Colorado lawmakers strip eating disorder treatment regulations inside bill

Amid a surge in eating disorder diagnoses in Colorado, budget-minded lawmakers stripped language from a bill Monday that would’ve more tightly regulated facilities that treat the disease, a change welcomed by some providers and lamented by advocates.

“In my advocacy mind, that just goes to, OK, so we’re choosing not to regulate care because it’s going to cost us something,” said Vincent Atchity, the president and CEO of Mental Health Colorado. “And in the meantime, substandard or unmonitored care will continue.”

As it was drafted, SB23-176 would’ve required eating disorder treatment providers be specifically regulated by the state Behavioral Health Administration, and it would’ve barred a series of practices that patients have described as traumatic and harmful, including nude weigh-ins and the overuse of restrictive treatment. The bill would’ve also required facilities to provide trauma-informed care and to respect and provide accommodations for LGBT people, who are disproportionately affected by eating disorders.

Several former patients previously described being weighed while nude or in ill-fitting clothing after waiting in line with other patients. Some said the use of room confinement or feeding tubes felt like punitive measures for patients who wouldn’t comply. Representatives from a national treatment provider headquartered in Denver said providers were already regulated and that eating disorders — which are among the deadliest mental illnesses — require intensive treatment to cure.

Still, Sen. Dominick Moreno, the Commerce City Democrat co-sponsoring the bill, described those practices as “bizarre” in February and said that he wasn’t sure they were “rooted in best practices for either medicine or mental health.” The bill would’ve been the first in the nation to specifically regulate providers’ practices, experts previously told the Post, and its introduction was particularly important now, given Colorado’s role as a national hub of eating disorder treatment and the increasing prevalence of the disease in the wake of the pandemic.

But those regulatory provisions would have cost several hundred thousand dollars to implement. Lawmakers, who have already passed a state budget and have a prescribed a pot of money to dole out for other legislation, stripped those regulatory provisions from the bill during a Senate Appropriations Committee meeting Monday, part of their annual work to square legislative priorities with finite funding. The amendments brought the estimated state cost of the bill to zero, according to an updated legislative analysis.

“When I heard about the amendments to the bill, I was pretty devastated,” said Em Troughton, a former eating disorder patient who was traumatized by the treatment they received in Denver facilities. ” … I have experienced firsthand the ways that this system fails folks over and over again. I felt really uplifted and invigorated by the prospect of informing legislation through those largely traumatic experiences, and at this point, I’m sort of reflecting on the ways that it is so difficult to affect sustainable change.”

The bill, which passed the Senate on Tuesday and cleared its first hurdle in the House on Thursday, still has key protections for patients and the public, advocates and supporters say. It still prohibits treatment providers or insurers from using the body-mass index calculation as a basis to deny a patient care; advocates say only 6% of eating disorder patients are underweight. The bill also prohibits the sale of certain diet pills to minors (though that, too, was pared back after grocers lobbied against it).

A companion bill, SB23-014, would create state-level resources and a grant program to better prevent eating disorders in the state. Troughton said the two bills, even pared back, were still “momentous” and signaled that policymakers were paying more attention to eating disorders.

Rep. Chris deGruy Kennedy, a Lakewood Democrat and the regulatory bill’s sponsor in the House, said he doesn’t plan to add the treatment regulations back into the measure, given budgetary constraints. Sen. Lisa Cutter, a Jefferson County Democrat and another co-sponsor, said the concerns raised by patients were “alarming” but that legislators must grapple with financial realities.

“There are some things that were really concerning,” she said of eating disorder treatment, “and every year it’s a balance. We have lots of priorities and lots of things we want to do. Every single year there’s a balance. It doesn’t mean we have to stop trying.”

The changes were welcomed by the Colorado Psychiatric Society, which had opposed the regulations as redundant and overly prescriptive for providers treating a deadly illness.

“I think that although the bill was well-intended, in many ways, shapes and forms, I think that sometimes there can be unintended consequences,” said Patricia Westmoreland, the legislative chair for the psychiatric society. “And we might have been dealing with some of those had it passed in its original form.”

The bill may still face more revisions. Representatives from the Eating Recovery Center, a national treatment provider based in Denver, asked a House committee Thursday to loosen the BMI prohibition and allow them to use it as one metric in evaluating care for anorexic patients. DeGruy Kennedy said he’s still researching that request.

Atchity and Troughton said they may bring the regulations back next year, despite Troughton’s “shock” that patients’ experiences weren’t enough to advance regulations this year.

Atchity said he didn’t blame lawmakers for stripping out treatment regulations. That’s the fiscal reality, he said, and it’s a symptom of Colorado’s broader aversion to paying “first-world taxes,” a reference to the state’s Taxpayer’s Bill of Rights and its limitations on state spending.

“We all lose,” Atchity said. “The folks on the receiving end lose, we lose in the system because our humanity is not what it could be, the individuals who work in the under-resourced system lose because their humanity and the quality of the workplace takes a hit. It’s just a failing proposition.”

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