Yet when Terrance Johnson started work at Charter Pines Psychiatric Hospital in Charlotte, N.C., he received no training in how to restrain patients.
At Charter Pines, Johnson witnessed eight restraints. These restraints were, he says, done haphazardly - no one seemed to know how to do them. During one restraint, an MHT injured a boy's wrist, then left him gasping and crying in leather restraints, surrounded by untrained employees who didn't know how to help him.
Another night, after working there for six weeks, Charter's staff bungled the admission of a teenage girl whose parents brought her to Charter for admission. The girl didn't know she was being admitted, panicked, and was immediately carried off and strapped into leather restraints by Charter's staff -- before they even knew her name or why she was in the hospital.
What's wrong with this? Several things, according to experts who saw the tape. "In some cases you may not be able to get the child there if you explain ahead of time. But once you get there that child should know what's going to happen to them," says Dr. Linda Finke, last year's president of the Association of Child and Adolescent Psychiatric Nurses. Finke, who has studied the use of restraints, calls the girl's restraint "a dangerous situation."
"They haven't tried standing her up and walking to where they're going," says Dr. David Fassler, who chairs the American Psychiatric Association's Committee on Children, and wrote the American Medical Association's policy on seclusion and restraint. "They sort of moved right away to deciding that she needs to be carried."
A few weeks before Johnson left Charter, the hospital offered the first training classes in eight months. This training, Johnson says, did not go into much depth: "We were told we were gonna get a test, and 'these are the answers: The first question is true.' And the class proceeded like that."
Johnson also saw, and recorded, a doctor back-timing a patient's chart. This doctor often arrived after the children on the ward were asleep, and one night Johnson taped him as he back-timed a chart entry so that he appeared to have observed a child earlier in the evening.
CBS showed these episodes -- which Johnson has captured with his hidden camera -- to June Gibbs Brown, the inspector general of the U.S. Department of Health and Human Services and the nation's highst authority on health care fraud. "It's a pretty appalling situation," says Gibbs Brown. "I truly would not expect to find anything like this in any legitimate health care facility."
The Inspector's General Office is now pursuing a nationwide investigation of Charter.
The atmosphere on the ward was often chaotic. "We were so understaffed, they had so many kids there, we couldn't properly watch them," Johnson says.
Johnson believes that for the most part, his colleagues were nice people who often acted with compassion. They just seemed poorly trained and overworked. They knew that patients were getting shoddy care, but believed that there was nothing they could do.
More than once, Johnson says, his co-workers told him that they would never send their own children to the hospital.
Who is in charge of overseeing the country's psychiatric hospitals? The only body in the country that accredits psychiatric hospitals is the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Although the federal government relies on Joint Commission inspections for its Medicare and Medicaid programs, JCAHO is a private agency whose inspections are planned -- and paid for -- by the hospitals themselves. "It's a classic case of the fox watching the henhouse," says Professor Wanda Mohr of the University of Pennsylvania Nursing School, who has studied psychiatric care in the U.S.
Six weeks after a 16-year-old boy died in restraints at Charter's Greensboro hospital, the Joint Commission confirmed that hospital's accreditation, scoring the facility 96 out of a possible 100 points.
Charter may also have concealed and falsified records at Charter Greensboro. Leslie Armeniox, a staff therapist for 14 years at Charter Greensboro until she quit in 1995, says that whenever inspectors were coming to the hospital, her supervisors asked her to write notes about patients she'd never met -- and that sometimes her supervisors even hid charts from inspectors.
Overall, Johnson says, the situation at the hospital was unsafe for everyone there: "I think it's dangerous for the workers, I think it's dangerous for the patients who are there. These kids are being restrained by people who are not trained to do restraints, they're being left with mental health workers who don't know how to do CPR, their vitals are being taken for some extreme medications by people who don't even know how to take vital signs."
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produced by David Kohn