CHARLOTTE, NC (Fred Classen-Kelly and Cassie Cope/Charlotte Observer) - By the time police arrived, the south Charlotte psychiatric hospital had descended into chaos.
Patients at Strategic Behavioral Center — some wielding wooden boards — attacked one worker, barricaded themselves in a room and escaped through a broken window. Others fought with each other or vandalized the building.
Amid the mayhem, some hospital staff watched in fear and did not try to control the situation. They initially delayed calling for help because a former executive had erroneously told them to not call the police for trouble with patients.
"I was afraid for my life," one worker told state investigators.
Newly released state documents reveal previously undisclosed details about New Year's Day when 10 children, as young as age 12, broke out of the hospital and went missing for at least two hours.
The report portrays overwhelmed staffers at the 60-bed facility on Sharon Road West near South Boulevard struggling to supervise the children in their care. They told investigators the hospital was severely short-staffed, some workers were afraid of patients and that five employees had been recently terminated.
After the New Year's escape, Strategic saw more trouble.
Video recordings from four days later show a resident cutting their arms with a broken DVD, records say. Another time, a resident is seen in a hallway with a wooden board.
Hospital administrators met with staffers to discuss concerns, but the facility was "not any safer because nothing had changed," one employee said, according to the report dated Jan. 17.
"We have been short staffed for 2 months," another worker told state investigators. "Not enough staff to be effective and supply the needs of the residents. ...There is a potential that the same situation could happen again."
On Feb. 6, another patient escape required police intervention.
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. It is owned by a Tennessee company that owns mental treatment centers in six states, including three in North Carolina.
The Charlotte hospital has faced public scrutiny over the safety of patients since last month. The Observer reported allegations from patients, including a girl who says she had sex with a staff member. In another case, a teen said a hospital worker called patients "b---hes and dumba---s" and slapped him in retaliation for being spit on.
The N.C. Department of Health and Human Services, which licenses and oversees psychiatric hospitals, shut down admissions of new patients in February. State officials also levied a $20,000 fine — the largest amount allowable under the law — and recommended Strategic no longer receive money from Medicaid, a joint state and federal health insurance program for the needy that covers the cost for most of Strategic's patients.
Federal officials have told Strategic they will cut off Medicaid payments by March 17 unless executives can make improvements.
On Tuesday, Strategic re-issued a Feb. 20 statement from the hospital's CEO, saying the company is optimistic it can satisfy regulators.
"Strategic Behavioral Center has made significant progress towards addressing the concerns raised by the Department of Health and Human Services," Orvin Fillman said. "Strategic Behavioral Center is responding with urgency and vigilance to implement lasting change."
Strategic says the state has approved a plan that calls for changes in admissions policy.
The hospital will no longer care for patients with gang ties or a history of escapes from other facilities, the newly released documents say. Strategic will also exclude patients if they have a history of felonious behavior or have a substance abuse disorder.
All hospital staff have been trained to call the Charlotte Mecklenburg Police Department if a patient situation can't be handled by staff on site, the records say.
During the New Year's Day incident, patients broke furniture to make weapons. Strategic told the state it has removed desks, reinforced chairs and designed a prototype desk with solid pieces to prevent boards from being broken.
The state report suggests Strategic staff missed warning signs that patients had planned to escape. They did not question residents who were wearing multiple layers of clothing that would allow them to change what they were wearing when they left the hospital. Patients now have a limit of three changes of clothes at a time in their room, records show.
Video cameras captured the anarchy inside Strategic's walls on New Year's Day.
In a less than five-hour span beginning in the late afternoon, there were seven "Code Purple" incidents in which workers are alerted to trouble.
A state investigator reviewed video showing patients going from room to room, throwing a trash can, tearing up paper and tearing schedules off the walls.
Sometime around 8 p.m., state officials report, two patients were fighting over a piece of wall trim.
Later, a patient punched a hospital employee, documents say. Several patients were following the employee down a hallway, when one picked him up by the waist from behind and tossed him.
Other staffers watched the incident but offered their colleague no help, records say.
Multiple patients began going into a room. A short time later, a patient reported that children were escaping the hospital from the room.
Hospital staffers were aware patients had gathered there, but state documents say they did not immediately close the door after the first patients escaped.
When one employee arrived, according to the report, he heard loud noises and cussing and saw trash all over the floor in the hallway. Patients had barricaded themselves in a room and had weapons he described as boards with six-inch screws.