The board that oversees the Brattleboro Retreat, Vermont’s largest inpatient psychiatric facility and the only one designated to treat children, has voted to “begin the process of either closing or selling” the facility, according to Secretary of Human Services Mike Smith.
Smith said Sunday that the Agency of Human Services denied a request last week from the Brattleboro Retreat for an emergency “bailout” of $2 million.
Smith said Retreat officials informed him Friday that, absent an infusion of additional state funding, “they will likely close or seek sale.”
“Make no mistake, any threat of closure is both the decision and the result of the Retreat’s current leadership,” Smith said in an email Sunday. “On Monday I will communicate with the board and management that their decision must be executed in a manner that protects patient safety.”
Brattleboro Retreat CEO Louis Josephson called Smith’s announcement a “slight mischaracterization.”
“The board instructed me to explore all options for the absence of increased support from the state … so that means possible sale, and in the worst, worst-case scenario closure, though we’re optimistic that’ll never happen,” Josephson said in a phone interview Sunday.
"I don't know how the state system exists without them." — Putney Rep. Michael Mrowicki
Josephson, however, confirmed that if the state of Vermont doesn’t increase financial support for the 185-year-old institution, the Brattleboro Retreat will at minimum scale back the scope of its operations. And he said his “optimism” for a positive outcome is based on his belief that the Scott administration will come to see the wisdom of increased state funding.
“We have stepped up to serve the neediest Vermonters, and we do that with a real sense of passion and mission,” Josephson said. “What the state has not done is provide the funding for that, so if they are not going to provide the funding, we are not going to be able to provide the services they have asked us to provide.”
Even critics of the Brattleboro Retreat say its sudden closure could have a “catastrophic” impact on the already strained mental health system in Vermont.
“I think you can draw a pretty clear parallel to what happened when (Tropical Storm) Irene closed the state hospital,” Northfield Rep. Anne Donahue said Sunday.
Donahue was referring to the 2011 flood that inundated the Vermont State Hospital in Waterbury, and forced the state to relocate the 54 inpatient psychiatric patients who were being treated there.
"The Retreat is clearly at a point where significant management and operational changes are necessary to save it and the jobs there." — Human Services Secretary Mike Smith
“Obviously it’s not possible to open inpatient beds anywhere else overnight, so it would be a short term somewhat catastrophic impact,” Donahue said.
Josephson said he doesn’t yet have a precise timeline for the dialing back of operations, or closure, if the Retreat doesn’t get more money from the state. He said he shares Donahue’s concerns, however, about the mental health system’s ability to absorb so much lost inpatient capacity.
“I am a mental health professional. I see the work we do for Vermonters with mental health (illnesses) and addictions every day,” Josephson said. “And I worry significantly that the state does not have a plan for these people’s care if we weren’t here. And I’m not saying that as a threat whatsoever.”
While Smith said his agency is in preparing a “contingency plan” to absorb patients now being treated at the Retreat, he said the facility’s closure would have a serious impact on Vermont’s ability to care for mentally ill patients.
Smith, however, said blame for any disruption to the mental health system lies with leadership at the Brattleboro Retreat, not his agency’s unwillingness to provide more funding.
Smith said the Retreat’s request for $2 million last week is the latest in a string of requests for “financial bailouts from taxpayers.” Smith said the Agency of Human Services granted rate increases to the Brattleboro Retreat less than two months ago that will result in revenue increases of more than $5 million over the next two years.
Combined with money the Retreat previously received to construct and operate 12 psychiatric beds for acute patients, Smith said that brings the state’s total investment in the facility to $16 million in the last few years alone.
“Their financial strategy appears to be built on a flawed premise that continued financial bailouts from taxpayers is an effective long-term solution or is expected when Retreat management makes a financial miscalculation,” Smith said.
Smith said that financial miscalculation occurred when the Retreat created a budget that over-estimated the number of patients it would serve.
“There is little clarity on where they stand financially and the prospects of better financial conditions in the future, including how they plan to pay over $1 million of taxes that are owed to the State of Vermont,” Smith said Sunday.
Josephson, meanwhile, said the Retreat’s financial straits are a product of underfunding by state government. He said Vermont spends $1,000 more per day, per patient to house people at the Vermont Psychiatric Care Hospital in Berlin than it does for patients at the Retreat.
