BRATTLEBORO — The Brattleboro Retreat announced sweeping changes Nov. 14, which met with scorn during contract bargaining from the union representing the psychiatric hospital's employees.
The union called foul at the Retreat's decision, pointing to a disconnect between two years of profits on the one hand and management cutting staff and programs on the other.
The Retreat, one of Windham County's largest employers, is a not-for-profit mental health and addictions treatment hospital providing inpatient and outpatient services.
The hospital announced plans to cut its Therapeutic Activities program. It will cut the number of inpatient chemical dependency councilors, and reduce the number of teaching positions at the hospital's Meadows Educational Center, which serves its younger patients.
Representatives of the Retreat management claimed that these measures were motivated by both a projected 2013 financial deficit and shortfalls that the hospital projects from changes in the state and federal health-care systems in how facilities are compensated.
In a press release, the Retreat stated that 31 positions would be cut. That number includes four vacant positions that will remain unfilled.
According to the press release, the Retreat faces “significant economic challenges related to meeting the increasing needs of our patients who present with significant medical, mental health and addiction illnesses.”
“This along with changes in how heath care is delivered and reductions in government funding require that the Retreat continue to be flexible in how it organizes its services in order to deliver the best care possible to the people it serves.
“Any staff reductions are regrettable and very difficult for all of us given the incredible dedication that our employees have for their work on behalf of patient care,” the release continued.
'Absolute, unadulterated bullshit'
Amid news of the announcement, members of union Local 5086 held the second of two informational pickets in front of the Retreat on Nov. 16.
UNAP represents approximately 6,200 registered nurses, technologists, therapists, support staff, and other health care workers. Its 15 local unions are located in Connecticut, Rhode Island, and Vermont.
Local 5068 formed at the Retreat in 1990, and its one strike in the early 1990s lasted one day.
The hospital and union have completed 12 bargaining sessions. According to Callaci, the sessions have yielded no significant progress.
“We are not planning for a strike, and we don't want a strike,” said Jack Callaci, director of collective bargaining and organizing for the United Nurses & Allied Professionals (UNAP).
But if management “provoke[s] a strike, that's their deal,” he said.
The union thinks the Retreat's chief executive officer, Robert E. Simpson Jr., has “squandered” or mismanaged the hospital's resources, said Callaci.
Callaci doesn't claim to “be a numbers guy,” but said in his experience, hospitals in trouble have a number of patients who don't pay their bills, are not receiving proper compensation from commercial carriers, or the number of patients - the census - has dropped dramatically.
“What you have here is the opposite picture,” he said.
At the Retreat, the revenues have held and the patient census has held or increased, he said.
The hospital has also added programs in recent years, such as a unit to take state patients, a program for lesbian, gay, bisexual, and transgendered youth, and a program for uniformed officers.
Callaci added that usually, during a financial crisis, an institution makes cuts across the board. But the brunt of the Retreat's cuts fell on the “front line” workers and not on administrative employees, he said.
When asked about the Retreat's explanation that the cuts came in response to changes in the wider health-care system, Callaci answered, “That's absolute, unadulterated bullshit. And you can quote me.”
Pay raise dispute
The programs that management cut represent specialized services that have set the Retreat above other psychiatric hospitals, Callaci said, calling the hospital administration's claim that the union sought 20-percent raises “misleading.”
According to Callaci, two types of pay raises exist: an across-the-board cost-of-living increase, and a “step” raise reserved for people rising along the pay scale, or grade, based on such factors as time in service and training. According to the contract downloaded from UNAP's website, pay grades range from testing technician, at step 2, to senior program therapist, at step 23.
A 3-percent cost-of-living raise and a step increase that can add 2 percent to a worker's paycheck, totaling a 5 percent raise for that employee.
But not all employees receive a step increase, and not all employees sit at the top of the pay grade, as some of the Retreat's numbers seem to assume, said Callaci.
As a result, Callaci said, when the Retreat states that the union has asked for a 20-percent raise, the administration omits the context that not all employees would receive the same raise.
The Retreat has also neglected to mention that as a result of the Retreat's financial problems in 2009, the union gave up pay raises and some pension contributions that year as part of negotiations, said Callaci.
In part because of these concessions, the Retreat turned a profit in 2010 and 2011, so the union feels its members deserve some reward for their sacrifice, he said.
Callaci added that the union's raise request represented its opening proposal. This proposal can change.
In session
According to Callaci, near the end of bargaining on Nov. 13, Retreat management informed the bargaining team of the layoffs.
The union and management agreed to keep the information from the press until the Retreat could issue an official statement.
Callaci said the union and Retreat view the situation surrounding the layoffs differently.
“Offended,” summed up Callaci's perspective.
According to Callaci, the Retreat management had referred to the eliminated programs as “non-essential.”
“Not essential,” said Callaci. “It's an insult to the individuals who provide those services.”
“It's a sad way for the administration to look at its own facility,” he said. “[The programs are] important services, and they ought to be restored.”
Callaci said the hospital made a “conscious decision” to eliminate whole programs rather than simply reducing the workforce.
“The Retreat has been a center of excellence,” said Callaci.
But “excellence” can no longer describe the facility after the hospital eliminates programs and skilled staff providing direct care to patients.
“They proudly and rightfully touted these services,” said Callaci.
