerous letters and resolutions 10 of support in the materials we have provided to OMH. 11 The St. Lawrence Psychiatric Center's track 12 record of delivering mental-health services in a 13 rural setting could be a model for other areas of 14 the state, and could be used as the foundation to 15 transform the St. Lawrence Psychiatric Center into 16 either a northern center of excellence or a center 17 of excellence for rural services. 18 In light of these issues, in light of our 19 concerns and our suggestions, and everything that 20 you have heard today, the St. Lawrence Psychiatric 21 Center Task Force has some requests for this 22 Committee. 23 We would ask you to ask OMH to provide 24 rankings for key performance measures -- length of 25 stay, overtime rates, quality-of service 1 indicators -- of the facilities across the entire 2 Office of Mental Health network, and that the 3 Committee share this information with the public. 4 We've had people ask, "Do you have this 5 information?" 6 Our request to you is, you should be asking 7 it of OMH. 8 We think your voice would resonate louder 9 with them, and you may have a more appropriate 10 channel for finding this information out. And find 11 it out statewide, and compare. 12 We ask that you look at the distances between 13 the proposed centers of excellence in the OMH plan 14 with an eye toward reasonable and fair access. 15 We ask that you determine which facilities 16 have the broad functionality in place to easily 17 transition into true centers of excellence. 18 And, we ask that you analyze and compare the 19 information and support materials provided to OMH at 20 each of the listening-tour locations. 21 We also wish that you would assess the 22 negative impacts of the OMH Regional Center of 23 Excellence Plan on the affected communities and 24 regions in light of existing economic and social 25 hardships. 1 In undertaking these steps, we think you will 2 see that this plan will not save money. In fact, it 3 will add costs and inefficiencies to the residents 4 and communities across the state. 5 The plan is not based on the needs of this 6 region; 7 It is not based on the quality of the OMH's 8 facilities; 9 It is not based on a facility's ability to 10 provide comprehensive services; 11 And in many cases, it not will not improve 12 access or care for those who need them the most. 13 Finally, we ask that the New York -- we ask 14 that New York State amend the OMH Regional Centers 15 of Excellence Plan to include the St. Lawrence 16 Psychiatric Center as either the northern center of 17 excellence or as a specialized rural center of 18 excellence, and in so doing, preserve three 19 inpatient adult wards, as well as three inpatient 20 children and youth service wards, at the center. 21 Improving the plan in such a manner would go 22 a long way toward providing the complete range of 23 mental-health services in the most integrated 24 setting possible for a large region of 25 New York State. 1 Thank you. 2 [Applause.] 3 ASSEMBLYWOMAN GUNTHER: Did you tell us -- 4 your title is...? 5 PATRICK KELLY: I am the chief executive 6 officer for the St. Lawrence County Industrial 7 Development Agency, and a member of the St. Lawrence 8 Psychiatric Center Task Force. 9 ASSEMBLYWOMAN GUNTHER: Any questions? 10 ASSEMBLYWOMAN RUSSELL: I think that was 11 quite thorough. 12 Thank you. Very nice job. 13 PATRICK KELLY: You're welcome. 14 SENATOR RITCHIE: I just have one comment, 15 Patrick. 16 If you could tell my colleagues about the 17 cogen plant, and what that means, as far as the 18 facility being more economically feasible than some 19 of the other ones. 20 PATRICK KELLY: Sure. 21 What -- I'm not sure how much background you 22 have on the site itself. 23 On site at the psychiatric-center grounds is 24 a privately-owned facility that used to be a 25 cogeneration plant. 1 The plant provides free steam as part of its 2 lease arrangement with OMH. 3 The owners of the facility have been working 4 to try to renegotiate their agreement, make it a 5 long-term arrangement, so they could take that, 6 create a long-term project, and repower the facility 7 with regionally-sourced biomass. 8 What that would enable us to do, is provide a 9 source -- an output source for local biomass for 10 landowners and for our -- we have a fairly robust 11 forest-services industry. And it would enable the 12 state to take advantage of a renewable energy 13 source. 14 You hear a lot of talk about microgrids and 15 about renewable energy, and the state trying to move 16 toward a green economy. 17 There's an opportunity here for OMH and 18 New York State to lead the way in creating a 19 solution that would be, I think, innovative and 20 impressive on a national level. 21 It would be something the State could point 22 to and say, We work together with private industry. 23 You hear a lot about public-private 24 partnerships. 25 This is -- this would be an opportunity to 1 lower the cost for the state facilities. It would 2 be an opportunity to get some private investment and 3 create jobs; not just retaining public-service jobs, 4 but create jobs in the private sector. 5 And these are all of the things everybody 6 talks about wanting to do. 7 Right here, we have a -- almost a 8 laboratory-style project where we could actually do 9 it. 10 SENATOR RITCHIE: We have the opportunity to 11 actually save the state money, too, because one of 12 those facilities currently is using that, but 13 Riverview is just across the road. 14 So this is an opportunity for the State to 15 save taxpayer money. 16 PATRICK KELLY: Yeah, the -- using the 17 electricity from a repowered facility would save the 18 state significant money, not just on a long-term 19 steam contract, but also on electricity as well. 20 And it would be green energy. 21 I mean, like I said, this is the stuff 22 everybody likes to talk about. 23 Here's a chance to do it. 24 You know, here's a chance to say: Okay, this 25 is something that Empire State development is 1 supposed to be working toward. This is something 2 that the Governor says is a priority. 3 This is something that we could be doing, and 4 we're not. We're leaving an opportunity on the 5 table. 6 And the real risk up here -- 7 And I know my local representatives know 8 this, so I'm going to focus on Ms. Gunther. 9 -- the -- here's what's going to happen if 10 this plan goes forward, and it is my concern: 11 You've got OMH pulling away from this area. 12 They're saying that this is a, you know, 13 regional-center plan. We're going to be a hub. 14 The fear is, we're going to look back, two or 15 three years from now, and say: Wow, that was really 16 the beginning of the end. That was when we had 17 520 people here providing robust services to all of 18 these regional residents. 19 And two or three years from now, we're going 20 do see about half that many people. 21 And then, eventually, we're going to worry 22 about what's going to happen with the other 23 facilities on site at that campus. 24 There's a correctional facility. 25 You've talked about the OASAS facility. 1 My concern is, that if this is the first 2 domino, and this is the State moving resources out 3 of our area, we're going to see a job loss, not just 4 of 500 people, it's closer to 1,000, when you look 5 at the other facilities that are there. 6 And I think we can either work creatively, we 7 can be innovative, and we can move forward for a 8 long-term future; or, we can watch the State pull 9 away from here and decimate the community. 10 The stakes are high. 11 It is very interesting that the 12 vice president of Clarkson came. 13 And, you know, we talk about, you're part of 14 economic development, and the regional economic 15 council. 16 And one of the important things that, you 17 know, the Governor has talked about, is the 18 relationship between universities and economic 19 development. 20 ASSEMBLYWOMAN GUNTHER: Well, health care is 21 economic development, absolutely, but, also, you 22 know, you have this established relationship, where, 23 these folks are doing their internships. 24 PATRICK KELLY: Correct. 25 ASSEMBLYWOMAN GUNTHER: And so what would 1 they do, if that's part of their rotation, if this 2 wasn't available to them? 3 And, again, you know, education is economic 4 development. It's all part of the whole equation of 5 making a community healthy. 6 So, I haven't read the book yet. I just got 7 it today, and my speed-reading has gone to the 8 wayside. 9 PATRICK KELLY: I want to draw your 10 attention, we highlighted the important stuff, but, 11 I'm on a roll [unintelligible] today, so I'll read a 12 little bit more. 13 [Laughter.] 14 ASSEMBLYWOMAN GUNTHER: Okay, go ahead. 15 PATRICK KELLY: This is from -- this is from 16 your binder: 17 "SUNY Canton has 40 new nursing students 18 performing their clinical rotations at the 19 St. Lawrence Psychiatric Center. 20 "Four of the college's graduates were hired 21 at the center in 2012, helping to contribute to 22 SUNY Canton's 94 percent placement rate for nursing 23 students last year." 24 I mean, this thing is filled. 25 And what is frustrating to us is, we were 1 proactive, we were ahead of the curve. 2 Look at the numbers that were here today. 3 The listening tour was the same way. There 4 were 300 people here. 5 Any opportunity to raise our voice and to say 6 how important this facility is, not just to 7 Ogdensburg, not to St. Lawrence County, but to the 8 entire region, we took advantage of those 9 opportunities. 10 And if you look, that's why I asked you to 11 compare the different materials that were 12 provided -- 13 No, no, don't read it right now. 14 ASSEMBLYWOMAN GUNTHER: No, I can't. 15 PATRICK KELLY: -- just, put everything that 16 we provided together, analyze it, and you'll see, 17 you know, you mentioned, the provost of 18 Clarkson University sat here for six hours. 19 That's stunning. 20 How important must this be to this region? 21 ASSEMBLYWOMAN GUNTHER: Absolutely. 22 PATRICK KELLY: You know, the county sheriff 23 is still back there. 24 He's got better things to do. 25 We've all got important, you've got 1 important, things to do. 2 The fact that this many people turned out and 3 sat here, I mean, this is an essential part, not 4 just of our economy, it's not just -- you know, 5 people say, Oh, you can't just talk about -- 6 ASSEMBLYWOMAN GUNTHER: Delivery on the 7 care -- 8 PATRICK KELLY: It's quality of life. It's 9 vitality. 10 It's the ability for this region to 11 participate in the New York State economy and in the 12 New York State -- and in society in New York State 13 in 2013. 14 ASSEMBLYWOMAN GUNTHER: The only way you can 15 increase your population is having -- having the 16 services in place that people are looking for. 17 PATRICK KELLY: Correct. 18 ASSEMBLYWOMAN GUNTHER: Good education. 19 You want job -- there are certain things you 20 definitely need. 21 And I still loved Michael, our veteran, when 22 he talked about, you know, being self-sustaining on 23 the farm, and, creating jobs. 24 I loved it. 25 You know, I see my friend in the back, 1 I forgot your first name. 2 But, you must have somebody that does 3 measurements, or come -- that comes to your facility 4 and inspects it. 5 So, a lot of those numbers, like, you -- 6 I don't know if it's Joint Commission or OMH, the 7 Department of Health, but, they know your 8 readmission rate. 9 Now, I've looked at it. 10 And also, Binghamton, they're doing great 11 too. 12 PATRICK KELLY: Yep. 13 The decision, I think John Pinkerton told 14 you -- 15 ASSEMBLYWOMAN GUNTHER: I mean, Sagamore, 16 I went to Sagamore. Those kids are -- you know, 17 kids and adults, it doesn't even -- they always -- 18 I just want to say one thing: 19 Kids are important, but, you know, that adult 20 is part of a family too. And to have a mother leave 21 her children, to go and do therapy with her -- you 22 know, with her husband is the same difference. 23 It's all about, you know, working as a 24 family. 25 And, more so, like a family, you have your 1 small family, but you have aunts and -- there's just 2 people that are involved in treatment. 3 And, it just makes it very difficult. 4 And I'm Sullivan County, and we have to go 5 down to Rockland County. 6 They did it, quite a few -- we do have some, 7 you know, outpatient facilities. 8 But, you know, an ER is not the appropriate 9 place to provide that kind of therapeutic care. 10 PATRICK KELLY: I agree. 11 And it has been enlightening to us in this 12 process to learn so much about the facility and its 13 interactions within the community. 14 You know, the -- when you look at the 15 decision that was made -- and we've done a great 16 deal of, admittedly, probably biased research -- but 17 when you look at the decision that was made, you 18 can't say that it's about the quality, you can't say 19 it's about fairness, because look at the map. 20 I mean, that makes no sense. 21 I mean, to close a facility up here, it 22 just -- it's -- it defies reason. 23 It feels like to us, it's about votes, it's 24 about politics. It's about where the power is 25 within the state. 1 And that's a frustrating feeling. 2 And that's why we elect people like you, 3 because we expect that, when we have the opportunity 4 to have a forum like this and the story is told, 5 that, hopefully, the message gets across, and 6 somebody can look at this and say, You know, we're 7 not a state that stops at the thruway. 8 That isn't even the midway point in the 9 state, geographically, when you look at the 10 distances we have to travel. 11 And you hear a lot about the Olmsted 12 decision. 13 You know, to have truly integrated care, you 14 need all facets of that care. 15 And to remove a key portion of it and say, 16 Well, you know, you can go to Utica for that, 17 because there's going to be -- you know, there's 18 gonna be high-quality research and excellence and 19 services there that you can't get here, people 20 aren't going to go. 21 ASSEMBLYWOMAN GUNTHER: What 22 would Judge Ginzburg say? 23 PATRICK KELLY: Yeah. 24 [Laughter.] 25 ASSEMBLYWOMAN GUNTHER: I shouldn't say that 1 right now. 2 PATRICK KELLY: You said it, not me. 3 ASSEMBLYWOMAN GUNTHER: Well, I can say it. 4 PATRICK KELLY: Yeah, go ahead. 5 ASSEMBLYWOMAN GUNTHER: I mean, 6 interpretation. 7 PATRICK KELLY: Yeah, it's your committee. 8 ASSEMBLYWOMAN GUNTHER: Well, I thank you. 9 PATRICK KELLY: You're welcome. 10 ASSEMBLYWOMAN GUNTHER: And I -- you know, 11 I have to say that -- I only -- this is a new 12 committee to me. We're pretty brand new. 13 And I'm sure, Patty, you must have talked to 14 David, but, Addie Russell and Donna Lupardo and 15 my -- I mean, they said we have to have a hearing. 16 And it's been really very, very enlightening 17 for me, and realizing the impact of this -- how 18 these decisions create such an impact in a 19 community. 20 I was in -- I got up at 5:00 this morning. 21 I came last night, and I went for a tour. 22 And I was in Phil's Diner. 23 [Applause.] 24 ASSEMBLYWOMAN GUNTHER: So I go there. 25 [Applause.] 1 ASSEMBLYWOMAN GUNTHER: So I don't know how 2 I found it, don't ask me. It was still dark. 3 But, anyway, I -- actually, I had my pajamas 4 on, because I figured no one would know me anyway. 5 [Laughter.] 6 ASSEMBLYWOMAN GUNTHER: But I was in there, 7 and there was a gentleman there, and he has a cab 8 company. 9 And, you know, I was asking him questions, 10 because, you know, that's the way, like, I like to 11 understand what's happening in a community. 12 So he said, Yeah, well, it's going to have a 13 really impact on my business. 14 He said, You know, I transport a lot of 15 people. 16 And he said, You know, my grandson comes with 17 me. 18 And, you know, he said, And it has a large 19 impact. 20 And then the diner itself serves, you know, 21 that community. 22 So, it's not -- it's a lot bigger than we 23 sometimes think. 24 And, you know, if you go into -- and I went 25 to your -- I went to the Trinity. Allison took me 1 on a tour. 2 We just found it on our own. We thought we 3 might get arrested. We were knocking on the -- at 4 the -- the state, you know, we didn't know if we 5 were supposed to be there or not, but we figured, 6 What the heck! 7 UNNKOWN MALE SPEAKER: [Unintelligible.] 8 ASSEMBLYWOMAN GUNTHER: My father was NYPD. 9 And -- but, it's an incredible facility. 10 PATRICK KELLY: It is. 11 ASSEMBLYWOMAN GUNTHER: And, you know, it's a 12 very therapeutic environment, just the grounds 13 itself, and everything. 14 PATRICK KELLY: You don't even have to read 15 this binder. I mean, you've pretty well got it 16 down. 17 [Laughter.] 18 ASSEMBLYWOMAN GUNTHER: No, a lot of it -- 19 PATRICK KELLY: That's what we're trying to 20 express. 21 ASSEMBLYWOMAN GUNTHER: Yeah, it is. It's 22 pretty incredible. 23 PATRICK KELLY: Thank you. 24 ASSEMBLYWOMAN GUNTHER: So, we're going to 25 work very hard. 1 UNNKOWN MALE SPEAKER: Well, thank you, 2 because I just want to mention that, we did this 3 battle four years ago with the prison. 4 ASSEMBLYWOMAN GUNTHER: I remember. 5 ASSEMBLYWOMAN RUSSELL: We speak to each 6 other, frequently. 7 UNNKOWN MALE SPEAKER: You see those binders 8 you got there? Remember back to those days? 9 Every member of the Legislature, in both 10 Houses, got one. And I'm afraid you're going to get 11 one before you're done here, too. 12 We're not quitting. I guarantee you that. 13 ASSEMBLYWOMAN GUNTHER: You're Irish. 14 UNNKOWN MALE SPEAKER: You got it. I got the 15 right name. 16 [Applause.] 17 ASSEMBLYWOMAN GUNTHER: Richard Halpin, 18 Karin Riches, Maybelle Rowland, Roberta Hagerty, and 19 Barbara Ward. 20 I don't know who's going first, but, thank 21 you for being so patient. 22 ASSEMBLYWOMAN RUSSELL: All right, who wants 23 start? 24 BARBARA WARD: My name is Barbara Ward. I am 25 the mother of a paranoid schizophrenic son -- 1 ASSEMBLYWOMAN GUNTHER: Can you speak up a 2 little louder? 3 BARBARA WARD: My name is Barbara Ward. I am 4 the parent of a paranoid schizophrenic son, who is 5 quite upset at this supposed decision. 