The CBS Response: Part II

A public relations firm working on Charter's behalf has sent more than 30 pages of material to the show's producers. CBS News has decided to put up on this Web site much of this information -- excluding the employee records and the confidential patient material-in order to address Charter's arguments in a fair and thorough manner. We have reprinted Charter's language just as it was sent to us, except when we deleted confidential patient material. Below is Part II of this response.

THE FOLLOWING POINTS ARE IN A MEMO THAT APPEAR TO HAVE BEEN WRITTEN BY A CHARTER PINES STAFF MEMBER

CHARTER ARGUMENT #10
"Terrance Johnson's assertions that he was not trained
On 8/12/99, I conducted a training of one hour and 15 minutes focused on therapeutic intervention versus punitive intervention including talk-downs and seclusion and restraint prevention. Included in this training was an emphasis on patient care, patient rights, and the fact that our mission is to take care of any patient who comes given by clinical necessity not by any financial considerations." (This memo is accompanied by two sign-up sheets, both dated 8/11/98. Terrance Johnson has signed both of them.)

CBS NEWS RESPONSE #10
On 8/11/98, Terrance Johnson attended a meeting led by a nurse manager. We have compelling evidence that the nurse spent the majority of the meeting discussing administrative issues and hospital policies, although she did talk about some patient issues. At the end of the meeting, she said that a Charter doctor had made a video tape that the staff should watch on their own time.

Terrance Johnson asked for this video tape repeatedly over the next couple of weeks, and repeatedly the staff members he asked could not find it to give it to him.

When Terrance signed into this meeting, he signed two sheets. One sheet gave a doctor's name as presenter, although that doctor was not present at the meeting. The nurse who ran the meeting made that clear. The other sheet gave the name of the nurse who held the meeting.

Only one meeting took place on 8/11/98. No meeting took place on 8/12/98. On 9/9/98, Johnson went to work early for what had been advertised as another in-service meeting, held by the same nurse manager. This meeting was cancelled, however.

CHARTER ARGUMENT #11 (NOTE: CBS News has edited the following paragraph that Charter sent to us, because it contains confidential information about a patient.)
"Incorrect presentation of female adolescent seclusion
The medical record reflects that the patient was indeed informed of her admission, that at the time she was informed was when she began to resist...CBS NEWS HAS EDITED CONFIDENTIAL INFORMATION HERE... The decision was made for her to be admitted with parents' consent, this was not an involuntary admission. Patient was well aware of the admission and the reason for the admission. Within 30 minutes of the time that the patient was admitted, her mother was alloed to visit and she was transported and taken to the inpatient unit without incident."

CBS NEWS RESPONSE #11
As Charter states, the evidence clearly shows that this girl became upset and agitated when she learned that she was going to be admitted to the hospital. What Charter doesn't say is that the girl had to learn this from Terrance Johnson, who was left alone with her. When Johnson first arrived in the lobby, she was calm.

Johnson subsequently discussed this case with other staff members-including the physician who participated in the girl's restraint-and they confirmed his interpretation of what had happened to the girl.

But the most important point about this girl's admission was not that she didn't know that she was going to be admitted. In fact, in Unsafe Haven, Dr. Linda Finke makes the point that the girl's parents may have felt, rightly, that they could not tell their daughter that she was going to be admitted to Charter. Rather, the most important point about this scene is that this girl was taken straight to restraints by staff members who made no real effort to talk to her and didn't know anything about her. They had no idea why she was in the hospital when they restrained her, and they had no idea if it was safe to restrain her.

CHARTER ARGUMENT #12
"Episode in which patient alleged that his wrist was injured
It is not noted in the 60 Minute episode that a portable x-ray was obtained of his wrist immediately after that episode and it was documented that there was no fracture incurred and the patient was evaluated in the emergency room at Presbyterian Hospital."

CBS NEWS RESPONSE #12
Unsafe Haven stated that this boy's wrist was "injured." We never said that his wrist had been broken - although in fact state records subsequently showed that his arm had been in a cast shortly before he was admitted to Charter.

