Editorial: Continuing Crisis; Problems Surface for Vermont’s Mental Health Plan

It was safe to assume that Vermont’s makeover of its mental health system would encounter some problems, but hardly of the magnitude of the one that has crystallized in recent weeks: The federal government is threatening to stop paying for treatment of patients at the Brattleboro Retreat because of inadequacies discovered during inspections.

The state planned for the Retreat, a private facility, to play a major role in the decentralized mental health system rolled out after the closing of the Vermont State Hospital in Waterbury, a 54-bed treatment center that lost federal certification in 2003 and was put out of its misery by flooding caused by Tropical Storm Irene. The overall plan calls for the construction of a 25-bed Green Mountain Psychiatric Care Center in Berlin for the most volatile patients, with the Retreat and several other facilities around the state providing additional in-patient treatment. With the Berlin center not expected to be operating until next spring, the Retreat has been caring for many of the most severe cases, including patients who have committed violent crimes and are receiving court-ordered treatment.

The latest inspection, conducted at the request of the Centers for Medicare and Medicaid Services, identified violations of federal standards that have been described as serious and systemic — involving not just the patients being cared for under the $8 million annual contract with the state but also private patients. The deficiencies varied from poor documentation to improper treatment to inadequate training. The federal government has threatened to stop covering Medicare and Medicaid claims in August, although the Retreat has some hope of avoiding that penalty if it can convince federal authorities that it has a viable corrective plan. Meanwhile, the state is making contingency plans to deal with the possibility that the Retreat will lose federal funding — a prudent course of action considering that the Retreat has been found in violation of federal standards four times in 18 months.

Peter Albert, the Retreat’s vice president for public relations, issued a statement that managed to simultaneously accept and deflect institutional responsibility. The Retreat is responsible for the problems identified in the inspection and for fixing them, the statement said, but it’s also important to realize that the problems have been created in part by the ongoing mental health crisis in Vermont caused by inadequate resources, facilities and leadership.

No doubt, there is plenty of blame to go around. We can’t help but wonder, for example, if the state is regretting its decision to decentralize services, which can only heighten the challenge of mustering an adequate number of specialized caregivers by dispersing the need for them at multiple sites (while also making it more difficult for state officials to keep on top of monitoring the quality of care). We also recall the warning issued in early 2012 by Vermont State Employees Association President John Reese when the Shumlin administration announced that the closing of the state hospital necessitated the layoff of as many as 230 employees and the eventual elimination of 80 positions. The layoffs will “only worsen the crisis because it takes many dedicated and knowledgeable caregivers out of the system and away from a patient population that depends on continuity of care and caregivers,” Reese said. It seemed self-serving at the time, but now seems prescient in foreseeing difficulties the state would have in replacing skilled and experienced employees.

In any case, there can be no doubt about one thing: The state is ultimately responsible for making sure that these extremely vulnerable residents receive the treatment they need, no matter what the setting.