“So do the math: 14 people times 365 days a year is $5.1 million,” Josephson said. “If those people were cared for in a state facility, it would cost the state of Vermont $5.1 million more. But if they don’t want us to continue to do that we won’t. That’s their decision.”
Smith said Josephson is comparing “apples to oranges,” since patients at the state-run hospital are higher acuity than people the Retreat is caring for
“Staffing patterns and security elements of the VPCH facility really reflect those significant safety and acuity needs, and hence a higher cost,” Smith said.
Northfield Rep. Anne Donahue said she’s long pushed for the closure of the Retreat. But she said the state needs more time to develop alternative services.
“It represents an archaic model of care. It delivers in many situations poor care, and it doesn’t meet the standard of integrated care because it isn’t part of a medical hospital, so I think it’s been part of a long-term vision of the state that we not rely on standalone institutional models,” Donahue said of her concerns with the Retreat. “But it’s a big difference between a long-term goal and an overnight outcome.”
Thirteen lawmakers that represent towns in Windham County issued a statement Sunday evening chiding Smith’s handling of the situation.
“To say we are disappointed by Secretary Smith’s public statement issued today is an understatement,” the delegation said in a written statement. “We have no doubt that the State of Vermont will continue to work, responsibly, in partnership with the Retreat to continue to provide care for all patients. We will work diligently with the Scott Administration and the Retreat to ensure that is the case.
Putney Rep. Michael Mrowicki said he can’t fathom the closure of the state’s largest inpatient psychiatric facility at a time when demand for acute care beds already exceeds supply.
“I don’t know how the state system exists without them,” Mrowicki said Sunday.
Mrowicki said solvency issues at the Retreat are symptomatic of financial stresses for rural hospitals across the state. And he said he had little faith in Smith's grasp of the problems the Retreat faces.
“We have a situation now where the Agency of Human Services is being led by someone without a human services background, and I’m not sure in a situation like this it helps to have someone who doesn’t understand the field they’re supposed to supervise,” Mrowicki said. “And I think when you put a businessman in front of a therapeutic agency, people tend to see things from their own viewpoint.”
Donahue, however, said she has little confidence in the Retreat’s leadership.
“My experience in dealing with the Retreat’s administration is that in terms of responsiveness to quality issues, the leadership is not where it should be. And in being transparent, the leadership is not where it should be,” Donahue said. “So it comes as no surprise at all to me to see where the finances are.”
Smith’s announcement comes as lawmakers prepare to return to the Statehouse this week to begin the 2020 legislative session.
Donahue said she and other legislators will “have to jump in pretty quickly at getting a handle on what kind of negotiations are possible, and whether there is any room in the budget to help create a longer bridge.”
“We also want to see what kind of contingency plans … the administration is working on to ensure that the needs of Vermonters are met,” Donahue said.
Josephson said then-interim Human Services Secretary Martha Maksym conducted a rigorous review of the Brattleboro Retreat last year that included a review of its finances and operations. He said the agency offered no concerns after it completed the review, and granted the Retreat a rate increase.
“There are new developments that (Smith) says are management related now," Josephson said. "He should tell ... me exactly what we are not doing that we (should)?”
Here's how Smith responded:
“Well the one thing they not ought to be doing it continually coming to the state of Vermont and asking for additional monies, and then sending a letter to me that says if they don’t get the additional monies they will likely close or seek sale,” Smith said. “That’s not the way it’s done in terms of trying to be a partner.”
Smith said he plans to meet with officials at the Brattleboro Retreat this week.
“I’m hoping that the board comes forward with realistic and with detailed proposals that take measurable steps towards improving the current and future financial viability of that organization,” Smith said.
But under no circumstance, Smith said, will he advise the governor or lawmakers to allocate more state funding for the Brattleboro Retreat.
“I don’t operate under the policy of too big to fail. If we’ve got a failing institution, a financially failing institution, then we need to do something about it,” Smith said. “And right now, I don’t see any way with what has been presented me that I would offer to the governor or to the Legislature a solution that has more money attached to it.”
Updated 5:45 p.m. This post was updated to include interviews Sunday with Human Services Secretary Mike Smith and Brattleboro Retreat CEO Louis Josephson.
