[Hpn] Federal team to re-inspect state hospital; Vermont; BFP; 6/15/03

Morgan W. Brown norsehorse@hotmail.com
Sat, 21 Jun 2003 15:23:55 -0400

Note: Recipient list undisclosed

Below is a forward of an article from last Sunday (June 14, 2003) which may 
be of interest to you and others you know if it has not been come across 

Following the forwarded article are related Web addresses and contact 
information for those seeking additional information.

Morgan <norsehorse@hotmail.com>
Morgan W. Brown
Montpelier Vermont USA
Norsehorse's Home Turf: http://nht.blogspot.com


-------Forwarded FYI-------

Sunday, June 15, 2003
Burlington Free Press: http://www.burlingtonfreepress.com
Local & State News section
Federal team to re-inspect state hospital

By Nancy Remsen
Free Press Staff Writer

MONTPELIER -- Any day, a team of federal inspectors will make a surprise 
visit to the Vermont State Hospital in Waterbury to see if the institution 
has remedied deficiencies found three months ago.

The deficiencies were serious enough that the branch chief for the Centers 
for Medicare and Medicaid Services warned hospital officials in March that 
the psychiatric facility could lose its federal funding for patients July 

The most serious problems included too few nurses, an inappropriate practice 
of locking some of the sickest patients in their rooms at night, and failure 
to show that all patients were receiving treatment.

Hospital officials responded quickly, drawing up plans to correct the entire 
list of deficiencies at the facility, which can house about 50 patients. 
Federal officials have accepted the state's proposed remedies, but plan to 
conduct a follow-up inspection.

"We are feeling very hopeful," said Mental Health Commissioner Susan Besio. 
Although she and the hospital staff were surprised by the criticisms, Besio 
said, "all of them are resulting in positive changes."

The toughness of the federal critique surprised patient advocates, too, but 
they agree with the findings.

Ed Paquin, executive director of Vermont Protection and Advocacy, said the 
nursing shortage has long been a concern. His agency also disagreed with the 
state's practice of locking patients on Brooks 1 in their rooms overnight.

"The results that come out of this are ones that we support," Paquin said.
Problems and fixes The shortage of nurses and other staff at the state 
psychiatric hospital isn't new. In 1986, inspectors cited a similar staff 
shortage and threatened to take away the hospital's federal funding.

Over the past year, Besio said the hospital has struggled to fill nursing 
vacancies. To compete in the tight market, the state hospital won permission 
from state hiring officials to offer higher wages.

"We have actually made some progress recruiting nurses," Besio said. Five 
nurses have been hired this spring. To meet the federal demand for increased 
staff, however, the hospital has also employed "traveling" nurses and other 

Adding nurses and psychiatric technicians has helped the hospital remedy the 
locked-door problem. "We have unlocked the doors," Besio said.

Patients on Brooks 1, the unit for people with the most serious mental 
illnesses, were often locked in their rooms to protect them from other 
patients. The practice allowed the unit to have fewer staff.

"When I heard about it, I was shocked," said Rep. Anne Donahue, 
R-Northfield, who serves on the House Health and Welfare Committee and edits 
Counterpoint, a newspaper of the Vermont Psychiatric Survivors organization. 
"This is a hospital, not a prison."

Patients were supposed to be advised of the lock-up policy, but federal 
officials questioned how often the notification took place.

Besio says the hospital has changed all the locks. The new ones allow 
patients to lock their doors for safety, but still come out at any time. 
Five additional staff work the night shift now that patients may choose to 
roam the unit at night.

Treatment standards

Perhaps the hospital's greatest challenge will be to meet the treatment 
standard set by the federal inspection team. The inspectors said the 
hospital failed to provide records that would allow them to determine if all 
patients were receiving treatment.

Besio said, "They have never, ever brought up this active treatment before."

