On Nov. 3, West Virginia Public Broadcasting published a news story based on a number of reports, and a letter from Senate President Craig Blair to Gov. Jim Justice, that called for an independent investigation into the state Department of Health and Human resources, and specifically, care at Sharpe Hospital.
Following the report, Secretary Bill Crouch issued a letter calling the initial story into question. We invited him into the studio to discuss the story and his concerns. News Director Eric Douglas sat down with him last week.
This interview has been lightly edited for clarity.
Douglas: We understand you had some concerns about our article outlining abuse suffered by people with disabilities at Sharpe Hospital. And in some of the managed care, third party facilities where people are cared for. Let’s talk about that. What were some of the issues you had with the article itself?
Crouch: I was very concerned about that. I thought the information was misleading and not really portrayed properly or fairly in any way. And if you look at the title of the article, it was “Reports Show People With Disabilities Are Abused In State Care.” And then the report goes almost immediately into discussing incidents from 2018, 2020, and 2021. This is information that is online from surveys. It seemed to be an attempt to mislead folks. This is all old information. And that’s not to say that incidents don’t happen. There is documentation of these incidents. The issue would be if they weren’t reported, or they weren’t investigated. And that’s not the case. We report all incidents at Sharpe.
Douglas: The argument I would make though, is the article said those are reports so it wasn’t implying that there were unreported incidents.
Crouch: I’m a UT football fan because I went to UT. It’s like reporting that the UT football team was doing terrible. They were 2-9 when, in reality, that’s old information; they’re 9-2 this year. It talks as if this is a current issue, that reports show people with disabilities are abused in state care. The reports are online, these incidents were reported. If there were individuals from Sharpe Hospital who did not treat individuals appropriately or fairly, or any kind of abuse, they were immediately put on suspension. And in many of the instances, or at least one of the incidents, I recall where individuals were fired from Sharpe Hospital. So it’s not that these incidents aren’t reported. They are reported and appropriate action is taken.
Douglas: How are patients admitted to Sharpe Hospital?
Crouch: Every civil commitment at Sharpe Hospital is a court ordered commitment, and every individual who’s admitted there has a finding of harm or potential harm to themselves or others, that they’re a danger to themselves or others. Our forensic population are all court ordered admissions — these are admissions where individuals have committed a crime. And the question is whether or not they’re mentally capable of going through the court system.
We have individuals who will be there for the rest of their lives, we have individuals who will be there for years, we have individuals who will be there for months. But it is a dangerous place to work. We have staff routinely who are sent to the hospital because of injuries from patients. The staff who work there do a great job. They’re all, by the way, mandatory reporters. Some of these incidents that were reported, five people called APS (Adult Protective Services) and reported them. So they’re reported, they’re investigated. Individuals that have acted improperly or abused a patient in any way — sometimes that’s self defense — but even if they do something in self defense, they may be suspended pending further investigation to make sure that appropriate action is taken.
So there’s a huge commitment from the administration of Sharpe Hospital to make sure things are reported, and they’re acted upon properly and appropriate action is taken with regard to any staff that does something wrong with regard to care of a patient.
Douglas: Let’s discuss some of the training that you go through to work at Sharpe Hospital or any type of facility like that.
Crouch: All employees have to go through training before they’re put on the floor without supervision. There’s an orientation and an on-unit preceptorship before they begin to work without direct supervision. That usually takes two to three weeks depending on what their job duties are. It can actually take several months. We have a difficult time finding employees who have psychiatric experience and training to work in a psychiatric facility. Many of these folks come in without the proper training and not knowing what they’re getting into. It’s not for everybody. There are a lot of folks who don’t stay long in psychiatric care, because it’s a difficult area to work in.
Douglas: You mentioned mandatory reporting a moment ago, so if somebody sees an incident, you mentioned the one incident where five staff members reported directly to APS, talk about that a little bit more.
Crouch: Everyone’s a mandatory reporter. If there is an incident of abuse or neglect of a patient. Everyone who works in Sharpe, especially all those on the floor, are responsible for reporting that. And by the way, anyone can report anonymously. There’s been discussion of fear of retaliation. No one should fear retaliation for reporting an incident, and if I learn of any kind of retaliation, then disciplinary action will be taken on with that person because that’s not acceptable. It’s not allowed. It’s part of our policy. Everyone is a reporter. We have two individuals with Legal Aid who are housed at Sharpe Hospital, they have offices in Sharpe. We have bi-weekly meetings where we discuss these incidents with Legal Aid present, also with the staff of Disability Rights (Disability Rights of West Virginia).
