November 14, 2017

Videos show misconduct at Alabama behavioral health facility, BuzzFeed investigation alleges

Daily Briefing

    A BuzzFeed News investigation alleges that a "culture of violence" flourished at Hill Crest Behavioral Health facility in Alabama, citing surveillance footage, staff and patient interviews, and a review of documents.

    In particular, BuzzFeed published surveillance videos showing instances in which Hill Crest staff members apparently "tackled" and "dragged" teenaged patients.

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    Hill Crest in a written statement said the BuzzFeed investigation depicts "isolated incidents" that are "not indicative of the quality of care provided at Hill Crest," adding that its "goal is to help and heal those who come to us at their most vulnerable times in their lives." Universal Health Services (UHS), which has owned and operated Hill Crest since 2010, declined to comment on BuzzFeed's investigation.

    Background

    Hill Crest is a 219-bed facility located in Birmingham, Alabama. It offers nine programs and serves adults and adolescents. Hill Crest holds several contracts for treating foster care children that as of September 2017 received more than $20 million in state and federal funding.

    Key findings

    According to Buzzfeed's Rosalind Adams, surveillance footage shows several instances in which Hill Crest staff members "tackled, dragged, and choked" patients. Citing interviews from patients and staff, Adams reports that employees in some cases took patients into bedrooms—outside of the camera's view—for some of the "most vicious beatings."

    Incidents of alleged mistreatment

    Among other incidents, surveillance footage showed episodes in which:

    • A nurse, Isaac Doughty, pushed a 15-year-old patient, Hayden Vice, up against a wall and to the ground. Hayden—who was on crutches and had his foot in cast—said that immediately before the incident, he had refused Doughty's order to take a shower, citing nurse instructions to avoid getting his cast wet;

    • Three staff members pinned down a 16-year-old patient, Adryana Metcalf, at one point flipping her face down, which—according to Buzzfeed—poses particular dangers because of suffocation risk; and

    • An adult patient, Ed Young, in 2015 became unresponsive in his room and died, out of sight of cameras, after staff members approached him and followed him to his room. Documentation from police and Hill Crest stated Young at the time he was approached was holding a plastic bottle that—according to the police report—he used as a weapon to attack the staff; however, surveillance footage reveals Young had nothing in his hands. An autopsy report determined that Young—who had received several sedative shots for what staff called combative behavior before he died—likely had died from hypertensive heart disease, but it noted that he had sustained bruising to his eye and contusions to his head. 

    Fallout

    According to Hill Crest, Doughty and those involved in the Metcalf incident all underwent mandatory retraining.

    Doughty remained at Hill Crest until a few months ago, when he quit because of scheduling commitments. And while the incident was reported to state and regulatory agencies, Doughty in conversation with Buzzfeed maintains he "didn't do anything wrong."

    Meanwhile, an Alabama Department of Human Resources investigation into the Metcalf incident determined no abuse had occurred. 

    While CMS requires psychiatric hospitals to report any patient deaths that happen within 24 hours of the patient being restrained physically or chemically—as had happened with Young—Hill Crest never submitted such a report following Young's death, Adams reports. Regarding the incident, Cathryn Conn, the director of human resources at the facility at the time, said while she could not recall this particular situation, all such incidents were appropriately investigated. According to Adams, Young's family is suing Hill Crest for medical negligence, as well as assault and battery.

    State regulators have given Hill Crest high marks

    Hill Crest has received strong marks from state regulators, Adams reports. The entity that licenses the main hospital, the Alabama Department of Mental Health, in a May 2017 site survey gave Hill Crest 100% on six of seven areas—including one for the use of restraints. The Alabama Department of Human Services, which licenses Hill Crest's group homes and oversees the state foster care system, in a May 2017 visit said there were no major deficiencies.

    Separately, the Joint Commission designated Hill Crest a top performer until 2014—when the commission stopped using the term.

    However, staff accounts suggest the outside assessments may not accurately capture what transpires at Hill Crest, Adams reports. For instance, a former nurse said that for Joint Commission visits, Hill Crest would "put so many people on the schedule to make it look like there was tons of staff."

    Layne Williams, a former nurse who worked at Hill Crest for more than a decade and was sometimes assigned to shifts in the medical records department, said, "I think there was an expectation to doctor the charts." Williams said she wouldn't compromise her license by falsifying imported data and that she only entered information she knew to be true.

    Hill Crest said it "strictly prohibits any employee from falsifying medical records."

    Hill Crest's comments

    Hill Crest in its statement said while the videos depict "isolated incidents" that are "not indicative of the quality of care provided at Hill Crest," the organization "regret[s] and [is] disappointed in the instances of inappropriate conduct by our employees, which was inconsistent with the facility's policies and their training."

    Hill Crest added that "it is important to note that many patient allegations are ultimately revealed to be unsubstantiated, inaccurate, or incomplete" (Adams, BuzzFeed, 11/13).

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