Exceptional patient care at the Brattleboro Retreat

Friday February 8, 2013

As Chief Medical Officer and Senior Medical Director of the Brattleboro Retreat, we write this article on behalf of the medical staff (20 psychiatrists and one family physician), all of whom support it. Our tenures range from one to more than 25 years of providing patient care. Each of us was troubled by certain claims related to patient care made by a small number of our unionized colleagues that were published in several media outlets. The medical staff stands firmly and proudly behind the quality of the care provided at the Brattleboro Retreat, and, in that spirit, we wish to set the record straight on several key issues.

Patients with aggressive behavior receive compassionate and highly effective care at the Brattleboro Retreat.

When Tropical Storm Irene hit Vermont in August 2011, devastating the Vermont State Hospital (VSH), the Retreat responded immediately and took in the highest number of displaced patients. Some of these patients were and continue to be more violent than patients we have admitted at the Retreat in the past. As a result, some Retreat employees were injured.

We were aware of this potential and made changes to accommodate the different and increased needs for these patients.

Specifically, upon transfer of VSH patients, we began a series of improvements to meet the increased demand of care. We expanded staff training, raised the number of staff on many units, and added 12 new security personnel; expanded our medical capabilities; made several architectural modifications to inpatient units to better address the needs of aggressive patients; and enhanced orientation materials for new employees. We also reached out to the State's Attorney office to help us pursue appropriate legal action against individuals when their mental illness was not the cause of an assault. Lastly, we have instituted work groups where direct care staff and clinical leadership meet regularly to develop ways to assure a safe environment for both patients and staff.

As a result, the number of injuries requiring medical attention decreased in 2012. Also heartening is the fact that, according to Brattleboro Police Chief Eugene Wrinn, our calls to the police for assistance have dropped dramatically. We are all devoted to patient and staff safety.

All injuries and "critical incidents" are reported and thoroughly investigated.

We request our staff to promptly report every incident relating to staff injuries. Not a single instance of patient violence or other dangerous activity has been ignored. These incident reports are always available for any authorized clinician or regulator to access. All Retreat employees have been trained and understand the importance of handling any incident in a professional manner.

Changes following recent employee layoffs help assure the financial viability of the Retreat and will not impact patient safety.

We meet and generally exceed all regulatory requirements for staff-to-patient ratios of care. During the period of labor negotiations in late 2012, we had a reduction of 30 employees, 12 of whom were relocated to new positions at the Retreat. Like other health care organizations, the Retreat cannot run a deficit and maintain its commitment to its patients, employees, donors, financial institutions and the community at large to remain a vibrant, going concern -- it is our responsibility to be viable for generations to come.

It is always difficult and painful to lay off dedicated and skilled employees and colleagues; yet, we must also adapt in today's changing healthcare environment. For example, in years past the Retreat provided care to patients with addictions when the average stay on inpatient programs was 4 weeks or longer. Today, the average inpatient stay is measured in days rather than weeks. That's why we are tailoring our programming (as are other hospitals) to adjust to shorter inpatient stays and arranging for post- hospitalization services (i.e., partial hospital care, intensive outpatient, 12-step). Despite what was alleged, we physicians at the Retreat have not and will not increase the frequency that we order seclusion or restraint - physical or chemical. We prescribe medicine to treat disorders -- not to sedate people. The rate of restraint and seclusion remains low and within every State and Federal guideline. We are committed to keeping it low. To do otherwise would only add to the societal stigma toward the mentally ill.

The Retreat's finances and clinical environment are much stronger as a result of strong leadership.

In the last 6 years, we have witnessed a total transformation of the Brattleboro Retreat under the strong, clinically driven, and compassionate leadership of its President and CEO, Dr. Rob Simpson. This transformation can be seen in the renovation of units and buildings, dramatic increases in patient census, growing philanthropic support, a revitalized campus, two innovative new programs attracting national attention, expanded medical services for our patients, and an admission process that is far more responsive and respectful of incoming patients' needs. Such changes require resources that are often not recovered by reimbursement. Furthermore, these changes require imagination and courage--qualities our leadership continues to demonstrate and foster. While most organizations turn their fortunes around by simply cutting staff and overhead, Dr. Simpson has added more than 200 jobs during his six-year tenure.

To be sure, significant resources have been allocated to long-overdue renovations and repairs that will ensure the Retreat's buildings and grounds will be of service to future generations. As the physicians of the Brattleboro Retreat, we proudly stand with all our colleagues and fellow employees to best serve the patients who have entrusted us with their care.

Fritz Engstrom, MD, is Chief Medical Officer at the Brattleboro Retreat. Robyn Ostrander, MD, is Senior Medical Director, Medical Director of Child and Adolescent Services, and Vice President of the Medical Staff at the Brattleboro Retreat.


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