6 It's obvious to me that whoever thought this 7 not-so-excellent plan up knows nothing about brain 8 diseases, for if they did, they certainly would not 9 close the St. Lawrence Psychiatric Center, a 10 facility covering a vast rural area that has 11 provided quality inpatient psychiatric care for 12 adults and children for over 100 years. 13 You see, if they knew anything at all, they 14 would realize that when someone is in distress, when 15 someone is suffering from a psychotic episode, when 16 someone's child is drastically out of control, or 17 suicidal, or threatening, they need the immediate 18 attention. 19 It is cruel to even suggest they be shipped 20 off hours away like cattle. 21 It is cruel to rip them away from family. 22 It is cruel to add additional hardship to a 23 very difficult situation. 24 Life is hard enough in the North Country for 25 so many families. I dare say, this plan had nothing 1 to do with excellence, but all to do with money, and 2 that is unforgiving. 3 Eric Leventhal, a senior social worker at the 4 outpatient clinic at Bellevue Hospital, and a 5 National Alliance for the Mentally Ill board member 6 states: 7 "The hospital stay of a loved one is a 8 critical time for families to get involved. There's 9 strong evidence that shows family participation 10 contributes to improved outcomes for both the 11 individual and the family itself. 12 "Hospitals are busy, high-stress places, and 13 families need to remain assertive. It is a vital 14 part of the recovery process, and learning how to 15 advocate for a loved up with will go a long way." 16 End quote. 17 Like anything else, you have to live it to 18 understand it. 19 I am the mother of an adult paranoid 20 schizophrenic son. I've lived a long frightening 21 journey of my son's and our family's journey for 22 over 20 years. 23 While, to date, my son has never been 24 inpatient as an adult at SLPC, he was inpatient at 25 children and youth as an early teen. 1 While he was inpatient, I was able to visit 2 most every day. I was part of his recovery. 3 To think that children in this region will 4 soon be sent hours away from family makes me cringe. 5 My heart aches for those families, many struggling 6 to make ends meet. 7 How will families handle this? 8 How, considering the distance and the cost? 9 Just having a child inpatient at a 10 psychiatric center is burden enough. 11 It was suggested by OMH that communication 12 between family and their loved ones can be set up 13 electronically. 14 Take it from me as a mother who's had a child 15 locked inside an inpatient facility, nothing, 16 absolutely nothing, replaces a warm and loving hug. 17 Nothing can replace the presence of loved ones when 18 one is in crisis, when one is in recovery, and 19 especially when that someone is a child. 20 An electronic device is just that: 21 electronic; cold and heartless, about a heartless as 22 those who conjured up this disastrous 23 reconstruction. 24 The mentally ill continue to take the brunt 25 of downsizing and cutbacks. You don't have to go 1 too far in Ogdensburg to see the results of empty 2 promises of extended outpatient services, the 3 closing down of valuable work programs, the lack of 4 quality housing. 5 It's frightening to think what lies ahead. 6 Marvin Swartz, a researcher at 7 Duke University, who has studied mental-health 8 systems for the past two decades, states: 9 "We say a better system would cost too much, 10 but we're spending more money ignoring the problem 11 than we would have to spend to address it." 12 End quote. 13 Instead of closing facilities and pulling 14 back on services, why not invest in those services; 15 offer quality work programs and decent housing. 16 If you nurture the human spirit, no matter 17 how injured that spirit is, it will grow and prosper 18 and become a contributing member of the community. 19 If we did this, the ERs would no longer be 20 crisis centers, prisons would no longer house those 21 who belong in a psychiatric center, police agencies 22 would not have as many calls, there would be less 23 need for public assistance, and so on. 24 This certainly make sense to me. 25 I live mental illness every minute of every 1 single day. I'm living it now as I speak, wondering 2 what my son is doing, waiting for me to come home. 3 I've seen madness in my son's eyes, wild eyes 4 that looked right through me, looked frightening, 5 taking me to a place I never imagined going as a 6 mother. 7 I've also watched my son flourish when he was 8 part of the greenhouse program on the grounds of the 9 St. Lawrence Psychiatric Center, responding to the 10 nurturing of seedlings, caring for them as they 11 grew, and taking pride in them as they blossomed, 12 for as they blossomed, so did my son. 13 Not only were seedlings being nurtured, so 14 was his soul and his spirit. He felt 15 responsibility, he felt worth, he felt pride. 16 He was up very early every day, waiting to be 17 picked up, and when he returned, the dinner 18 conversation was all about his day at the 19 greenhouse, until the New York State's Office of 20 Mental Health closed that program down and locked 21 the doors. 22 My son lost his job. 23 You all have your jobs. 24 My son had his, and they closed it down. He 25 lost his source of pride. 1 That plot of land on the grounds of our 2 psychiatric center was his office, and they closed 3 it down. They closed it right down. 4 They closed down other work programs too, and 5 now it is the psychiatric center itself being 6 targeted. 7 While my son remains stable, doing jigsaw 8 puzzles, working out in his gardens, listening to 9 music, I worry. 10 If you are a parent of a child who is 11 chronically ill with any illness, you worry. Even 12 if your child isn't sick, you worry. 13 Are those strong anti-psychotic meds too 14 strong? 15 What will happen to him when I'm gone? 16 Will he end up wandering the streets? 17 Who will answer his endless questions? 18 Who will reassure him that his face is not 19 elongated, or his right side is not bigger than his 20 left, or he won't grow so tall that he won't be able 21 to fit in the car, let alone the house? 22 Who will listen about him having wings and 23 special powers, and that God is his father? 24 What will happen if he needs inpatient care? 25 And so on. 1 You need to know there is flip side to my 2 son. He has the ability to analyze the situation 3 and solve it in seconds. 4 He told me early on in the Iraq war, there 5 were no weapons of mass destruction. 6 The Sunday night when we heard that 7 President Obama was going to speak, my son 8 nonchalantly told me that we probably got Bin Laden. 9 My son is a superb artist. 10 And, somehow, after the hell he continues to 11 live, he has a wonderful sense of humor. 12 You see, when one suffers from a brain 13 disease, it doesn't mean that person should be 14 feared or left to fend for himself. It only means 15 their brain is wired a bit differently. 16 This could happen to my brain, this could 17 happen to anyone's brain. 18 And if it happened to a loved one of yours, 19 what would you do? 20 How would you feel about this plan if it 21 affected your family? 22 Thank you. 23 ROBERTA HAGERTY: I'm Roberta Hagerty. I'm, 24 first and foremost, mother of Dennis. 25 I'm a retired senior budget analyst from 1 Fort Drum. I'm a former volunteer executive 2 director of the Mental Health Association in 3 Jefferson County at the time of reinvestment 4 funding. 5 My son suffers from chronic paranoid 6 schizophrenia. Having more than 40 years' 7 experience in eight different hospitals, 8 four states, and various community and peer 9 initiatives, I can tell you about the old, the new, 10 the good, the bad, and indifferent treatment and 11 services. 12 There are no words to tell you how much 13 families suffer -- feel as they deal with lack of 14 knowledge, stigma, and hopeful denial. 15 Dennis says, "You cannot imagine what it's 16 like to be -- not be able to control your own mind." 17 The beginning of chronic mental illness is 18 insidious and ever-more frightening for the patient. 19 As a distorted reality builds in his or her 20 mind, an individual will not, then cannot, ask for 21 help. 22 That responsibility falls to family or 23 friends. 24 Not knowing what to expect, a pick-up order 25 brings two or three policemen as first responders. 1 By law, Dennis is put in handcuffs and taken to the 2 local hospital. Frequently, he must stay local, 3 waiting for a bed at St. Lawrence. For his safety, 4 and hospital liability, he is transported by 5 ambulance staffed by two or three squad members. 6 For people like Dennis, other than expensive, 7 court-ordered, forced treatment, no amount of 8 community mental-health services will prevent this 9 from happening again and again. 10 In July, I wrote a letter to Mayor Nelson, 11 with a copy to Charles Kelly. I berated the task 12 force for whining about the transportation and 13 distance. 14 Living in Watertown, halfway between 15 Ogdensburg and Syracuse, my primary issue was not 16 miles or jobs per se; it was, and is, quality of 17 treatment and services that have evolved over 18 100 years at St. Lawrence and in the city of 19 Ogdensburg. 20 Trying to understand the task force concerns, 21 I put a large map on the wall. As I stared at it, 22 questions we all need answered came to mind. 23 I trust you will give serious thought to each 24 question and the consequences of each answer. 25 If my son must wait for an available bed, why 1 are you closing St. Lawrence? 2 If local hospitals, like Claxton-Hepburn, 3 must increase waiting beds, why are you closing 4 St. Lawrence? 5 If rural police, already understaffed and 6 underfunded, are dealing with mental-health pick-up 7 orders, who is available to cover accidents and 8 other enforcement -- law-enforcement emergencies? 9 If rural ambulance squads, already 10 understaffed and underfunded, are tied up for hours 11 transporting mental-health patients to Syracuse or 12 Utica, who is available for accidents and other 13 medical emergencies? 14 A two- or three-hour distance is more likely 15 to be a five- or a seven-hour round trip. 16 Since real brain research is done under 17 controlled and voluntary conditions at such places 18 as National Institute for Mental Health, and 19 McLean Hospital in Belmont, Massachusetts, why 20 would you send any mental-health patients to a 21 hospital that, according to its website, is 22 primarily focused on being a fertile training 23 ground, rather than a center for therapeutic 24 treatment, leading to stability and potential 25 recovery? 1 How could you think that the sending of a 2 frightened child far from home would not adversely 3 impact his or her treatment? 4 Do you truly believe that an e-mail or a 5 Skype visit can replace a hug? 6 In the 1980s and '90s, bed reduction, 7 followed by reinvestment in communities, was an 8 exciting concept like fireworks that flourished and 9 fizzled. 10 But, in Ogdensburg, beginning with inpatient, 11 then supported by St. Lawrence and New York 12 Association for Psychiatric Rehabilitation Services, 13 community and peer services continues to grow. 14 Whatever your decision, we are all dependent 15 on taxpayers: that's you, and me. 16 Human and fiscal responsibility dictates we 17 put our tax dollars to work expanding valid existing 18 outreach services, not in creating further economic 19 stress, and perhaps danger in our rural communities. 20 Thank you. 21 [Applause.] 22 KARIN E. RICHES: Hello, name is 23 Karin Riches. 24 I actually came from the Buffalo area. 25 I came that far because this Committee was looking 1 at shutting down beds, and that is really passionate 2 to me, because my son has paranoid schizophrenia, 3 and, also, severe PTSD. 4 My son Jacob has been in special education 5 throughout his school years. In spite of his 6 special needs, Jacob worked part time in a 7 restaurant from age 16 to 18. 8 Upon graduation, Jacob worked full time until 9 age 27. This is when he began to change. Anxiety, 10 increased delusions, hallucinations, self-injury, to 11 threats of violence. 12 As an ICU nurse, I only took care of people 13 until they're stable, then we sent them to the 14 floor. 15 I had no idea where this journey was going to 16 be, and I still don't. 17 This is the negative stuff, called "stigma," 18 that needs a lot of work. 19 I went to his primary doctor, to only be 20 accused of not handling my son correctly, and that 21 maybe I just wanted to medicate the problems. 22 Upon going to our local hospital with psych 23 intake, I was told, "Take him home and call his 24 psychiatrist." 25 Jacob didn't have a psychiatrist. He had to 1 wait for almost six months on a list. 2 Jacob continued to cut his arms and wrists so 3 deeply that the ER doctor said he missed his artery 4 and tendons by a hair. 5 As a nurse, I could see his tendons and 6 arteries as it pulsated in his arm. 7 We then, after that was stitched up, went 8 over to psych intake, only to be told there's not 9 enough beds. 10 Jacob went to psych intake about 15 times. 11 I was told to go to a psych doctor. 12 When he was finally accepted by a psych 13 doctor -- 14 Hang on one minute. 15 When he was finally accepted by a psych 16 doctor, uhm -- okay, the doctor told -- I'm sorry. 17 My computer went down last week, and I had a 18 lot of problems typing this up. 19 ASSEMBLYWOMAN GUNTHER: Just go slow, it's 20 okay. 21 KARIN E. RICHES: The doctor -- okay. 22 I went back and forth continuously, going 23 from the staff at the doctor's office, saying that 24 he was too sick to be -- dealt with anything into 25 his office, so, they recommended me to go to the 1 psych hospital. 2 And the psych hospital said, "Absolutely not. 3 He has to go back to his doctor." 4 And, there, I would flip-flop for at least 5 six months. 6 Okay? 7 One time, he would -- one of those times 8 I brought him home, and it only took him about 10 to 9 20 minutes, I found him on the top of my roof of my 10 house, because -- 11 [Pause.] 12 -- he wanted to fly like an angel; that he 13 was seeing his brother. 14 His brother died about two years prior to 15 that, because he also had neurofibromatosis. 16 And he wanted to fly like his brother. 17 I had no one to call. 18 You see, we was involved in serious 19 domestic-violence issues years prior with his dad, 20 and the local police there told us that they do not 21 deal with mental issues. 22 I was concerned about a possible rape that my 23 son, with my ex, what he had done to my son. 24 The domestic-violence unit said if I called 25 the police, and went to court, on Jacob, then the 1 jury would see me as a mom wanting attention, and 2 then I would be jailed. 3 I was told that police do not deal with PTSD 4 or any mental issue. 5 I didn't know who to call. This was new for 6 me. 7 So we stayed on the roof for hours and hours 8 with Jacob, until I got him down. 9 But he wasn't -- a couple hours prior to 10 that, he was not sick enough to be hospitalized. 11 Jacob wanted help, but he was continuously 12 turned away. 13 Jacob went missing in the city of Buffalo. 14 Thanks to the Buffalo PD, they found him 15 hours later. He was hiding in -- he was hiding in 16 Friday's restaurant. He was afraid that his father 17 was going to get him. 18 Jacob used to hide in his closet and sleep in 19 his closet so his father couldn't find him. 20 Time went on, Jacob finally got into a psych 21 hospital. This happened when Jacob started pulling 22 fire alarms in the local hospitals. 23 His father used to teach the boys how to burn 24 things and start fires in the house. 25 Jacob spent three months before he was 1 actually diagnosed with his first visit. In his 2 first visit, they did diagnose him with severe PTSD. 3 It took another two visits in the hospital, 4 a couple of months each, to be able to get the 5 diagnosis of paranoid schizophrenia on top of that. 6 Being that he's got Medicaid, there is no 7 help for PTSD. It's a very specialized counseling, 8 and only if you're a veteran, you're allowed help. 9 But he's on Medicaid, Medicare, and there is 10 no help for PTSD. 11 So I do thank God for those hospital visits. 12 Jacob was tried with cheaper psychotropic 13 drugs, 'cause new legislation with Governor Cuomo 14 said that people on Medicaid is not allowed on your 15 higher tier of medication. 16 So, he went on slicing his wrists, being very 17 violent. 18 It took another four or five months before he 19 was allowed to go on to other medications. 20 Jacob now thinks that he's the devil. This 21 was two weeks ago. 22 His doctor's office said that he was way too 23 sick to deal with him, and due to his aggression, he 24 needs to be seen by the ER. He needs to be -- go to 25 that hospital. 1 He engraved "666," not into his skin of the 2 knuckles, to the knuckle, he engraved. He believes 3 he is satan. 4 He has taken his aggression outward now, and 5 I am very worried. 6 His dad used to teach the boys how to kill. 7 My ex-was very sick. 8 I did finally get the boys away from the 9 father, but not until they were about 9 years old. 10 And then he spent another 10 years stalking us. 11 Jacob communicates better if you write to 12 him. 13 The intake doctor said, "No, that's fine, 14 I just need to speak to him. He don't need to 15 write." 16 He said he was fine, so he sent him home 17 again, only to put his head through a window, and 18 broke two of the other windows with his fists. 19 Senator Ritchie, will you -- you wondered 20 what happens to people that don't get beds? 21 This is what you deal with; and, yet, I still 22 have to go out and maintain a full-time job in 23 between all this. 24 So we continue to watch as -- okay, as the 25 doctor said, to "send him home," the psych hospital 1 intake room, when I went there at ECMC. 2 Buffalo General was a little bit easier 3 taking in a child -- a young adult, he's 30, that's 4 handicapped. 5 I went there to ECMC, and I've been there at 6 least 15 times. It looked like a third-world 7 nation. There were people laying on bare tile 8 floors, with only sheets over them, because they 9 were waiting in line to get a bed. 10 In the Intake Number 3, there were seven 11 patients lying on the floor, two of them had their 12 legs up on the wall just so they could get some rest 13 in there. 