BRATTLEBORO — A federal agency has found more deficiencies at the Brattleboro Retreat and has given the hospital 45 days to make more improvements.
If the psychiatric hospital is not in compliance by the next visit from Centers for Medicare and Medicaid (CMS), it could lose its Medicare provider agreement and federal funding, according to a statement from the Vermont Department of Mental Health. However, the Retreat is not in immediate jeopardy of losing funding.
The last CMS survey was conducted on June 7; the Retreat and the state were notified on June 14.
Roughly 30 percent of the Retreat's patients are Medicare recipients, according to Peter Albert, senior vice president for government relations at the Retreat. Of those recipients, he said, many are state patients.
The latest development comes on the heels of two previous surveys, one in January and another in March after the death of a 29-year-old man who died of a drug overdose from methadone he snatched from a nurse's cart.
The Retreat was investigated by state and federal agencies and deficiencies were found in nursing and pharmacy services. The facility wrote a corrective action plan and succeeded in improving both areas of concern.
The problems at the Retreat occurred at the same time lawmakers drafted legislation to make the facility a key component of the state's community mental health system. Legislators weren't aware of the problems at the hospital when they approved the plan. The state now has a contract to renovate the facility to accommodate 14 beds for psychiatric patients who formerly would have gone to the Vermont State Hospital.
At a Statehouse hearing on June 13, Rob Simpson, CEO of the Brattleboro Retreat, apologized to lawmakers for not being more forthcoming.
“I have listened to the tapes myself and if I could do it over, I would,” Simpson said.
For the time being, the Retreat is no longer admitting adult private patients until issues at the hospital had been completely cleared up, he said.
Simpson pledged to keep doing everything he can to inform legislators in future.
This time federal surveyors found the Retreat was out of compliance with two conditions of participation; the “governing body” and “quality assessment and performance improvement plan.” Both compliance deficiencies are related to internal communication between staff and management, according to Albert.
“The findings contained in the report deal with communication issues among our staff, our analysis of an adverse event, and with a deficiency in how we communicate treatment plans to patients,” Albert said in a statement. “The findings, although serious, do not indicate that any of our patients are in any immediate jeopardy. We had already begun making internal changes to address these issues.”
In an interview, Albert said CMS can “look at anything else they want” in a survey. “It is serious, we need to be in compliance,” he said.
There were two other incidents this month at the Retreat, Albert said.
In one instance, too much of a methadone maintenance medication was given to a patient. Albert said the patient was “fine.”
In another, a patient who was a ward of the state and was being evaluated for a forensic psychiatric diagnosis “eloped,” or escaped the grounds, when he went for a walk with a member of the staff. Albert said the patient had been cleared of the forensic diagnosis before he was given permission to go on the walk.
Several hours later, the patient went to the Brattleboro Memorial Hospital for treatment after he was bitten by a dog, Albert said. Retreat officials were contacted.
Brattleboro Memorial Hospital - which treated Jared Fitzpatrick of Middlebury, the patient who overdosed in January - was investigated by CMS in March. According to documents obtained from the Division of Licensing and Protection, the hospital was not out of compliance in any area.
Flood defends Retreat
Patrick Flood, commissioner of the Department of Mental Health, told lawmakers on June 13 that they have a right to know of deaths or other “sentinel” events and that information should come from him.
“When someone in the custody of the state dies, especially in an unexpected way, it is a matter that's legitimate for public inquiry and discussion,” Flood said.
Flood said they would need to discuss what level of “event” would be appropriate to share with the public. He suggested, for example, that elopements might not be worthy of lawmakers' attention.
Talking about “adverse events” like the deaths, Flood said “we stand ready to provide the information however best you decide to receive it.”
He agreed it is a “matter for public inquiry and discussion.”
Right now, the state and Legislature do not have a process, and that is the heart of the problem, according to Flood. Lawmakers agreed they have no clear sense of what level of information they should get and suggested he provide them with some guidelines that they can then discuss to clarify what level of information they want.
Flood also defended the Retreat, saying the hospital had been “an incredible partner in this difficult situation” after the Vermont State Hospital was damaged by Tropical Storm Irene.
He said they had been “incredibly flexible” and willing to solve problems and “there have been some really difficult problems to solve.”
“The Brattleboro Retreat takes the hardest patients. They stand out in what they do,” he said, noting the facility takes patients from other hospitals that those hospitals can't handle.
The Retreat now has 22 patients that are being treated under state custody, though they only signed on for 15. Flood said there inevitably will be other problems, but “I have great confidence in the Retreat.”
“None of us can sit here and promise there won't be another untoward event,” he added.