CHARLOTTE, NC (Fred Clasen-Kelly and Cassie Cope/The Charlotte Observer) - In April, a 17-year-old with a history of suicide attempts and depression escaped from a south Charlotte psychiatric hospital. Staff members who caught him used unnecessary force, the teen said, and threatened to beat him up if he told anyone.
At the same facility in September, according to court and police records, a teenage girl said she had sex with a staff member. A grand jury later indicted the Strategic Behavioral Center employee on a charge of statutory rape.
Most recently, someone shattered a window on New Year's Day and 10 children, as young as 12, broke out of the center, a police report shows.
State investigative reports obtained by the Observer date to 2016 and reveal allegations of sexual and physical abuse, verbal abuse and failures by Strategic Behavioral Center to properly investigate or report serious accusations made by patients.
Strategic is one of 37 licensed psychiatric residential treatment facilities in North Carolina where patients get round-the-clock care for severe mental and behavioral conditions.
The incidents raise questions about whether the 60-bed facility on Sharon Road West near South Boulevard is properly treating and supervising children in its care, advocates for the disabled and lawmakers say. The N.C. Department of Health and Human Services has two open investigations into complaints against the hospital, including the January escape.
The allegations have also drawn concern from critics about whether the state agency has acted swiftly enough to discipline Strategic and ensure the safety of its patients.
Complaints from patients were documented by DHHS regulators.
After learning about the state's findings, three state lawmakers told the Observer they believe that DHHS failed to adequately oversee Strategic and keep children safe. One also said the hospital should be shut down.
DHHS is responsible for licensing residential treatment facilities like Strategic and making sure that taxpayer money – which often pays for the services through Medicaid – is used properly.
State Sen. Tommy Tucker, a Union County Republican who is a member of the General Assembly's legislative oversight committee on Medicaid, criticized oversight by DHHS and said Strategic has been given enough chances to improve its performance.
"They may need to move quickly to suspend this organization," Tucker said. "You need to move these people to other places."
The Tennessee-based company that owns the hospital – Strategic Behavioral Health – operates treatment centers in six states, including three in North Carolina. The company says it has boosted quality by hiring an outside expert to conduct regular surveys to measure patient outcomes.
While Strategic's other facilities performed well, the Charlotte hospital suffered recently with problems in management, said Art Frankel, a UNC Wilmington social work professor who conducts the surveys.
A quarterly survey from last year found 60 percent of patients returned to long-term psychiatric care within six months of discharge from the Charlotte hospital, Frankel said. In the past, the facility's rate had hovered around the national average of 19 percent, he said.
Roughly one in three patients visit emergency rooms for mental health issues within one month of discharge, another measure used to determine whether treatment was effective. That's three times higher than the national average, Frankel said.
"It didn't take a rocket scientist to see this place was not doing as well as the others," Frankel said. "Administration was not taking care of business."
Strategic refused to make company leaders available for interviews, but released written statements in response to questions from the Observer.
Overall patient care meets national guidelines for behavioral health and rehabilitative services, Strategic said.
"An important part of our commitment is to continually improve our performance," the company said. "That is why we are one of the few behavioral health providers who contracts with the state that also engages an independent expert to evaluate our programs and track our outcomes on an ongoing basis.
"We examine those reports, as well as feedback from state regulators, patient advocates, and others, and modify our programs so that we can best serve the youth we treat."
Strategic has temporarily relocated one of its top executives to Charlotte to help oversee operations. The company also hired a new chief executive officer for the Charlotte hospital.
Asked about the DHHS investigation into the New Year's Day patient escape, Strategic said it has sent the state a corrective action plan meant to prevent a repeat.
That plan includes retraining staff and amending its admissions policy, the company said.
"We have reviewed operations at our center, including two unfortunate recent incidents involving residents we admitted without realizing they were not suited for our level of care," the company said. "We are making some changes so that we can most effectively and safely treat our patients."
Health and safety concerns
Troubles at Strategic have existed since at least early 2015.
In North Carolina, seven managed care organizations contract with providers to treat people who receive Medicaid, a joint state and federal health insurance program for the needy that covers the cost for most of Strategic's patients.
Cardinal Innovations Healthcare and Alliance Behavioral Healthcare have ended contracts with the Charlotte hospital, a move that advocates for the disabled and state lawmakers say should have raised red flags.
Cardinal coordinates care for Medicaid recipients in Mecklenburg and 19 other counties. State leaders and others harshly criticized DHHS oversight of Cardinal last year after audits found alleged misspending, including taxpayer money used for high-priced parties and retreats, chartered flights and pay bonuses.
Spokeswoman Ashley Conger said Cardinal stopped referring clients in April 2015 after concerns surfaced about quality of care and health and safety.
Conger said Cardinal provided oversight and technical assistance to Strategic, but the hospital did not improve.
Alliance Behavioral Healthcare serves clients who live in Durham, Wake, Johnston and Cumberland counties. A spokesman said Alliance stopped referring patients to the Charlotte hospital in July 2017 in response to substantiated complaints about quality of care.
State Rep. Donny Lambeth, co-chair of the House Health Committee, said DHHS should have acted to stop other managed care organizations from referring children to the hospital.
