Tag Archives: Vermont State Hospital

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.

Continue reading

Shumlin’s mental health care system still kind of a mess

Very interesting article by VTDigger’s Morgan True, which will get buried under today’s good news about Vermont Health Connect. The story details a plan to build a 16-bed secure inpatient facility for the severely mentally ill.

This specific plan comes from Northeast Kingdom Human Services, which proposes the hospital as part of a multipurpose “social service campus” in the distant hamlet of Bloomfield, pop. 262. How distant? It’s more than an hour northeast of Saint Johnsbury.

That seems like a bad idea for a number of reasons. It’s awfully far away from any sizeable hospital; proximity to a full-scale medical center is considered prudent for a secure inpatient facility. It’s a hell of a drive for the vast majority of those wanting to visit a patient. And there’s the problem of attracting qualified staff to such a remote locale.

This may be nothing more than a fever dream by NKHS; the state is nosing around for a new facility but has made no commitments to the Kingdom. But it does point out something I hadn’t realized: the administration is again looking to expand the system because it is still overstressed.

It’s almost a year since the new hospital in Berlin opened its doors, and there are still severely mentally ill patients waiting in emergency rooms for days at a time because there aren’t enough secure beds. And the state faces a looming, if somewhat unofficial, deadline to close a “temporary” seven-bed facility in Middlesex by 2018. Continue reading

Let’s hope nothing else goes sideways at the Retreat

Thanks to Governor Shumlin, this is a fact:

The [Brattleboro] Retreat is home to the Tyler 3 unit, the only child and adolescent inpatient psychiatric unit in Vermont.

It was Shumlin who wanted to decentralize inpatient services, despite his own experts’ call for a new improved Vermont State Hospital after Tropical Storm Irene. Now, any time we have a child or teen with severe mental illness, they’re off to Brattleboro.

The place where three teens have attempted suicide — two of whom died as a result — in the past 14 months. This comes to mind today because the family of one of those teens is suing the Retreat for negligence.

The patient in question tried to kill herself on May 5 of last year, by hanging herself over a door with a pair of jeans. The brief remainder of her life?

The teen suffered “serious, painful and permanent injuries” including strangulation, unconsciousness, cardiorespiratory arrest, lack of oxygen to the brain, prolonged coma, physical pain and suffering and eventual death, according to the family’s lawsuit.

These days, inpatient psychiatric facilities are carefully designed to eliminate ways for a patient to harm him/herself or others, which is always a high risk. Furniture is soft and rounded, large items are built-in or bolted down, no sharp edges or blunt implements or long ropey things allowed, doors are angled downward so you can’t, say, hang yourself over one of them. Every possible precaution is taken.

The Retreat has, to put it mildly, a checkered history for diligence in patient care. Not to mention financial and administrative competence. And every time there’s a screwup, we hear the same refrain: We’re making improvements, we’ve got a plan, we’ll make things better.

On behalf of every troubled child or teen in Vermont, I sure as Hell hope so. Every tragedy is another black mark on the Retreat’s record — and on the Governor’s.

Now, I know the old VSH had its own troubled history, but its problems were largely in the past. A new State Hospital could have provided a state-of-the-art facility and an expert staff, almost certainly for a lower cost than the current multi-site system. The Governor wanted a decentralized system and ignored the advice of his own people in the field. Now he, and we, are stuck with the Brattleboro Retreat. Let’s hope they make it work from now on.

Vermont’s new mental health system will have more inpatient beds than the old one

I wouldn’t blame Jay Batra if he felt personally vindicated today. Maybe even a little bit smug. VTDigger’s Morgan True: 

The state wants to replace a temporary psychiatric facility in Middlesex with a permanent structure twice the size, officials told lawmakers last week.

… Last June Vermont opened the doors of the Vermont Psychiatric Care Hospital in Berlin, but the system still lacks the capacity to keep people with acute psychiatric needs out of emergency departments.

How about that. “…the system still lacks the capacity…”

Vermont’s new, decentralized, community-oriented system currently has 45 beds: 25 at VPCH, 14 at the struggling Brattleboro Retreat, and six at Rutland Regional Medical Center. If/when the Middlesex facility is built, the system will have 59 beds.

Before Tropical Storm Irene, the Vermont State Hospital had 54 beds. After Irene, the Shumlin administration insisted, repeatedly, that if we had a more robust community-based system, we wouldn’t need that many inpatient beds. In the process, it ignored the counsel of psychiatric professionals, who said that 50 was the bare minimum.

What’s happened since then? The administration has slowly, quietly, built the system back up. And it has found that, yes indeed, those professionals knew what they were talking about.

Let’s take a trip in the Wayback Machine to Tuesday, December 13, 2011

Gov. Peter Shumlin announced on Tuesday that his administration plans to replace the Vermont State Hospital in Waterbury with a decentralized, “community-based” plan with 40 inpatient beds in four locations around the state. …

The unveiling of Shumlin’s proposal came on the same day a top mental health psychiatrist called for almost the exact opposite of what the governor proposed. Dr. Jay Batra, medical director of the state hospital since 2009 and a professor at UVM, told lawmakers at a hearing on Tuesday that the state should have one central mental health facility serving 48 to 50 patients in order to provide the best clinical treatment and best staffing model.

That, from a lengthy VTDigger account of Shumlin’s announcement, which was made in the conspicuous absence of Dr. Batra. At the time, Shumlin was planning on a central hospital with as few as 16 beds. It was a well-intentioned effort to avoid the serious problems that had plagued VSH in the past. But it was a misdirected effort, pursued against the advice of those actually in the field.

At the time, I wrote some highly critical stuff about the administration’s plan, and I got some active pushback from administration officials who basically accused the psychiatric community of professional puffery — overstating the need for their own expertise.

Now, it’s safe to say that the administration was wrong.

Assuming the Legislature approves the $11.4 million Middlesex facility, the mental health system will have more beds than before Irene, and those beds will cost more than a similar number at a single, central State Hospital. How much more, I don’t know. But the system has had persistent problems hiring and maintaining the staff it needs for the specialized care its patients require. Those problems are exacerbated when the beds are spread among four separate facilities.

Also unknown is how much money was [mis]spent on the long and winding road to get exactly where the experts thought we should go in the first place. Plus, we are left with a system that’s almost certainly more expensive to operate and harder to administer because of its geographic spread.

One of Governor Shumlin’s great strengths is his decisiveness. He can assess a situation quickly, make a decision, and carry it through. Well, it’s a strength when he’s right. When he’s wrong, and he stubbornly insists on staying the course, that same decisiveness is one of his great weaknesses.