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CBS Responds To Charter

A public relations firm working on Charter's behalf has sent more than 30 pages of material to the show's producers. This material includes a taped statement by Charter's chief medical officer, several memos and letters, some Charter employees' and former employees' records, and some records from the file of an adolescent patient at Charter Pines. None of this material answers any of the specific questions we have posed to Charter. But it does outline some of Charter's positions on our program, Unsafe Haven. 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.


"CBS News assertion that Charter went to court to block the show"
False. We went to court to block the use of a video tape that we feel was obtained in violation of state and federal confidentiality laws. The objection was not to the right of CBS News to produce and air a show about Charter but simply the rights that our patients have and the obligations that Charter has to protect the patients rights of confidentiality."

Charter went to court in order to block the broadcast of the hidden camera footage which ran throughout the show and constituted its most compelling evidence. As we clearly stated in Unsafe Haven, the only way we could report this story completely was by using hidden camera footage. Very few public records exist, because under the law in most states-including North Carolina-private psychiatric hospitals don't have to report to the state, even when a child dies under their care. Pulling the hidden camera footage would have been no different than blocking the show from airing.

Furthermore, CBS News obscured the identity of all patients included in this broadcast.

"Terrance Johnson's assertion that he was only interviewed for five minutes.
False. The employee had a first interview with a nurse manager in the facility lasting approximately one half hour to one hour and had a second interview with another nurse manager (perhaps only for five minutes). Also, it is important to note that a reference check and criminal background check was conducted by HR Plus. The employee did not begin working until this process was completed."

In Unsafe Haven, Johnson describes his interview as taking "probably about five minutes or so." CBS News reviewed the details of this meeting carefully with Johnson, who says that he met with two people who talked to him for a total of approximately five minutes. One asked him a few minutes' worth of questions. The other told Johnson that they could use a bi man like him on the 3-11 shift on the adolescent unit, because the children sometimes get agitated after their parental visits.

Charter did in fact check Johnson's reference before hiring him. However, Charter never asked Johnson for a release to run a criminal background check on him. CBS News checked with a company that runs criminal background checks for Charter, and that company said it would never run a criminal background check without a release from the employee.

"Assertion that training had not been held for seven months
False. In July (the month he started to work) there were two sessions of MAB conducted. Additionally, during his five-week absence from August to September, another class was conducted. In October, another class was offered that he attended."

The month that Terrance Johnson started working at Charter, Charter advertised and then cancelled a course in management of aggressive behavior (MAB), for proper restraint procedure. Johnson could not take the course because it was cancelled.

Johnson worked from July to August, left for five weeks, then returned in September. When he returned, he asked if Charter had offered a restraint class in his absence. The person who conducts the restraint classes for Charter told Terrance that the classes had not been offered for seven months, but they would be offered soon.

On October 23, Charter offered a restraint training session from 8 AM to 2:30 PM. Johnson took the course, and described it in his interview with Ed Bradley in Unsafe Haven:

ED BRADLEY: What were those classes like?

TERRANCE JOHNSON: 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.

Several employees told Johnson that Charter Pines had discontinued the restraint training classes during the summer, while the hospital had a low census. In a conversation with Johnson, one of the employees explained that he had not had any restraint training for this reason. This conversation took place moments after this employee had just restrained an adolescent patient.

While Terrance Johnson was working at Charter Pines, no training sessions were offered there that he failed to attend.

See also response #10.

"Impression that staff was not trained.
False. All staff shown to have hands on a patient during a seclusion or restraint had received prior training in CIT or MAB. One employee that is shown on the video saying that he had not received any training was hired on September 3, 1998. (Remember Terrance Johnson was employed from the end of July 1998-October, 1998 so it may have been just days since his hire date)."

Unsafe Haven did not claim that none of the staff members at Charter Pines had any training. In fact, the report made a point to say when we had evdence that "at least one staff member here had been trained by Charter." But we also showed evidence that many staff members had not been trained for jobs they were called on to perform-such as restraining children.

Furthermore, three of the employees whom Unsafe Haven shows handling patients during restraints told Johnson that they had never had any restraint training. One employee said this moments after he had just restrained a patient-then he explained that all classes had been discontinued during the summer while the hospital's census was low. Another of those employees was a doctor, who said that he thought he should get restraint training, since he does participate in restraints.

Another employee told Johnson emphatically that she had never had any restraint training whatsoever, but she had participated in restraints at Charter.

Another employee told Johnson that she had been working at Charter for two years but never received any training.

Another employee told Johnson that when she first started at Charter, she was filling out patients' charts without knowing what she was doing.

Two employees told Johnson in detail how, just before inspections of the hospital, they had been instructed to fill out paperwork for the inspection which exaggerated their qualifications and training. One of those inspections occurred just after Tristan Sovern died during a restraint at Charter Greensboro.

