Hill Crest on the Record

Responding to BuzzFeed’s Misleading Portrayal

The article published by BuzzFeed on November 11, 2017 presents a very misleading and sensationalized portrayal of Hill Crest, our values, dedicated staff and record for providing quality care. We provided comprehensive answers to BuzzFeed’s questions, although little of this was actually represented in the published article. Below we address and clarify important topics to set the record straight.

Employees of Hill Crest:

• We proudly employ 435 hard-working and compassionate staff members who come to work every day dedicated to providing high quality care to improve our patients’ lives.
• Caring for our patients and keeping them safe is our staff’s top priority. Many of our patients suffer from serious psychiatric conditions including displaying reactive and violent behaviors that can endanger patients and staff.
• Over the past decades, Hill Crest has employed thousands of people, nearly all of whom exhibit the highest levels of professionalism and compassion. BuzzFeed irresponsibly extrapolates a few isolated incidents to make inaccurate conclusions about Hill Crest’s overall multi-decade record of quality care.

Restraint and Seclusion Policies:

• Restraint and seclusion techniques are rare at Hill Crest and per our policies are used as options of last resort when all other tools, including verbal de-escalation have failed. All clinical employees must complete an accredited course and demonstrate proficiency in safe physical management techniques.

Hill Crest reports much lower rates of restraint and seclusion than national and Alabama averages as publicly reported by CMS’ Inpatient Psychiatric Quality Reporting System (IPFQR).

Hill Crest has had zero seclusions in 2016 and 2017.

Our usage rates for these strategies are low, in part, because Hill Crest endorses the Six Core Strategies for Restraint Reduction© developed by the National Association of State Mental Health Program Directors.

• In cases where staff members significantly deviate from our standards of care and their training, we take disciplinary measures including mandatory retraining, suspension, termination and referral to appropriate law enforcement authorities if required.

Surveillance Video, Isolated Inappropriate Employee Conduct:

• Surveillance cameras are in place in common areas for the safety of both patients and staff.
• BuzzFeed selectively showcases a few moments (out of 9,000+ annual hours) of video footage from nearly two years ago involving isolated instances of regrettable and disappointing employee conduct.
• The individual instances of inappropriate employee conduct depicted in the selected video clips is wholly inconsistent with Hill Crest policies, staff training and our overall record of providing high quality, compassionate care.
• Hill Crest conducted full internal investigations immediately following each incident, and implemented remedial actions including mandatory retraining and other disciplinary actions up to and including termination.
• We also reported these matters to appropriate regulators who conducted full reviews and confirmed that Hill Crest’s follow-up actions were appropriate.

Regulatory Agency & Accreditation Oversight:

• Hill Crest fully cooperates with all regulatory agencies and accreditation oversight and views every inspection as an opportunity to enhance our operations.
• Hill Crest has a documented record of superior regulatory compliance and when deficiencies are noted, we work to fully remediate them with the goal of sustained compliance.

The Alabama Department of Mental Health (DMH) awarded us a score of 100% across six of seven categories in its most recent site survey in May 2017.

• Regulators routinely complete comprehensive site visits (often unannounced) including reviewing current and historic performance data, medical records, conducting patient and employee interviews, staffing levels, etc.
• The Joint Commission accredits facilities every three years, which includes making unannounced site visits and detailed reviews of processes, procedures and clinical practices.
• When deficiencies are identified, no matter how minor, we respond quickly to make the proper adjustments to ensure our patients receive the care and treatment they deserve.
• All BH facilities (including Hill Crest) may sporadically receive standard level citations for minor recordkeeping errors, however this does not equate to willful falsification which is totally unsupported by any regulatory or accreditation citation.
• Hill Crest rejects any accusation that we increase staffing or perform extra cleaning before inspections since we typically do not know when they will occur.
• A March 2016 CMS survey confirmed that Hill Crest was in compliance with all requirements.
• Hill Crest rejects BuzzFeed’s characterizations regarding the condition of its facility. Health Department permit renewal inspections routinely identify areas of improvement and Hill Crest successfully implemented all recommendations, including contracting for weekly pest control.

Staff Training, Education & Staffing Levels:

• Hill Crest prides itself on being an employer of choice in the Birmingham community, providing rewarding and challenging career opportunities. We employ thorough standards to ensure that only qualified candidates are hired.
• Hill Crest has never been cited by any regulator for any hiring or training deficiencies.
• All employment offers are contingent upon successful completion of a comprehensive background check including criminal history, education verification, professional license verification (when applicable), employment references, and sexual offenders and predator registry verification administered by the FBI and AL Department of Human Resources.
• New employees receive 40 hours of initial training utilizing an approved curriculum including courses on Confidentiality, Behavior Management, Therapeutic Communication, Facility Policies and Procedures, Service Excellence, Age Specific Training and an accredited 8-10 hour course in Non-Violent Crisis Intervention and Verbal De-Escalation, including appropriate use of physical restraint techniques.
• We deny any allegations that Hill Crest training personnel help new hires “cheat” in order to pass mandated competency exams. As is common in many types of job training settings, employees are permitted to re-take a test if they do not attain the minimal passing score. Trainers are available to clarify issues but only prior to the exam.
• During the orientation period, new employees receive continuing supervision by an experienced mentor who demonstrates skills, offers encouragement, answers questions and coordinates additional training when requested.
• Hill Crest’s hiring requirements for Mental Health Techs (MHTs) are consistent with and often more rigorous than comparable facilities.
• Hill Crests maintains appropriate staffing levels consistent with state and federal guidelines and are adjusted daily based on patient census and acuity. No regulatory agency has identified any deficiencies related to staffing numbers.