A subsequent report by the State of North Carolina, which inspected Charter Pines after Unsafe Haven aired, cited the hospital for violating state law when its staff restrained this boy. Specifically, the hospital was criticized for restraining the boy by his wrist, even though his record showed that he had recently broken his arm for the fourth time, and even though the boy complained that his arm was hurting him. The state report goes on to point out that, although Charter received x-ray results on 8/29/98 that confirmed that the boy's wrist was not re-broken, the staff at Charter restrained the boy by his wrist twice between the time he started complaining about pain in his wrist and the time the hospital received the negative x-ray finding.

CHARTER ARGUMENT #13
"The assertion that the patient was overmedicated after a seclusion and restraint episode.
The review of the medical record indicates that the patient's PRN medications were well within appropriate dosages for his age and size and not even close to being considered 'overmedicated.'"

CBS NEWS RESPOSE #13
Unsafe Haven never used the word "overmedicated," although Dr. Linda Finke does comment in the piece that this boy "appears groggy, which is very sad to see. He seems to have been heavily sedated." The boy is indisputably groggy-in the video, he is clearly having trouble walking. And, as Terrance Johnson witnessed and discussed with other staff members, the boy received a number of shots that day to sedate him. Furthermore, as Drs. Finke and Fassler observe in Unsafe Haven, the boy receives at least one of those shots when he is already strapped down and calm.

CHARTER ARGUMENT #14
"The assertion that our facility trained people to document negative data to keep people in the hospital "longer than needed."
This is ludicrous, in that our hospital is on of the shortest length of stay hospitals in our community, as well as other Charter hospitals."

CBS NEWS RESPONSE #14
Unsafe Haven never made the claim that Charter kept people in the hospital "longer than needed." We presented evidence that Charter trained its staff to document negative things about patients so that insurance companies would pay for their hospital stays. This was confirmed when the nurse and mental health technician told Terrance Johnson how they were trained to "focus on the negative...so that this place can get paid." It was confirmed by Leslie Armeniox, who said that this was part of the inservice training at Greensboro. It was also confirmed by many other Charter employees around the country.

CHARTER ALSO SENT CBS NEWS A MEMO CONSISTING MOSTLY OF CONFIDENTIAL PATIENT INFORMATION WHICH CBS NEWS WILL NOT REPRINT HERE. THE FOLLOWING ARE EXCERPTS FROM THIS MEMO WHICH DO NOT INCLUDE CONFIDENTIAL INFORMATION:

CHARTER ARGUMENT #15
"In your program you identified Leslie Armeniox as 'an administrator at Charter Greensboro and a therapist there for 14 years.' Her employment record (attached) shows that Ms. Armeniox was a 'movement therapist.' As the attached job description notes, the movement therapist coordinates physical activities such as dance and recreational activities. Outside of these physical services, Ms. Armeniox's duties had no bearing on the physical condition of patients, their care, or course of treatment."

CBS NEWS RESPONSE #15
In its memo, Charter sent CBS News only a few pages of Leslie Armeniox's employment record from her 14 years at Charter Greensboro. CBS News checked with Leslie Armeniox for the remaining parts of her employment record, which show that she was not only a movement therapist for 14 years at Charter Greensboro, but also an administrator there for at least five years. Her job description, according to Charter's evaluations, was mostly managerial and administrative during that time. Her duties included the following:
--working on budget matters for the hospital
--formulating hospital policies, procedures and programs
--hiring, firing and evaluating staff
--attending meetings wit other administrators concerning program planning, marketing, quality assurance
--providing clinical and administrative supervision for staff
--attending management retreats with other hospital management staff

CHARTER ARGUMENT #16
"I have attached a list of every Charter staff member who appears, without their knowledge, on your hidden camera footage...The attached sign-up sheets show that they attended in-depth classes in crisis intervention, the proper use of seclusion and restraints and patient safety." (list attached)

CBS NEWS RESPONSE #16
During the eight weeks that Terrance Johnson worked at Charter Pines:
1. Johnson received no formal training, except for a half-day restraint class near the end of his tenure--which was not a serious training session.
2. Johnson spoke to many other staff members who told him that they had not had a single day of training, even after months of work at Charter.
3. The staff member who runs Charter's restraint classes told Johnson in October that the hospital hadn't offered restraint classes since spring, because the patient census had been too low and there was not enough money for it.
4. Several staff members told Johnson that they had worked for months and never had any restraint training-and told him this in the context of either performing a restraint on a patient or recounting a restraint they had recently performed.
5. Two employees told Johnson how they were ordered by their supervisors to falsify their training and qualifications in their records, in preparation for inspections.