14 And this bothers me, not only as a mom, but 15 as a nurse. 16 And some were wandering in just a very small 17 area. 18 Jacob feels he is becoming his father, and 19 that there is not much hope. 20 The State wants to close beds. 21 Center of excellence is supposed to be 22 center patient-driven. 23 50 percent of schizophrenics and 40 percent 24 of bipolar patients have is what's called angano -- 25 I can't say this word -- "anosognosia." 1 This is a belief that they are not sick, and 2 unaware of their brain disease. This comes from 3 impaired right hemisphere frontal-lobe damage. 4 They can't advocate for themselves. Many 5 don't take their drugs, and they don't believe 6 they're sick. 7 Again, the severely mentally ill are not 8 helped until they are reached -- until they reach 9 the courts and they are jailed. 10 As a nurse, we take care of people that can't 11 breathe, have chest pain, perhaps a broken bone or 12 two. 13 In America, we jail our mentally ill. That's 14 where I'm afraid my son is going to end up. 15 Helping the severely mentally ill does not 16 make the news. Only when they kill someone, then it 17 does. 18 And if you guys can do anything, trauma 19 counseling would be good on Medicaid. 20 ASSEMBLYWOMAN RUSSELL: Yeah, I get it. 21 KARIN E. RICHES: Because this -- we, us 22 three -- my son Jason was so terrified to die, to 23 leave me and Jacob non-protected from his father. 24 We, all three, have PTSD. 25 I've gone through counseling for, like, 1 seven years, and on meds. And I've learned how to 2 deal with a lot of it. 3 I have to, as you see, I've work in an ICU 4 for the past 17 years, because I was determined not 5 to have that slow me down. 6 But, my son has multiple issues. He can't 7 handle it. 8 And I think it's not the schizophrenia, but 9 I think it's the trauma that's going to put him into 10 jail. And I have no hope for the system. 11 I'm sorry. I know you guys work for the 12 system -- 13 ASSEMBLYWOMAN RUSSELL: No, we don't. 14 KARIN E. RICHES: But I don't have hope. 15 ASSEMBLYWOMAN RUSSELL: We work for you, not 16 the system. 17 RICHARD HALPIN: I'm going to let the next 18 gentleman testify. 19 KARIN E. RICHES: Okay. 20 ASSEMBLYWOMAN GUNTHER: And then if anybody 21 wants to have any questions of you. 22 I'm sorry. 23 RICHARD HALPIN: What they said, because the 24 stories are very common. 25 My name is Richard Halpin. I am from 1 Watertown. I'm a retiree from Jefferson Community 2 College, and from the Cornell Cooperative Extension 3 system. 4 One of the reasons I retired, is so that 5 I could spend the time that my daughter needed; 6 needed some full-time attention and support. And 7 how privileged, it was a circumstance that I could 8 do that. 9 I speak to you today primarily as a father. 10 I know the agenda mentions that I'm a member 11 of the Community Services Board in Jefferson County. 12 I am, as I -- 13 Thank you. 14 -- as a representative of -- what am I trying 15 to say? -- one of those people that are in the 16 system. 17 But, I'm on the Community Services Board 18 because I am the father of a beautiful, smart, 19 precious daughter who is mentally ill; severely and 20 persistently mentally ill. 21 She is Bipolar I, with schizo-effective 22 disorder, and it's an incredible challenge to try to 23 manage that. 24 My comments are mine, not the 25 Community Service Board's. 1 I know you know this, but we have to say it 2 again: Mental illness hurts. Profoundly, 3 profoundly hurts. 4 Take the worst dental pain you can imagine, 5 magnify it by any number you want. 6 Mental illness turns the world gray. It 7 turns the world dull. It turns the world cold. 8 Mental illness takes away from people, the 9 capacity to feel happiness, joy, or hope, any sense 10 of accomplishment. 11 Mental illness takes away from people, 12 vision, and aspirations. 13 Mental illness takes away from people the 14 ability to even manage their lives. 15 And so, somebody, often a parent, takes that 16 role as best they can. 17 Mental illness often kills. 18 "Mental illness often kills." 19 Mental illness stole my daughter's 20 adolescence, and it fractured our family, but 21 I've also learned this: With good treatment; with 22 courageous, insightful, wise treatment providers, 23 and a reliable system of care, the worst aspects of 24 mental illness can be mitigated. 25 New York State is currently planning to 1 consolidate, and the numbers I saw, include further 2 reducing the number of beds available. 3 This is unimaginable to me, to do this. 4 It's often nearly impossible to get into a 5 hospital now. 6 My daughter, when she was 15, spent a week in 7 Samaritan Medical Center, in a general room, with 8 this nice lady crocheting something, watching her. 9 She was a watcher. 10 That's what they call it, "watchers." 11 And somebody had to watch her 24/7. 12 And it took her a week to find a youth 13 placement. And when they found that, it wasn't 14 here, but, in fact it was in Saratoga Springs. 15 They said, "You want to go away?" 16 We said, "You bet we do. We're out of here." 17 And off we went in the ambulance, after a 18 week sitting in Samaritan, knitting sweaters. 19 There's a supply-demand problem right now 20 with psychiatric beds, and there's little to suggest 21 that this Center of Excellence proposal can do 22 anything other than exacerbate that. 23 How can this Center for Excellence be other 24 than a disaster for the people, for the communities, 25 for individuals involved? 1 I'm going use a phrase that my daughter used, 2 and I'll pass it along you to. 3 She said, "Dad, this is a crazy plan," 4 intended. 5 It is. 6 It is. 7 For severely and persistently mentally-ill 8 people, careful medication management is crucial, 9 talk therapy is necessary, group therapy is 10 essential, some kind of social-support network is 11 imperative. 12 And even with all of that, and as we've heard 13 often, that's not there. 14 At the foundation of the core of that, a 15 hospitalization is sometimes absolutely necessary. 16 Over the past 7 years, my daughter has been 17 hospitalized 13 times, for periods ranging from 18 4 days to well over a month. Many of these 19 hospitalizations were in a facility over 200 miles 20 from our home, although some were here in the local 21 region. 22 Now, fortunately, we had the means, and the 23 ability, to get her to the hospital, or, when she 24 went by ambulance, we were able to visit her 25 regularly. 1 That is not universally the case with 2 everybody, certainly, across northern New York. 3 We were fortunate, and I'm thankful for that, 4 but I recognize that that isn't universally the 5 case. 6 During hospitalization, you need to 7 understand, from my perspective, the patient is 8 safe. The patient, she doesn't feel confined, she 9 feels safe. 10 She has the space to gather herself, to 11 reboot emotionally and psychologically. 12 Intensive treatment can occur in a 13 24/7 environment that's just not possible in a 14 community setting. 15 She is surrounded by other patients who 16 understand, because they have the same issues. 17 So instead of being on the outside of society 18 kind of looking in, and feeling awkward, she is, for 19 once, in. She has this community of peers 20 momentarily. 21 The value of that cannot be underestimated. 22 She does not have to be embarrassed or 23 ashamed about her illness. And, ideally, she's also 24 surrounded by a rich array of specialists who bring 25 experience and wisdom to her treatment. 1 Now, I say she's been in a hospital 13 times. 2 You say, isn't that a hospital failure? 3 And the answer is, absolutely not. 4 And your metaphor of the chiropractic visit 5 is right on the money. That's exactly what folks 6 need. 7 They can get a little better. And, 8 sometimes, stuff slips. And without the opportunity 9 for hospitalization, that can't be corrected. With 10 it, it can. 11 Hospitalization is critical to an effective 12 mental-health system. 13 I'm happy to tell you, and almost embarrassed 14 for my friends here, that my daughter appears to be 15 recovering after these seven years. 16 Not getting over it, not like you get over 17 cold or you get over measles, or whatever, but 18 I think she's finding a way to manage, and she's 19 reembracing her life. 20 She takes, every morning, seven psychiatric 21 meds, heavy meds. She sees a psychiatrist weekly. 22 Who has that advantage? 23 And she sees a therapist weekly as well. 24 And without all of those pieces, it all -- 25 it's too fragile. 1 But, it's working. 2 She's on Social Security Disability, and 3 she's in school, believe it or not. 4 And with the help of VESID, which has been 5 invaluable to her, and I need you to know that, 6 I think in another year, she may actually be in a 7 position where she is employable, and employed. 8 To even imagine this, four years ago, 9 three years ago, two years ago, would have been 10 beyond the pale. 11 So friends of mine, it can happen. 12 "It can happen." 13 Two things about the discussion of this 14 initiative I want to strongly address: 15 One is, while I understand and I empathize 16 with folks, I believe, we believe, that this issue 17 has been framed as a jobs issue, to excess. 18 Please, the point here is not about economic 19 development. The focus here is not about jobs. 20 Those are ancillary benefits, I suppose, but 21 the goal of a mental-health hospital, the 22 psychiatric hospital, is to assist people to get 23 well. 24 And I ask you, please, to focus on that 25 first, not second, and not third. 1 Kelsey -- oops -- my daughter said this, she 2 said, quote, "The workers in the hospitals are 3 dependent on their jobs for their incomes, but the 4 patients in the hospitals are dependent on the 5 hospitals for their lives." 6 This is not an exaggeration, so let us have 7 the right discussion about this initiative. 8 Let's talk about the impact on the lives of 9 mentally-ill people, and let's quiet the noise some, 10 about some of the peripheral issues, please. 11 The second, and I just need to say this, and 12 I'm sorry, I am personally offended by the hyperbole 13 of Centers for Excellence. 14 How in the world can a proposal that 15 (a) expands the distances; and, therefore, the 16 barriers, and (b) reduces the number of beds, be in 17 any lifetime, something that resembles excellence? 18 It's right out of -- it's right out of -- 19 it's Orwellian, isn't it? 20 The mislabeling of things, that idea that -- 21 double-speak, isn't it? 22 It's double-speak. 23 If you call a thing a different thing, and 24 you say it often enough, soon enough, people will 25 come to believe it. 1 I can't find a thing, in what I know about 2 this, that suggests that we're going to have a more 3 excellent system by the time we finish. 4 I think we'll have a less costly system, and 5 I understand the need for that. 6 And with that in mind, I'm in favor of 7 containing costs of government, but I'm also in 8 favor of ensuring that the pain of that is spread 9 around evenly. I want you to feel it and me to feel 10 it, and everybody to feel it. 11 And I want avoid temptation to burden those 12 who can least squawk about it. 13 The mentally ill don't have a good strong 14 lobby, if you will. 15 Please strive to maintain current levels of 16 access to hospitalization for mentally ill. The 17 option of hospitalization is at the foundation of 18 successful treatment for severely and persistently 19 mentally-ill people. 20 The existence of a safety net of accessible 21 residential psychiatric hospitals is essential. 22 Treatment can work, people can get better, 23 but it won't happen by just -- by just wishing it to 24 be. 25 Thank you so much for being here, thank you 1 so much for your tenacity, thank you for listening, 2 and your presence speaks volumes, but, please help 3 us. 4 ASSEMBLYWOMAN GUNTHER: That's why we're 5 here, Richard. 6 And I -- 7 [Applause.] 8 ASSEMBLYWOMAN GUNTHER: And I -- you know, 9 you're right, the most important thing is the care, 10 and the accessibility to care. 11 And we didn't mean to take anything away. 12 As my teacher friend -- 13 I forgot your first name back -- 14 VIRGINIA E. DAVEY: Ginny. 15 ASSEMBLYWOMAN GUNTHER: -- Ginny back there, 16 I mean, her tears were for the children that won't 17 get what they need. 18 So I didn't want to -- and, you know, you're 19 right, that's primary here. 20 RICHARD HALPIN: But you're right. 21 I've heard people talk today whose first 22 interests may be job-related, but who clearly have a 23 sense of need of the welfare of the folks as well. 24 So I don't mean to disparage anybody, but, 25 the focus is on the patients. 1 ASSEMBLYWOMAN GUNTHER: You're right, 2 Richard. 3 SENATOR LITTLE: You know, one of you asked 4 the question, What would you do if it was your 5 child? 6 And I just want to say, I would do exactly 7 what you're doing. 8 And I want to thank you for being here, for 9 sharing your story; having the time and the courage 10 to come, and talk about how this -- these 11 psychiatric hospitals have helped your children. 12 And you're what's making a difference. 13 So, thank you very much for being here. 14 ASSEMBLYWOMAN GUNTHER: And, Karin? 15 KARIN E. RICHES: Yes? 16 ASSEMBLYWOMAN GUNTHER: You know, I just -- 17 there's experts in the audience here, and they might 18 be able to direct you, to see if you could get the 19 help that you need. 20 Obviously, you need an advocate, because 21 you're not getting the services you need for your 22 son. 23 And there's got to be somebody in the 24 audience that knows a lot more than I do. 25 And if not, you know, you know my name, and 1 if you call our office, we'll help you. 2 KARIN E. RICHES: Okay. 3 ASSEMBLYWOMAN GUNTHER: You know, we're 4 pretty good at that. 5 KARIN E. RICHES: You know, I just want to 6 say one last thing, real quick, on beds. 7 That doctor told me, he said, "We have to 8 worry who has a home to go to, and who don't. He 9 has a home to go to, so that's why I'm discharging 10 him." 11 But it wasn't based on psychiatric need. 12 ASSEMBLYWOMAN GUNTHER: Well, I'm sure 13 there's somebody in the audience that's an expert, 14 that might be able to help you, because I just think 15 you need a little help to get where you need to go. 16 KARIN E. RICHES: I want to thank you for 17 your time. 18 ASSEMBLYWOMAN GUNTHER: Thank you, guys. 19 [Applause.] 20 ASSEMBLYWOMAN GUNTHER: Okay, now we have 21 Panel 15: John Burke, Frank Spotswood, and 22 Douglas Jones. 23 Are we here? 24 ASSEMBLYWOMAN RUSSELL: Welcome, gentlemen. 25 Look likes we're missing one, but we will go 1 ahead, and, whoever would like to start, please do. 2 JOHN BURKE: I'm John Burke. I retired from 3 Binghamton as the director of inpatient psychiatric 4 services. Most of my career was spent with 5 St. Lawrence Psychiatric Center. I started in 1968 6 as a therapy aide, and had the pleasure of working 7 under some -- 8 UNNKOWN MALE SPEAKER: Can't hear you. You 9 have to speak up. 10 JOHN BURKE: Oh, I'm sorry. 11 I had the pleasure of working under some 12 wonderful directors who truly advocated for quality 13 of care. 14 This is -- this is very upsetting to me. 15 When I -- even though I'm retired, my heart 16 has always been near and dear to the people that 17 need our help. 18 And, I guess, I -- I have a little thing to 19 read. 20 OMH has attempted to market this plan as a 21 strategy for improving care that appears to be based 22 on the premise that if you close hospital beds and 23 reallocate resources to urban hospitals out of the 24 area, with the promise of expanding community care, 25 you will need fewer hospital beds for the most 1 seriously ill. 2 Thank goodness this line of reasoning hasn't 3 been embraced by general hospitals, with the promise 4 that if you close hospital beds and reinvest some of 5 the savings, that -- in the community care, that 6 this will be good for the seriously ill and their 7 families. 8 And there was a mention here today, that -- 9 and, certainly, by the Office of Mental Health, 10 about the cost of hospitalization, that I believe 11 they used the statistic that -- that 20 percent of 12 the OMH funds goes to 1 percent when they're 13 hospitalized. 14 But, that by no means is out of the norm. 15 I mean, general hospitals, usually it's, 16 33, 34 percent of the total health-care expenditures 17 goes to a stay in the general hospital. 18 So, the -- and somebody mentioned thirteen to 19 fourteen hundred dollars a day for inpatient care in 20 a psychiatric hospital. 21 That truly pales in comparison with a stay in 22 the general hospital. I mean, it's a small amount. 23 Well, anyways, in the decades since the 24 Community Mental Health Center Act of 1963, 25 psychiatric hospitals have significantly decreased 1 capacity as more people were being treated in the 2 community. 3 Today, SLPC's hospital capacity is a small 4 fraction of what it was 50 years ago. The 5 facility -- the facility's capacity for 6 adults is 70, and for children it is 28. 7 Currently, because of this reduced capacity, 8 a large number of patients needing hospital care are 9 being sent throughout the state every year. 10 Not only is the present hospital capacity 11 inadequate, OMH's plan will eliminate this capacity 12 altogether for northern New York. 13 Access to psychiatric care is of paramount 14 importance to the citizens of northern New York. 15 All six county areas are officially designated as 16 "mental-health-professional shortage areas," and 17 most have had that designation for years, yet OMH 18 plans to remove access to hospital care and give our 19 resources away. 20 They are -- you know, the strange part about 21 this whole plan, is that they demonize large 22 hospitals, large psychiatric centers, and say that 23 it's from centuries past; that the theory of 24 providing treatment is age-old. 25 That is not the case with St. Lawrence 1 Psychiatric Center. 2 St. Lawrence Psychiatric Center has -- is 3 small. It's a relatively small hospital. 4 And their plan is to create larger hospitals. 