开云体育

The board that oversees the Brattleboro Retreat, Vermont鈥檚 largest inpatient psychiatric facility and the only one designated to treat children, has voted to 鈥渂egin the process of either closing or selling鈥� the facility, according to Secretary of Human Services Mike Smith.

Smith said Sunday that the Agency of Human Services from the Brattleboro Retreat for an emergency 鈥渂ailout鈥� of $2 million.

Smith said Retreat officials informed him Friday that, absent an infusion of additional state funding, 鈥渢hey will likely close or seek sale.鈥�

鈥淢ake no mistake, any threat of closure is both the decision and the result of the Retreat鈥檚 current leadership,鈥� Smith said in an email Sunday. 鈥淥n Monday I will communicate with the board and management that their decision must be executed in a manner that protects patient safety.鈥�

Brattleboro Retreat CEO Louis Josephson called Smith鈥檚 announcement a 鈥渟light mischaracterization.鈥�

鈥淭he board instructed me to explore all options for the absence of increased support from the state 鈥� so that means possible sale, and in the worst, worst-case scenario closure, though we鈥檙e optimistic that鈥檒l never happen,鈥� Josephson said in a phone interview Sunday.

Josephson, however, confirmed that if the state of Vermont doesn鈥檛 increase financial support for the 185-year-old institution, the Brattleboro Retreat will at minimum scale back the scope of its operations. And he said his 鈥渙ptimism鈥� for a positive outcome is based on his belief that the Scott administration will come to see the wisdom of increased state funding.

鈥淲e have stepped up to serve the neediest Vermonters, and we do that with a real sense of passion and mission,鈥� Josephson said. 鈥淲hat the state has not done is provide the funding for that, so if they are not going to provide the funding, we are not going to be able to provide the services they have asked us to provide.鈥�

Even critics of the Brattleboro Retreat say its sudden closure could have a 鈥渃atastrophic鈥� impact on the already strained mental health system in Vermont.

鈥淚 think you can draw a pretty clear parallel to what happened when (Tropical Storm) Irene closed the state hospital,鈥� Northfield Rep. Anne Donahue said Sunday.

Donahue was referring to the 2011 flood that inundated the Vermont State Hospital in Waterbury, and the 54 inpatient psychiatric patients who were being treated there.

鈥淥bviously it鈥檚 not possible to open inpatient beds anywhere else overnight, so it would be a short term somewhat catastrophic impact,鈥� Donahue said.

Josephson said he doesn鈥檛 yet have a precise timeline for the dialing back of operations, or closure, if the Retreat doesn鈥檛 get more money from the state. He said he shares Donahue鈥檚 concerns, however, about the mental health system鈥檚 ability to absorb so much lost inpatient capacity.

鈥淚 am a mental health professional. I see the work we do for Vermonters with mental health (illnesses) and addictions every day,鈥� Josephson said. 鈥淎nd I worry significantly that the state does not have a plan for these people鈥檚 care if we weren鈥檛 here. And I鈥檓 not saying that as a threat whatsoever.鈥�

While Smith said his agency is in preparing a 鈥渃ontingency plan鈥� to absorb patients now being treated at the Retreat, he said the facility鈥檚 closure would have a serious impact on Vermont鈥檚 ability to care for mentally ill patients.

Smith, however, said blame for any disruption to the mental health system lies with leadership at the Brattleboro Retreat, not his agency鈥檚 unwillingness to provide more funding.

Smith said the Retreat鈥檚 request for $2 million last week is the latest in a string of requests for 鈥渇inancial bailouts from taxpayers.鈥� Smith said the Agency of Human Services granted rate increases to the Brattleboro Retreat less than two months ago that will result in revenue increases of more than $5 million over the next two years.

Combined with money the Retreat previously received to construct and operate 12 psychiatric beds for acute patients, Smith said that brings the state鈥檚 total investment in the facility to $16 million in the last few years alone.

鈥淭heir financial strategy appears to be built on a flawed premise that continued financial bailouts from taxpayers is an effective long-term solution or is expected when Retreat management makes a financial miscalculation,鈥� Smith said.

Smith said that financial miscalculation occurred when the Retreat created a budget that over-estimated the number of patients it would serve.

鈥淭here is little clarity on where they stand financially and the prospects of better financial conditions in the future, including how they plan to pay over $1 million of taxes that are owed to the State of Vermont,鈥� Smith said Sunday.

Josephson, meanwhile, said the Retreat鈥檚 financial straits are a product of underfunding by state government. He said Vermont spends $1,000 more per day, per patient to house people at the Vermont Psychiatric Care Hospital in Berlin than it does for patients at the Retreat.

