As a long time RN and former 36-year employee of The Brattleboro Retreat it has been sad to witness the organization’s decline. It isn’t certain that Louis Josephson is the most incompetent CEO in the hospital’s history yet he may end up being the last. In its present course, an institution that has weathered two world wars, The Great Depression, past pandemics and numerous economic recessions risks being shuttered or changed beyond recognition within a matter of months. What is particularly sad is that things didn’t have to go this way.
All hospitals face external problems. This is particularly true for small facilities situated in rural areas. These obstacles, even the most organized and talented administrations may find daunting. In the case of The Retreat, an entire layer of new challenges and separate problems resulting from in-house decisions and policies have become its biggest liability. For example, five years ago, at the beginning of Dr. Josephson’s tenure, the hospital’s biggest economic challenge was costs associated with staffing. Contract labor including travel nurses and locum (temporary) M.D.s were costing the organization millions of dollars. At that time there was wide recognition that this was not sustainable. It would seem critical to the institution’s survival that this existential crisis be put into competent hands. Instead, a new director of nursing was charged with turning things around.
Soon after, a disastrous battle over extensive and involuntary schedule changes began what continues to be a mass exodus of nursing staff from the hospital. Draconian disciplinary methods and record numbers of terminations pushed numbers further in the wrong direction. Tens of thousands of dollars were (and are) wasted annually on expensive arbitrations related to contract violations. LPNs, a category of nurses that had been playing a critical role in successfully caring for patients at The Retreat for decades, were suddenly made to feel unwelcome and new LPN positions eliminated. This is particularly difficult to understand as there existed no external or regulatory pressure to make this expensive change. A travel nurse represents an expenditure of three to four times the rate paid to a dedicated and qualified LPN. Seeing these loved and respected staff members made obsolete was demoralizing to the staff members that had worked side by side for decades.] The economic impact of the pandemic has been mixed with regards to the organization’s survival. In the spring the hospital stopped admitting clients residing outside Vermont. This dropped the census down to about half-capacity. Despite this, staffing remains the central problem. There continues to be a dependence on expensive contract labor and a need to regularly pay staff time and one half or double their regular rate when they are mandated (forced to stay due to not having a replacement from the next shift available). It now seems inconceivable that the facility could care for numbers even close to pre-COVID capacity.
A $10 million injection of COVID related money by the state supported the hospital for a number of months. That money is long gone and it is unlikely that the state with its own economic shortfalls will have anything more to contribute. Any appetite to do so is further diminished by the Vermont Legislature’s awareness that Retreat administration has been inactive except in the area of aggravating existing problems. It seems unwise to pour in good money after bad.
For too long The Retreat has relied on the notion that, as an institution, it is too important to the State of Vermont to be allowed to fail. This has been used to justify losses of as much as $1 million a month. Perhaps Vermonters should ask themselves if there may be another option. What about a Brattleboro Retreat managed by a different administration and in a way that attracts and maintains a local, stable workforce? Closure, a real possibility, would be devastating to everyone including clients, staff, and the community. Unless things change fundamentally (beyond program closures, “sustainability” plans and proposals) that is where things are heading.