5 You know -- I mean, figure that out if you 6 can. 7 It's -- yet -- you know, they criticize the 8 size of the psychiatric centers, but yet their plan 9 is to go -- from Hutchings, it's to go to 10 185 adults; and for Utica, it's to go to 11 90 children. 12 And they're giving one of our adult wards to 13 CDPC in Albany, supposedly, with a theory that 14 people from Plattsburgh, and that area, might choose 15 to access care in the Albany area. 16 The logic behind all of their argument seems 17 to fall apart, even by using their own words. 18 On their website, they did a needs 19 assessment, and you can see it there. It's dated 20 2011. 21 OMH did a needs assessment -- unmet needs 22 assessment, I should say. 23 And they talked about the rural population, 24 how they are disproportionately disadvantaged 25 because of barriers, such as lack of transportation, 1 lack of insurance, lack to -- lack of specialized 2 services. 3 Now, this is in their own report; yet, what 4 does their plan do? It further disadvantages the 5 rural populations. 6 Also in that report, and I would respectfully 7 ask that maybe you look into this, if you would, 8 they talk about state and federal laws that 9 guarantee equal access to care for all -- 10 [Technical difficulties.] 11 JOHN BURKE: -- New Yorkers. 12 Now, if there are state and federal laws that 13 guarantee equal access to all New Yorkers, how do 14 they reconcile that with the plan that they have 15 proposed? 16 It doesn't guarantee equal access. You know, 17 it creates barriers to access. 18 And how can they say one thing out of one 19 side of their mouth, and then something completely 20 different out of the other side? 21 And, if you were to present a business plan 22 the way they presented this plan, and you were to 23 tell somebody, that, We're going save $20 million in 24 the first three years, and we're going to expand 25 community services, we're going to shut down 1 15 percent -- 2 I believe that's the figure they gave you. 3 They said they're going to utilize 85 percent of the 4 current capacity. 5 -- and they're going to shut down 15 percent 6 of the inpatient beds, but, yet, this is going be 7 wonderful. It's going to be so good, that we're 8 going to call it "Centers of Excellence," I mean, 9 you know, I just can't imagine. 10 If I were asked to do a plan, and I came up 11 with a plan like that and presented it to OMH, you 12 know, I don't know what they would say. I think 13 they would probably laugh me out of the room. 14 Yet, here is this agency, responsible for the 15 mental-health care for the entire state, proposing 16 this plan, which has no substance. 17 You know, Where is the treatment? Where is 18 the rehabilitation? Where are all of the components 19 that go along with a good plan? 20 Where are they? 21 They've been absent during this whole 22 discussion, other than the promise that, Look, we'll 23 put together these committees, and we'll give them a 24 little window of opportunity to come up with ideas; 25 yet -- yet, look at who's chairing those committees. 1 You know, they maintain tight control of 2 this, but, they're trying to sell us on the fact 3 that this committee is going to put together such a 4 wonderful plan that other states will look to us as 5 leaders in mental health. 6 You know, it's just -- it's deceptive, at its 7 very best. 8 It's deceptive, and I hope you call them on 9 it, because it's wrong. 10 It's wrong what they've done for the most 11 disadvantaged population that we have in our state, 12 and it shouldn't be allowed. It's unfair. 13 And, well -- go ahead, Frank, take over. 14 I get a little emotional, because I have to 15 tell you, I'm angry, I'm really angry, with the 16 Office of Mental Health. 17 I can't believe they would have put forth 18 such an ignorant plan and expect people to embrace 19 it. 20 And the only people I see embracing this, are 21 the people who are looking forward to whatever 22 scraps of money are left over from the closure of 23 hospital beds, who are looking to see if their 24 agency can't get some of that money. 25 Those are the only people that I see somewhat 1 excited about this. 2 You know, people who know about mental health 3 realize that psychiatric-center care, hospital care, 4 is the heart of the mental-health system. 5 It's the heart of it. You have to have a 6 place to treat the most critically, seriously, 7 persistently mentally ill. 8 ASSEMBLYWOMAN GUNTHER: Okay, Frank. 9 FRANK SPOTSWOOD: Thank you for coming to see 10 us. 11 ASSEMBLYWOMAN GUNTHER: You're welcome. 12 FRANK SPOTSWOOD: My name is Frank Spotswood. 13 I'm a former staff member of SLPC, and I was 14 working there during our previous downsizing 15 escapade in the late '80s, instituted by 16 previous-Governor Cuomo, Sr. 17 I once again have been questioning the 18 rationale of our closure since it hint print a few 19 months ago. 20 I feel I'm qualified to talk you to about 21 this because, from the inside out, I previously 22 served in the capacity at SLPC as an RN nurse 23 administrator. 24 Now, that's a fancy name for a ground 25 supervisor on the midnight shift for the children 1 and adult inpatients. 2 I just retired one month ago after 33 years 3 of service. 4 My function as an RN ground supervisor was 5 the representative and liaison during the early 6 morning hours to the director of the facility, the 7 chief of service, the director of nursing, the 8 treatment teams. I was responsible for all movement 9 that are patient- and staff-related on the midnight 10 shift. 11 My role, also, was to handle all admissions 12 initiated by other hospitals whose patients were in 13 their ER, getting medically cleared, and with a 14 pressing need to be seen by us in our psychiatric 15 setting. 16 These patients were brought into their ER by 17 law enforcement, or by other hospital ambulances, or 18 family members that had a love one who was in dire 19 threat to themselves or others. 20 And in the admission process, be it mental or 21 medical, family support and involvement is extremely 22 important for the care of their child or adult 23 family member, as their unpredictable behavior needs 24 immediate attention. 25 The adult patient or child has exactly the 1 same needs for timeline treatment, due to their 2 unpredictability and impaired behavior. 3 In questioning the rationale for Albany 4 wanting to close the children and adult services of 5 SLPC, I can't unravel the logic. I really can't see 6 justification. 7 And I keep seeing and hearing the catch 8 phrase of these new academic buzz words, as the 9 state's goal is to want to create centers of 10 excellence in 15 other regional centers, but not 11 SLPC. 12 But what does that actually mean? 13 What constitutes the merit of arrogance for 14 other facilities to be called the new academic term 15 "Centers of Excellence" now, when they were never 16 considered to be before. 17 SLPC has proven themselves for over a 18 century. They have earned that title of 19 "excellence," the state credentials and 20 accreditations that were awarded by you: Albany. 21 The demonstration of an actual admission 22 process and legal protocol set by the State are 23 elaborate, concise, and cause insurmountable duress 24 to the patient and the family. 25 The role of the patient and family during a 1 child or adult admission needs complete support by 2 a conscientious treatment team of professionals made 3 up of psychiatrists, psychologists, psychiatric 4 nurses, ward staff, social workers, and 5 rehab specialists. 6 The burden of the financial obligations 7 alone, and emotional distresses for a child or adult 8 and their family, only to be sent 100 miles away, 9 many times in the middle of the night, to a strange 10 city where they probably have never been, especially 11 when they are in dire circumstances of mental 12 trauma, is unwarranted. 13 It's unwarranted, it's unnecessary, it's 14 unethical, to put these obstacles and mazes for 15 someone seeking treatment for themselves and their 16 loved one who are now in a frenzied emotional 17 crisis. 18 How [unintelligible] Albany star chamber can 19 make decisions of such magnitude with the flick of a 20 pen, without any consciousness whatsoever and 21 feeling, our SLPC closure is indicated, and faraway 22 [unintelligible] transports are beneficial for all 23 involved, is beyond comprehension. 24 And I keep asking myself in a ruminating 25 fashion, though, that if one of your panel had 1 family -- son, daughter, mother, or father -- that 2 came across a psychiatric problematic episode which 3 needed immediate constructive attention, wouldn't 4 they want to expediate [sic] efficient treatment, 5 and within a close proximity so they could be with 6 them? 7 You know, excessive distance, many times, 8 I've seen, especially with dysfunctional families, 9 and, is in, actuality, out of sight, out of mind. 10 As cold as that may sound, it's true, 11 especially with today's family dynamics. It's not 12 "Beaver Cleaver" no more. 13 Our local schools, private, and state 14 colleges, some ivy, have students that, many times, 15 warrant psychiatric attention due to an overwhelming 16 stressor, showing questionable signs of danger to 17 self or others on their campuses. 18 Many times these students are brought into 19 our facility, professionally screened, only to find 20 that admission isn't indicated. That student 21 immediately goes back, but, get outpatient treatment 22 with us first, expertly trained for follow-up. 23 In turn, these students, since they don't 24 need admission, don't jeopardize their educational 25 attendance, they can go forward without gaining an 1 elaborate stigma on campus, which, unfortunately, as 2 you know, would occur if their school involvement is 3 curtailed. 4 Has a consideration of transportation fees 5 for a private ambulette or ambulance services been 6 considered during this financial tallying? 7 This would prove to be astronomical for the 8 taxpayer to have to pay transportation fees to 9 distant facilities, considering many admissions may 10 be two a day or more. This would mean that each 11 separate trip, with each fully staffed at each 12 admission. 13 What is not general knowledge is that -- 14 unless you're hospital-oriented, is that patients' 15 admissions cannot ride together at any time, due to 16 insurance and legal purposes. 17 I read in last Tuesday's paper, in quote, 18 "That the cost of transportation would be another 19 unfunded mandate, with the cost having to be picked 20 up by the taxpayer." 21 It was documented as saying, in quote, "That 22 if patients needed to be transported to Syracuse or 23 Utica, your cost, upwards of $400." 24 Well, I'm not a numbers person, but I would 25 have to make a biggest bet that that transportation 1 fee alone, with trained staff would have to 2 accompany them, would be quadruple that, and 3 equivalent to taking a cab to Boston, and back, then 4 to New York. 5 The other factors to be taken into 6 consideration, if there was closure, would be: 7 Obvious employee-family stress, where wages 8 considered middle-age -- -class would be lost; 9 Crime rate would spike due to our patients 10 now avoiding needed treatment, because they no 11 longer want to go anywhere else, and we're not 12 there; 13 Domestic violence and drug involvement would 14 be considerably more noticeable to all of our law 15 enforcements; 16 And, your box stores, they'd bail, due to 17 lack of constructive sales. 18 And it all should be noted that, Fort Drum, 19 only an hour away, we were always there for them to 20 assist in their traumatic events, along with their 21 family issues. 22 I'd like to thank you for giving me the 23 opportunity to express my concerns, and the liberty 24 to say them. 25 But, again, while we're on the subject, if 1 you happen to need a center of excellence, we got 2 one two miles down the road. 3 [Applause.] 4 ASSEMBLYWOMAN RUSSELL: Well, just, John, 5 could I ask you a question? 6 You've been on the inside at the director 7 level; correct? 8 What did you do in Binghamton? Can you 9 remind us? 10 JOHN BURKE: Initially, director of 11 outpatient. Then I went as director of inpatient 12 services. 13 ASSEMBLYWOMAN RUSSELL: Okay. 14 And, you're familiar with the different types 15 of scoring -- 16 JOHN BURKE: Yes. 17 ASSEMBLYWOMAN RUSSELL: -- and I guess, 18 scores, or indicators? 19 Could you tell us what the history has been 20 with this psychiatric center here, versus others in 21 the state? 22 JOHN BURKE: Yes. 23 St. Lawrence Psychiatric Center, Binghamton 24 as well, Elmira, three of the facilities slated for 25 closure, consistently scored in the top four or 1 five hospitals. 2 ASSEMBLYWOMAN GUNTHER: In the state of 3 New York? 4 JOHN BURKE: In the state of New York. 5 On the management, there's two -- you should 6 probably ask for them from OMH, but, there's a 7 Management Indicator's Report. There's an ORYX 8 Report; O-R-Y-X. 9 And, there is also, you should look at the 10 overtime reports as well, because, St. Lawrence has 11 been consistently number one in the least amount of 12 overtime for the state. 13 You know, St. Lawrence, and it's been 14 mentioned here before, they have career employees. 15 There's a relatively low turnover of staff. These 16 are people that are truly dedicated to the care and 17 treatment of the mentally ill. 18 And, you know, if you look at -- you know, if 19 you look at the indicator report, you will see that 20 these facilities score in the top three, four, and 21 five positions. 22 St. Lawrence, historically, has been 23 number one outpatient productivity. St. Lawrence 24 has been number one quite frequently over the years. 25 So, that's information that -- again, to talk 1 about the business model, if you were going to 2 select a facility that should be called a "Center of 3 Excellence," shouldn't you look at the performance, 4 the past performance, of the hospital; all the 5 indicators that Office of Mental Health routinely 6 evaluates, shouldn't you look at that; and make that 7 information public? 8 You know, they talk about the need for 9 transparency. 10 Where is the transparency? 11 What went into their decision-making, other 12 than seeing a little statement about -- from 13 Kristin Woodlock, about, this was the most difficult 14 decision she's had to make? 15 Well, you know, that doesn't tell us anything 16 that went into the decision-making. 17 You know, it should be, and you mentioned 18 this earlier, Assemblywoman Gunther, that you like 19 the flow sheets; you like to see the data. 20 You know, that hard data that went into this 21 decision-making should be available for all of us to 22 see and examine, in a truly transparent system. 23 And if that were the case, they'd have -- 24 they would be hard-pressed to set -- to explain to 25 us why St. Lawrence was one of the facilities slated 1 for closure. 2 Because, it's one of the most cost-efficient, 3 highest-performing facilities in the state. 4 It just defies logic. 5 ASSEMBLYWOMAN GUNTHER: Well, you had 6 inspect- -- when you were a director of patient 7 services, you certainly had inspections in your 8 hospital. 9 JOHN BURKE: We did. 10 ASSEMBLYWOMAN GUNTHER: I mean, you know, you 11 had accreditations, whether it's the 12 Joint Commission, whoever it might be. 13 JOHN BURKE: Right. 14 ASSEMBLYWOMAN GUNTHER: So, I mean, those are 15 some of the things that we are definitely going to 16 look at and see, you know, we -- because there is -- 17 we've been looking, and we have seen, like, the -- 18 either, readmissions, this, that, and all that 19 information is important information. 20 Thank you very, very much. 21 [Applause.] 22 ASSEMBLYWOMAN GUNTHER: You're not related to 23 John Burke at Goshen? 24 JOHN BURKE: In where? 25 ASSEMBLYWOMAN GUNTHER: I went to John Burke 1 Catholic High School in Goshen. 2 I thought maybe you were a distant relative. 3 [Laughter.] 4 ASSEMBLYWOMAN GUNTHER: Okay, the next folks 5 are -- oh, just, is Connie here? 6 There was Connie and David, but David isn't 7 here. 8 SENATOR RITCHIE: No, Dave's here. He's 9 sitting in the back. 10 ASSEMBLYWOMAN GUNTHER: Oh, hi, Dave. 11 CONNIE SHANNON HARREL: He's not going to 12 speak. 13 ASSEMBLYWOMAN GUNTHER: You know, in terms of 14 time, if you'd get your paper, if you just want to 15 give the testimony in, you know, we want to listen 16 to you, feel free. 17 CONNIE SHANNON HARREL: Well, first, I want 18 to say thank you very much for giving us this 19 opportunity to share our perspective. 20 Today, I want to share the peer perspective. 21 And, I want to start by telling that you 22 I spoke at the listening tour, and I walked away 23 disheartened, because, no offense to anybody, but 24 the focus of that day was jobs. 25 I'm a big-picture girl, I understand the 1 importance of jobs, but I'm an advocate. And I was 2 disheartened at the listening tour. 3 But I have been refilled today, because, 4 today, the point has been quality of care, service 5 to the individual. 6 And I was terrified that that was getting 7 lost. 8 And today has given me back my hope, and 9 I thank you, and I thank everybody that has come 10 here today, because today was about my peers, and 11 the quality of their lives. 12 My name is Connie Shannon Harrel. I am the 13 contract coordinator for Step By Step, Incorporated, 14 of Ogdensburg. 15 Step By Step is a peer-run, not-for-profit 16 agency that provides a wide variety of services to 17 individuals 18 years of age and older, living in 18 St. Lawrence County, and recovering and living with 19 issues related to their mental health. 20 As a contract coordinator -- 21 I'm kind of not staying with this, but I'm, 22 kind of. 23 As contract coordinator, I am directly 24 responsible for the delivery of peer services within 25 Trinity, and at the three wellness centers in 1 Ogdensburg, Massena, and Gouverneur. 2 I have a firsthand picture of the quality of 3 services delivered by SLPC. 4 I am a fourth-generation Ogdensburg native, 5 and I am a third-generation mental-health service 6 provider. 7 As a child, I can remember the patients 8 walking down the street to go to Phillip's Diner. 