Patients who are admitted to the state hospital routinely reject medication 
and therapy. If they had agreed to treatment, they would have been cared for 
at one of the regional psychiatric units in the state. Officials at the 
state hospital frequently go to court to win permission to involuntarily 
medicate individuals who pose a serious threat to themselves and others.

Paquin's agency helps patients challenge legal orders for involuntary 
medication. "We definitely concern ourselves with an individual's right to 
have a controlling part in what their treatment is and receive treatment 
without coercion," he said. "As much as the state has made strides, we are 
still behind state of the art in how we handle people in crisis."

Besio says hospital staff try to work with patients, "develop a 
relationship, gain people's trust and get them to want treatment, to realize 
they need treatment.

"What we do very well is start trying to engage people from the minute they 
walk in our door," the commissioner said. "What we haven't done is document 

"It's a challenge," Besio said, "but we are hopeful we can show progress to 
the reviewers."
Contact Nancy Remsen at [(802)] 229-9141 or nremsen@bfp.burlingtonfreepress 


--End of forwarded article--

~~~Related Web addresses & contact information:

* Centers for Medicare and Medicaid Services: http://cms.hhs.gov/

Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore MD 21244-1850

Toll-Free: 877-267-2323

TTY Toll-Free: 866-226-1819


* Department Developmental & Mental Health Services (Dept. of)(AHS): 

State of Vermont Department of Developmental and Mental Health Services:

Susan W.Besio, Ph.D., Commissioner
Vermont Department of Developmental and Mental Health Services
103 South Main Street
Weeks Building
Waterbury, Vermont 05671-1601
Phone: (802) 241-2610
E-mail: sbesio@ddmhs.state.vt.us

The Division of Mental Health
Paul Blake, MSW, Director
E-mail: pblake@ddmhs.state.vt.us
Phone: (802) 241-2604

-- "The Division of Mental Health is divided into adult and children units, 
oversees the operations of the Vermont State Hospital (VSH) in Waterbury, 
the state's only public psychiatric facility, and purchases community-based 
services from the state's ten Community Mental Health Centers (CMHC's) and 
from a non-profit provider of residential services for children and 
adolescents. The Vermont State Hospital serves people who need short-term 
acute care and people who are under court-ordered psychiatric observation or 
are committed by the Courts. [...]"


* Vermont Protection & Advocacy: http://www.vtpa.org/

Vermont Protection & Advocacy
141 Main Street
Suite 7
Montpelier, Vermont 05602

(802) 229-1355
(802) 229-2603 (TTY)
(802) 229-1359 (FAX)
Email: info@vtpa.org


* Vermont Psychiatric Survivors (VPS): http://www.sover.net/~vpsinc/

Vermont Psychiatric Survivors (VPS)
One Scale Avenue, Suite 52
Rutland, Vermont, 05701

Phone: 1-800-564-2106

E-mail: vpsinc@sover.net


* State Representative Anne Donahue, R-Northfield:

Republican -- Donahue, Anne B. , 148 Donahue Drive , Northfield, VT 05663
Phone: (802) 485-6431
E-Mail: adonahue@leg.state.vt.us & counterp@tds.net

State Legislative Bio: 


Self-determination and independence versus force and dependency: 
Commentary by Morgan W. Brown
National Empowerment Center (NEC) Newsletter


Alternative Mental Health Links: http://nht_amhl1.blogspot.com/

-- This is a links page concerning information about alternatives to the 
traditional, medical model-based, mental health system.

Included within these listings as well, will be links to certain Websites, 
articles, reports and other informational pages determined to be of related 
interest concerning these matters.


**In accordance with Title 17 U.S.C. section 107, this material is 
distributed without charge or profit to those who have expressed a prior 
interest in receiving this type of information for non-profit research and 
educational purposes only.**


-------End of forward-------

Morgan <norsehorse@hotmail.com>
Morgan W. Brown
Montpelier Vermont USA
Norsehorse's Home Turf: http://nht.blogspot.com

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