THE FOLLOWING IS A LETTER THAT CHARTER'S PRESIDENT AND CEO SENT TO CBS NEWS ON JUNE 14:

June 14, 1999

Ed Bradley
CBS NEWS 60 Minutes
524 West 57th St
New York, NY 10019-2985

Dear Mr. Bradley,

The videotape that you received earlier today is our response to your planned rebroadcast of the "60 Minutes II" program related to Charter Behavioral Health Systems and specifically to the letter faxed by David Gelber on June 8, 1999. As we have communicated to you since Mr. Gelber's letter, it has always been our intention to respond, in the interest of a fair and balanced story, as the attached letter notes.

To re-emphasize the videotaped response, at Charter we take very seriously the great responsibility that we have to our patients and staff to fulfill the need for quality mental health services. Because of this we have taken all actions within our capability to help ensure consistent and high standards of care in each of our facilities.

These actions include:

1. We launched an internal review of our systems, which is ongoing. We took immediate actions as a result of our initial findings including staff suspensions, terminations and recently announced our plans to close one facility and consolidate another.

2. We sought the consultation of the Joint Commission on Accreditation of Healthcare Organizations in their review of 18 of our facilities. Although their reiew was intense, we are committed to ensuring that each of our systems is in total compliance with JCAHO standards. Based on their initial findings, we have some corrective actions which we are currently putting in place.

3. We worked cooperatively with all our managed care partners to ensure that we are able to continue to allow their clients access to quality mental health care and a choice in providers. Although three companies temporarily suspended direct referrals pending audits of our facilities, nearly all have been reinstated. Some audits and follow-up issues are currently ongoing.

4. We announced the initiation of an independent review, through counsel, of the company's corporate oversight functions, policies and procedures by Towers Perrin Consulting.

As stated in the tape, we welcome scrutiny of our systems. We believe in the staff, systems and services we provide. I hope the purpose of the scrutiny is to help us improve our services, not eliminate an option for those who suffer from mental illness.

In your report aired April 21, we feel the many inaccuracies you reported are an illustration of the unfair scrutiny that makes it difficult for an organization dedicated to improving its services. Also, quite a number of the issues had been corrected by Charter long before your broadcast but you left the viewers with the impression that they still existed. We request that you correct these factual inaccuracies. In addition to the inaccuracies included on the tape we also want to mention:

* Terrance Johnson claimed that he was interviewed for only five minutes before being hired, when in fact Charter Pines interviewed him twice, conducting a background and criminal check before hiring him.
* You stated that all employees shown to be restraining a patient had no training, when in fact all employees shown had been trained in Critical Incident Training and/or Management of Aggressive Behavior.
* You stated that Leslie Armenox and Jim Lell were Charter "administrators" when in fact she was a movement therapist and he a clinical program director.

These are just a few of the many other misrepresentations which we will be happy to work with your staff on to at least present the true facts.

As President and CEO of Charter, since October of 1998, I have complete confidence in our staff to uphold our mission of providing the highest quality of care to our patients and to continuously improving our care through careful examination of our systems, policies, and procedures.

Sincerely,

Mike French
President and CEO
Charter Behavioral Systems

CBS NEWS RESPONSE TO MR. FRENCH'S LETTER
CBS News has already responded earlier in this Web site to all the significant points in this letter, except for the point about Jim Lell. Charter claims that he was a clinical program director, and not an administrator. However, on July 1, 1992, Charter sent a letter to "Mr. Jim Lell, Program Administrator, Adolescent Unit I" and told him that he could receive a bonus for as much as $15,000 for the following performance criteria: "JCAHO performance, State Board of Health compliance, FTE management, patient/family satisfaction surveys, quality care based upon outcome data, referral development, length of stay to budget, average daily census to budget."

Incidentally, Jim Lell himself says that he was an administrator at Charter Terre Haute.