9 As a child, I can remember the gentleman who 10 spent so much time next door visiting the family 11 that I thought he was their grandfather, only to 12 find out that he was a gentleman who worked on the 13 farms and lived at the St. Lawrence Psychiatric 14 Center, and came home regularly with the lady who 15 worked in rehab. 16 This city is a psych-center city. 17 We have 100 years of caring for people at 18 St. Lawrence Psychiatric Center. 19 When we talk about the importance of 20 community supports, and I strongly advocate for the 21 development of specific community services, we do 22 not have enough housing. We do not have enough 23 supportive housing, transportation, access to 24 services. 25 You can give me a list of 40 services, and 1 I'm telling you we don't have enough of it. 2 But what we've got is a committed community: 3 People who spend their whole lives working at 4 St. Lawrence Psychiatric Center, who go there with 5 the intention of staying there to retirement; 6 People who connect with the recipient of 7 service, who know them. Like Terri Langenmayer said 8 about Mike Spellman, "We know Mike's baseline." 9 It terrifies me to think of people I've known 10 and provided services to for 20 years, to end up, 11 they're lucky, in Syracuse. 12 'Cause what people forget to tell you is, if 13 you're in Claxton-Hepburn's ER, and you need 14 admission, and SLPC is closed, and there's no beds 15 in Syracuse, they're going to look at Buffalo. 16 And if there's no beds in Buffalo, they're 17 going to look further south. 18 It happens all the time. 19 I worked 12 years at the acute-care unit in 20 Claxton-Hepburn. I can't tell you how many times 21 I've seen people sit for days on end, looking for a 22 bed. 23 Closing this hospital is only going to make 24 that worse. 25 If you want to keep people connected to their 1 natural community supports, and to their family that 2 we all know is integral to their recovery, 3 St. Lawrence Psychiatric Center and the people who 4 work there are their family. 5 This community is their family. They're not 6 strangers. 7 You know, there are police officers here who 8 make sure, that when they pick somebody up for a 9 psych eval, that if that person is a smoker, that 10 they get a smoke before they go into the ER. Or 11 that get a sandwich. 12 The levels of care are -- you can't begin to 13 comprehend the levels of care that are provided by 14 this community. 15 Our agency has grown in 16 years primarily 16 because of our relationship with the psychiatric 17 center. 18 Our contracted services with them has opened 19 doors for us, for our agency, for the people that we 20 serve. It has given us credibility with other 21 community providers. 22 It -- St. Lawrence Psychiatric Center opened 23 doors to peer services 14 years ago. 24 When other psychiatric centers in this state 25 didn't know what a "peer service" was, we were it. 1 Well, then it was Bridgeview, I think, 2 because it was before I worked for them. 3 We were providing peer services before OMH 4 really started selling that dog, okay? 5 [Laughter.] 6 CONNIE SHANNON HARREL: And St. Lawrence 7 Psychiatric Center has the resources. It has the 8 trained staff, the committed staff, the community 9 commitment, to be the center of excellence that the 10 Office of Mental Health theoretically wants. 11 We have the connections to the economic 12 development, to the colleges. 13 I don't get it. 14 We are the living definition of a 15 "Regional Center of Excellence," but, clearly, we, 16 don't generate enough money or enough votes. 17 But the North Country clearly has a voice, 18 we've demonstrated that. 19 I hope that my community partners are far 20 from ready to give up on this. 21 I am fearful of the future that lays ahead 22 for my peers. 23 And I urge you to demand that the Office of 24 Mental Health and that Governor Cuomo not abandon 25 the North Country, not abandon the people here who 1 are good people. Good, hard-working, honest, 2 tax-paying people. 3 You know, we're the core of what this country 4 is about. 5 And, I know it's about dollars and cents, 6 I know it's about a statewide economy, but if you 7 allow them to abandon us, it's going to cost more in 8 the long run. 9 ASSEMBLYWOMAN GUNTHER: Connie, that's why 10 we're here today, to hear these testimonies. 11 CONNIE SHANNON HARREL: Yeah. 12 ASSEMBLYWOMAN GUNTHER: So, obviously, you 13 have some very committed -- 14 CONNIE SHANNON HARREL: Yep. 15 ASSEMBLYWOMAN GUNTHER: -- and interested -- 16 CONNIE SHANNON HARREL: You are very 17 committed, or you wouldn't be here and haven't been 18 here -- set here all day. 19 But I know these people by their first names. 20 ASSEMBLYWOMAN GUNTHER: I understand that. 21 CONNIE SHANNON HARREL: You know, and they're 22 terrified of the thought of this hospital closing. 23 They ask me, "What are we going to do?" 24 And I try to give them tools. You know, this 25 is what we have to do to try to stay out of the 1 hospital. 2 But inpatient care is always going to be 3 necessary for a small portion of my peers. 4 Sending them to Utica, to Syracuse, to God 5 knows where, is not going to help them, and it's not 6 going to help our community. It's not going to help 7 this state. 8 So, again, I urge you to have faith, and to 9 encourage the Office of Mental Health to have faith, 10 that the people here have the ability to provide 11 quality services to make a difference in the lives 12 of human beings. 13 ASSEMBLYWOMAN GUNTHER: Thank you very much. 14 CONNIE SHANNON HARREL: Yeah, thank you. 15 [Applause.] 16 ASSEMBLYWOMAN GUNTHER: Do you have any 17 questions? 18 Thank you. 19 CONNIE SHANNON HARREL: You're welcome. 20 ASSEMBLYWOMAN GUNTHER: Thank you for your 21 patience. 22 The sheriff. 23 KEVIN WELLS: Did you hear Mr. Kelly's 24 comment back there? 25 ASSEMBLYWOMAN GUNTHER: What did he say? 1 KEVIN WELLS: He said this is probably the 2 first full day the sheriff's had. 3 [Laughter.] 4 ASSEMBLYWOMAN GUNTHER: You're not 5 Mr. Kelly -- oh, Mr. Kelly. 6 ASSEMBLYWOMAN RUSSELL: Because he doesn't 7 include nighttime that you're working. 8 KEVIN WELLS: No, no, it doesn't include 9 that. 10 First of all, I'd like to thank all of you 11 for coming to Ogdensburg, and for listening to this. 12 I'm almost glad I went near the end, simply 13 because I got to hear it, and share it here with 14 everybody else here, I think. 15 So, I am going to do my darndest to not be 16 repetitive of some of the things that have been 17 touched on. 18 I'll send you something more detailed after 19 this, especially based on what you asked for 20 questions, possibly, so... 21 I sit here before you with 30 years of law 22 enforcement experience. I have done deputy sheriff 23 work, police officer work, been a supervisor, I've 24 been administrator, and I'm a lifelong resident of 25 this county. 1 And, throughout those years, I have had many, 2 many, many contacts with the St. Lawrence 3 Psychiatric Center. We used to refer to it as the 4 "state hospital." And, all of those which have been 5 positive. 6 And I have seen, you know, people in real 7 dire need, by working in law enforcement, and have 8 to, you know, transport them there, or transport 9 them to Hepburn. That I know, from Claxton-Hepburn, 10 they've made it over to the psychiatric center. 11 And -- but my part of this whole thing is law 12 enforcement. 13 So I'm sitting here, not only representing 14 myself, but also representing the other sheriffs 15 that are in the region, because as we talk about 16 this, this isn't just an Ogdensburg issue; this is a 17 regional issue. 18 This is a North Country regional issue that 19 stretches all the way to Plattsburgh, and across the 20 Adirondacks. 21 And so, I know when I speak, that I'm also 22 speaking with the voice of my other sheriffs. 23 One of the responsibilities we have as 24 sheriff is to run a county correctional facility. 25 And I know this was touched on earlier, but 1 as part of those responsibilities of running a 2 correctional facility, we have to wear multiple hats 3 as sheriff, and one of those hats we wear within the 4 correctional facility is, we run our own 5 mental-health units. 6 And, you know, we might not be providing the 7 clinical services ourselves, there's other staff 8 that do it, but, we're there, that's what we do. 9 Because, one of the dirty secrets that 10 people -- nobody wants to talk about is, as the 11 closure of facilities went down over the years, and 12 as where maybe there wasn't enough of a 13 community-based plan, that a lot of these people in 14 our communities that are dealing with mental illness 15 have ended up in our county correctional facilities, 16 and they've ended up in state prisons. And this is 17 across the whole nation. 18 This isn't just a New York problem; this is 19 across the whole nation. 20 We talk about it as sheriffs, every time we 21 get together. 22 We talk -- we have data that's sent to us all 23 the time. 24 There are surveys being done continually 25 among the sheriffs of New York, that are -- they're 1 asking about, How are you dealing with this, and how 2 are you dealing with that? 3 I have a correctional facility that, with all 4 the variances that come into the facility, we have a 5 bed capacity of 186. 6 As of this morning, when I came in here, we 7 had a population inside the facility of 172. 8 And out of that 172, 50 -- when I came this 9 morning, there was 55 people with inside that 10 facility that are being treat for some type of 11 mental illness in various levels. 12 Now, you know, that may be from the very, 13 very bottom, in somebody that's just having issues 14 in regards to the fact that this is their first 15 arrest; 16 Or, a family member -- which is an example 17 that's prevalent to us in the last day or two, a 18 family member just died outside the facility, so 19 it's an immediate thing, you know, where they're in 20 crisis. 21 But at the same time, it's all the way up to 22 those people that were sitting on one-and-one 23 watches; spending overtime, and sitting there, 24 one-on-one watches, and watching somebody that's a 25 complete suicide risk. 1 And then we have a forensic team that works 2 with Angela Doe, that you met earlier in the day, 3 the director of community services for the county. 4 You know, we have people from her staff that 5 come in and work in a forensic capacity, as doing 6 psychological work with our inmates. 7 And then at the same time, we have a nurse 8 practitioner that also works with the psychiatric 9 center, works with county mental health, that's 10 cross-trained in that way. 11 But the other thing that comes with it, and, 12 you know, you heard the legislators and you heard 13 the county administrator wanted to talk about budget 14 issues, well, comes the fact that, you know, one of 15 the things we spend within a county correctional 16 facility is for medications, and the majority of 17 those are the psychotropic medications that, out of, 18 probably, the hundred and twenty-five to 19 a hundred and forty thousand dollars a year we spend 20 in meds, probably 60 percent of those go to some 21 type of psychiatric meds, that help us manage the 22 facility, and provide the help that these people 23 need that came into our facility. 24 These people come to us based -- you know, 25 based on crimes that they committed in a community, 1 but what were those crimes? 2 That's what you have to look back, and what's 3 the basis for those crimes? 4 A lot of it is because their mental illness 5 is being masked by the substance abuse of illegal 6 drugs or prescription meds, is what the majority of 7 it is that comes forward. 8 And, so, you know, people are coming to us in 9 many ways, but there's an underlying reason that 10 everybody does everything. 11 And if you went into our facility and looked 12 at why everybody was there, most of it goes back 13 somewheres to the level of some type of abuse of a 14 medication or a drug. 15 You know, in this county, lately, instead of 16 prescription meds, it's starting to turn more 17 towards heroin and crack cocaine. 18 But, you know, it's being -- it's masking 19 some other behaviors, masking some other problem, 20 whether, you know, something happened in their 21 childhood, to -- you know, to a mental illness. 22 We as police officers deal with mentally ill 23 on domestic incidents, because things happen within 24 families, that nobody's getting treatment for, 25 nobody's talking about. 1 But when we go there, and we to go a domestic 2 incident, it's the child that's in the middle of the 3 domestic incident, it's one of the parents that's 4 got a mental illness. 5 We're doing mental-health pick-up orders as 6 law enforcement across our communities, and those 7 come from the director of community services, they 8 might come directly out of the psychiatric center, 9 they may come from an emergency room doctor. 10 Those are people that all have the power to 11 sign those, uhm -- 12 ASSEMBLYWOMAN GUNTHER: Orders. 13 KEVIN WELLS: -- orders to -- yeah -- to 14 mental-health pick-up orders, to -- for law 15 enforcement to act to make that civilian arrest. 16 We deal with the director of community 17 service. 18 We're on the phone with her, probably, at 19 least three days a week, where, she's on the edge of 20 signing a pick-up order; or, we as law enforcement 21 have come -- have encountered somebody that we know 22 of, or through an incident or complaint, where we 23 need that director of community services to sign 24 that order; or, we're just acting as police 25 officers, because that person in front of us is a 1 threat to themselves or others, and they're 2 demonstrating that in front of us, and we make that 3 arrest then. 4 We, as a correctional facility, deal with the 5 mentally ill. Sometimes we can't deal with them in 6 the -- inside the jail, so we end up transporting 7 them to Marcy Psychiatric Center. 8 And for those of you familiar with Marcy, or 9 not, Marcy is a state-ran facility that has security 10 provided by the county sheriff for that county. 11 So out of that, we -- you know, we'll send 12 somebody there. That's not something that you ever 13 plan in your budget. You just know that there's a 14 possibility that, at some point, it's either going 15 to be court-ordered, because of an evaluation, to 16 see if somebody is able to stand trial; or, the 17 person's going to be of such a high risk within a 18 county directional facility that the sheriff or -- 19 and the staff cannot deal with that person, so that 20 person ends up down in the Marcy setting. 21 ASSEMBLYWOMAN GUNTHER: And then you pay for 22 it? 23 KEVIN WELLS: And we pay for it. And then it 24 could be gone. 25 The one that we've had for this year cost the 1 county in the neighborhood of $100,000 for about a 2 six -- 6-, 6 1/2-month stay, and that's the 3 two bills; that's the one paying the sheriff for the 4 security of the facility, and the other one 5 providing the State for providing the services of 6 care that come with that. 7 And -- but that's the level, from that 8 entry-level person who may just be in crisis, to an 9 immediate crisis or a temporary crisis, to that 10 person that ends up in a Marcy-type situation. 11 And -- but, again, this isn't unique to us; 12 this isn't unique to St. Lawrence County. This is 13 across the state, is how this works. 14 One of the biggest things that we don't talk 15 about enough within this county, and something that 16 you would have heard from earlier in the day, and 17 you have his testimony from Chief Timmy Currier from 18 the Massena Police Department, who was here earlier, 19 is the amount -- the rising concern about the amount 20 of suicides within the North Country region. 21 Some studies up there, some surveys, are 22 showing that we could be three times the amount of 23 other parts of the state, and other parts of the 24 country, in the suicide rates and -- in this county 25 and in this region. 1 Many of us turn -- you know, a lot of people 2 out there turn their heads to this issue, but the 3 rise in suicides is alarming. 4 These are our people; these are our brothers, 5 our sisters, our friends, who very well have 6 untreated mental illnesses. They're hiding behind 7 other issues, such as substance abuse. They're 8 committing crimes. 9 They're screaming for help, and not all of us 10 are able to listen, because we're not hearing them. 11 We're being told that -- by the OMH and by 12 the Governor's Office that it's all going to be 13 about the services that are going to be provided in 14 our communities. 15 Well, I'm hearing from this group that's been 16 here all day, and prior to everything I was able to 17 find, that, what's this plan? 18 You know, what's this plan for this 19 community-based safety net that's going to be out 20 there if these services aren't available right here 21 in this region? 22 Because this hospital supports, and the 23 psychiatric center supports, not just Ogdensburg, 24 and not just St. Lawrence County, it supports a 25 region. 1 And, I'm in the people-moving business. 2 I move people; as an agency, we move people 3 for a living, and, as far as inmates. 4 And I've housed out, you know, 50 to, you 5 know, 60 inmates at a time, back before we built a 6 new correctional facility. 7 And so, you know, I know about moving them 8 around, and I just can't figure out how they expect 9 everybody to be trucking people all the way down to 10 Utica and Syracuse, especially juveniles that are 11 going to require somebody to be sitting right there. 12 Sometimes we've transported them to secure 13 facilities, when it wasn't so much maybe a mental 14 illness. It's just the fact that they just, you 15 know, committed a violent crime, or whatever. 16 It's a full-time -- that's a dangerous job. 17 And now you're going to talk about driving 18 through Tug Hill Plateau, and through the snowbelt, 19 and everything else that goes into that. 20 We intentionally, when we were housing out 21 inmates, quit using jails south of us, because it 22 was easier for us to go north of us, and into the -- 23 across the Adirondacks, most times, during the 24 winter to house inmates. 25 I just don't know how that's going to happen. 