They’re present either virtually, or, in terms of Legal Aid, personally, so we’re open about that. We’re open about what happens, the incidents we have, and in discussing those incidents. We try to make sure they don’t happen again, if there’s a way to look at what happened and make sure it doesn’t happen again, we do that.
Douglas: If somebody is found to have committed some level of abuse there, I assume there’s retraining or disciplinary action or potentially firing.
Crouch: If there is evidence that they have abused a patient, they’re fired. We don’t have any tolerance with regard to patient abuse. If you’ve never been on a ward of a psychiatric hospital, it’s a different world, it’s a different environment. And it is not a typical hospital. These patients can be very dangerous. I’ve been there a couple of times and been told we need to get behind a locked door. Things are not as easy as it sounds.
Abuse is something that we don’t tolerate, but again, you have patients who are dangerous. So we have staff who get worried and nervous and scared. And if something happens, they have to protect themselves as best they can, while still making sure that patients are safe. So sometimes it takes two or three people to try to get a combative or an aggressive person under control.
Douglas: Explain the difference between the halfway houses. Are you responsible for the criteria for them? But they’re not administered by DHHR?
Crouch: I think you’re talking about group homes. Group homes are run by private entities. These are either private for-profit or private, not for-profit entities who are multi-state. It’s a company. And so we have some out there, they’re good, and we have some that are not so good. And I’ve actually met with those that are not so good and told them, “You’re not so good.” And in terms of regulation are these facilities, OHFLAC surveys these facilities and goes out on complaints that are sent to OHFLAC directly or to CMS.
Douglas: Do me a favor, fill in those acronyms.
Crouch: Office of Health Facility Licensure and Certification, and CMS is the Medicare and Medicaid entity that regulates those facilities.
OHFLAC is a state entity that’s part of the Inspector General’s Office of DHHR. We work together in a lot of areas to try to make sure that care is good. In terms of OHFLAC responsibility with CMS through a licensure, or through a contract to review facilities that are licensed such as hospitals and psychiatric hospitals and nursing homes in the state. That’s independent of DHHR. They report directly to CMS on those issues. I’ve never been told that OHFLAC was entering, or going to enter a state facility. I’ve never been asked to comment on any survey and would not comment. And they know and we’ve had that discussion with every inspector general that has been there in my tenure. We don’t have any say in what they do, or how they do it.
With regard to group homes, we want to make sure that the care provided to individuals is good, that the quality is good. We’re paying for much of that care throughout the state. So if we have a provider that’s not doing a good job, OHFLAC will do a survey, and then they will alert me that we have a problem with this provider. It could be structural in terms of the facility having safety issues. It could be a number of things, but they will report that to me to make sure I’m in the loop and tell me what their plan is with regard to either banning admissions from that facility or making sure that the facility is held accountable. And even up to the point of providing a monetary penalty to those companies. I actually went to the legislature, I think it was 2018 or 2019, and asked for the legal authority to levy fines because I was concerned about these facilities not providing good care. I didn’t get as high a limit as I wanted, but we sent out four or five fines three weeks ago or so.
Douglas: The reason I asked was because I just wanted to be clear that in the report that we had, there were some allegations or some reports of abuse that were at group homes versus Sharpe Hospital. And so I wanted to make the distinction that some of what was in that report was at group homes versus not everything mentioned in our story was the Sharpe Hospital.
Crouch: That’s correct. And again, the ones that were mentioned at Sharpe have been investigated, action had been taken and everything had been publicized on those. The ones that were at the group homes were not Sharpe Hospital, they weren’t services provided by DHHR. So again, it was misleading from the standpoint that DHHR was responsible for this care. These are individual providers out there, private providers that operate these group homes. Now we fund those and we’re going to make sure that care is quality care. And if it’s not, then we’re going to do something about that.
Douglas: Tell me about 2017, Sharpe Hospital lost its certification. Let’s talk about that.
Crouch: I think that was in the fall of 2017. I started in January. I really got into Sharpe in the summer. I think there were actually a couple of surveys that were sent to me around documentation of treatment plans. And the treatment plan issue is important in terms of making sure individuals and psychiatric facilities are provided a safe place while we determine capacity, but it’s also making sure that they’re progressing from the standpoint to get that mental competence back and they get back into society. We have civil commitments and we have forensic patients.
