CMS termination letter cites ‘deficiencies’ at Retreat

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CMS termination letter cites ‘deficiencies’ at Retreat

Sat, 10/11/2014 - 4:49am -- tim

by Morgan True A letter sent this week from the Centers for Medicare and Medicaid Services to the Brattleboro Retreat psychiatric hospital sheds more light on the process that is expected to allow the facility to keep its federal certification. The letter from CMS Associate Regional Administrator William Roberson confirms that the latest survey of the Retreat, conducted Oct. 1 by state investigators acting on CMS’ behalf, identified “deficiencies” that “posed immediate jeopardy” to patient health and safety. However, the letter also states that the cause of that immediate jeopardy was removed the same day.

Retreat officials did not immediately respond to VTDigger’s questions about what conditions posed the immediate jeopardy.

Brattleboro Retreat, VBM file photo

The state Division of Licensing and protection has not made public its report from the Oct. 1 trip to the Retreat — the third in six months. That report will likely contain greater detail on the issue identified during the visit.

But the CMS letter said the survey found that the Retreat had not met the Medicare conditions for participation based on deficiencies in the Retreat’s governance, protection of patients’ rights and quality assurance program.

“These deficiencies have been determined to be of such a serious nature as to substantially limit Brattleboro Retreat’s capacity to render adequate care,” according to the CMS letter.

“Accordingly, CMS will terminate the Medicare provider agreement between Brattleboro Retreat and the Secretary effective November 5, 2014,” it continues.

CMS published a public notice about the Nov. 5 termination date in the Brattleboro Reformer on Friday.

The Retreat received a termination letter from CMS in July, giving an Oct. 6 termination date for its provider agreement. That letter came on the heels of two suicide attempts. In one instance the patient later died, and her parents say it was a direct result of her injuries at the Retreat.

A follow-up survey in August uncovered a sexual assault on the same adolescent ward where the suicide attempts happened.

The hospital can avoid termination if it demonstrates “progress toward achieving corrective actions, and execution of a Systems Improvement Agreement with CMS prior to November 1, 2014,” the letter states.

Such an agreement will allow the hospital to avoid termination in exchange for submitting to a prolonged period of increased oversight from CMS, which could last as long as two years, a state official said.

As part of the agreement, the Retreat must hire a CMS-approved consultant to help it make lasting changes to its patient care practices and governance structure.

“I don’t really see a scenario where the agreement is not finalized by then,” said Retreat Vice President for Strategy and Development Konstantin von Krusenstiern in an email to VTDigger this week. “From our perspective the November 5 date is not the focus, but rather what are the steps we are going to take over the coming many months.”