Cross posted from Beyond VSH

It's almost a week now that we've known about the latest denial of certification for the Vermont State Hospital, but we just got the actual report from CMS, the federal Centers for Medicare and Medicaid Services, earlier this week.

The way the state tells it, CMS is picking on them, and they really haven't been doing anything wrong.

If you dig into the report, though, the facts are something very different.

Take this tidbit. One of the problems they identified was in incident in which a patient barricaded herself in her room with her bed, and used the time she was in there to reopen a self-inflicted wound on her arm. It apparently didn't last long, but it could have resulted in a serious injury. It was kind of a mystery, though, how a patient could do this.

 From the report:

During a group interview with facility Administration and staff at 2:10 PM on 3/10/10, in response to the surveyors's question regarding the above event, the facility's Executive Director and Staff Educator #1 both stated that the beds in patient rooms were not movable.

Per observation, while accompanied by Staff Educator #1, at 3:30 PM on 3/10/10, of rooms #11 and #19 (the room Patient #20 had occupied
at the time of the event) on the Brooks 2 Unit, there were wooden framed beds in each room that could be easily moved about the room and
pushed up against the door. Upon observation of the beds Staff Educator #1 stated; “they do move….am I embarrassed.”

We'd provide the link, but it seems to be kind of a challenge to find the report at the Department of Mental Health web page. Maybe that's what they mean by “Challenges for Change”.