SB 1538, An Act Concerning Emergency Department Boarding And Crowding
TESTIMONY OF THE CONNECTICUT HOSPITAL ASSOCIATION
SUBMITTED TO THE PUBLIC HEALTH COMMITTEE
Monday, March 24, 2025
The Connecticut Hospital Association (CHA) appreciates this opportunity to submit testimony concerning SB 1538, An Act Concerning Emergency Department Boarding And Crowding. CHA supports the bill and asks the committee to specifically include hospital representatives as direct participants in the evaluation of the feasibility of establishing an expedited process for the appointment of a conservator for patients of hospital emergency departments (EDs).
Connecticut hospitals and health systems care for patients, strengthen the state’s economy, and support vulnerable communities across the state. Every day, they work to improve healthcare access, affordability, and health equity.
Under SB 1538, the Probate Court Administrator and the Commissioner of Social Services shall evaluate the feasibility of establishing an expedited process for the appointment of a conservator for patients of hospital EDs who lack the capacity to consent to receive healthcare services from the hospital to ensure such patients receive such services in a timely fashion and help alleviate emergency department boarding and crowding.
As stated above, CHA respectfully asks that the individuals charged to conduct this feasibility study be expanded to include representatives of hospitals. The proposed areas of focus for this working group are of keen interest to hospitals. We believe the hospital perspective is essential to assisting the group in developing recommendations that will benefit patients, conservators, healthcare providers, and the probate court system.
Patients in Connecticut hospitals rely heavily on the services provided by the probate court system, particularly with respect to conservators. Connecticut hospitals have a long history of working with the Probate Court Administrator and with probate judges, including direct participation in the development of the chapter on conservatorships in the Probate Practice Book in 2011-2012. CHA works regularly with the Probate Court Administrator and with probate judges, having hosted informational forums and meetings to address matters of mutual concern involving conservators.
Challenges relating to the performance of conservators have been highlighted in two recent reports as a cause of emergency department boarding and crowding and as an impediment to achieving timely and effective discharge of patients from hospitals.
The final report of the Connecticut Emergency Department Boarding and Crowding Workgroup, released on December 18, 2024, highlighted recent concerns about the performance of conservators of patients receiving hospital care.
Patients with conservatorship or guardianship who are occupying hospital beds without having any immediate medical needs presents a serious drain on healthcare resources and compromises the quality of care for acute medical patients. In many cases, this is not because there are not potentially available solutions, but because the healthcare facility is unable to obtain consent or confirmation for treatment and/or disposition issues due to inability to contact a legally authorized representative.1
On February 28, 2025, CHA submitted a report to the Public Health Committee in accordance with the requirements of Public Act 24-4, An Act Concerning Emergency Department Crowding, on behalf of its member hospitals. This report included the following section on conservatorship and streamlining proxy decision-making,
Emergency departments often treat patients who are no longer capable of caring for themselves and do not have a designated healthcare representative or family member able to take on this role. In some cases, the patient may not have made any arrangements for the appointment of a healthcare representative or conservator in advance of the onset of an incapacitating condition or event, so a conservator must be appointed for them through a probate court process. These situations present an array of challenges to hospitals and other healthcare providers, in terms of making timely decisions regarding a patient’s medical care, resulting in longer hospital stays for these patients, and reducing access to hospital resources and services for other patients.
Hospitals are reporting challenges in securing conservators for newly-admitted patients. It may take weeks or even months to get a conservator appointed by a probate court, even in cases where a willing conservator has been identified. There is no expedited process to appoint a conservator to make timely medical decisions for a patient. There is also a shortage of qualified conservators available.
In addition, court-appointed conservators are often difficult to contact off business hours or on weekends, since they are often attorneys in private practice. Moreover, conservators often refuse to make a treatment decision for a patient, and will request a hearing with the probate judge in order to obtain a court order to allow for various healthcare services to be administered. It may take weeks or even months to get a hearing.
In addition, conservators will often ask a hospital to delay the patient’s discharge from the hospital in order to afford the conservator more time to arrange for post-acute treatment. In these cases, hospitals are forced to extend a patient’s hospital stay, not for sound treatment-related reasons, but for want of a safe discharge option. When hospitals seek relief from the probate court, judges will typically opt to keep the patient in the hospital rather than order their discharge. These extended non-medical hospital stays are detrimental to the patient’s health and well-being and place undue burdens on hospital staff and resources.
These situations are occurring on a more frequent basis in hospitals around the state, resulting in inordinately long hospital stays and untenable delays in obtaining timely and necessary healthcare in the most appropriate setting.2
For these reasons, we ask that the committee revise the bill to include hospital representatives as members of the group conducting this feasibility study.
Thank you for your consideration of our position. For additional information, contact CHA Government Relations at (203) 294-7301.
1 Final Report to the Connecticut Department of Public Health and the Connecticut State Legislature, The Connecticut Emergency Department Boarding and Crowding Workgroup, page 37, December 18, 2024. A link to this final report is provided here.
2 Report of the Connecticut Hospital Association Submitted to the Public Health Committee, page 7, February 28, 2025. A link to this report is provided here.