1 And then when it comes down to ironic -- the 2 most ironic thing I've heard all day, is they're 3 talking about Skype. They're talking about the 4 aspect of utilizing Skype for a parent to be able to 5 visit with their child, or an adult to visit with 6 their loved one, or whatever. 7 This is coming from a State of New York who 8 will not allow an inmate to be not transported to a 9 court and utilize the Skype system for the courts. 10 The way the law works, for anybody that 11 doesn't know, is, New York State law says, yes, you 12 can do video arraignments and video court process as 13 long as the inmate agrees to do it. 14 And the inmate never agrees to do it, folks. 15 They all want the road trip that comes with being 16 out of the jail. 17 So, we have pushed as New York State 18 sheriffs, we have pushed as other groups in state 19 and county -- the county associations of counties; 20 everybody has pushed, and we cannot get it through 21 the legislative process to allow sheriffs' offices, 22 district attorneys' offices, public defenders, and 23 the courts to all save time and energy and finances 24 by using a Skype or a videoconferencing system. 25 I am set up in a county correctional facility 1 to do it today. 2 Half the courts in my county are set up to do 3 it today. 4 Everybody is ready to do it today; the 5 technology's there, the technology's cheap. 6 But they want to do it for somebody that 7 just -- that they use it as reason that somebody can 8 go see their loved one that way, but they won't do 9 it for a county inmate? 10 That's just ridiculous. 11 ASSEMBLYWOMAN GUNTHER: I agree with you. 12 KEVIN WELLS: That's just ridiculous. 13 It's the most insane thing I've heard all 14 day. 15 So -- 16 ASSEMBLYWOMAN GUNTHER: Can I -- I just want 17 to go the origin of that telemedicine. 18 What that -- where that came from, was the 19 mental-health community. And it was areas like -- 20 one like I live in, or in areas, like up in Buffalo, 21 and it really -- it really was about having a 22 psychiatrist from a facility, sometimes it's very 23 hard to recruit psychiatrists. 24 KEVIN WELLS: Uh-huh. 25 ASSEMBLYWOMAN GUNTHER: So what happened was, 1 we wanted to be able to have a primary interact 2 with, you know, somebody that's a psychiatrist, and 3 that's their specialty, to be able to help them with 4 management of, you know, more difficult patients, 5 like, because the primary physicians are taking care 6 of so many of our psychiatric patients. 7 KEVIN WELLS: Sure. 8 ASSEMBLYWOMAN GUNTHER: So that's where the 9 telemedicine came from. 10 KEVIN WELLS: Sure. 11 ASSEMBLYWOMAN GUNTHER: That we would accept 12 the credentialing of the distant -- where the -- 13 where it -- where the site of origin, and there 14 would be distance. 15 So, we would accept their credentialing, so 16 we didn't have to do it in a rural hospital. 17 So that's why. It was to provide better 18 care. 19 KEVIN WELLS: Right. 20 ASSEMBLYWOMAN GUNTHER: And when we 21 couldn't -- we couldn't -- you know, it's very 22 difficult to get psychiatrists -- 23 KEVIN WELLS: Right. 24 And county jails across the state and across 25 the country use telemedicine for just that person, 1 for psych -- for -- to get that -- especially on a 2 weekend, where somebody's on a one-on-one watch, and 3 you just need somebody to say, do an evaluation of 4 it, to see if they need continue them on that watch. 5 And, so, they'll do that that way. 6 But we're also using it to get to emergency 7 room doctors, so jail medical staff can talk back 8 and forth. 9 ASSEMBLYWOMAN GUNTHER: Right. 10 KEVIN WELLS: You're also using it -- we use 11 it for the public defender and probation officers, 12 to talk to their clients so they don't have to come 13 to the jail. 14 Less movement we have in a jail is always 15 better. 16 And -- but, yeah, we're set up to do it 17 today. 18 But I just -- you know, it's the irony part 19 of it, that they want to do it for family members to 20 visit somebody in a, you know, remote psychiatric 21 center from where they live, so... 22 I'd like to finish up just by saying, that 23 the St. Lawrence Psychiatric Center has always been 24 a beacon of light for this region, and for the 25 people that it has treated. 1 I ask the State to reconsider, and put the 2 resources towards an area that can support growth of 3 a system, such as right here, and, a location that 4 already has the space, already has the workforce, 5 and already has proven their excellence. 6 I thank for taking the time to listen to this 7 message. 8 I encourage you to take back the message 9 that, this hospital, and all that it has done, and 10 all that it will do, does matter. 11 It does matter to this whole region. 12 It matters to a community, it matters to its 13 employees, and most of all, it matters to the 14 patients that it serves. 15 And I just urge you, it would be a travesty 16 not to have this facility here, for so many reasons. 17 I appreciate it. 18 [Applause.] 19 ASSEMBLYWOMAN GUNTHER: Sheriff, how far away 20 are you transporting inmates because your jail is 21 overcrowded? 22 KEVIN WELLS: Right. Today we brought back, 23 the only five inmates I have had housed out, and 24 that was from Washington County. 25 ASSEMBLYWOMAN GUNTHER: Okay. 1 And you said, you know, you can't really go 2 points south. 3 I'm assuming that would be -- 4 KEVIN WELLS: We've tried. We've housed in 5 Cayuga, we've housed in Montgomery, we've housed, 6 you know, points south along the thruway from us, 7 over the years. 8 We don't have that issue anymore. I mean, 9 the few inmates that we house out now, we're at a 10 point -- you know, I know Mr. Burns said something 11 about it being a brand new facility, we're housing 12 out. 13 Well, that's -- there's many reasons for 14 that. It's, mostly, the criminal justice system is 15 at a crawl. 16 But, you know, it's great facility. You 17 know, the facility is doing everything we 18 anticipated it to do. We just didn't build it, 19 probably, quite big enough. 20 ASSEMBLYWOMAN RUSSELL: Because there's so 21 many folks in there that are on medications, that 22 are committing crimes, that -- 23 KEVIN WELLS: Yeah, I mean, we do. You know, 24 we were averaging 140 inmates for the first couple 25 of years we were open, and now we're averaging 1 over -- anywheres from 168 to 175. 2 ASSEMBLYWOMAN RUSSELL: Okay. 3 And I guess, broadly speaking, you have to go 4 so far to house inmates because the closer jails are 5 all full as well? 6 KEVIN WELLS: Right. Jefferson County is 7 full, Franklin County is full, Lewis County is full. 8 And then, when you look at some of the 9 others, they're taking on federal inmates, and 10 that's what's filling up their capacities. 11 ASSEMBLYWOMAN RUSSELL: Because, 12 traditionally, a lot of federal inmates have been 13 housed in Jefferson County, and they're so full. 14 KEVIN WELLS: And, you know, and for people 15 that don't know a lot about county jails, and 16 they're picturing them in their mind, comparing them 17 to a prison: Unlike a prison, who knows exactly 18 what they're getting for their inmate, they're 19 already been, kind of, pigeonholed as to what that 20 facility is going to have, a county jail has to take 21 in both held and sentenced inmates: males, females; 22 minors and adults. 23 And everybody -- you have to find room for 24 everybody, and you have to classify them. And then 25 you have to keep certain ones away from others. 1 And, it's a complicated process. 2 ASSEMBLYWOMAN GUNTHER: You have folks that 3 you suspect are committing petty crimes because they 4 have nowhere else to turn? 5 KEVIN WELLS: Uh-huh. Without a doubt. 6 Without a doubt. 7 Or there's people just looking for help. 8 And we have people, my jail psychologist will 9 tell us that, as you're talking to her, she says 10 she'll have people that come in, that have committed 11 crimes, because they just figured they could get a 12 chance to talk to her again. 13 ASSEMBLYWOMAN GUNTHER: Thank you so much. 14 KEVIN WELLS: Yep. Thank you. 15 Thanks for your time. 16 [Applause.] 17 ASSEMBLYWOMAN GUNTHER: Okay, 18 Iggy Gillette-Ferguson? 19 Okay. 20 And after this -- after Iggy testifies, I'm 21 going to have Daniel Harradine and Laura Farr come 22 up together. They're both community members. Okay? 23 I'll take the two of them together. 24 IGGY GILLETTE-FERGUSON: Senator Little, 25 before you leave, I wanted to let you know that 1 "geographic discrimination" was identified by the 2 State of Ohio Supreme Court, in a means of 3 discriminating in school funding. 4 SENATOR LITTLE: Wow. Okay. Thank you. 5 And I apologize for leaving. 6 IGGY GILLETTE-FERGUSON: That's all right. 7 SENATOR LITTLE: The trip up was 198 miles. 8 I just looked, the trip home is 180. 9 So, I'm not sure I'm going to get there, 10 really. 11 [Laughter.] 12 SENATOR LITTLE: I must have gone the wrong 13 way someplace along the way. 14 But, thank you very, very much, and I will 15 catch up with the remaining testimony. 16 I apologize for leaving. 17 IGGY GILLETTE-FERGUSON: That's all right. 18 I've actually put in a hundred miles today to 19 get here. 20 ASSEMBLYWOMAN GUNTHER: And, again, if you 21 want to summarize, that would be great. 22 IGGY GILLETTE-FERGUSON: I think I will. 23 ASSEMBLYWOMAN GUNTHER: Okay, that will be 24 great. 25 IGGY GILLETTE-FERGUSON: Because 1 I understand. 2 ASSEMBLYWOMAN GUNTHER: You know, it's 3 important to me, but if you would. 4 We're losing people like -- 5 IGGY GILLETTE-FERGUSON: And I also want to 6 tell you, if you haven't stood up in awhile, please 7 stand up. Deep-vein thrombosis is a very real 8 issue. 9 ASSEMBLYWOMAN RUSSELL: We had cookies to get 10 our blood sugar back up. 11 IGGY GILLETTE-FERGUSON: Yeah, I had to run 12 back to Potsdam, and come back up, because I had a 13 class this afternoon. 14 All right, first of all, I'd like to say 15 I was really honored to be asked to give testimony 16 today, and I really thank you for the opportunity, 17 even though we're dwindling. 18 My name is Alana Gillette-Ferguson, but most 19 people know me as "Iggy." 20 I am an assistant professor at 21 Clarkson University, but I'm not talking to you 22 today from Clarkson University. I think you've 23 heard Provost Thorpe. 24 I'm speaking to you today as a citizen of 25 New York, a taxpayer, and a scientist, a very 1 different perspective from what I've heard today. 2 You have my testimony, so I'm going to 3 summarize some of this and not read it all. 4 First of all, the Office of Mental Health 5 keeps comparing us to different states. 6 Specifically, the last statement that they 7 made to this Committee on September 9th compared us 8 to California and Texas. 9 It was an impressive statement, but, I come 10 to a very different conclusion than they did. 11 In 2009, the National Alliance of Mental 12 Illness did a report. They did research. 13 They gave the United States an overall grade 14 of D for its delivery of mental-health care. 15 In that survey, New York State was given a 16 grade of B. 17 We were only one of six states that received 18 such a grade, and no state was given an "A." 19 The Office of Mental Health compares New York 20 with California and Texas, both of which received 21 grades lower than New York State's in this report. 22 It seems backwards to use these states as a 23 model to achieve better mental-health care for our 24 citizens when they are unable to provide it for 25 theirs. 1 My 6-year-old son came in while I was writing 2 this a while ago, and after reading it, reading what 3 I had wrote, he summed up the issue very eloquently 4 by stating, "According to this thinking, developing 5 nations don't have clean drinking water, so we 6 shouldn't have clean drinking water either." 7 ASSEMBLYWOMAN GUNTHER: Rah! for your son. 8 IGGY GILLETTE-FERGUSON: Is this the way we 9 want to save money? 10 I believe that New York taxpayers cannot 11 afford to move backwards in our care of 12 mental-health patients. 13 The Office of Mental Health is pushing for 14 the idea of community-based programs, yet they have 15 a record of not supporting these programs. 16 When I first moved to Potsdam in the summer 17 of 2006, there was a St. Lawrence Psychiatric Center 18 child psychologist who had an office in the Potsdam 19 schools. 20 That community outreach no longer exits. 21 If you take away the St. Lawrence Psychiatric 22 Center, what would attract qualified mental-health 23 professionals to this area? 24 We have a shortage of doctors in this area. 25 How does the Office of Mental Health plan to 1 overcome this? 2 It is clear in the literature that 3 deinstitutionalization without the proper community 4 support only leads to homelessness or incarceration. 5 In fact, most studies of severe mental 6 illness have shown that the community-based-care 7 models have little impact on social functioning, 8 arrests, and time spent in jail; thus, not saving 9 the state money, but, rather, shifting the money 10 from the Office of Mental Health to the prisons. 11 There was a study by Drs. Lamb and Bacharach 12 that warned that hidden costs associated with 13 responsible programming need to be considered. 14 Community services will not result in substantial 15 savings over inpatient care. 16 So why should New York State give up our 17 "B" rating on the National Alliance of Mental Health 18 report to do what OMH is suggesting? 19 OMH also suggests that -- in their 20 September 9th statement to use, said, "First and 21 foremost, the redesign of the public mental-health 22 system must be good for children, adults, and 23 families we serve." 24 This is about statements. 25 Families have to be included, and you've 1 heard over and over today, How do families from here 2 get down to Utica? get down to Syracuse? 3 We have a 9.3 percent to 12 percent 4 unemployment rate for last three years. 5 We are 17.6 percent under the poverty rating. 6 At one point, the former-acting commissioner, 7 Kristin Woodlock, suggests using face time. 8 I researched this, because her idea was 9 poorly researched. 10 In 2011, in an effort to save money, 11 New York State stopped free busing for families of 12 prisoners, a program that allowed families to visit 13 their incarcerated loved ones on the weekends. 14 This was replaced by televisiting. 15 Prisoners found this program to be 16 impersonal, full of technical glitches, and at 17 times, devastating, as the personal visits were 18 unaffordable. 19 In addition, it has been determined that 20 prisoner families used these personal visits to 21 maintain family structure and bonds; yet the 22 Office of Mental Health seems willing to treat 23 mental-health patients with the same family 24 disruption as criminals. 25 I'm sure any military family can reach the 1 same conclusion as me. Face time is no substitute 2 to the healing powers of a parent's hug. 3 I understand that New York State wants to 4 push forward in the care of those with mental 5 illness. 6 I applaud these efforts, but only -- 7 "only" -- if they are evidence-based and well 8 thought out. 9 The proposal for Regional Centers of 10 Excellence made by the Office of Mental Health is 11 neither evidence-based or well thought out. 12 Deinstitutionalization for the sake of saving 13 money is not in the best interests of people with 14 mental illness, nor is it in the best interests for 15 tax payers of the state, as the evidence shows, due 16 to hidden costs. 17 It will not save money. 18 Despite what television commercials would 19 have us believe, a pill cannot cure a mental 20 illness, but evidence-based practice can put it into 21 remission, and isn't that what we should be 22 demanding from the Office of Mental Health? 23 Members of the Assembly, Senators, I ask that 24 you table the Office of Mental Health's plan for 25 Regional Centers of Excellence, and create an 1 independent committee of academic researchers, 2 clinical psychologists and psychiatrists, to review 3 New York State's mental-health-care system and the 4 context of the current literature. 5 I believe that a well-researched plan can be 6 devised to allow New York State to continue to be a 7 leader in mental-health care in the United States 8 despite the challenges of today's economy. 9 New York taxpayers deserve a plan with a 10 better chance of success. 11 Thank you. 12 [Applause.] 13 ASSEMBLYWOMAN GUNTHER: I'm just making sure 14 that I have your testimony. 15 IGGY GILLETTE-FERGUSON: Well, thank you. 16 ASSEMBLYWOMAN GUNTHER: I'm sorry that it 17 took so long. 18 Does anybody have any questions? 19 ASSEMBLYWOMAN RUSSELL: Thank you for coming 20 again. 21 IGGY GILLETTE-FERGUSON: Thank you. 22 ASSEMBLYWOMAN GUNTHER: I'm sorry you had to 23 drive back and forth. 24 IGGY GILLETTE-FERGUSON: It's okay. 25 1 ASSEMBLYWOMAN GUNTHER: Okay, let's see. 2 Who's next? 3 ASSEMBLYWOMAN RUSSELL: Two of them. 4 Dan and Laura. 5 ASSEMBLYWOMAN GUNTHER: Dan -- Laura -- so 6 it's just -- is it Laura? 7 Okay, I just want to ask, that somebody gave 8 some cards, and I want to see if these folks are 9 here. 10 Is there a Thomas, and I can't read your last 11 name? 12 ASSEMBLYWOMAN RUSSELL: It's "Patterson." 13 ASSEMBLYWOMAN GUNTHER: Is he here today? 14 No, he's gone. 15 ASSEMBLYWOMAN RUSSELL: It was Tom Patterson. 16 ASSEMBLYWOMAN GUNTHER: Is Kevin Hammond 17 here? 18 KEVIN HAMMOND: Yeah, right here. 19 ASSEMBLYWOMAN GUNTHER: Okay, Kevin, you're 20 here. 21 So we have Kevin. 22 ASSEMBLYWOMAN RUSSELL: And Sam. 23 ASSEMBLYWOMAN GUNTHER: And who's -- 24 ASSEMBLYWOMAN RUSSELL: Sam is Number 21. 25 ASSEMBLYWOMAN GUNTHER: Sam is -- okay. 1 Good. 2 ASSEMBLYWOMAN RUSSELL: Is Dan here? 3 SENATOR RITCHIE: Yes. He's right here. 4 ASSEMBLYWOMAN GUNTHER: Dan? You want to 5 come on up, Dan? 6 You're not -- well, each one can testimony. 7 DANIEL HARRADINE: [Unintelligible], I'm kind 8 of deaf. 9 ASSEMBLYWOMAN RUSSELL: Yes, it's you. 10 Please. 11 ASSEMBLYWOMAN GUNTHER: Sorry. 12 Okay, do you want to start? 13 LAURA FARR: Hi, my name is Laura Farr. 14 Most of you don't know me. 15 I don't hold a position in any office, 16 I don't even work at SLPC, but the closing of the 17 facility may have the biggest impact on me, and 18 countless others like me, because I suffer from a 19 mental illness. 