As Charter points out, one of the employees shown in Unsafe Haven who tells Johnson that he hasn't had any kind of training had in fact just been hired that week. As CBS News shows in Unsafe Haven, this employee went to work on Charter's children's ward without any training, and during his first week he was left alone on the ward with no idea where to call if he needed help. He says in the broadcast that "9-1-1's the only thing I can think of" if he gets in trouble when left alone on the ward like that.

What the employees at Charter Pines told Terrance Johnson was confirmed numerous times with dozens of employees from Charter hospitals around the country, who told CBS News that the training at their hospitals was infrequent and inadequate.

"Assertion that Terrance was not trained to take blood pressure of patients.
False. You can hear on the video the employee tell the nurse 'I remember you showing me how to do this now.' This indicates that he had previously been trained. Further, the machine that he is being trained on is an automatic blood pressure machine."

In fact, Johnson does NOT say "I remember you showing me how to do this now" at any point in the broadcast or on hidden camera video. What he DOES say, while a nurse is training him to use a blood pressure machine, is "Yeah, I've never been shown how to do this."

As Charter points out, this nurse is training Johnson on an automatic blood pressure machine. Johnson says that an employee at Charter Pines broght this machine from her home. Johnson had not been trained how to take vital signs, either with or without this machine. Neither had some of his coworkers at Charter.

"Problems with the seclusion by the elevator
Our employed physician is shown in the video contrary to the show's assertion that no physician was involved. Further, this particular physician is excellent at de-escalating a crisis situation and did in fact try to intervene with less restrictive alternatives. Our Medical Director had already accepted the patient prior to the employee being called down to escort the patient upstairs. Once upstairs in seclusion, our Medical Director allowed another intervention that is not typical by allowing the mother to go to the seclusion area to talk to her daughter. The daughter was out of restraints quickly and integrated with the other patients on the unit."

A physician was involved in this girl's restraint for approximately three minutes, from shortly after the time that Terrance Johnson called for help until she was strapped down to a bed. Then the physician left other staff members alone with the girl, who was still in a highly agitated state.

According to a number of experts in the field who have advised CBS News on this issue, this does not constitute a meaningful authorization, diagnosis or observation of a patient in restraints by a physician.

The following is what happened: The girl was brought to Charter by her family. Johnson was called down to the lobby to escort a new patient to the ward, and when he got there, the girl was sitting calmly with her family. When she got to the elevator with Terrance, she asked where he was taking her. Everyone froze, including the intake staffer who was backing away from the girl. Terrance explained to the girl that she was being admitted to the hospital, and she became very upset and started screaming and trying to run away. She threw her shoes. Terrance held the girl's hands, and told the intake staffer, who was backing out of the room, to get help. The physician arrived within a minute, looked at the girl and Johnson from across the room, and immediately turned into a locked room from where he apparently called for a "Dr. Strong," a code in the hospital to call for staff support. Moments later, the physician came out of the room and approached the girl and Johnson. At this point, the girl was sitting on the floor and Johnson was holding her hands. As the girl screamed and struggled, the physician said, "Okay, quiet down, try and calm down. You need to calm down." Then the physician held the girl flat on the floor and said, "Alright, alright, come on now, we're just gonna calm you down." About a minute after the physician's phone call, other staff members arrived, immediately picked up the girl by her waist, hands and feet, and carried her straight to the restraint room. The physician carried the girl along with the oter staff members, helped strap her into the bed, and left. Soon afterward, a nurse involved in the restraint asked Johnson if the physician was still around somewhere. This nurse then got on the phone and said she was trying to locate this doctor, and asked if he had left the hospital yet. She could not locate him, and much later she told Terrance that she was still trying to find a doctor to sign an order for the girl's restraint. (In North Carolina, a physician must authorize a restraint.) Eventually, another doctor signed the paperwork for her restraint.

If this physician "did in fact try to intervene with less restrictive alternatives," as Charter claims, then the evidence does not show it. If he had any complaint with the way Johnson was handling the girl, then he did not express it at the time, either to hospital administrators or to Johnson. In fact, weeks after the restraint, this physician talked to Johnson about the restraint, and did not contest Johnson's account of what had happened in the lobby.

This physician told Johnson, weeks after this restraint, that he had never been trained how to do restraints, but he thought that he ought to be trained.

CBS News does not dispute that the medical director may have already accepted the patient before Terrance Johnson was called down to escort her upstairs. If that is so, however, then the medical director had not told the girl that she was being admitted to the hospital, because Johnson was the first one to tell her that. Furthermore, the medical director was nowhere to be seen when Johnson got downstairs to the lobby. The medical director did not respond when the girl became hysterical upon finding out that she was going to be admitted to the hospital. Finally, the medical director did not call the charge nurse or other staff on the ward to help them find this girl's records, which they spent a long time looking for after they put her into restraints.

