UPDATE: The Brattleboro Reformer now has the story.

http://www.reformer.com/ci_233…

 There are more problems for the Brattleboro Retreat and for the Department of Mental Health's increasing reliance on the Retreat as a location for involuntary mental health treatment.

Late Friday afternoon the weekly update circulated by the Department included the following statement:

 This week, the Brattleboro Retreat received its report from the Centers  for Medicaid and Medicare Services (CMS).  CMS provides deemed status to entities which meet Medicare health and safety conditions.  Surveys of deemed status are conducted when the Secretary of Health and Human Services determines that there is a need based on substantial allegations of deficiencies which would adversely affect the health and safety of patients.  Once surveyed, if a psychiatric hospital is found to have deficiencies with respect to compliance with one or more Conditions of Participation, deemed status must be removed. 

 On February 21, 2013, a substantial allegation survey was conducted and the Retreat followed up by submitting a plan of correction, which was accepted. 

 On April 18, 2013, CMS conducted a full Medicare survey of the psychiatric hospital and determined that Conditions of Participation were not met in two areas:

·         Compliance with Federal, State, and Local Laws

·         Patient’s Rights

This survey has resulted in the determination by CMS to terminate the Medicare provider agreement between Brattleboro Retreat and the Secretary effective August 15, 2013.  However, the Retreat now has the opportunity to avert this termination through submission of another Plan of Correction within 10 calendar days.  A revisit survey will then be scheduled by the Division of Licensing and Protection to determine whether compliance has been achieved.

 

Asked for comment, the Retreat provided the following statement:

CMS Press Statement May 2013   “ Following an on-site survey in April by the Centers for Medicare and Medicaid Services (CMS), the Brattleboro Retreat received a letter on Monday, May 20, citing deficiencies. In the coming days, the Retreat will submit to CMS a Plan of Correction, and CMS will return for a follow-up survey to determine the effectiveness of our Plan,” said Peter Albert, senior vice president of Government Affairs. “Our recent growth as a hospital, and in particular our contract with the State to care for patients on a newly renovated 14 bed unit who would in the past have gone to the now closed Vermont State Hospital has been accompanied by a process of continuous learning, problem solving, and innovation. In reviewing the data from the survey we recognize that the majority of the issues identified are related to this new state hospital unit, we have been and will continue to work on making the necessary improvements. As a result we are confident that all cited deficiencies will be corrected, and the improvements we make as part of this process will help us continue our focus on excellence in our clinical practice at all levels of the organization, and assure our patients, and their families, that we are providing exceptional and compassionate care.”

 

As I say, this is a big problem for the state for a couple of reasons.

First, when Waterbury closed the state moved a lot of patients to the Retreat, and it has continued to be one of the main locations for involuntary commitments and the only hospital accepting criminal defendants for forensic evaluations.  

Second, this is not even the first time this year that the Retreat has been found deficient in meeting federal standards, and at least the third time since 2012.

Last, and possibly most important, the Retreat has been justifiably criticized by state officials and legislators for being, shall we say, extremely slow in letting the information about their disciplinary problems make its way to the public. The latest decision from CMS, the federal agency responsible for the Medicare program, was received by the Retreat on Monday, May 20. We don't know when the state got notice, but it was not released to the public, or at least to the limited e-mail list for the Department's weekly e-mail advisories, until Friday, May 25, at 5:31 p.m.  

Last year and earlier this year the Retreat came under heavy fire from legislators for slow-walking bad news like this. I don't know if the Retreat sat on this, but it is reasonable to think that if either the Retreat or the Department had released this information earlier to the members of the Mental Health Oversight Committee the news would have become public much earlier than after deadline on the Friday of a holiday weekend.  

Granted, the Retreat has time to submit a plan of correction, so it's possible that the won't actually lose Medicare funding.  On the other hand, when they are repeatedly cited for violations, including patients' rights violations, is this the kind of place we should be locking up our most vulnerable people?

We have not received the CMS statement yet, but we’ll keep the readers posted when we do.