Regulatory Oversight by the State of Oklahoma:
Ongoing media stories by BuzzFeed and other outlets regarding regulatory compliance matters at Shadow Mountain provide an incomplete and inaccurate portrayal and we welcome the opportunity to clarify important facts. As is typical, BuzzFeed chooses to sensationalize common aspects of the regulatory process governing all behavioral health facilities without appropriate context regarding Shadow Mountain’s overall compliance record and the quality of care provided to patients by our compassionate and dedicated staff now and over the past 36 years.
Contrary to the incomplete insinuations by BuzzFeed and related media stories, Shadow Mountain remains open, fully operational, licensed by the State of Oklahoma and accredited by The Joint Commission (TJC). Children and adolescents who are currently being treated at Shadow Mountain will continue to receive high quality and appropriate care by compassionate and trained staff.
Like all behavioral health facilities, Shadow Mountain is highly regulated. Federal and state regulators, as well as third-party accreditation organizations, routinely visit our facility to review the care provided and to ensure compliance with applicable state laws, federal regulations, and accreditation and contract requirements. Shadow Mountain takes all feedback received from regulators and accreditors seriously and constantly explores ways we can improve our services.
The vast majority of Shadow Mountain’s survey inspections over the past 10 years confirm that Shadow Mountain is in compliance with relevant regulations, statutes, contract and accreditation requirements, which is our consistent goal. In the minority of situations where surveys and accreditation inspections allege or reveal areas of non-compliance, we devote the necessary resources to proactively remediating deficiencies even where we may disagree with some or all the underlying allegations, including the rights to formally appeal. Shadow Mountain is proud of our demonstrated record of working collaboratively with regulatory authorities and accreditors to successfully address prior matters (including those outlined in occasional preliminary program termination and de-certification warning letters) in a timely manner.
There has been much misinformation about the current regulatory status at Shadow Mountain and recent survey events. While a recent TJC survey did cite certain findings which the facility disputed and denied, two subsequent follow-up surveys conducted by TJC in recent weeks have resulted in findings which cleared the facility of the prior alleged infractions and found no deficiencies at the facility relating to quality of care or any other issues. In addition, as stated above, despite reports about findings by the Oklahoma Department of Health, Shadow Mountain’s CMS certification remains in place and Shadow Mountain has submitted a plan of correction which has been accepted. This is a normal and standard procedure as a part of the ordinary survey and certification process for any health care provider. We are confident that the follow-up survey will demonstrate Shadow Mountain’s compliance with all regulatory requirements. In addition, recent surveys conducted by the Oklahoma Department of Human Services found no deficiencies. The Oklahoma Health Care Authority (OHCA) was sent notice of its intent to terminate certain Medicaid payment agreements with Shadow Mountain. OHCA claims this termination is “without cause.” Notwithstanding, Shadow Mountain has filed litigation against OHCA to prevent the termination and to demonstrate the high quality care and treatment patients are receiving at Shadow Mountain.
Use of Stolen, Incomplete “Surveillance Videos”:
We strongly condemn the use of video illegally taken from our facility by a former disgruntled employee. The video clips were presented to the public without context or knowledge of the patients involved and their specific diseases and trauma history, their required treatment, or knowledge of the staff and their professional backgrounds. Such action demonstrates a careless disregard for the patients, the truth and is a callous willingness to sensationalize events, stigmatize mental health treatment and impugn the professional integrity and compassion of our staff. Moreover, to selectively highlight a few minutes of non-contextualized footage out of nearly 9,000 annual hours is highly irresponsible and misleading.
Restraint and Seclusion Use:
With regard to restraint and seclusion (often referred to as restrictive interventions), these are always options of last resort when a patient is at imminent risk of hurting themselves or others. It is undertaken for the patient’s protection and used only when all other tools have failed including verbal de-escalation.
All facility clinical employees are required to be trained in an accredited or certified program for physical management. Verbal De-escalation is an additional component of that training. It is always preferable that staff utilize those techniques to assist a patient in regaining control.
Federal and state guidelines govern the use of these interventions. Each facility has policies and procedures that address the utilization of restraint and seclusion including the required training elements. The majority of UHS facilities are mechanically restraint free, including Shadow Mountain. 97% of UHS behavioral health facilities have lower rates of restraint and seclusion than the national averages as reported by both The Joint Commission and CMS’ (a federal government agency) Inpatient Psychiatric Facility Quality Reporting System (IPFQR) in 2015. Shadow Mountain’s IPFQR measures related to restraint and seclusion utilization are dramatically below the national average—which is our constant goal.
UHS endorses the Six Core Strategies for Restraint Reduction© developed by the National Association of State Mental Health Program Directors as our guide for assisting facilities in reducing the use of these interventions. These principles have assisted in the reduction of restraint use year over year by more than 10% and are the foundation for the establishment of a philosophy statement, data analysis, patient feedback and leadership involvement.
Unfortunately, restraints and seclusion must be used on occasion particularly in a treatment program like the one at Shadow Mountain, especially considering the patient population who often act out their trauma histories through aggression or self-harm. When a patient is in restraint or seclusion, they are subject to constant monitoring to ensure their safety. This occurred during events in the video. At all times the safety of our patients and staff is our highest priority. None of the patients depicted in the video suffered any injuries or bodily harm. External reporting of restraint and seclusion is required in the case of a significant injury.
