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M arrived at intake covered in scars.
He was a big kid, but the wounds were self-inflicted. For the staff at The Pines residential treatment center, the marks up and down his arms and legs should have been warnings signs about his ambitions.
This March, less than two months into his stay, M dug into his own arm with a plastic spoon. He was supposed to be watched. He wasn’t. The spoon was all he needed to rip himself a primitive bloody hole. “It takes a bit of psychosis for him to cut himself with a piece of plastic as deep as he did,” recalls a current employee.
In interviews, two staffers familiar with M’s case recall him saying he didn’t want his arm anymore. Another said he was suicidal. But he was nonetheless able to hurt himself repeatedly. Staffers recall multiple E.R. trips. “Each time he ripped a staple or stitch out, did no one see that he was doing it?” asks a former staffer, who, like colleagues, declined to speak on the record due to the sensitive nature of the incident. “And why didn’t they try to stop him?”
It’s easy to see how M could get lost. From March to mid-April, according to incident records from the facility, there were 50 fights or assaults among kids—sucker punches, biting, outright brawls. There were also two suicide attempts and 15 incidents of self-harm. At the end of March, two boys, ages 8 and 9, confessed to engaging in oral and anal sex.
With three sprawling campuses in Virginia’s Tidewater region, The Pines is the biggest for-profit residential treatment center in the state. It’s a complex operation that sustains itself on the idea of accepting just about any kid. The sexual predator, the orphan, and the gang member all occupy The Pines’ fortress of smash-proof glass and sky-blue cinderblock.
But in the past three years, The Pines has faced more abuse and neglect allegations than any other RTC facility in Virginia, according to a review of state records. Its campuses have been under constant scrutiny, threats of sanctions, and state orders to correct problems. One staffer described M’s unit as a “dog pen.”
Officials from The Pines, which changed ownership late last year, declined repeated requests to discuss specific incidents turned up in this investigation, saying new management was making changes. “All of the Pines Campuses are safe,” explains a statement sent by Kathy Parker, director of business development for Universal Health Services, its parent company. “We take the safety and well being of each resident very seriously…The Pines management team is continually reviewing clinical programming, procedures and staff training to enhance the provision of safe, effective, and patient-centered treatment.”
As it happens, this story from the far side of Virginia should matter to D.C. residents. Every year, the District spends tens of millions of dollars sending its most troubled children to distant RTCs—and The Pines has benefited like few others. Between 2009 and 2010, the city’s Department of Youth Rehabilitative Services nearly doubled the number of kids it sent there. Several other city agencies that tend to troubled kids also use The Pines.
Why keep using the place? City officials were aware of some problems, according to hundreds of emails and monitoring reports obtained through Freedom of Information Act requests. But those same documents demonstrate a cozy relationship between the city and the facility, one that persisted despite the countless warning signs.
Other governments moved more quickly. In early spring, well after the management change, North Carolina announced that it had begun the process of yanking its own kids out of The Pines. D.C. agencies, though, have been confused on just how to respond. On May 16, after repeatedly defending the placements in interviews for this story, DYRS announced plans to pull them. “Based on discussions with our partners in the District and the licensing authorities in Virginia, we believe it would be easier for The Pines management to deal with some of their operational and administrative challenges with a smaller population,” says DYRS Chief of Staff Christopher Shorter.
At least one other city agency, though, still has kids at the Pines. And the story of why that is explains a lot about how D.C. cares for troubled kids.
If Virginia officials had their way, D.C. would never have sent so many kids to The Pines. In spring 2009, an agreement with Virginia officials stipulated that the facility would improve its care and work toward “decreasing the number of Out-of-State residents, particularly those with very serious histories of violence or gang activity.”
That promise had no effect on The Pines’ business with the District. A Pines worker was even given a desk in 2009 in DYRS’ offices, according to three current and former city workers. Sources say she handled the heavy paperwork load for the city’s many dealings with The Pines. “She was actually really good—on the business side,” recalls one former official. The in-house Pines staffer left last summer after other RTCs asked for space, and the city decided it couldn’t accommodate all of its contractors.
But at a minimum of $250 per child per day, District officials had by then sent an unprecedented number of kids to The Pines, records show.
- In 2009, DYRS, the city’s juvenile justice agency, sent 103 kids. In 2010, it sent 172.
