The Brattleboro Retreat on Linden Street in Brattleboro. (Reformer file photo)
The Brattleboro Retreat on Linden Street in Brattleboro. (Reformer file photo)
Friday March 15, 2013

BRATTLEBORO -- The Brattleboro Retreat is once again facing sanctions from the Centers for Medicare and Medicaid Services after a February survey found the psychiatric hospital to be not in compliance with three conditions of participation.

The most recent report follows a similar report from last June which found problems with governance and quality assessment at the mental health hospital.

The Retreat, at that time, faced losing its federal Medicare funding before the hospital was able to submit a corrective plan to address the CMS violations.

The most recent survey, which the Retreat revealed in a letter to its employees Wednesday, found the hospital to be noncompliant with federal, state and local laws, and also to have had substantial deficiencies in protecting patients' rights.

The Retreat also did not follow its own quality assessment and performance improvement program, the February survey found.

The seven-day February visit followed a patient complaint and the Retreat first learned of the most recent deficiencies on March 11.

Inspectors who visited the Brattleboro Retreat in February found substantial deficiencies, putting the Retreat under the jurisdiction of the Vermont Division of Licensing and Protection until the hospital is in compliance.

"CMS has stated that these deficiencies have been determined to be of such a serious nature as to substantially limit our capacity to render adequate care and prevent it from being in compliance with all conditions of participation for psychiatric hospitals," Retreat CEO Rob Simpson wrote in his letter to employees.

Following the most recent report the Retreat will now be subject to an unannounced Medicare survey from the Vermont Division of Licensing and Protection. The Retreat will then have to submit a plan, with completion dates, for correcting all deficiencies.

"I am optimistic that we will correct these deficiencies just as we have in the past," Simpson wrote. "Our growth as a hospital has been accompanied by a process of continuous learning, problem solving, creativity and innovation that the Joint Commission noted and complimented us on in their recent accreditation survey. We must nonetheless remain vigilant and focused on excellence in our critical practice at all levels of the organization."

The Retreat has been contending with a series of visits from CMS after a Retreat patient died from an overdose last year after stealing drugs while at the hospital.

That incident led to the visit from CMS in June 2012 that found the two previous deficiencies.

The Retreat was able to put together a corrective action plan in time to save its federal funding, and following the report this week the hospital once again will have to put together a plan to address the most recent survey findings.

"Over the next several weeks we will be developing processes to specifically address the three conditions of participation and working directly with all inpatient staff to implement our plan of correction," Simpson wrote in his letter. "We are a learning organization and our continued focus on patient care will enhance the improvements that will bring us back into compliance."

Simpson faced harsh criticism from some Montpelier lawmakers last year when they accused him of not being forthcoming about ongoing CMS investigations while the Retreat was trying to win approval for its inclusion in the state's mental health system following the closing of the Waterbury State Hospital.

The developing relationship between the Retreat and the state has raised questions about the Retreat's role and responsibilities in communicating with lawmakers and mental health officials.

Former Commissioner of Mental Health Patrick Flood came out in support of the Retreat during the previous incident.

On Thursday Commissioner Mary Moulton said she did not yet have details on the most recent survey, but she spoke with Simpson earlier in the day and said she expected to work closely with the Retreat as it addresses the issues in the coming weeks.

"These hospitals are dealing with a great deal of CMS oversight," Moulton said. "A lot of people are going into and out of their doors and we have a system in place to review the procedures."

Moulton said the 90 review is not as serious as surveys that require immediate action.

She recognized the work the Retreat did to address its previous deficiencies and said she was going to be in contact with Simpson as the Retreat puts together its new correction plan.

"I'm sure they will work hard to address this, just as they did before," Moulton said. "Rob Simpson has assured me of this."

Retreat Senior Vice President for Government Relations Peter Albert said the number of complaints to CMS has increased since the Retreat first started taking State Hospital patients three years ago.

Albert said it is hard to say why State Hospital patients file more complaints.

Some of the deficiencies come from the emerging relationship between the state and the Retreat as both sides figure out how to develop the system to treat patients in the satellite community centers.

And Albert said he expects there to be additional challenges while the Retreat works on its internal reporting and oversight systems.

"We will continue to evaluate and improve what we do. The fact is patients have an absolute right to complain and express concerns and when they do CMS is responsible for investigating the complaints," Albert said. "Sometimes they don't find things and sometimes they do. We anticipate that we will continue to be under this level of scrutiny. This is going to be ongoing."

Howard Weiss-Tisman can be reached at hwtisman@reformer.com, or 802-254-2311, ext. 279. You can follow him on Twitter @HowardReformer.