Integrity of Medical Records:

• We strongly deny the allegations that medical records are falsified.  As per hospital policy, Hill Crest strictly prohibits any employee from falsifying medical records. During orientation, each employee receives training in and attests to their understanding of the Code of Conduct and has an obligation to report any such activity to our local compliance officer, UHS’ Corporate Compliance Officer, and/or they can make anonymous reports on the toll free UHS Compliance Line. Also, it is the responsibility of each employee to use their professional judgment in ensuring their documentation is accurate and reflects the services they provided to the best of their knowledge.
• All BH facilities (including Hill Crest) may sporadically receive standard level citations for minor record-keeping errors, however this does not equate to willful record falsification which is totally unsupported by any regulatory or accreditation citation.

Isolated Patient Accounts:

• Due to patient confidentiality laws, Hill Crest is constrained in providing the complete set of facts concerning patient care episodes referenced in the article, many of which we dispute.
• While every allegation is thoroughly reviewed (including by outside regulatory authorities), many patient allegations are ultimately determined to be unsubstantiated, incomplete or disproven.
• No inspection or citation has ever alleged or revealed any evidence that improper restraints are conducted in patient rooms away from cameras.
• Hill Crest rejects any allegations that it administers medicines for any non-clinically justified purpose and it has never received a citation alleging such conduct. All dispensed medications at Hill Crest require the specific order of a licensed psychiatrist.
• Regarding the teen whose phone call was interrupted: the portrayal of events is inaccurate, and incomplete. BuzzFeed’s failure to provide a valid, written patient consent to release information prevents us from providing details necessary to prove that the allegations were unsubstantiated.
• Regarding the alleged RISE unit incident, Hill Crest conducted an internal investigation and reported the incident to DHR and the Alabama Disabilities Advocacy Program (ADAP). After a thorough investigation, DHR concluded that abuse and neglect did not occur. Notwithstanding those findings, Hill Crest still took disciplinary and/or corrective actions against many of the employees involved.

Allegations from Former Disgruntled Employees:

• BuzzFeed relies heavily on a non-representative sample of largely anonymous and unreliable former employees spreading uncorroborated and misleading accounts.
• Hill Crest disputes allegations of any purported widespread practice of staff “purposefully provoking patients to get them to react so staff members could restrain them” which would constitute a major violation of our policies. No practice of this kind has ever been documented or cited by any state or federal regulator or accreditation organization.
• Hill Crest disputes Stephanie Jenks’ unfounded allegations. Her observations communicated to Hill Crest administration were appropriately reviewed. We dispute Ms. Jenks stated reasons in the article for her resignation from Hill Crest.
• We also dispute the accounts of Tommy Horton, a disgruntled former employee terminated for falling asleep on the job. Instead of taking responsibility for his actions, he has sadly elected to lodge self-serving attacks on Hill Crest without any supporting evidence.

Higdon Hill School:

• Higdon Hill is an important Hill Crest program where we can concurrently treat a teen’s serious behavioral health challenges while providing an excellent onsite education. Higdon has a demonstrated record of successful student academic achievement notwithstanding that in most instances, the students’ local schools were unable to meet their specialized academic needs.
• Higdon received accreditation from AdvancED in 2017 for a period of five years. AdvancEd is a nationally recognized and rigorous accreditation program enabling Higdon students to receive transferrable credits to their home school district.
• Higdon consistently achieves a 100% graduation rate and over the past three years we awarded 48 students their high school diplomas.
• We adhere to stringent curriculum requirements, document grades, and school is in session 186 days per year. Class sizes are small for the best possible learning environment.

Responding to Inquiries & Communicating with Parents & Legal Guardians:

• Hill Crest understands the importance of keeping parents and legal guardians informed of treatment progress and any issues impacting the care of their loved ones and we reject any allegation that we ever knowingly mislead parents or family members.
• Our goal is to resolve issues and concerns quickly in a manner consistent with clinical best practices and patient safety.
• Many of our patients are within the custody of the DHR of their local county and therefore Hill Crest is required to communicate primarily with the legally recognized guardian.
• To promote the healing process, Hill Crest undertakes good faith efforts to facilitate communications between minor patients and their parents. This includes extending invitations to participate in important events and treatment milestones. We work closely with the legal guardian to determine the appropriate scope of communication and interaction based on the patient’s family history, diagnosis and treatment plan.

Patient Personal Care, Hygiene and Nutrition:

• Some patients arrive at Hill Crest without adequate clothing and personal hygiene products and we maintain a central supply to meet the hospital’s needs.
• In the event that an employee independently purchases an item for a patient, they may seek reimbursement by alerting their supervisor and providing a purchase receipt.
• We dispute BuzzFeed’s anonymously sourced and untrue allegations of “food shortages” and no regulator has ever cited Hill Crest for such conduct.
• Hill Crest provides full meal plans (including snacks) to all patients during the duration of their stay which are reviewed and approved by a Registered Dietician and coordinated by the Director of Dietary Services.