- In 2008, the D.C. Public Schools were responsible for 27 kids’ education at The Pines. In 2009, that number climbed to 35. In 2010, it hit 40.
- In 2008, the city’s Child and Family Services Agency had as many as four youths at The Pines. In 2009, it had seven. In 2010, it had as many as 10.
Every year, the District sends roughly 500 kids to RTCs. The Pines takes in at least 30 percent of D.C.’s most troubled kids. A census taken in September 2010 from The Pines’ Crawford campus showed that the District had more children there than any state except North Carolina. The city had 31 kids enrolled. Virginia had 29. Maryland had one.
The District relies on The Pines in a variety of ways. Sometimes, kids are sent there while “awaiting placement” elsewhere. Other times, Pines staffers help determine where someone should be placed. “There was an obvious incentive for them to say, ‘Guess what? This person needs The Pines,’” recalls the former District official, who declined to be identified because of the sensitive nature of the story.
City email records show a warm relationship between officials and Pines staff, notably Randall Goldberg, the former vice president for national marketing at the facility’s then-parent company, Psychiatric Solutions Inc. The records show Goldberg helped attract business to The Pines in part by keeping it friendly—remembering birthdays, liberally using exclamation points and emoticons. After providing the number of a Pines campus, he wrote one D.C. agency staffer: “Do I get to keep a list of times I’ve been helpful?” He added a smiley face.
On the occasion of a child-welfare administrator’s birthday, he gushed: “You look great for 30!!” One Goldberg colleague wished a CFSA worker a “happy hump day!”
Hundreds of email exchanges between Goldberg, his co-workers, and D.C. government personnel show how in the loop the firm was on placement decisions. “Hello ladies,” wrote a Goldberg subordinate to a child-welfare agency administrator on Nov. 3, 2010, “I understand [redacted youth’s name] is resistant to going into RTC placement. Let me know if there is anything I can do to assist.” In an email dated Feb. 16, 2009, Goldberg writes to the agency about several children: “I was hoping you could give me a synopsis of their needs so that we could brainstorm about which programs of ours might be the best match.”
When James Ballard III, the Department of Mental Health’s clinical program manager covering residential treatment centers, wanted advice on keeping kids out of such facilities, he reached out to Goldberg. “I completely get it,” Goldberg replied. “Believe me we are on the same page…When I am in town next (maybe 2 weeks) maybe we can sit down and write down some ideas together?”
Why was the District government asking an RTC marketer for advice on how to not send so many kids to RTCs? “DMH regularly talks to providers, advocates, other child serving agencies about best practices and other models of care that will meet the needs of District youth,” explains a statement forwarded by agency spokeswoman Phyllis Jones. Goldberg, who recently left his position with The Pines’ new parent company, declined comment.
In their many emails, District officials evince little skepticism about The Pines. The same goes for interviews conducted before last week: “It is a D.C. Medicaid approved facility,” Shorter said May 13. “In addition, the proximity of the Pines to D.C. makes a big difference in meeting one of our main goals of keeping young people as close to home as possible.”
Ward 6 D.C. Councilmember Tommy Wells, who until recently chaired the council’s Human Services Committee, also said little about the therapeutic or educational upsides when discussing The Pines. “A lot of young adults were sent that were awaiting placement,” he says. “It was used because it was a secure facility that [the District] had under contract—not for any type of treatment.”
Current and former juvenile-justice agency officials cite a more prosaic reason for The Pines’ frequent use: Pines staffers were willing to bring the city’s wards to the Virginia facility. “They come pick the kids up,” says a juvenile-justice official who declined to be quoted by name for fear of being fired. “They go the extra mile. They really do.”
In Virginia, the Department of Behavioral Health and Developmental Services oversees RTCs via its Office of Human Rights and Office of Licensing. A combined 42 investigators and administrators peruse documentation of altercations, staff-on-resident restraints, escapes, and suicide attempts. For especially bad cases, inspectors visit facilities and try to get reluctant, troubled kids and reluctant, low-wage employees to open up. Though officials are only required to make one unannounced visit to residential facilities per year, current and former officials say there were stretches in 2009 and 2010 when they would visit the Pines as frequently as once a week—a marked difference from their colleagues in D.C.