Callaci said the layoffs were not about low patient numbers or insurance reimbursements. The hospital is full, he said, and the Retreat made millions in 2010 and 2011 while it expanded programs.
And now it can't pay its bills? Callaci asked.
“The status [of negotiations] at this moment is unchanged to the extent that when we left bargaining on Tuesday we had not made progress,” Callaci said.
More meetings between the union and Retreat will continue Nov. 20 and Nov. 21.
Callaci said the union will leave addressing the issue of the layoffs to the eight-member bargaining team composed of Retreat employees.
Callaci said he hoped the community understands that the employees and union members “are standing up for the right things.” He said he wasn't sure the same could be said for the administration.
In the past, when faced with financial issues, management has found a way to support “core benefits” such as pensions, he said. This year, the response remains no.
“It's [management's] job to make sure the resources coming to the Retreat are apportioned properly,” said Callaci.
Busy is not therapy
Standing on the green along Linden Street on a cold evening on Nov. 16, the union local's presidents, Bonnie Chase and T. Vincent Flood, expressed concern for their colleagues and patients.
“Sad, betrayed,” said Chase when asked how her fellow employees felt.
Layoffs never arrive at a good time, she said. But in winter, people especially need their paychecks to fill their fuel tanks.
But the union leaders are also mourning the implications for the workplace.
“We're looking like we're becoming a warehouse,” said Flood.
Chase added that the therapeutic activities and addiction counselors provided patients with skills that helped them thrive after they returned home.
Inpatient addiction counselors worked with patients to identify “triggers” and develop coping mechanisms to stay sober, said Chase.
Therapeutic services helped patients develop social skills, she continued.
According to Chase, Vermont law requires therapists to be licensed. Anyone can give someone pen and paper, she said, but not everyone can turn an art class into therapy.
“Keeping people busy [with games or crayons] is not therapy,” she said. “Once gone, where will you get those services?”
As a Retreat employee, Chase said she has believed in providing “Anna's dream” in terms of patient care.
According to Retreat history, its founder, Anna Marsh, wanted to create a hospital where patients were treated like people, with dignity and respect, and were given the tools to heal. That set of expectations for mental health was radical in the 1800s.
“But we're turning into Anna's nightmare,” said Flood.
It's about numbers
“There's no smoke and mirrors,” said Retreat spokesperson Peter Albert, the hospital's senior vice president for government relations and managed service organization. “It's about looking at the numbers. We're pretty transparent.”
According to Albert, the Retreat added 200 jobs over the previous four years, and “we plan to continue to grow,” he said.
But the hospital also needs to remain “flexible and adapt,” he said.
Without cutting the two programs and reducing the teaching staff, said Albert, the Retreat will sink to the same deficit levels of four years ago.
“The essences of what the hospital is doing will stay the same,” Albert said.
In the press release, the Retreat touched on its plan going forward.
“By continuing to focus on access for emergency care, by providing critical psychiatric care throughout a continuum of services, by creating partnerships with other providers that will assure seamless transitions back to community care, and by investing in technology, the Retreat will remain a strong partner with Vermont and the region,” the document said.
The Retreat has focused its energies of late around emergency care and transitioning patients back to the community, Albert said, but reimbursements from Medicaid and from insurance companies are dropping.
“[The Retreat must] be good stewards of the resources we have,” Albert said.
Regarding changes to the Meadows Educational Center, Albert said that the Brattleboro Retreat Individually Developed & Guided Education Services (BRIDGES) alternative day school program and the residential school will remain.
The adolescents in the inpatient programs, now students at the Meadows school, will receive tutorials on the units, as they don't typically stay as long in these programs as they once did, said Albert.
The layoffs will affect the inpatient chemical dependency counselors but not those working for the outpatient programs, Albert said.
“The layoffs are not a statement of the quality of [employees'] work,” he said; rather, the layoffs reflect the Retreat's desire to stay sustainable.
According to Albert, 2012 started well for the Retreat's budget sheet. The hospital added staff.
The patient census dropped over the summer, but that trend is typical. Combined, however, with the trend toward lower reimbursements and shorter patient stays, the hospital has cause to worry, said Albert.
Management decided to wait and see what happened in September, he said. And then, the declining numbers continued in September and October, according to Albert.
The Retreat looked at its numbers for the remainder of 2012 and 2013. Projections pointed toward a deficit, said Albert.
Albert added that the union has seen the same set of numbers. The institution's financials don't warrant pay cuts, but the Retreat must remain flexible and vigilant, he said.
“We felt the need to get on this sooner rather than later,” he said.
Looking into the future
The Retreat, as the largest provider of psychological services in the state, will feel the effects of the future of health care in general, and the results of health care reform in Vermont specifically, Albert said.
But although those specific effects remain largely unknown, Albert said that the Retreat is able to predict some of the changes looming.
Paying hospitals for every service rendered, called fee for service, will end, Albert said, and hospitals will be compensated based on health outcomes. Patient care will also move from “siloed” health-care providers, working out of context with one another, to health-care partners working across disciplines.
This shift will “refocus treatment in a positive way,” said Albert.
“[But] hospitals as we know them may be changing, so we have to fine-tune what we're doing,” he said.
Albert didn't shrink from the enormity of the Retreat's decision to close programs and lay off employees.
“That's just sad,” he said. “There's no other way to put it.”
“[But] unless we do something,” he added, “we put the entire organization in jeopardy.”