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The main entrance to Brattleboro Memorial Hospital.

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Brattleboro Memorial Hospital in compliance, state says

Vermont Division of Licensing and Protection says a follow-up inspection shows that BMH has addressed problems related to the treatment of mental health patients

BRATTLEBORO—Two months after a state inspection found violations of patient rights and emergency-services standards, Brattleboro Memorial Hospital has been given a clean bill of health.

The state Division of Licensing and Protection on May 26 issued a letter saying the hospital had “corrected all deficiencies that were cited” during an investigation in late March.

That means the state is satisfied with BMH’s corrective plan, which included new policies, additional monitoring, and increased education related to the treatment of mental health patients and the use of police officers at the hospital.

“We conducted the unannounced follow-up survey and determined the hospital was back in compliance,” said Suzanne Leavitt, the Division of Licensing and Protection’s assistant director. “The hospital is expected to maintain ongoing compliance.”

Hospital administrators haven’t commented on the specifics of the case. Following the state’s declaration of compliance, a spokeswoman said only “we are always looking to improve patient care and take opportunities like this to do exactly that.”

The Division of Licensing and Protection conducts health care inspections under the auspices of the federal Centers for Medicare and Medicaid Services. Unaddressed violations can jeopardize a hospital’s eligibility for Medicare and Medicaid funding.

Leavitt has said the Brattleboro Memorial Hospital inspection, completed March 24, was spurred by several patient complaints. The state’s subsequent report cited the hospital’s “failure to provide sufficient interventions to assure each patient’s rights are protected” in the hospital’s Emergency Department.

Regulators focused mainly on incidents involving two mental health patients, identified in state documents only as Patient No. 1 and Patient No. 2.

The latter patient was admitted in early January and became agitated when “a specific psychiatric facility s/he had requested for admission had no beds available,” documents show. Brattleboro police were summoned to help control Patient No. 2 several times over the course of several hours; officers eventually used a “noncompliant escort hold,” a takedown move, and handcuffs to subdue the patient.

BMH staff “failed to follow hospital policy when allowing the police to use physical force, manual restraint and the application of handcuffs to a patient requiring psychiatric hospitalization who was not under arrest or in police custody,” state inspectors found.

Patient No. 1 stayed at BMH’s Emergency Department from Dec. 31 to Jan. 6. In spite of a psychosis diagnosis, the state report says the patient remained in the Emergency Department “due to the lack of availability of a psychiatric admission bed.”

State officials documented multiple disruptions caused by Patient No. 1 at BMH, but they also documented instances when hospital staff failed to remove restraints at the earliest possible time and didn’t use the least-restrictive methods to restrain the patient.

In addition to those issues, the state’s report found several other problems at BMH, including a potential safety hazard, inadequate record-keeping, and staffing shortages.

On that latter topic, the Emergency Department manager told state inspectors that “night resources are slim” in the unit and law enforcement is used as a “backup” and a “show of force,” according to the report.

BMH’s corrective plan was accepted by the state in late April, a little over a month after the inspection was completed. The plan included new instruction for emergency staff on the use of patient seclusion and restraint, as well as education on “appropriate interactions” between staff and law enforcement on the hospital campus.

The hospital also implemented a modified “Code Green” policy for using police officers to help manage patients.

Additionally, BMH administrators have had meetings with local law enforcement agencies; the state Department of Mental Health; and other health care providers in the area to talk about issues related to the inspection’s findings.

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Originally published in The Commons issue #359 (Wednesday, June 1, 2016). This story appeared on page C1.

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