In late October 2008, eight Pines kids went AWOL. “Video showed staff not intervening until the third resident had escaped,” says one Virginia report. “Still one more managed to escape at that time. Then four more escaped at a different time.” Two months later, according to state records, officials uncovered an incident where a resident had been choked to the point of unconsciousness. Pines staff had simply labeled the incident “horseplay” and failed to report it.
It was around this time that Virginia Office of Human Rights official Reginald Daye, at one of the office’s regular public meetings, expressed concern over The Pines’ use of restraints, reporting that, “The Pines’ numbers are extreme outliers, and have been for quite awhile. The aggressive population excuse only goes so far because changes have been made in the past, and after a month the numbers go back up to what [they] were before.”
The following February, a licensing office report shows, a resident tried to hang herself with a bed sheet. She was found in “respiratory arrest” and “unconscious.” When EMS workers asked if this was a suicide, staff said no, according to the report. Officials discovered that the girl had previously tried to kill herself four times at The Pines—including once while a state investigator was on the scene. Pines officials originally labeled the incident merely a “suicidal gesture,” the report noted. Virginia officials wrote that The Pines “failed to provide services according to sound therapeutic practices.”
The next month, a resident set a lounge on fire. A licensing investigator happened to be on campus when the fire trucks arrived, a report shows. An administrator told him that the alarm had merely been pulled as a prank. Even after the investigator picked up a copy of the fire department’s report, Pines administrators claimed that they did not have to report the fire since no one was hurt, according to the investigator’s final report.
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In 2008, according to data collected by the Office of Human Rights, there were 1,024 abuse and neglect allegations at all three Pines campuses. In 2009, allegations doubled to 2,232. That year, local police were called to 47 incidents at The Pines’ Crawford and Brighton campuses, records show, including 12 runaways, eight larcenies, five missing persons, nine simple assaults, three aggravated assaults, and three reports of forcible sodomy.
“I don’t know that they have given thorough consideration to the clients they are taking,” a licensing worker wrote in an internal email early that April. The number of times residents were physically restrained by staff bears that out. From January through April 2009, there were a combined 901 restraint episodes, according to minutes from Office of Human Rights public meetings during that period.
Following the fire, state officials drew up a plan for more scrutiny—and one that might lead to the issuance of a provisional license, something that could be devastating for business.
“I think we have a lot of facts to support this decision,” wrote Leslie Anderson, then-director of the Office of Licensing in an email to her superiors. “I do not know if people appreciate how much real work we have to do…. I do not have enough staff to have them having to figure out if a professional provider is lying to them, and trying to outsmart them, before someone gets killed.”
“I have to say that this is why I have wanted out of this job,” Anderson went on to write. “If I told this to anybody else, they would think that we should have revoked their license.”
Instead, authorities negotiated an agreement that merely stipulated a number of reforms. Less then a week later, after an escape, state watchdogs sounded even more frustrated. “I already know that what is lacking is SUPERVISION,” a subordinate wrote in a mid-April email to Anderson. “Having viewed a number of videos, it is clear that this is a problem…The residents are not being supervised and the staff are not being supervised…Something is up with the staff, be it training or not really caring.”
On Nov. 3, 2009, licensing officials issued
a 71-page corrective action plan for the Crawford campus. Its conclusion: the facility had “widespread programmatic and systemic deficiencies.”
The report detailed a now familiar litany of medication errors, poor training, and at least one horrifying incident: “On October 30, 2009, resident indicated to staff that he did not want to live, turned down the hall and ran head first into the exit door. Video confirmed the incident and showed that the resident was unconscious for approximately 1 minute, 55 seconds.” A doctor was never notified, the report noted.
District officials rarely made the 200-mile trip down to The Pines’ campuses, but when they did show up, the facility’s administrators were ready. “When the D.C. people come to check on their kids, everybody has to be up to par,” says one former Pines staffer who requested anonymity because of the sensitive nature of the story. The ex-staffer claims administrators checked for cleanliness and added extra staff before the pre-announced visits: “They say D.C. is our biggest moneymaker.”
Shorter, the DYRS chief of staff, refused to comment on the claim: “It’s an employee that isn’t speaking on the record and I couldn’t confirm if what he or she is saying is true. If it was something official that The Pines said, some official policy that made them operate differently when we came or sent investigators down or follow up on some sort of allegation then I would be able to say something.”
But two current Pines employees confirm that it was routine for administrators to dial up special preparations for outside visitors such as D.C. officials or insurance companies.
