Our mental health sandcastle, part 1

And every one that heareth these sayings of mine, and doeth them not, shall be likened unto a foolish man, which built his house upon the sand:

— Matthew 7:26

Here’s something that close observers won’t find surprising at all: fresh signs of trouble in Vermont’s mental health care system. In my next post: staffing shortages and other troubles in the system’s crown jewel, the Vermont Psychiatric Care Hospital. This time: Again with the Brattleboro Retreat.

The Vermont attorney general’s office is conducting a criminal investigation into the Brattleboro Retreat following a whistleblower’s complaints about alleged Medicaid fraud at the private psychiatric hospital, The Associated Press has learned.

Ruh-roh. The AP’s Dave Gram quotes AG Bill Sorrell as characterizing the probe as “not narrow in scope,” and that it goes beyond the whistleblower’s complaint into other areas.

As for that complaint:

[Former Retreat staffer Thomas] Joseph alleged a yearslong pattern of instances in which, if overcharges showed up in patient accounts, Retreat staff would not make refunds but instead would change the account to reflect a balance of zero.

If the accusations are true, the Retreat would be in deep shit with Medicaid, which (according to Gram) supplies the Retreat with roughly one-fourth of its total funding.

Yeah, that’s not an enemy you want to make.

Maybe the accusations are baseless and the Retreat will emerge from the investigation with a few tatters of dignity. But there’s a long history of sketchy dealings and shaky finances down there, not to mention the odd instance of malpractice and even patient deaths.

In the wake of Tropical Storm Irene, Governor Shumlin opted very quickly for a decentralized system. The Brattleboro Retreat immediately became one of its linchpins. Given the Retreat’s checkered past, one could well question that decision. Every time there’s another hint of scandal at the Retreat, the question arises in my mind.

Former state mental health commissioner Patrick Flood had words of high praise for the Retreat, asserting that “they absolutely saved our bacon” after Irene. True enough; but only because of Shumlin’s immediate — and never reconsidered — decision to never, ever go back to the old State Hospital. I’ve been told that part of the building could have been rehabbed at reasonable cost, and used as a temporary hospital while a permanent one was built.

If that had been done, our mental health system wouldn’t have been such an unholy mess for the last four years. And the state wouldn’t have been so dependent on the seemingly unreliable Retreat.

If we’re lucky, the Retreat will keep on dodging the bullets. But the state has made a big fat gamble on the Retreat’s viability. It hasn’t come up snake-eyes yet, but you never know when.

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