The Brattleboro Retreat on Linden Street in Brattleboro. (Reformer file photo)
The Brattleboro Retreat on Linden Street in Brattleboro. (Reformer file photo)

BRATTLEBORO -- The Division of Licensing and Protection has approved the plan of correction submitted by the Brattleboro Retreat in response to a site visit on Aug. 11 that turned up a number of deficiencies.

The deficiencies were related to inappropriate sexual contact between two patients of the Retreat's Tyler 3 ward, which offers treatment to teenagers.

"The hospital failed to provide sufficient interventions to assure each patient's rights are protected by maintaining care in a safe setting," noted DLP's investigators.

According to documents obtained from DLP, an adolescent with a diagnosis of anxiety, assaultive behaviors, suicidal ideation and post traumatic stress disorder was not only a victim of sexual offending, but also a "... perpetrator against males, females and mother."

"However, goals and treatment modalities did not address how they would assure (the patient) maintained personal and physical boundaries with both staff and other patients," noted the documents.

Despite being placed on a monitoring rotation of every 15 minutes and being allowed only in a public area near the nurses' station, the patient was able to initiate sexual contact with another patient with a history of being sexually, physically and emotionally abused.

A social worker was unable to explain to state authorities how the incident was allowed to happen, according to the documents.

"In addition, it was acknowledged the treatment plan ...


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failed to specifically address individualized actions/interventions to assist staff in the prevention of inappropriate sexual behaviors from occurring ...."

In response, the Retreat undertook "a series of targeted actions" meant to "implement a more structured approach in the reporting and reviewing of a patient's known history to improve its analysis, action planning, communication and coordination of activities to address potential safety concerns."

The actions, which are detailed in a nine-page plan of corrections submitted to the Division of Licensing and Protection, will be evaluated by investigators from the DLP during an upcoming visit. The Retreat has until Oct. 6 to assure its plan of correction is effective and has been implemented. If the actions taken pass muster, the Retreat will continue to qualify for federal funding from the Centers for Medicare and Medicaid Services. The Division of Licensing and Protection is delegated by CMS to conduct investigations and rule on whether plans of correction are adequate.

Bob Audette can be reached at raudette@reformer.com, or at 802-254-2311, ext. 160. Follow Bob on Twitter @audette.reformer.