The Brattleboro Retreat (Zachary P. Stephens/Reformer)
The Brattleboro Retreat (Zachary P. Stephens/Reformer)
Monday May 27, 2013

BRATTLEBORO -- The Brattleboro Retreat is once again facing sanctions from the Centers for Medicaid and Medicare Services, and the psychiatric hospital has 10 days to come up with an accepted plan of correction or its federal Medicare funding will be terminated on Aug. 15.

During an April 18 survey by CMS officials the Retreat failed to meet two conditions of participation. CMS inspectors found that the Retreat was not in compliance with federal, state and local laws, and the hospital also failed to adequately protect patients' rights.

Details about the survey were not available.

The Retreat will now develop a plan to address the deficiencies and then receive another visit by CMS to determine if compliance has been achieved.

Brattleboro Retreat Senior Vice President of Government Relations Peter Albert said most of the CMS deficiencies were discovered in the hospital's new 14 bed unit which accepts Vermont State Hospital patients.

Since Tropical Storm Irene forced the Vermont State Hospital to close the Retreat has admitted 5,385 individuals, and of this number 331 would have qualified for admission to the state hospital.

It is a small number of these patients that the CMS issues relate to, Albert said.

Albert said the Retreat, which has been treating patients with mental illness for 179 years, has been facing new challenges caring for the involuntarily committed State Hospital patients.

"Our recent growth as a hospital, and in particular our contract with the state to care for patients in a newly renovated 14-bed unit who would in the past have gone to the now closed Vermont State Hospital has been accompanied by a process of continuous learning, problem solving and innovation," Albert said. "In reviewing the data from the survey we recognize that the majority of the issues identified are related to this new state hospital unit. We have been, and will continue to work on making the necessary improvements."

The Retreat has been facing a number of negative reports from CMS since agreeing to care for State Hospital patients following Tropical Storm Irene, which forced the closure of the troubled Waterbury facility.

The Vermont State Hospital had its own issues with CMS, and had been without federal Medicaid funding for almost 10 years, costing the state about $8 million per year.

Earlier this year the Retreat was cited by CMS after one patient reported having sex with another patient, and demanded medical treatment.

The hospital also was cited after an unqualified worker grabbed an adolescent by the arm and led the patient into a secluded room.

The Retreat also faced questions earlier this year on how quickly it was reporting incidents back to the state

Last year CMS cited the Retreat after determining that the hospital had governance and quality assessment problems that needed to be addressed.

In each instance the Retreat was able to submit a plan, which was accepted, and the hospital's federal funding was never terminated.

The most recent visit by CMS followed the Feb. 21 survey, which was undertaken after allegations were made against the hospital.

The Retreat submitted its plan, which was accepted, and then CMS returned on April 18 to conduct a complete survey.

During that visit it was determined that the Retreat had not met its conditions of compliance in two areas.

While Albert recognized that the Retreat had work to do to make sure it was meeting CMS expectations, he also said the state's complete mental health system was in crisis.

The Department of Mental Health has had five commissioners in four years, Albert said, and there currently is no DMH medical director to provide clinical support to the overall system.

Albert also said the state still needs more inpatient psychiatric beds and there is a need for more community support programs to discharge patients who are ready to move back into their communities.

And with the Retreat now playing a major role in that system, Albert said the Brattleboro psychiatric hospital was working to improve conditions both within, and outside of the Retreat's walls.

"We recognize that much of our work is done within the context of a larger system that remains in crisis," Albert said. "Many of the solutions we identify go beyond just the Retreat and the only way to effect real and lasting change is to address not only our own issues but the ones that continue to impact the entire system."

The Retreat received its letter from CMS on Monday, May 20, and Albert said the hospital has been working on its latest plan of correction which will be filed with CMS.

"We are confident that all cited deficiencies will be corrected as they have been in the past," Albert said. "The improvements we make as part of this process will help us continue our focus on excellence in our clinical practice at all levels of the organization, and assure our patients, and their families, that we are providing exceptional and compassionate care."

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