20 I not only suffer from a mental illness, but 21 I was a former patient at SLPC. 22 I am now -- I now live in the community, and 23 I've been living in the community for five years 24 now. 25 I understand that consolidating the 1 psychiatric units is going to save the state money, 2 and that this is the true agenda of why we are 3 closing the psychiatric center. 4 Is closing SLPC going to save money? Maybe, 5 but only at the cost of the mentally ill. 6 It sounds great on paper. We'll send the 7 patients to the Center of Excellence facilities, and 8 everything will be fine. 9 I have several problems with this. 10 First, it's going to cost the State to ship 11 the patients to the hospital, which you've heard all 12 day. 13 Then, when it's time, there's the cost of 14 sending the patients home. 15 Nobody's mentioned that. 16 And what about the patients that need to find 17 a new place to live when they get out? 18 This happens to many, many patients. 19 How many trips is the State going to be 20 willing to pay for, to go look for suitable places 21 for these people to live if they want to come back 22 to the North Country? 23 We are people just like Governor Cuomo. We 24 are no less important than he is. 25 We deserve a safe place to live. 1 We do not deserve to live on the streets just 2 because we are mentally ill. 3 We have an illness. 4 Would you throw a cancer patient out on the 5 street just to save money? I doubt it. 6 I say you will be throwing patients out on 7 the streets because SLPC is full to the max most of 8 the time, and you are shutting down, not only our 9 facility, but others like it. 10 We will have no place to go. 11 Outpatient facilities are not enough. They 12 cannot provide the services that inpatient services 13 can. 14 Some people with mental illnesses just need 15 long-term care. 16 For many years, we have downsized these 17 facilities, saying it's better for patients to 18 receive outpatient therapy instead of inpatient. 19 In some cases, this can be true, but I am 20 here as living proof that long-care term is 21 sometimes needed. 22 In 2007, I found myself unable to care for 23 myself because of my mental illness. 24 SLPC took me in and cared for me for over a 25 year, until I could get back up on my feet and care 1 for myself. 2 Had I been sent downstate away from my 3 children, family, and friends, I know it would have 4 taken a lot longer for my recovery, if I had 5 recovered at all. 6 Taking a mother so far away from her children 7 is not going to help in her recovery, and 8 vice versa. 9 How much more would the State have to pay if 10 I had had an extended stay in the hospital due to 11 the fact that I did not have the support I needed, 12 and I ask, Is this going to save us any money? Save 13 the state any money? 14 This will happen to so many of us if we are 15 forced to seek long-term care so far away. 16 I also ask, What would happen to me if there 17 were no beds in any of the long-care facilities, 18 because this is an issue we'll all be facing with 19 the closures? 20 I have no doubt that they would have -- 21 I have no doubt that I would have been sent home. 22 That being the case, I would not be here 23 today, because my mental illness would have gotten 24 the best of me. I needed long-care service. No 25 outpatient service was able to help me because of 1 the severity of my disease at the time. 2 I would have killed myself, and my children 3 would have been left without a mother. 4 I ask you, Governor Cuomo, how many lives are 5 you willing to lose just to balance your budget? 6 Are the mentally ill any less important than 7 anyone else? 8 I say "no." 9 I'm afraid you have chosen to make this 10 budget cut from the mentally ill because you think 11 we are too sick to fight back. 12 I have news for you: we are fighting back! 13 Let me explain some things to you. 14 When a person has a mental illness, recovery 15 can depend heavily on family and friends' support. 16 If a patient -- and you've heard this all 17 day -- if a patient is miles away, how is that going 18 to happen? 19 As it -- as it is, being in the rural area 20 that we are in, it can take a good 45 minutes for 21 family to come and visit, attend meetings regarding 22 our treatment, which are so vital to our recovery. 23 A three- to four-hour journey to Syracuse, 24 Albany, or Utica would be out of the question for 25 most people, particularly in the winter here in the 1 North Country. 2 Such a situation would leave us alone and 3 frightened, suffering from our acute episode of our 4 mental illness in a strange place among strange 5 people. 6 This is not an acceptable form of treatment. 7 So balance your budget by hurting the people 8 that need your help the most, the mentally ill. 9 Go home and rest your head at night. 10 Don't think about why there are suddenly more 11 homeless people on the streets; 12 Don't think about why the suicide rate has 13 just jumped higher than it has ever been; 14 And don't think about the fact that your 15 jailed population has just skyrocketed. 16 Be rest assured, your budget's balanced. 17 Thank you very much, Mr. Cuomo. 18 ASSEMBLYWOMAN GUNTHER: We're going to ask 19 questions of [unintelligible]. 20 Do you want to -- 21 DANIEL HARRADINE: Pardon? 22 ASSEMBLYWOMAN GUNTHER: Do you have something 23 you want to read? 24 DANIEL HARRADINE: Well, I was going to do a 25 little something, yes. 1 ASSEMBLYWOMAN GUNTHER: Sure, go ahead. 2 DANIEL HARRADINE: I was going to wait, if 3 you had any questions for this lady. 4 ASSEMBLYWOMAN GUNTHER: I'll wait. Go ahead. 5 DANIEL HARRADINE: Okay. 6 Hi, I'm Dan Harradine. I'm a retired school 7 teacher. 8 I had the fortunate career of teaching at 9 Heuvelton Central School. 10 And I was also a part-time immigration 11 inspector at the bridge, when time allowed. 12 I felt compelled to come today because of the 13 fact that I felt I owed it to the hospital, and 14 because I personally have experienced the 15 hopelessness, the fear, the anxiety of dealing with 16 people that are mentally ill. 17 My wife was an in-house patient, and an 18 out-house patient, at the psych center for 19 30-some years. 20 And in 1983, my mother, after a three-year 21 stay there, died of complications from Alzheimer's. 22 So I'm well aware of a need for this 23 facility. 24 Diane became ill around 30 years old. We had 25 four kids at the time: a boy, 7; a boy, 5; a girl, 1 3; and a girl, 1. 2 She woke me up in the middle of the night and 3 announced to me, "I'm blind, I can't see." 4 What do you do? 5 You look at the yellow pages? 6 I didn't know what to do. 7 I called one of the -- I woke up one of 8 our -- one of the psychiatrists that works at the 9 school on a part-time basis, and I said, "What 10 should I do?" 11 He says, Well, I'll set you up. I'll set you 12 up with a counselor. I'll set you up with a 13 psychiatrist or psychologist, whatever we can get. 14 I said, "What about going to school the next 15 day?" 16 He said, It shouldn't be any problem. Have 17 somebody come and stay with Diane. 18 Two of the kids were in school, the two girls 19 were home. 20 My mother came, fortunately, and my father. 21 They were both retired, they were elderly. 22 I go to school, and about three hours after 23 I'm there, I get a knock on the door from the 24 principal. He said he wants to see me in the hall. 25 The school nurse and he are there, and 1 someone else, and he says, You're wanted at the 2 emergency room in Ogdensburg. Your wife tried to 3 kill herself. 4 Talk about a shock. 5 What do you do? You don't know where to go. 6 The family doctor was there. 7 The family doctor was there, and he says, 8 We'll take her to the psych center. 9 Fortunately, again, and I want to keep 10 emphasizing, it was local and it was nearby. 11 After talking to the professionals down 12 there, they said that she had slit her wrists, but 13 she didn't a bad enough job to really hurt herself. 14 But she was yelling out for help, that we 15 didn't recognize. 16 Right? 17 Diane was eventually, after many other 18 diagnoses, she was diagnosed as a -- she was 19 diagnosed as bipolar, suffering from manic 20 depression and manic exultation. 21 On one hand, she was the devil causing evil 22 in society; and on the other hand, she was 23 Jesus Christ, that could help people and care for 24 them. 25 In all actuality, you know, it was actually 1 easier for her to being Jesus Christ than it was 2 being the devil. 3 The only thing is, she gave away many of our 4 possessions that we could use. 5 Okay? 6 Being nearby, I could visit Diane on a daily 7 basis, and the kids often visited her. And I think 8 this enhanced her treatment. 9 Eventually, after several years, she was able 10 to come home and she functioned as a regular person. 11 The State gave her a job on a temporary 12 basis, that she did well with. 13 She went to Step By Step activities, she 14 stopped in at the Seaway House, and she raised the 15 kids. We went on vacation. 16 We saw them grow. They went to college, and 17 they're all successful. 18 And that's because -- I really sincerely 19 believe it was because of the excellent care we 20 received here, and the fact that we're home, that we 21 could see them often. 22 There were setbacks. 23 When we first went there, she was 24 misdiagnosed, but we had different doctors all the 25 time. And that's the way it was. 1 We had a doctor from Prescott. 2 And then a couple months later, we had a 3 doctor from the Philippines. 4 And they all had their own -- they all had 5 their own diagnosis, I guess you'd want to call it. 6 I sat in counseling sessions with Diane. 7 I went through psycho-drama with her, and saw what 8 they did. 9 And the most distasteful thing I did, was to 10 watch her have shock treatments. 11 And you see it in the Frankenstein movies, it 12 brings it back to you. 13 But, we had our setbacks, but we had good 14 times, too, in this treatment. 15 A couple of instances, I hope I'm not boring 16 you, but a couple of these instances: 17 One time, I was -- it was the first time she 18 could come home, and it was Thanksgiving. Everybody 19 was happy. My mom and dad were there. Her dad was 20 there. 21 My mother and her father decided to stay with 22 the kids. Dad was going to come back and bring her 23 back to the hospital with me. 24 We're not being trained, and made a mistake, 25 and dad sat in the back seat. She sat in the front 1 seat. 2 We're going over the railroad bridge, that's 3 no longer there, near the hospital, and jumps out of 4 the car going 50 miles an hour. 5 Fortunately, no one was coming, and I grabbed 6 the steering wheel. And she wore a trench coat with 7 a thick belt, and I reached through the door, like 8 that, and grabbed her, and held her up off the 9 pavement, until we were able to stop. 10 She got scraped and cut, but it wasn't 11 terminal. 12 Another time, we were bringing her back, and 13 we're loading the kids in the car, getting the kids 14 ready, to go back, because they wanted to go back 15 with mommy, and she disappears. 16 We can't find her. 17 But 10 minutes later, we get a phone call, he 18 says, Are you looking for Diane? 19 It was neighbor around the corner. 20 "Yeah," I said. 21 "She's over here." 22 So I went over, and I looked, and I says, 23 "Where's Diane?" 24 I looked, she's hiding under the dining room 25 table. 1 Okay? 2 But this is all part of it. 3 But one of the funniest things that ever 4 happened, if you want to call it funny: 5 I went down to visit her, like I always did, 6 and I said, "Where's Diane?" 7 She says, "Well, she decided to go out for a 8 walk today with the other clients." 9 I said, "Okay, where? I said, "I'll go meet 10 her." 11 And I had my little daughter with me. The 12 rest of them were in school. 13 My daughter, 3 years old. 14 So we're going down the road, and I look, and 15 there she is, walking hand in hand with a guy. 16 I says to her, I said, "Hey, what's going 17 on?" 18 She says, Well, Al here was a member of our 19 unit today. He had a bad time in psycho-drama, and 20 he got a phone call from home, and he had problem, 21 so I'm trying to help him. 22 So I said, "Well, help him in other ways." 23 So my little daughter goes up, she looks at 24 him, like this, and she says, "You leave my mother 25 alone," and kicked him in the shins. 1 Okay? 2 Now, this psych center has served Ogdensburg 3 for over 100 years. 4 Okay? 5 It's been innovative, it's been effective. 6 Diane wouldn't have been the person she was 7 without it. 8 It's the location, and the fact that the 9 staff is outstanding; was, still is. 10 Diane died in 2003, not from mental illness, 11 but from diabetes and heart. 12 And you know what was surprising? 13 At the wake service and at the funeral, there 14 were a lot of caregivers that had taken care of her 15 over the years, that came. Maybe 20 or 30, on their 16 own time, and at their own expense. 17 That tells you something about North Country 18 people taking care of North Country people. 19 And I'd like to end by saying: 20 That to the Dianes out there, whether they're 21 in Tupper Lake, Lake Placid, Saranac Lake, 22 Heuvelton; to the kids out there that need help, 23 okay; whether they're in De Peyster, Peru, 24 Lyons Falls; and to the people that have terrible 25 addiction to drugs and alcohol; 1 I hope that they have the opportunity, as 2 Diane did, to be treated nearby at a local facility. 3 So in summary, and school teachers always 4 summarize, there are two things I'd like to convey: 5 One is, that in your deliberations, please 6 keep the human factor involved. 7 Isn't that what we're all about: the human 8 factor? 9 ASSEMBLYWOMAN GUNTHER: Yep. 10 DANIEL HARRADINE: And the second thing is, 11 is that I want you to see the need for a facility 12 here. 13 Thank you. 14 ASSEMBLYWOMAN GUNTHER: Thank you. 15 [Applause.] 16 ASSEMBLYWOMAN GUNTHER: All I can say is, 17 she's [unintelligible] the facility, you know, when 18 they talk about having family involvement? 19 Your mother and father and the children, that 20 all helped, too. 21 DANIEL HARRADINE: Yes, it did. 22 ASSEMBLYWOMAN GUNTHER: So proximity was 23 important also. 24 DANIEL HARRADINE: That's correct. 25 ASSEMBLYWOMAN GUNTHER: Thank you, both. 1 DANIEL HARRADINE: Thank you so much. 2 LAURA FARR: Thank you. 3 SAMUEL LAMACCHIA: Have you had enough? 4 ASSEMBLYWOMAN GUNTHER: Sam, Ogdensburg 5 Bridge and Port Authority. 6 Is that correct? 7 SAMUEL LAMACCHIA: That's correct. 8 ASSEMBLYWOMAN GUNTHER: Okay, you had me a 9 little befuddled, like, about the bridge and the 10 Port Authority, and -- 11 UNNKOWN MALE SPEAKER: He'll have you more 12 befuddled when he's done. 13 ASSEMBLYWOMAN RUSSELL: He's the Chair of the 14 board. 15 ASSEMBLYWOMAN GUNTHER: Oh, the Chair of the 16 board. 17 SAMUEL LAMACCHIA: Well, I think there must 18 be a reason why I'm last, and, hopefully, it has an 19 impact what I have to say, or, you have the 20 opportunity to listen, whatever. 21 First of all, I'm chairman of the board of 22 Bridge and Port Authority. 23 I work for the Governor's Office, and I have 24 loyalty to the Governor. 25 That means a lot to me, that what the 1 Governor wishes to do, I follow that mission, and 2 I want that to happen. 3 So my mission statement from the Bridge and 4 Port Authority is, create jobs, do those type of 5 things, and keep the community moving, commerce, 6 whatever we want to do. 7 So, for Patty and Addie, we work closely 8 together, communicating what's going on, and how to 9 make things happen here in the North Country, and 10 I then take that representation back to the 11 Governor's Office, or wherever I want to be. 12 The Bridge and Port Authority, we operate a 13 railroad, port, industrial park, airport, bridge. 14 Over the bridge, we probably have 3 million 15 people probably go over our bridge every day -- or, 16 over a year. Over a year. 17 So, movement of people, and the way our 18 lifestyle here is, is greatly affected by a lot of 19 different things. 20 Okay? 21 And the other part of it is, what the psych 22 center has to do with that part. 23 And I'll get to you where I'm gonna go. 24 And you're saying, Where's he going with 25 this? 1 You'll figure it out in a while. 2 We affect a thousand -- probably a thousand 3 jobs right now. That's what we affect, jobs, 4 whatever. 5 So, we are about jobs. 6 So people here say, I am going to talk about 7 jobs, but it's going to get different as it goes on. 8 So that's me, as the Bridge and 9 Port Authority. 10 We endorse the psych center, everything 11 that's been said here today. 12 Patrick back there; John Burke back there; 13 Virginia Davey, if you remember her as the PEF 14 person; they couldn't have said -- all three would 15 say everything I would say, and endorse it, rubber 16 stamp it, 100 percent, whatever. 17 So who am I? 18 Who am I? 19 I sit here with -- I worked at the children's 20 unit for 20 years, and I was hired back 7 years ago 21 as a consultant. 22 And what I did there -- what I did there, 23 I was a teacher -- vocational teacher, and worked 24 with children. 25 And what we did was, I think somebody was 1 talking earlier about, what programs you did, and 2 what you didn't do. 3 I had a work program, I had a wood shop, 4 I did vocational counseling, and type of things with 5 students. 6 So, that being said -- that being said, back 7 in those days, back in -- I started in 1978. At 8 that same time, I became a PEF steward, and became a 9 union leader, for 20 years. 10 So I engulfed myself as a teacher, as a union 11 leader, and there's the first part of what's going 12 on. 13 So, I can remember back in those days, Patty, 14 remember the days when the grounds, and the patients 15 walked the grounds, and everything was -- it was 16 amazing to go down there as a kid to, see what the 17 grounds looked like. 18 The fish, you could go watch down by the 19 ponds, and you could see the fish, and you could see 20 everything. 21 So everything that was living here, was part 22 of this whole culture that was involved with the 23 North Country, evolved into the psych center. 24 It was an honor to work there. 25 It was an honor there, to work there. 