"DHHS has got to step up," said Lambeth, a Forsyth County Republican and a retired hospital executive. "If there are repeated offenses they need to be dealt with or closed down. There are fundamental problems here."
State defends oversight
DHHS spokeswoman Chris Mackey said in an email that each managed care organization is responsible for making its own determinations about health providers. The organizations are notified when the state suspends, revokes or imposes other sanctions against a facility's operating license.
Regulators have investigated 21 complaints against the Charlotte hospital since 2015, Mackey said. Strategic has drawn up corrective action plans when DHHS cited problems during past investigations, she said.
The agency recently rejected an application from Strategic to add 40 beds to the facility for adults, Mackey said. Under that plan, officials would have transferred patients from a state hospital in Burke County to the Charlotte facility.
Mackey said investigators have also recently visited Strategic multiple times to look into serious allegations reported in December and January.
"If justified, there will be specific enforcement action taken," Mackey said. "Since safety of the residents is the top priority, while we were on site, we verbally informed the facility about our findings so they could move forward with implementing an immediate corrective action plan."
'A lot has come to light'
Both supporters and critics say even the best-run psychiatric centers are bound to see trouble. Many patients suffer with serious conditions such as personality disorders and learning disabilities and sometimes behave violently.
But the allegations against Strategic's Charlotte hospital stand out, advocates for the disabled said.
"During the past six months, at minimum, (Strategic) has committed numerous statutory and constitutional violations against the children it has admitted," says a 2016 complaint letter sent to DHHS by the Council for Children's Rights, a Charlotte nonprofit that provides legal services for Strategic patients and others.
State regulators, who looked into complaints against the hospital in 2016 and 2017, found troubling accusations. Among them:
In the April 2017 incident, investigators reported, a 17-year-old with a history that included three suicide attempts, childhood abuse and major depressive disorder escaped from the hospital grounds. When Strategic staff members caught him two blocks from the facility, the teen said, they used unnecessary force, tackling him and dragging him into a car.
He also alleged that staff threatened to beat him up if he told anyone about being tackled, the report said.
"I do not believe they had to tackle him," a Strategic worker said in an interview, according to documents. "I have worked with the police department prior to this with the same staff and know them."
Two days later, the teen attempted suicide. Staff found him lying in front of a sink gasping for air and blue in the face.
State officials concluded that the hospital did not properly report the suicide attempt to the state and did not investigate the circumstances.
According to state regulators, a Strategic executive acknowledged the staff's response to the incident was flawed.
"A lot has come to light with your (state agency) investigation and we feel it is in the best interest that we self-report the suicide attempt and investigate the possible abuse reported upon his (Resident #1) return," the executive said. "This event with (Resident #1) has opened my eyes to a lot of things such as our reporting processes, the need to dig deeper, and not taking things at face value."
In September, reports say, a patient suffering from depression alleged that a staff member physically abused him. The patient alleged that the worker had upset patients by calling them "b---hes and dumba---s," so he decided to spit on the worker.
That's when he says the staffer slapped him and put him in a restraint hold normally used as a last resort when patients present a danger to themselves or others.
Investigators watched video to determine whether the patient was abused, but said it was inconclusive.
A day after the confrontation, the child's mother said Strategic informed her about the restraint hold, but said she was not told about her son's physical abuse accusation, reports say.
State regulators found that the hospital did not report the alleged slap to a state registry within 24 hours as required. A review of Strategic records showed the patient spit and hit staff, but did not mention the accusation of abuse, the state said.
Strategic said that DHHS investigated the accusations of abuse and ruled them unsubstantiated. The company also said it notified the state and the child's family about the incident.
But Strategic acknowledged that workers did not submit a report to the Health Care Personnel Registry within 24 hours.
In the sexual assault case from last fall, court and police records say a teenage girl alleged that about 10 months earlier she and a Strategic staff member had sex.
A grand jury in November indicted Lavic Williams on charges of having vaginal intercourse with a victim age 15 or younger.
Williams, 28, has denied having any sexual contact with the girl, court records say. Prosecutors dropped the charges in December, saying they could not corroborate the victim's account.
DHHS spokesman Cobey Culton said regulators visited Strategic in January to investigate the New Year's Day escape. Culton would not answer questions about the incident or provide a copy of reports.
A police report says patients between the ages of 12 and 17 damaged property and assaulted someone before leaving the hospital about 10 p.m.
Frankel, the UNC Wilmington professor, said he visited the hospital soon after the escape.
One of the patients dismantled part of a wooden desk and the patients used the furniture piece to shatter a window and escape, Frankel said.
He said it was a mistake to furnish a residential psychiatric center with furniture that can be taken apart.
A balancing act
Karen McLeod, president and chief executive officer of Benchmarks, a Raleigh-based trade association for behavioral health service providers, said that unsubstantiated allegations against Strategic and other providers should be viewed skeptically.
Patients sometimes concoct phony stories about sexual and physical abuse to try to make trouble, McLeod said.
That's why state regulators work with operators such as Strategic who show a desire to improve instead of revoking their license, McLeod said.
"If you close down every facility where something happens, you would have no facilities," McLeod said.
But state Rep. Verla Insko, an Orange County Democrat who has been a staunch advocate for mental health services, said the Strategic case reflects how DHHS might be too reluctant to revoke the licenses of psychiatric centers.