Brattleboro Retreat Fails Compliance Inspection But Maintains Funding

A repeat inspection this week has found the Brattleboro Retreat remains out of compliance with federal Medicare and Medicaid standards.

The psychiatric hospital was threatened with the loss of federal funds because of problems identified in earlier inspections. But it now has another chance to keep its Medicare certification.

A team of state regulators carried out the three day return inspection on behalf of the Centers for Medicare and Medicaid Services, or CMS.

Retreat Spokesman Konstantin von Krusensteirn says the hospital hasn’t seen a final report from CMS. But he says the team’s exit interview made the outcome clear.

Now, with help from the Shumlin administration, von Krusenstiern says the Retreat has a new arrangement with CMS.

“And now the Retreat and CMS have agreed to enter into what’s called a Systems Improvement Agreement,” he says. “And that will provide more time for us to make sustainable improvements, quality assurance, patient and governance. Those are the areas of concern.”

Under the agreement The Retreat will hire an approved outside expert to analyze systemic issues, make changes and prepare for a future inspection. The hospital will also work more closely with CMS.

The Retreat’s current problems began with a suicide attempt on its adolescent unit last May. Follow-up inspections turned up new problems. They ranged from questions about staff access to locked rooms to a case of sexual contact between minors which regulators say staff should have had enough information to prevent.

  Von Krusenstiern says the problem isn’t so much with the specific incidents, which the hospital has addressed.

“There’s a concern that our quality improvement processes are not where they need to be to assure that a similar incident wouldn’t happen again,” he says.

The Retreat is a key player in Vermont’s mental health system. The state has an $8 million contract with the hospital to treat acutely ill patients formerly sent to the state hospital in Waterbury. The Waterbury facility lost its Medicare funding a decade before it closed permanently after Tropical Storm Irene.

Vermont Mental Health Commissioner Paul Dupre says these complex cases, often patients who have been involuntarily committed, have meant a steep learning curve for the Retreat.

But Dupre says he thinks the hospital will make the necessary changes and keep its Medicare funding.