Patient privacy laws largely prohibit us from offering detailed comment on the patients shown in the video including their diagnosis and treatment. We believe it is irresponsible for any alleged “expert” to comment on the totality of the situation involved in any of the videos clips without a complete understanding of the individual case histories or the circumstances that led to the use of restrictive measures.
In each situation depicted in the limited footage, much of what our staff was doing to assist the patient was not visible, the behavior of the patient that caused the hold and/or seclusion was not visible or audible on the tapes. The selected and sensationally edited videos do not depict the efforts and repeated attempts by staff to verbally calm and de-escalate the situation prior to employing physical management techniques. The videos also do not depict the efforts to verbally communicate and diffuse the situation during and after the holds. In the case of a patient who appears to be hitting himself in a seclusion room while a staff member seemingly looks on, a viewer with no background or knowledge would not be aware of the underlying pathology and history of the patient, which includes escalation with any physical contact inciting further violence for a sustained period of time. With such a patient, while the conduct is disheartening, observation to ensure that no actual harm occurs is the best course of conduct as opposed to physical intervention which has previously escalated and continued the behavior. In this specific case, if the patient was harming himself our staff would have immediately intervened. As seen from the video of this incident, the patient is constantly being watched and monitored.
We dispute any claims that we are intentionally admitting patients who do not meet admission criteria or that administrators inappropriately pressure psychiatrists to admit patients for solely financial reasons. Admission and discharge decisions are made solely by the psychiatrists based on widely accepted, written medical criteria in consultation with the treatment team at the facility and are respected regardless of patient census. While we are recognized for our capability to provide evidence-based, specialized care for patients that other facilities are unwilling or unable to treat, every month Shadow Mountain turns away approximately 20 potential admissions who fail to meet admission criteria or as a result of non-alignment with our treatment specialties or other factors.
Police Calls, Allegations of “Riot” and “312 Reports”:
This portrayal represents a gross distortion and misapplication of the issue of police calls associated with Shadow Mountain and similar facilities. It is exceptionally rare for police to be called to our facility to intervene with patients. This is in large part because our highly-trained staff is well equipped to deal with psychiatric patients, applying de-escalation techniques. Our facility’s interaction with police is often to meet legal notification obligations which the police are required to investigate (mostly resulting in unsubstantiated matters), to deal with outstanding warrants, to follow-up on an investigation that is completely unrelated to our facility, or for other reasons.
Regarding the incident that took place in February 2015 involving multiple adolescents, these adolescents were being treated for a variety of serious trauma-related issues. The matter began and ended in less than 20 minutes. While police were called, our facility CEO assessed the situation and determined that they were not needed. We are proud of the way that our staff responded, and how they were able to calm the situation and the patients in a way that everyone was safe and returned to the unit. Subsequent to the incident, we terminated a manager who in our view precipitated the situation.
BuzzFeed also referenced “312 reports” made to Oklahoma’s state regulatory agency over a 3 year period. However, the reporter failed to mention that over 90% of those reports were determined to be unsubstantiated and others involved minor administrative matters that did not materially impact patient care or safety.
UHS takes any employee complaint against another employee or facility leader seriously. The company provides a third-party administered Compliance Hotline and web reporting program as a confidential way for employees to use to ask questions or voice concerns that they may have about suspected violations of company policies or violations of the law. All complaints regarding improper or unethical business practices, violations of the law or company policies, including harassment, fraud, retaliation and discrimination are taken seriously, addressed promptly and handled in a manner that protects the privacy of the caller and are investigated without regard to the person’s position or tenure at the company. When a call is related specifically to a facility CEO, details are forwarded to the assigned Regional Vice President and to the Corporate HR department for investigation. Any issues that require further action, up to and including coaching or other discipline are handled with the Regional Vice President.
Peer Assistance Program:
The Peer Assistance Program administered by the Oklahoma Board of Nursing is a voluntary, confidential program which assists licensed nurses in returning to the safe practice of nursing. Participation in the program includes development of an individual plan of recovery, monitoring of compliance, support and education. UHS and Shadow Mountain are supportive of programs like this that offer a chance for impacted individuals to recover and return to safe and productive employment and help patients suffering from similar challenges.
We dispute the contention that “80% of the nurses were in the Peer Assistance Program.” A small percentage of Shadow Mountain’s nurses participate in the Peer Assistance Program. We respectfully decline to give the exact number because that is against our goal of a confidential program and may cause undue pain and stigma to those participating. We feel strongly that it is our obligation to assist professionals in getting their lives back on track in a safe and responsible way. Any negative and fear inducing portrayal is not only cruel to the people involved, but also emblematic of the unfair stereotypes regarding the ability of people suffering from mental illness and substance abuse to successfully change their lives.
Shadow Mountain’s Director of Nursing:
BuzzFeed’s callous and inaccurate depiction of our current Director of Nursing is very disappointing and an insult to all individuals who’ve previously faced mental health and substance abuse challenges and successfully turned their lives around. The incident referenced occurred almost 6 years ago. This individual sought medical treatment for the medical disease of addiction and has been in recovery now for almost 6 years. Her nursing license is in good standing with the state of Oklahoma.
Attracting employees and compensation:
We challenge the incorrect assertions with regard to Shadow Mountain’s ability to attract qualified staff, as well as the assertion that our pay scale is somehow deficient. Shadow Mountain is proud to be an employer of choice in the community for those seeking employment in behavioral health.
With regard to compensation, Shadow Mountain’s pay scale is based on local market analysis with appropriate adjustments made periodically as required to ensure market compatibility in order to ensure recruitment. We receive many applications and resumes every week from interested applicants.