BRATTLEBORO - The Centers for Medicare and Medicaid Services, or CMS, has accepted the Brattleboro Retreat's plan of correction.

CMS has been investigating the Retreat for violating patient rights at the hospital and the federal office's decision to accept the plan of correction paves the way for a surprise visit from regulators.

That visit will take place before the end of October.

If the Retreat is successful in proving that it is following its plan of correction then the hospital finally will be able to move beyond the recent CMS investigation.

Brattleboro Retreat Director of External Affairs Peter Albert said the hospital has been struggling to meet federal guidelines, and adequately train its staff to appropriately care for the state's most mentally ill patients since the Retreat stepped in to care for the State Hospital patients who came to the Retreat after Tropical Storm Irene forced the closure of the State Hospital in Waterbury in August 2011.

As hard as the process has been, Albert said, ultimately it has forced the Retreat to be a better hospital.

"Our approach to this has been to step back and look at the entire facility and say, ‘Let's not miss anything,'" Albert said. "Let's think about patients' rights, processes of seclusion and restraint, and let's create new trainings, new supervision, new education processes, so that we're not just looking at this one thing, but that we're looking at the whole concept of patient rights, dealing with very mentally ill people in an environment that has a potential to be violent. We don't want to leave it to chance."

CMS investigators determined in July that the Retreat had violated standards concerning restraint and seclusion after Brattleboro Police were called to help deal with a patient who had become violent.

The Retreat submitted its initial plan on Aug. 2 and then heard from CMS that the federal agency would be reviewing it.

During that time Retreat officials held a conference call with staff from the National Association of Psychiatric Health Systems to find out what other hospitals around the country were doing to appropriately care for violent, mentally ill patients.

"The issue that this all revolves around is how to provide a safe environment when working with patients who have a mental illness that is quite significant, and that results in violence," Albert said. "How do you maintain a safe environment on the unit, respect patient rights and more quickly identify situations that could escalate to violence, and do so without involving the police."

On Aug. 20 the Retreat held another conference call, this time with CMS officers in Vermont, Boston and Washington, D.C. to discuss alternative to calling in police help.

After that call, Albert said, a revised plan was sent to CMS.

"CMS said the use of police is not appropriate," Albert said. "We did not know that."

The new plan was sent in on Sept. 5, and on Sept. 10 the Retreat learned that the plan had been accepted.

Albert said the staff is now waiting for the surprise review, though he said the hospital likely will be continually striving to learn how to provide care for the state's most mentally ill patients.

"Our responsibility is to train, and re-train our staff, and look at issue about creating a safe environment," he said. "We're still working on this. For not only us, but for every hospital in the state that is working with people who are in the care and custody of the commissioner, we're all continuing to work on this."

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