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Location: Pled's Pig Farm, Virginia
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|Mental health commissioner kept centerís problems quiet|
< on 5/31/2010 5:08 PM >
|By David Ress |
Published: May 31, 2010
Updated: May 31, 2010 7:42 AM
A top state official last year quashed a move to publicize significant problems at a children's residential treatment center run by a major donor to state politicians.
The spring 2009 decision by the mental health commissioner to keep quiet the problems at Psychiatric Solutions Inc.'s The Pines Residential Treatment Center in Portsmouth came after state licensing officials investigated a series of incidents including:
•a choking that rendered one resident unconscious;
•staff members telling paramedics responding to a 911 call that a girl was suffering respiratory distress but not that she had attempted suicide;
•staff members failing to report two other suicide attempts to regulators;
•staff members telling regulators that the fire department responded to a false alarm instead of a small fire that forced an evacuation; and
•staff members allowing residents to run away -- three of them at one point before any staff intervention, with that intervention unable to prevent a fourth from running away.
Despite the list of problems, a recommendation to downgrade The Pines' license to provisional -- the most serious sanction short of shutting down the facility -- was not approved.
"Met with the Commissioner this morning. It was clear he was not going to approve this provisional" license, wrote Leslie Anderson, the former director of licensing for the state's mental health agency, in an April 2009 e-mail. That document and other records about the state's handling of complaints and problems at Psychiatric Solutions facilities were obtained by the Richmond Times-Dispatch under the Freedom of Information Act.
The mental health commissioner at the time, Dr. James S. Reinhardt, said the decision reflected a policy of the Kaine administration and his boss, then-Secretary of Health and Human Services Marilyn Tavenner, to strike a balance between encouraging private-sector providers and regulating them to ensure they operated safely and gave quality care.
Reinhardt, in an interview this month, said that when Tavenner took office and looked at the challenges the mental health system faced, "we realized then we needed to play with not only the CSBs [Community Service Boards, the local mental health agencies] but with the private sector, we needed them as partners. . . .
"We needed to make sure the quality is there, that human rights are respected, but we needed to allow them to be businesses," Reinhardt said.
Reinhardt said he did not believe Psychiatric Solutions received special treatment. And based on visits to Psychiatric Solutions facilities he has made since he left state government and the company asked him to consult for it, he said his impression is that it provides cutting-edge care.
Psychiatric Solutions, which operates in 31 states, Puerto Rico and the U.S. Virgin Islands in addition to Virginia, gave $25,000 to then-Gov. Timothy M. Kaine's political action committee in 2007 and $50,000 to Gov. Bob McDonnell's inaugural committee this year. In addition, the Tennessee company gave $10,000 each last year to McDonnell and Democratic gubernatorial hopeful Brian J. Moran and $13,500 to Democratic nominee R. Creigh Deeds.
Reinhardt said he did not remember the specifics of The Pines license case, but he added that it reflected the department's partnership approach.
"We work closely with the Virginia Department of Behavioral Health and Developmental Services to maintain high standards and follow state guidelines," said Wes Mason, chief executive officer of The Pines. "We don't consider that we have received any special treatment with respect to licensure."
Mason said The Pines provides quality care and takes standards for appropriate and safe care very seriously.
Six weeks after the commissioner quashed the recommendation for a provisional license, which would have meant public disclosure of regulatory concerns, the department negotiated a "memorandum of agreement."
The agreement required The Pines to give local rescue and fire crews accurate information when responding to emergency calls; to inform social services officials and guardians of serious incidents involving residents; and to increase staff. Such notifications are already required.
Unlike a provisional license, the memorandum was not public.
When people seeking treatment for disturbed children and teens checked The Pines' license status, there were no indications of regulatory concern.
Despite the memorandum, The Pines continued to have problems.
The department finally issued a provisional license at the end of last year. It has since been upgraded, ahead of schedule, because the company made the necessary improvements, said Meghan McGuire, spokeswoman for the Department of Behavioral Health and Development Services.
Those problems included a staff member punching a resident in the face and a case in which staff members did not seek medical help when a resident, saying he did not want to live, slammed his head into a wall and was unconscious for nearly two minutes, records show. In another case, when a resident suffered a broken arm as several staff members were attempting to subdue him, state officials determined there were no grounds for complaint.
McGuire said the department did not have any records of conversations, minutes of any meetings that may have been held, memoranda or notes of former officials involved in the decision to quash the original request for a provisional license.
"But generally speaking, a provisional license may result in financial consequences and may affect admissions for a facility," she said. "A provisional license for larger facilities that take the most difficult cases could affect the ability of individuals who need mental health treatment to find placement."
McGuire said that in the case of The Pines, new leadership "expressed a commitment to making changes," adding that the memorandum of agreement was intended to hold them accountable by setting standards to be monitored in follow-up inspections.
"There are few places in Virginia that take the difficult cases that this facility takes," she said.
One that does is the state-operated Commonwealth Center for Children and Adolescents in Staunton, which Kaine wanted to close and McDonnell proposed selling for $9 million when an official appraisal put its value at $11 million to $12 million. The General Assembly objected, and the facility remains open.
Not long before Reinhardt quashed the provisional license for The Pines, Tavenner led officials from Psychiatric Solutions through the state facility in Staunton. A few days after that, they told the state they wanted to operate a psychiatric hospital of exactly the same size for young people in Staunton.
Late last year, Kaine's office was involved in discussions that led to the suppression of findings that two state children's hospitals, including the Staunton facility, that he wanted to close provided an essential service.
The state Department of Behavioral Health and Developmental Services, in a series of e-mails from Nov. 5 to Dec. 16, 2009, between the governor's office, Tavenner and the department, discussed revisions to an expert panel's report on the care for children with severe mental illnesses.
The revision removed from the report a finding that no other hospitals in Virginia could care for the 800 children with serious mental illnesses treated every year at the state's center in Staunton and a smaller facility in Marion. Kaine and Tavenner have declined to comment about their actions, saying they are no longer in office.
Psychiatric Solutions' 10 residential treatment facilities in Virginia are licensed by the state. State reports show that the facilities have well-above-average numbers of founded complaints of abuse -- in the case of one facility, roughly 20 times the average of other licensed residential facilities.
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