On April 8, 2009, just as The Pines was promising Virginia it would improve, a District teen, S.Z., alleged that he’d been roughed up while being restrained by a Pines staffer. He received a laceration to his chin and a minor abrasion to his right cheek. He told Virginia licensing investigators that the staffer “picked me up and body slammed me,” records show.
It began when S.Z. was hit in the back with a football. A staffer jumped in when S.Z. sought to fight the culprit. S.Z. claimed the staffer “held both my hands behind my back and [lifted] me up” and then threw him down on “the patio court,” according to a state report.
To their credit, D.C. officials noticed the incident. City emails show that agency directors from the city’s Department of Child and Family Services, Department of Mental Health, and Department of Youth Rehabilitative Services all received write-ups concerning S.Z.
According to the internal emails, Vincent Schiraldi, then the director of DYRS, was sent documentation that Virginia licensing officials had issued a three-page corrective action plan after the incident. Officials found that the staffer had “minimal or no documented experience” working with youths in residential facilities, and said that S.Z. had received sub-standard medical treatment. But it is unclear what Schiraldi and DYRS did with the case—or if they ever followed up with S.Z., who had complained to Virginia officials that his DYRS social worker didn’t call back and was “very difficult” to reach. S.Z.’s own file with the juvenile justice agency contains no record of the incident at all.
Schiraldi refused to comment for this story. “I’ve been gone from DC for a year now, and I’ve decided I’m no longer commenting on DC juvenile justice stories,” he says in an email.
Twenty days later, the same Pines staffer was involved in another questionable restraint that resulted in a resident receiving eight stitches for a laceration to the chin, according to Virginia licensing documents.
Records of the subsequent investigation by Virginia licensing officials show that a staff member stated the restraint methods used at The Pines “are not safe.”
“The CEO brought in an Agency Trainer who indicated that the program being taught is not to be used for restraining residents on the floor,” the report states. “However, staff indicated they were taught to use the technique to take residents to the floor. Because the technique requires staff to bend the resident over with their head close to the floor and their arms pinned by staff, it appears to this specialist that injuries to client’s chins and their heads would almost be a natural consequence.”
Despite longstanding controversies around RTCs in general, the District’s monitoring reports were far less frequent. A review of the past five years found repeated instances in which some of the city agencies that house kids at The Pines had failed to produce annual reports on the center. And the reports that were produced sometimes stand in contrast to the official criticism leveled by Virginia’s regulators. A 2010 report on The Pines from D.C.’s child-welfare agency highlighted a “strong woodwork program,” and noted there was “adequate staffing” and that “the therapeutic environment was found to be clean and in order.” But it also expressed concern over things like the increase in kids going AWOL.
The same month as the S.Z. incident, representatives from the District’s Department of Mental Health conducted a scheduled visit. The conclusion, according to city records: “There are no safety and supervision concerns at this time.”
In fact, by fall 2009, DMH had issued a lengthy corrective action plan similar to those issued by Virginia. And the agency’s 2010 monitoring report noted that The Pines had a waiting list for substance abuse counseling and said resources were limited for other therapies. The report stated that many District kids at the Pines complained that residents had been allowed to use racist and homophobic slurs without consequence.
Still, in an interview, Ballard, whose supervises the team that oversees RTCs, said he did not remember ever hearing about the fire, the suicide attempt, or other incidents that got The Pines crosswise with Virginia authorities. He also did not recall the alleged assault on S.Z.
Jones, the agency’s spokeswoman, said that monitoring reports on incidents at the facility was actually the job of DMH’s Office of Accountability. That office declined to discuss specifics of the cases.
When asked about his overall take on The Pines, Ballard said he thought RTCs in general were not the best way to treat troubled kids. “I believe youth need to be at home with their families who care about them and in their communities,” he said.
D.C.’s Child and Family Services Agency, which has also housed kids at The Pines, also refused an interview request. Instead, the agency turned over emailed responses to questions. Agency spokeswoman Mindy Good refused to say who supplied those responses. “Can’t you just put the agency responded?,” Good asked.
The agency, according to the unattributed response, was not aware of any corrective action against The Pines. When given the names of the director of Virginia’s licensing office and one of its main investigators—the people who know The Pines best and have access to reams of investigative reports on all of the state’s RTCs—the agency replied that it hadn’t heard of them, either.