1 And I worked as a teacher in Iowa, and I came 2 back, and I couldn't find a job. 3 And for me personally to be involved into the 4 psych center was, Wow, I needed a job. Let's see 5 what this is all about. 6 I was all about being a phys ed teacher, 7 coach, athlete, and so sports was my career. 8 But I was very fortunate -- very fortunate to 9 be involved. I needed a job, and you say, I need a 10 job, back in 1978, and I got hired as a vocational 11 teacher. 12 What that meant for me was, I had to go back 13 to school, get certified, do all that type of 14 things. And I had a length of time to understand 15 that it's going to take a little while to get 16 recertified, become a teacher in another area. 17 That being said, I said, Well, I'm not going 18 to do that. 19 I said, I'll just work this job. A phys ed 20 job would come available, coaching job would come 21 available, and away we go. 22 So thinking about that, I didn't understand 23 mental health. 24 I was green. I didn't know if it was 25 something I wanted to do. 1 And as the more I got involved, and year one 2 goes by, and I start to see things evolve, and then 3 you start to realize, this is something special. 4 This is really special. 5 And the reason it's special, is because I've 6 worked with higher-ed children who doesn't really 7 need the support system that the underdog needs. 8 And the kids here, whatever you realize, it 9 took a special type of person to work with them, and 10 I felt myself evolving into that type of person, and 11 working there, whatever. 12 That being said -- being said, as a union 13 leader, in 1991, realized we had a problem. 14 And, all of a sudden, we decided that we're 15 going to -- the State of New York was going to take 16 a look at this system, and we're going to downsize 17 it, back in 1991. 18 As a union president leader at that time, you 19 know, one of the hardest things that you deal with, 20 is when you say to some employees, that: You're not 21 going to be moved, you are going to lose your job, 22 and you're going to have a exit interview, whatever. 23 After you go through 200 or so, 300 or so, of 24 those exit interviews, when you say "good bye" to 25 people, you realize, Wait a second here. This is 1 not more than I bargained for. 2 And it was a very difficult time here, 3 because you realized that something was evolving in 4 our culture, it was evolving in mental health, that 5 we are -- and the nationalist thing is, we're going 6 to slide out of inpatient care, and we're going to 7 do something different in a different way. 8 So, in 1991, we lost a lot of people here, 9 whatever. 10 Since 1991, and moving our way forward, we 11 realized that we don't fire people. We don't really 12 fire people. We just say, wait for them to retire, 13 and we'll just move on, and we'll do more with less. 14 You've heard that before, haven't you? 15 "Do more with less," and that's exactly 16 what's been involved there. 17 I didn't know what I was going to say here. 18 I didn't know, because I listened to 19 everybody, what I heard, and say whatever. 20 When Ginny said there was 10 people on staff, 21 there were 10 people on staff. 22 All right? 23 Now we're down to four. 24 And I -- actually, my last day of working 25 there was last August 23rd. 1 So what did I do? 2 What they hired me back to do, was to be a 3 consultant, and, actually, to teach some of the 4 programs and classes that I taught when I was there 5 20 years earlier. 6 So, that -- I'll give you a timetable. 7 So, I worked 27 years in mental health; 8 I worked 10 years as a school administrator; 9 I worked -- I sat in Patty's seat, right 10 there, for 8 years as a city council here; 11 20 years as a union leader; 12 35 years of high school, college, basketball 13 official, track official; 14 And now, all of a sudden, I'm board member, 15 whatever. 16 So, as I evolved into this situation, was, 17 I worked 10 years as a school administrator. 18 And what they asked me to do is go back and 19 work at the children's unit to do one thing: help 20 students understand, and work with our teachers to 21 help them understand, what it's like when someone is 22 emotionally disturbed, who is suicidal, and they 23 come into the psych center, all right, they need 24 help and care, they need that type of treatment, and 25 they need to go back, back to the school. 1 So the length of time, it may be weeks. 2 2 weeks, 20 days, whatever it may be. 3 So one of the hardest things to do, is the 4 expectation factor of that child. 5 Okay? 6 Does he receive the services that he 7 received? 8 Is he educatedly [sic] provided all the 9 things they need to do, all right, so when they go 10 back to their home school, they haven't missed a 11 beat? 12 Because, the reason for that is, if you're 13 there for emotional issues, and then you solve your 14 emotional issues, and then you go back to your 15 school, as a principal I realized, Now, wait a 16 minute, you're not able to compete. You've lost too 17 much work, whatever you want to be. 18 So what you did is, you created a vicious 19 cycle, where the student is, Well, I feel good about 20 myself, but I'm not educated and able to compete. 21 So we've done, I think, a fabulous job. 22 As I worked as a school administrator, go 23 back and work with the children and youth services, 24 and see exactly what's happened. 25 And if you realize, if you went into the 1 system, the technology of how recordkeeping is done, 2 how the things are provided for, how students are 3 tracked, how the students are -- know exactly what 4 they're doing. 5 So, there's a huge range of communication 6 that is happening in doing those type of things. 7 So that part, for me, is a critical 8 component, how schools in this area -- well, the 9 school buses pull up on daily basis. Mike Lumley of 10 the collaborative treatment program, all the schools 11 that we associate. 12 And, actually, what I did for a while, was 13 I was educational supervisor at the psych center 14 during -- after my retirement. 15 ASSEMBLYWOMAN GUNTHER: I'm not going to end 16 it. 17 What -- so, as we move on, what do you think 18 about this plan, as far -- 19 SAMUEL LAMACCHIA: I'm going to get to that. 20 ASSEMBLYWOMAN GUNTHER: Okay. 21 SAMUEL LAMACCHIA: I'm going to get to that. 22 Now, that being said -- that being said, 23 I just want to communicate where I'm coming from, 24 so, kind of evolve. 25 And I know it's late, and you guys are -- 1 your stomachs got to be growling pretty good. 2 By the way, I started working at age 12. 3 [Laughter.] 4 SAMUEL LAMACCHIA: Not really. 5 So, anyways, I've been doing it a long time. 6 Here's what I know -- here's what I know, 7 okay, and I'm not sure what facts you have or don't 8 have, whatever you want to be. 9 What I know now, investigating this 10 situation, whatever -- and somebody can correct me 11 any time they wish to do that, whatever -- when this 12 is all done, Trinity, and the children and youth 13 services building are gonna be closed. 14 "Closed," that's what I'm hearing. 15 Okay? 16 Not to be opened for anything whatsoever, 17 whatever. It is closed. 18 The next facts, and I got a bunch of bullet 19 points here, whatever. 20 What I -- the next thing I know is -- 21 actually, what I know also is, 268 employees do not 22 work in inpatient care. 23 So what I found out also, out of that list, 24 85 people are on the list for possible retirement. 25 So those 85 people are going to save 85 jobs, 1 someplace, if they retire to where you want to be. 2 So the next question I got was: Where do 3 200 people go? 4 Where do 200 people go? 5 All right? 6 They have jobs, but where are they going to 7 go? 8 Is there a plan for that? 9 Don't know that yet. 10 So, what the thought here is, well, if you 11 don't have a job here, where are they going to go? 12 Well, are they gonna go to Utica, or they 13 gonna go to Syracuse? 14 That's the thought. 15 But a couple things came to mind. 16 If -- an important element of this whole plan 17 is, and I thought when I was on the listening tour, 18 whatever it was, we have three factors here: 19 SOTP, we have the children's unit, and we 20 have adult. 21 We close adult, we close children and youth, 22 with the SOTP, whatever. 23 What I found out is, the pharmacy unit is in 24 Trinity. 25 Oh, but we're going to close that building, 1 so where does that mean, about the SOTP unit? 2 I don't know. 3 Well, wait a minute. 4 Where's the kitchen for the SOTP unit? 5 Anybody know? 6 ASSEMBLYWOMAN GUNTHER: In the SOTP. 7 RICHARD HALPIN: No. 8 ASSEMBLYWOMAN GUNTHER: No, it's -- no, it's 9 in the children's unit. 10 SAMUEL LAMACCHIA: It's in Trinity. 11 ASSEMBLYWOMAN GUNTHER: Trinity? Okay. 12 SAMUEL LAMACCHIA: It's in Trinity. 13 So now I ask -- I started asking myself a 14 question: Okay, the plan is, four years from now, 15 okay, is the possibility that the SOTP unit may be 16 gone also. 17 Well, something has to happen here, to really 18 coordinate all these type of things of, what is 19 going to happen or not going to happen. 20 ASSEMBLYWOMAN GUNTHER: You know what? I'm 21 going to ask you, because of the time, to end. 22 SAMUEL LAMACCHIA: Yeah. 23 ASSEMBLYWOMAN GUNTHER: So -- 24 SAMUEL LAMACCHIA: I want to -- 25 ASSEMBLYWOMAN GUNTHER: I just -- 1 SAMUEL LAMACCHIA: I want to go to one thing. 2 ASSEMBLYWOMAN GUNTHER: Okay -- 3 SAMUEL LAMACCHIA: And I'll close it off, 4 whatever you want to be, because there's so much 5 involved here. 6 Commissioner Hogan was here a while back. 7 You all familiar with Commissioner Hogan? 8 ASSEMBLYWOMAN GUNTHER: Yes. 9 SAMUEL LAMACCHIA: Yes? Thank you. 10 I want to know if -- if we are going to 11 follow the Ohio Department of Mental Health plan 12 that he initiated in Ohio? 13 Is that a fact? 14 Does anybody know that? 15 ASSEMBLYWOMAN GUNTHER: I don't think that 16 there is any concrete information I can give you 17 exactly. 18 You know, I think that they went on a 19 listening tour, and I don't know that we know all 20 the facts beyond that. 21 Would you agree, Senator, and Addie? 22 SAMUEL LAMACCHIA: Okay. 23 Well, the reason I asked that question, 24 because -- 25 ASSEMBLYWOMAN RUSSELL: It would be great if 1 they were following some sort of plan. 2 SAMUEL LAMACCHIA: Well, what I'm saying is, 3 because Woodlock was a disciple, or whatever. 4 All I want to bring about is, is, really, 5 people here don't know. 6 It's an unknown, whatever it want to be. 7 If it is that plan, okay, the state of Ohio 8 has six regional centers. They have 11 million 9 people. 10 We have five regional centers for 20 million 11 people. 12 I think we need another regional center, and 13 I think it should be right here. 14 ASSEMBLYWOMAN GUNTHER: Thank you. 15 [Applause.] 16 SAMUEL LAMACCHIA: Thank you for your time. 17 ASSEMBLYWOMAN GUNTHER: Is there anybody else 18 testifying? 19 I think one more? 20 Yes? Thomas? 21 THOMAS: No. 22 ASSEMBLYWOMAN GUNTHER: No? 23 Kevin. Okay, Kevin. I'm sorry. 24 Thanks, Kevin. 25 KEVIN HAMMOND [ph.]: Hard shoes to fill 1 right there. 2 ASSEMBLYWOMAN GUNTHER: Do we -- 3 ASSEMBLYWOMAN RUSSELL: He wasn't on the 4 list. 5 ASSEMBLYWOMAN GUNTHER: You aren't on the 6 list. 7 KEVIN HAMMOND [ph.]: No, I -- 8 ASSEMBLYWOMAN GUNTHER: All right. 9 Thank you for being so patient. 10 ROBERTA HAGERTY: No problem, ma'am. 11 My name is Kevin Hammond. I reside in 12 Tampa Bay, Florida, but my home is Rensselaer Falls, 13 New York. 14 ASSEMBLYWOMAN GUNTHER: Okay. 15 KEVIN HAMMOND [ph.]: I go back a long ways 16 with the St. Lawrence Psych Center. 17 I'm a laid-off worker from 1991 there. 18 Also, my mom took a job there in 1949, as a 19 Cleaner, Grade I. She made $43 a week there. 20 She was a personal servant of the director of 21 the hospital, Dr. Hanes -- or, Dr. Hadek [ph.], 22 excuse me. 23 So this goes back a lot deeper in my family 24 roots. 25 Also, I have mental issues in the family. 1 I have two nieces that are mentally 2 handicapped. 3 I have a nephew. Once in a while, I get a 4 phone call, when I'm living up here for the five 5 months I'm home. I have to take him up to Floor 3 6 up there in [unintelligible] Hospital, which is 7 great. 8 The last couple of visits I was up there 9 with, we end up in emergency room for, like, 10 four days before a bed became available. 11 There's got to be something the State can do 12 to keep this place open. 13 Now, if you look at the map, there's nothing 14 north of the thruway, the Interstate 90. 15 Nothing. 16 To me, that's discrimination of the region. 17 You know, I don't know about this name, you 18 guys made this, Regional Care Center of Excellence. 19 ASSEMBLYWOMAN RUSSELL: That's the Governor, 20 not us. 21 KEVIN HAMMOND [ph.]: I know, but you know 22 what I'm saying? 23 ASSEMBLYWOMAN GUNTHER: Yeah, you're saying, 24 where did that come from? 25 KEVIN HAMMOND [ph.]: Yeah, I mean, this is a 1 new entity. No one knows if it's going to be 2 excellent. 3 Now you got one of the best hospitals rated, 4 in the world, in the United States, right down the 5 road here. 6 ASSEMBLYWOMAN GUNTHER: Right. 7 KEVIN HAMMOND [ph.]: And everybody's going 8 to lose their jobs, like I did in '91. 9 Now it's all coming to light, what they said 10 to me when I got laid off. 11 Number one, this is what they told us, 12 "meds over beds." 13 That came right from the State, "meds over 14 beds." 15 ASSEMBLYWOMAN GUNTHER: That was the mantra 16 back then. 17 KEVIN HAMMOND [ph.]: Yeah, yeah. 18 Then we had this guy named Mr. Gilleal [ph.]. 19 He's up there in heaven, watching me right 20 now. 21 He called it like he saw it. 22 He turned around, and he said, "You're right, 23 meds over beds, but the world is gonna change." 24 And if you look in history, you look at the 25 facts of the matter, it has changed. 1 Look at the shootings we've had in our 2 schools, what happened yesterday in Washington, D.C. 3 Now, I know the state is really strapped for 4 cash. 5 As my dad would say, "You can pull the 6 rubber band so far, and it's going to snap, and 7 usually it's gonna snap and hit your own self right 8 in the face." 9 Now the history of my dad, was he was the 10 leading producer of Carhart clothing in this region. 11 I also worked for Red Wing Shoes and Nascar. 12 Some of the three biggest entities in the 13 United States. 14 I do promotional work for them. 15 Okay? 16 To me, this is a grave injustice over the 17 balance of a budget. 18 It's very grave. 19 It's very -- I mean, there's other avenues 20 that can be done to save money for the state. 21 And why is it always the mental health 22 falling through the cracks of society? 23 ASSEMBLYWOMAN GUNTHER: Well, Kevin, we came 24 here to listen because, you know, we're gathering 25 this information. 1 And, you know, I think, sometimes, when we 2 think that we're going to cut services, that we're 3 going to save money, but that doesn't actually 4 happen at times. 5 KEVIN HAMMOND [ph.]: Right. 6 ASSEMBLYWOMAN GUNTHER: Because you spend 7 more money in acute care, and ambulance. 8 So, I think that all of this information 9 received today was very, very important. 10 Do you agree, Patty? 11 SENATOR RITCHIE: Yes, I do. 12 ASSEMBLYWOMAN GUNTHER: And, Addie? 13 ASSEMBLYWOMAN RUSSELL: Yes. 14 KEVIN HAMMOND [ph.]: Yes, it's great. Very 15 informative. 16 ASSEMBLYWOMAN RUSSELL: It is going to snap 17 you back in the face, like that rubber band, yes. 18 KEVIN HAMMOND [ph.]: Right. 19 You know -- I mean, basically, you know, 20 it's, like -- it's really a nightmare for me. 21 I mean, I don't trust anybody anymore, 22 because I got laid off by the State. 23 At the time, I had two beautiful kids, I had 24 a home, I had a car. 25 I lost everything. 1 I started back over again, I landed on my 2 feet, thanks to my folks. 3 But it ain't right. 4 This is all wrong, that's all I got to say. 5 It's all wrong. 6 [Applause.] 7 ASSEMBLYWOMAN GUNTHER: Thank you. 8 ASSEMBLYWOMAN RUSSELL: Thank you for taking 9 the time. 10 [Applause.] 11 ASSEMBLYWOMAN GUNTHER: Okay, we have one 12 last person that's going to say goodbye. 13 UNNKOWN MALE SPEAKER: One last one? 14 ASSEMBLYWOMAN GUNTHER: No, you. 15 UNNKOWN MALE SPEAKER: All I'd say is, 16 Good bye! 17 I want to thank all of you for being here. 18 It's been a long day. 19 It's been a good day for us, because you 20 have -- you know more now about us than you did 21 before. And that's good. 22 And our task force will work very hard. 23 We're going to work harder. 24 You're going to hear more from us. 25 You can see that the people who testified 1 here today did a wonderful job, all of them. Got a 2 lot of homework done. 3 And we appreciate the time. 4 I know some of you got up awful early to get 5 here. 6 I know coming from Watertown isn't far, but 7 coming from [unintelligible]. 8 I know the rest of you, [unintelligible]. 9 I talked to one person who said she got up at 10 5:00, to get started. 11 So -- but, again, I want to thank Addie and 12 Patty for their part in bringing this about, and 13 their staff. 14 Because I know -- I understand, I've been 15 around a long time. 16 Staff does all the work, you do the smiling. 17 [Laughter.] 18 ASSEMBLYWOMAN GUNTHER: Excuse me. 19 Right church, wrong pew. 20 UNNKOWN MALE SPEAKER: All right, thank you 21 very much. 22 And you'll hear from us again. 23 And we do appreciate, very much, all the 24 effort. 25 And I want to thank all of the people who 1 came here today to testify, because they've all 2 worked hard. 3 Patrick back there, he hasn't slept in 4 three days. 5 ASSEMBLYWOMAN GUNTHER: And we have Katie 6 that came from Albany, part of the Assembly staff. 7 And Jessica's in the back, with a 8 14-month-old baby, and wants to get going back -- 9 UNNKOWN MALE SPEAKER: Well, they're the ones 10 who told me how long they got -- when they got up. 11 All right, thank you. 12 [Applause.] 13 (Whereupon, at approximately 5:30 p.m., 14 the public hearing held before the NYS Assembly 15 Standing Committee on Mental Health and 16 Environmental Disabilities, the NYS Senate 17 Standing Committee on Mental Health and 18 Environmental Disabilities, and the NYS 19 Senate Standing Committee on Health, concluded, 20 and adjourned.) 21 22 ---oOo--- 23 24 25