鈥淪o do the math: 14 people times 365 days a year is $5.1 million,鈥� Josephson said. 鈥淚f those people were cared for in a state facility, it would cost the state of Vermont $5.1 million more. But if they don鈥檛 want us to continue to do that we won鈥檛. That鈥檚 their decision.鈥�

Smith said Josephson is comparing 鈥渁pples to oranges,鈥� since patients at the state-run hospital are higher acuity than people the Retreat is caring for

鈥淪taffing patterns and security elements of the VPCH facility really reflect those significant safety and acuity needs, and hence a higher cost,鈥� Smith said.

Northfield Rep. Anne Donahue said she鈥檚 long pushed for the closure of the Retreat. But she said the state needs more time to develop alternative services.

鈥淚t represents an archaic model of care. It delivers in many situations poor care, and it doesn鈥檛 meet the standard of integrated care because it isn鈥檛 part of a medical hospital, so I think it鈥檚 been part of a long-term vision of the state that we not rely on standalone institutional models,鈥� Donahue said of her concerns with the Retreat. 鈥淏ut it鈥檚 a big difference between a long-term goal and an overnight outcome.鈥�

Thirteen lawmakers that represent towns in Windham County issued a statement Sunday evening chiding Smith鈥檚 handling of the situation.

鈥淭o say we are disappointed by Secretary Smith鈥檚 public statement issued today is an understatement,鈥� the delegation said in a written statement. 鈥淲e have no doubt that the State of Vermont will continue to work, responsibly, in partnership with the Retreat to continue to provide care for all patients. We will work diligently with the Scott Administration and the Retreat to ensure that is the case.

Putney Rep. Michael Mrowicki said he can鈥檛 fathom the closure of the state鈥檚 largest inpatient psychiatric facility at a time when demand for acute care beds already exceeds supply.

鈥淚 don鈥檛 know how the state system exists without them,鈥� Mrowicki said Sunday.

Mrowicki said solvency issues at the Retreat are symptomatic of financial stresses for And he said he had little faith in Smith's grasp of the problems the Retreat faces.

鈥淲e have a situation now where the Agency of Human Services is being led by someone without a human services background, and I鈥檓 not sure in a situation like this it helps to have someone who doesn鈥檛 understand the field they鈥檙e supposed to supervise,鈥� Mrowicki said. 鈥淎nd I think when you put a businessman in front of a therapeutic agency, people tend to see things from their own viewpoint.鈥�

Donahue, however, said she has little confidence in the Retreat鈥檚 leadership.

鈥淢y experience in dealing with the Retreat鈥檚 administration is that in terms of responsiveness to quality issues, the leadership is not where it should be. And in being transparent, the leadership is not where it should be,鈥� Donahue said. 鈥淪o it comes as no surprise at all to me to see where the finances are.鈥�

Smith鈥檚 announcement comes as lawmakers prepare to return to the Statehouse this week to

Donahue said she and other legislators will 鈥渉ave to jump in pretty quickly at getting a handle on what kind of negotiations are possible, and whether there is any room in the budget to help create a longer bridge.鈥�

鈥淲e also want to see what kind of contingency plans 鈥� the administration is working on to ensure that the needs of Vermonters are met,鈥� Donahue said.

Josephson said then-interim Human Services Secretary Martha Maksym conducted a rigorous review of the Brattleboro Retreat last year that included a review of its finances and operations. He said the agency offered no concerns after it completed the review, and granted the Retreat a rate increase.

鈥淭here are new developments that (Smith) says are management related now," Josephson said. "He should tell ... me exactly what we are not doing that we (should)?鈥�

Here's how Smith responded:

鈥淲ell the one thing they not ought to be doing it continually coming to the state of Vermont and asking for additional monies, and then sending a letter to me that says if they don鈥檛 get the additional monies they will likely close or seek  sale,鈥� Smith said. 鈥淭hat鈥檚 not the way it鈥檚 done in terms of trying to be a partner.鈥�

Smith said he plans to meet with officials at the Brattleboro Retreat this week.

鈥淚鈥檓 hoping that the board comes forward with realistic and with detailed proposals that take measurable steps towards improving the current and future financial viability of that organization,鈥� Smith said.

But under no circumstance, Smith said, will he advise the governor or lawmakers to allocate more state funding for the Brattleboro Retreat.

鈥淚 don鈥檛 operate under the policy of too big to fail. If we鈥檝e got a failing institution, a financially failing institution, then we need to do something about it,鈥� Smith said. 鈥淎nd right now, I don鈥檛 see any way with what has been presented me that I would offer to the governor or to the Legislature a solution that has more money attached to it.鈥�

Updated 5:45 p.m. This post was updated to include interviews Sunday with Human Services Secretary Mike Smith and Brattleboro Retreat CEO Louis Josephson.