Medicare and Medicaid officials have put the Brattleboro Retreat on notice. The hospital has until October 30th to implement changes in its handling of violent or aggressive patient behavior.
The federal reimbursements account for more than half the hospital’s revenues.
The Retreat has been under the threat of losing federal reimbursements for patient care since March. An inspection then found problems with record keeping and the use of seclusion and restraints.
The Retreat was working on corrections approved by CMS, the agency that governs Medicare. The hospital was given until August to correct the problems.
But in July, inspectors investigated a complaint that revealed more problems.
“I think the issue that we’re working with CMS on now is the role of law enforcement,” Retreat Senior Vice President Peter Albert said.
In the case that was cited a patient had behaved aggressively for several days. According to official documents, he had frightened other patients and repeatedly struck a mental health worker. When the patient resisted emergency medication, Brattleboro police were called in to help and the patient ended up being tasered.
CMS said the Retreat violated the patient’s rights by handing over authority to police when the patient was under the hospital’s protection.
The agency says police can be used only for law enforcement, and not for clinical situations.
Albert says the problem is part of a learning curve that began in 2011 when the state hospital closed and the Retreat agreed to take patients who would have gone to the state facility.
“We have had a small number of involuntary patients that are in the care and custody of the Department of Mental Health who have been violent and caused harm to themselves and others,” says Albert. “And those are the people that we’re focusing on.”
The Retreat has called on the police four times so far this year. Albert says that will no longer happen.
He says, “We’ve adjusted our policies to state that and more importantly we’ve created proper training and supervision of staff around the issue of managing violent, very acute mentally ill individuals.”
Albert believes the Retreat is now on the right track with CMS. But the hospital’s staff is less enthusiastic about the new policies.
Tom Flood is president of the union that represents about four hundred workers at the retreat. He says staff has embraced the new trainings in preventing violence and found them useful.
But he says workers have been seriously injured.
“Some clients that we work with are very big, very angry and very strong,” Flood says. “And those people in particular are whom we’re really somewhat fearful of at this point. Because they were the people we would call the police on in the past. And now we can’t do that.”
Vermont Mental Health Commission Paul Dupre is working with a study committee examining these and other mental health care issues.
He says the state is building a decentralized mental health system to replace the old state hospital and many adjustments will have to be made.
Dupre says the Brattleboro Retreat, with its fourteen-bed addition paid for by the state, is an important part of that new system. And he’s hopeful that the necessary adjustments are underway.