The forensic [patients] were a little different from the standpoint, especially if they’re not mentally competent, how do you restore them? How do you provide a correction plan for individuals who can’t understand what you’re trying to get them to do from the standpoint of treatment plans.
The issue was working with CMS through our consultants to get them to understand that forensic patients don’t have the same capacity as civil patients. But also that we recognize we had to fix our [computer] system. Our system was not very good. I think it was a 20-year-old system. As I recall, it was a system that was part of the public domain that had been used by the VA. And it didn’t have the modules we needed to really document treatment planning. So we actually added another module to that and part of the problem was simply internet access. We had to run a high speed line, if you know where Sharpe is up on that hill, we had to run it, I think it was a total of two miles. We had some consultants to help us do this. And I remember one calling me and saying it’s taking two minutes to go to the next page when they’re on the medical records.
It was really, as I recall, a software problem from a standpoint of upgrading software, upgrading the system, and getting to making sure there was a clear understanding of the difference between forensic and civil patients and what we needed to do with regard to that documentation.
Douglas: On Oct. 14, Senate President Craig Blair sent the governor a letter questioning a lot of that. And frankly, that was the basis for a lot of the report that we shared — was off of the president’s letter to the governor. He asked for an independent investigation into DHHR. Were you aware of this letter when it came out?
Crouch: Initially, no, it wasn’t addressed to me. It did get sent to me, and I asked the governor to respond and I have responded, and I believe everyone that was copied on that has responded. Again, it was totally misleading. I’m fine with any kind of investigation that anyone wants to do. I’ve told our folks and everyone knows this. If we’re wrong, we’ll admit it. We own it. It’s ours. We’ll fix it and try to make sure it never happens. Again, we’ll never cover anything up, ever. It’s very misleading to imply that we’re trying to cover something up. I have no problem with an investigation. I think the investigation should include anybody involved in that report, because I think there is information there that’s incorrect.
Douglas: You said that the governor’s office has replied to that letter. As of the time we released our report, the Senate said they had not received a reply to that letter, to the original letter.
Crouch: Yes, that’s correct. It has been replied to now a couple of weeks ago. That was after your report that we responded to. There’s been claims and allegations that we’re refusing to respond to. I’ve heard this, I don’t know how many times from Disability Rights folks, that there was a 2020 letter that we never responded to. Communication is not rocket science. Rather than go to the press and go to the legislature and say, “We [DHHR] haven’t responded to a 2020 letter” how about sending us the letter back. We have no idea what that’s about. There’s no intent to not respond. We also are still responding to letters from Disability Rights. I’m very troubled by what’s going on with Disability Rights. I’m not sure if the board is providing any oversight there or not. But I have some real concerns about what is happening there.
Douglas: Disability Rights West Virginia — they’re sort of supposed to be DHHR’s watchdog.
Crouch: I don’t see them as our watchdog. I see them as the advocacy group for those individuals in the state who need them, regardless of whether it’s DHHR or anybody else. If they see an issue where an individual was abused or neglected, they should blow the whistle. Blow the whistle is probably not a good term, they should raise their oversight from the standpoint of trying to be the watchdog of DHHR and be the watchdog for those individuals. That’s what their responsibility is: to advocate for individuals. They’re looking at information here that’s attacking DHHR and again it’s troublesome.
Douglas: Just to back up a moment, you said you would be fine with some kind of external or third party investigation to get to the bottom of this for both sides.
Crouch: Absolutely. We have nothing to hide. We’ve answered every allegation, we provide the information and show that it’s not true. Again, you can’t take incidents that have happened because you had a combative patient. And one of our staff may have done something, it may not have been self-protection. We have folks who probably have lashed out or have done things. We know they have but they’re fired. Or if it’s something less, then we take disciplinary action.
I know of no cases myself where we didn’t take appropriate action with staff who have been aggressive to patients. That’s not the way we operate. So I’m fine with an investigation. If there’s something, someone needs to tell me and we’ll do further investigations or we’ll take further action, but to keep pulling up issues that have already happened that we’ve already investigated — I’ve investigated, they’ve been investigated by CMS, been investigated through OHFLAC and are years old — to bring those up and claim folks are being abused at a state facility using years-old information. That’s wrong. There’s another intent here. And it’s wrong.