Terrance Johnson did see that Charter let the girl visit with her mother, but he witnessed this visit with her mother outside the seclusion room, after she was let out of the restraints.

"Implication that Dr. Holscher made a chart entry on a patient, indicating he saw the patient when he did nothing more than open the door and see the child sleeping.
The show implied that the physician looked in on the patient sleeping and then made a note in the medical record as though he had seen the patient. False. The physician's note that day indicates that he reviewed the record for the day, including lab results, and made a medication change. It does not indicate he saw the patient. There is an acceptable CPT code for that level of service. The facility by-laws only require that the patient be seen by the doctor a minimum of five days out of seven."

Unsafe Haven showed evidence that Dr. Holscher frequently had only the briefest of interactions with his patients. This is suported in the report by the interview with Justine Campbell's family, and by comments from other staff members.

The other staff members also tell Johnson that Dr. Holscher often makes rounds after the children are asleep and that he writes false times in the patients' charts, both of which occur during the visit which Charter cites here. Specifically in this instance, Dr. Holscher arrives on the ward at 10:05 PM, then writes in a child's chart that the time is 2100 hours, or 9 PM. This was one of several similar instances which Johnson observed. CBS News cannot say why Dr. Holscher would make rounds after his patients are asleep, or why he would backtime patients' charts. We can only show the evidence that he did so, and cite professional codes of conduct which maintain that this is not an acceptable practice.

"Changed vital signs
Through a detailed review of the videotape, we have concluded that the example used by CBS News to imply a changed medical record was a splice of two separate records. The first record shown when the elevated vital signs are identified is different from the second one shown in the video as the 'changed' medical record. The other vital signs on the forms shown are different, the name does not appear on one, and the precautions that the patients are on are different on the two forms. Further, watching this particular series you can see items on the desk that are moved between the two segments".

This scene in Unsafe Haven was an edited version of one continuous scene that Terrance Johnson witnessed. Because the original scene was about five minutes long, CBS News showed only the most pertinent exchanges in it-taking care not to do anything in editing that would make this scene more incriminating than it was in life. Here is what Terrance Johnson witnessed and taped:

The nurse picked up a page of a patient's record and said "These vital signs are all off. Respiration's 40, somebody's hyperventilating." She then narrates for Johnson step-by-step as she writes on the record a made-up scenario about how this child was running down the hall to the bathroom that morning and that was why his respiration rate was so high. She then says that she will write that she retook the vital signs, "to cover myself...because I'm signing these. I'm signing my name after all these. I'm cosigning these, 'cause I'm a registered nurse and I'm signing them to say that everything's fine." The nurse then set down the page and took a phone call. Then she picked up another page from where she set down the first page and said "I'm changing this, I'm changing this. This is not true...Nobody would be 40-they'd be in the hospital." She then handed the sheet to Johnson, and said that the employee who recorded the vital sign "probably did it subconsciously wrong."

This was one event, taped all at once. The nurse wrote on two pages, both of which represented a patient's respiration abeing 40. As she wrote on each page, the nurse commented that 40 was a dangerously high respiration rate, and on each page she changed the record to make the patient's reading appear normal. Unsafe Haven's statements that "when another technician recorded abnormal results, Terrance Johnson's supervisor showed him what she would do about it," that "she scratched out what she thought was wrong, and replaced it with what she thought it should be," that "she changed that vital sign, his respiration rate, without checking the child," and that "she just basically made it up"-all are completely accurate and true statements.

"The total video time shown on the show was 12 minutes out of 360 hours that he worked at Pines. The equates to .05%. A comparable amount of time would be to take 2 seconds out of an hour presentation and say that is reflective of the hour long presentation."

Although this hidden camera footage was extremely important to this show, it was not by any means all of the evidence that CBS News had to offer in Unsafe Haven. We left time in our show to present evidence from documents, former employees, former patients, experts in the field, and the Inspector General of the US Department of Health and Human Services. In fact, we did a great deal of reporting before Terrance Johnson started working at Charter Pines, and we took care to report wrongdoing only when we found it more than once, verified by more than one source. We also took care to show hidden camera sequences that portrayed the system at work at Charter Pines, and not just the behavior of one or two employees acting on their own.

In an hour-long program, we simply do not have enough time to present all of the evidence we have gathered, and we certainly do not have enough time to present everything that Terrance Johnson taped in his eight weeks at Charter Pines. However, we did take the time in Unsafe Haven to point out instances where employees at Charter Pines dealt with patients in a caring, compassionate manner, because we felt that this was an important element of the story.

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