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Brattleboro Retreat's Problems Tied To State's Mental Health Plans

VPR/Susan Keese

The Brattleboro Retreat is a key player in the state’s plan to replace the shuttered Vermont State Hospital with a network of regional facilities. But now the Retreat stands to lose federal funding unless a number of ‘deficiencies’ are quickly resolved.

The federal agency that oversees the Medicare program has approved a plan to correct the problems, but an upcoming inspection will be a critical test. The Retreat was notified in May that its Medicare and Medicaid payments would end if it couldn’t meet federal standards by August 15.  The psychiatric hospital learned this week that the Medicare agency has accepted its plan of correction.

This is the second time in the past year and a half that the Retreat has faced possible decertification.

State officials and mental health experts are pitching in to help the Retreat make the necessary changes to prepare for an unannounced inspection later this summer.

Administration Secretary Jeb Spaulding expects the facility to pass that test. Spaulding says the state is grateful to the Retreat for taking patients from the State Hospital in Waterbury, which was closed by Tropical Storm Irene.

“They have taken our most difficult patients over the last two years,” Spaulding says. “And on the whole I think they’ve done an excellent job.”

The state has an $8 million contract with the Retreat to continue that service. It has invested heavily in a new, 14-bed unit for state patients at the Brattleboro facility.

The problems identified in the latest inspection  range from inadequate information on patients’ charts, to unnecessary seclusion and restraint. There’s also one case of involuntary medication.

The inspection report also calls for more training for staff -- especially in less aggressive ways to deal with out-of-control behaviors.

Retreat CEO Rob Simpson traces most of the problems to the influx of state patients who don’t want to be hospitalized and often refuse treatment.

“We’re talking about a very small number of patients that present with very complex illnesses, usually admitted involuntarily, sometimes with violence in their histories.” Simpson explains.

“So it’s not a surprise to me that we would find ourselves in a situation where we had challenges and where we had to make changes in how we’re practicing, to deal with a population that is different  from our general population.”

Simpson says part of the problem is that the state’s new system of regional mental health facilities isn’t yet in place.  “So the burden has fallen largely on the Retreat,” Simpson says. "And it’s a burden we’ve accepted.”

But Ed Dowd, a registered nurse at the Retreat since 1984, says it hasn’t been easy. Dowd says many of his co-workers have devoted their lives to helping people with mental illness. But the job has become more dangerous.

“And what’s very concerning is the serious injuries that have occurred,” he says. “We’ve had people with concussions, a broken bone -- and many of those injuries have occurred on that unit.”

Frank Reed, Vermont’s interim mental health commissioner, says the new unit can’t be blamed for all the Retreat’s problems.

“Not all of those deficiencies identified are that population,” says Reed. “There are also other, systemic issues that are being surfaced through these deficiencies.”

Rob Simpson, the Retreat CEO, says he takes the report very seriously. But he isn’t worried.

“We have some problems,” he admits. “We are fixing them. Our patient care is excellent at the Retreat. We will move through this and we will continue to be a stronger and stronger hospital.”

Reed, the interim Commissioner of Mental Health, says he’s hopeful that the Retreat will pass its next inspection. But he says the state is also looking into contingency plans, in case that doesn’t happen.

Susan Keese was VPR's southern Vermont reporter, based at the VPR studio in Manchester at Burr & Burton Academy. After many years as a print journalist and magazine writer, Susan started producing stories for VPR in 2002. From 2007-2009, she worked as a producer, helping to launch the noontime show Vermont Edition. Susan has won numerous journalism awards, including two regional Edward R. Murrow Awards for her reporting on VPR. She wrote a column for the Sunday Rutland Herald and Barre-Montpelier Times Argus. Her work has appeared in Vermont Life, the Boston Globe Magazine, The New York Times and other publications, as well as on NPR.
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