THE FOLLOWING IS A TRANSCRIPT OF A TAPED STATEMENT FROM CHARTER'S CHIEF MEDICAL OFFICER, SENT ON JUNE 14:

Dr. Gary Henschen, MD
Charter Behavioral Health System Statememt
June 14, 1999

Hello, I'm Dr. Gary Henschen, Chief Medical Officer of Charter Behavioral Health Systems. Our company is dedicated to providing the highest quality mental health and substance abuse services to our patients. That is and will continue to be our top priority. We continue to take all necessary steps to help ensure that our patients receive the specialized treatment and therapy that will enable them to attain mental and emotional health. We believe in our highly skilled medical staff, our systems, and the services we provide. We welcome scrutiny of our system by responsible regulatory agencies. We believe that legitimate scrutiny can improve even the best health care facilities. The program broadcast by 60 Minutes II on April 21, and rebroadcast tonight was neither legitimate nor fair. In fact, many of the statements contained in the program are false. We have provided to CBS News documentation of several instances of false allegations and misstatements of fact. By far the most irresponsible act undertaken by CBS News was their decision to plant an undercover reporter with a hidden camera at one of our facilities to record the details of patient treatment. This was a profound violation of our patients' privacy. When we learned that CBS News intended to broadcast hidden camera footage of our patients, we went to court for only one reason, to protect our patients' rights to privacy. While the judge could not prevent the broadcast due to legal precedent, he stated that the actions of CBS News were most likely illegal. In his opinion, Judge Graham Miller said, and I quote, ?I will ask the United States attorney to look into the actions of the CBS News technician who went to this place and may well have communicated lies and thereafter received a pay check for it, to see if perhaps there is a federal felony involved.? In fact, the CBS News undercover reporter, Terrence Johnson, made many false statements during his employment at Charter Pines and in the broadcast. During a situation involving the admission of a highly agitated teenage girl, a staff psychiatrist who was present at the time and is shown on the CBS tape, reported that Mr. Johnson may have escalated the situation by using improper restraint techniques and not gaining the assistance of qualified staff. The physician also stated that he called additional staff to the scene wh quickly took all appropriate measures to calm the patient down. Mr. Johnson also claimed he had no training for seven months after being hired, when in fact, he attended two training sessions during the month in which he was hired.

In the program, CBS News depicted a young woman being admitted to the hospital against her parent's wishes. A decision to admit a patient involuntarily is one of the most difficult that a doctor has to make, particularly if family members disagree. In this case, the doctor acted because she believed that this young woman's life was in very real danger. This young woman had attempted suicide, she was carrying a note in which she threatened to kill herself, and she had access to a gun. This doctor's opinion was confirmed by the hospital's medical director and by a court order.

These are just some of the many examples of false statements we have submitted to CBS News. We believe CBS News should conduct a full investigation into their own irresponsible and possibly illegal news gathering tactics. We felt an obligation to our patients and to our staff to correct the inaccurate information broadcast by CBS News. However, the main concern of management and medical staff of the Charter Behavioral Health Systems remains the confidential care and treatment of our patients.

CBS NEWS RESPONSE TO DR. HENSCHEN'S STATEMENT
With two exceptions, CBS News has already responded earlier in this Web site to every point Dr. Henschen raises in his taped statement. The first exception is the "young woman being admitted to the hospital against her parents' wishes." Unsafe Haven never took sides in the dispute between the young woman's parents and Charter Pines about whether the young woman should have been admitted. In fact, Ed Bradley says in the piece that "we can't say whether Krystle needed to be hospitalized. But even after she was admitted, she says the counseling she got at Charter didn't amount to much-about a half-hour of family therapy, and two quick exchanges with her Charter psychiatrist." Dr. Henschen correctly points out that "a decision to admit a patient involuntarily is one of the most difficult that a doctor has to make." But he does not address the fact that, after making that decision to hold the girl against her will and her parents' will, all the doctors and therapists at Charter Greensboro spent less than an hour with her during her four days of hospitalization.

The second new point that Dr. Henschen makes is an allegation raised by the physician involved in the restraint of the girl who did not at first know she was being admitted to Charter. This physician observed Johnson for a few seconds before he took over handling the girl in the lobby, and he saw that Johnson was left as the only staff member with her. This physician spent approximately three minutes with this girl from the time he first approached her to the time he left her in restraints. This physician did not say anything to Johnson bout his handling of the girl and did not do anything noticeably different than Johnson did when he approached her. This physician spoke to Johnson a few weeks later about this restraint, and did not contest Johnson's account of what happened in the lobby. And this physician never told Johnson or had anyone else tell Johnson that he had acted incorrectly or done anything to escalate the girl's behavior.