MONTPELIER -- The House Judiciary Committee passed a greatly revised version of a Senate bill late Monday that is meant to streamline the judicial review process for involuntary treatment and medication of psychiatric patients.

The bill, S.287, is focused on a small number of patients who the state determines should be treated for mental illness - and in some cases medicated - against their will.

Vermont had 52 involuntarily committed patients at four psychiatric facilities in January. There are more awaiting beds in emergency departments across the state.

Only 14 of those had symptoms severe enough for clinicians to petition the court for them to be medicated against their will, according to figures from the Department of Mental Health.

"I realize we haven't satisfied everyone's concerns, but that's not something we were going to be able to do," Judiciary Chair Rep. Bill Lippert, D-Hinesburg, told a group of stakeholders anxious to see how the bill would sugar out in his committee.

Patients' rights advocates don't see the need for legislation, and believe proposed changes detract from the state's statutory obligation to reduce coercion in the mental health system and minimize the use of involuntary medication.

Representatives for the private nonprofit hospitals that stepped in to treat acute psychiatric patients since the closure of the old Vermont State Hospital expressed concern that the House version strikes provisions for accelerated judicial review that is in the Senate-passed version.

Lippert said he believes the legislation his committee settled on strikes an appropriate balance between protecting people's rights and giving clinicians the ability to provide the care they deem appropriate.

"As a whole it definitely improves current law," agreed Rep. Anne Donahue, R-Northfield, a longtime mental health advocate, who represented the House Human Services committee during Judiciary's deliberations.

"There are new important protections for patients, but there's also an avenue for those rare situations where the patient is a danger to other people even though clinical efforts have been made in the hospital," Donahue said.

The House version creates a mandatory process for the courts to accelerate review of involuntary medication orders when a patient is determined to be dangerous. However, it reins in language in the Senate-passed bill allowing for accelerated judicial review of other acutely mentally ill patients.

In addition, the House version changes current law to initiate review of a case when a psychotic episode lands someone in a hospital emergency department, instead of when a bed in a secure psychiatric facility becomes available.

"I think we've tightened things up at the beginning of the process, by eliminating repetitive emergency exams," which can cause the involuntary treatment process to unnecessarily start at square one, said Tom Koch, R/D-Barre.

The aim is to get to a decision for a patient's release or continued treatment in a timely manner.

Acutely psychotic patients often wind up in hospital emergency departments, in many cases for significantly longer than allowed by law.

Changes in the House version also clarify that a patient awaiting a judicial review is in custody of the Department of Mental Health regardless of the setting.

"Creating a temporary custody status places responsibility on the commissioner because the state has determined that this person is not free to go, so the state has to take responsibility for their care," Donahue said.

The opening this summer of a new state psychiatric hospital in Berlin is expected to reduce pressure on hospital emergency departments and hospital-run psychiatric facilities, but it's not clear that improved judicial review and added beds will allow the state's mental health system to meet the needs of patients with severe and chronic mental illness.

Many advocates have pushed for greater investment in community mental health resources to address systemic problems that predate the state hospital's closure.

The bill is expected to reach the House floor later in the week.