In its statement to Washington City Paper, The Pines says things have changed: “The new management of the facility is focused on a comprehensive process improvement plan, re-evaluating each of its programs to make sure that the highest possible standard of care is being provided.”
But the facility promised changes before. In memos to Virginia officials through 2009 and into 2010, administrators heralded changes in things like infection control, risk assessments, and “management of the Environment of Care.” They boasted of “new observation sheets” that included “less checkboxes and more progress notes.” An incentive program offered stellar employees “Mason Bucks,” named for The Pines’ then-CEO, which could be redeemed for movie passes and gas cards. Management introduced “the Matrix,” a point system under which residents can earn privileges based on good behaviors.
But the complaints continued. In July 2010, a state review found that two Pines therapists were not actually licensed. In September, a resident fought another resident for three minutes without staff intervention; one of the residents broke his hand. A month later, a resident lost consciousness after staff member put him in a “full nelson.” The resident fell and hit his head during the restraint, records show, and was unconscious for two minutes; licensing officials called the incident abuse.
Last fall, the state’s inspector general conducted a one-day visit to The Pines, finding the facility safe. In a subsequent interview with City Paper, he called the facility “challenging” and said he thought licensing officials should continue handling oversight. Les Salzberg, director of the licensing office, said in an interview at the time that while the place had improved a bit, staff ratios remained an issue: “You can’t be leaving three, four, five kids with one staff,” he said. “That’s been an on-going challenge.”
Workers say The Pines is just a really tough place to work. Many of its children—like M—have problems beyond The Pines’ expertise. In too many cases, they arrive without case histories. Some staffers wonder if The Pines is just traumatizing these kids all over again.
One former staffer tells of a child who waited eight months to get a pair of glasses, and another who endured a toothache for five months before seeing a dentist. “I’ve seen staff buy soap, socks, underwear, shoes,” explains the former employee. “I mean the kids don’t have any soap.” Says a former administrator: “There were a lot of kids that didn’t have the proper clothing and shoes.”
Of course—and still under the cloak of anonymity—another current worker says other colleagues aren’t so charitable. “There is kind of an attitude that if they’re not scared of you they’re not going to follow direction,” the worker says. “To get them scared of you, you have to put hands on.”
This past October, Norfolk’s Virginian-Pilot published one in a long line of scathing editorials demanding better state oversight of The Pines. Back in D.C., though, the facility had a defender: the same city government that had sent so much business its way.
Following the editorial, Goldberg emailed talking points to Linda Harllee-Harper, a DYRS supervisor. Harllee-Harper passed them along to Ballard and others, according to email records. When an advocate raised the issue of the editorial, Harllee-Harper replied with an argument similar to those talking points, the documents show. She wrote: “The Pines has partnered with the DYRS to support us in meeting the needs of our agency and our population of young people; they have always been very responsive to any and all questions and concerns raised by our agency. We will not rush to judgment based on the contents of the circulated opinion piece.” Harllee-Harper did not return calls for comment.
And yet, during that same month, DYRS was investigating The Pines. After five returning kids made allegations that they were improperly restrained and over-medicated during their Pines stays, the agency finally attempted a serious investigation in late 2010. One D.C. ward had been so over-medicated he’d developed a life-threatening reaction that had gone undetected, according to a confidential District report, which said The Pines admitted it needed to “tighten up” medication practices. The Pines also acknowledged that two incidents where youths were restrained hadn’t been justified; a staff member was put up for termination, the same report noted.
But the agency concluded “there is no convincing evidence to suggest to the improper use of physical restraints is an endemic issue.”
D.C.’s counterparts in North Carolina took a different tack four months later. Citing concerns over a sex-abuse allegation as well as issues with staff training, staff-to-resident ratios, and patient care, state authorities announced plans to remove 150-plus wards from The Pines. Last month, Virginia also issued a provisional license and froze admissions.
Meghan McGuire, communications director for the Department of Behavioral Health and Developmental Services, said the changes were “not related to any one incident, but are the result of ongoing performance issues that must be corrected to ensure safety and effective treatment for the troubled children there.”
At first, D.C. barely reacted to the news. At the end of this April, DYRS still had 31 children there. On May 13, Shorter was still defending The Pines. But after repeated questions, he emailed three days later to say that the agency had decided to pull out all of its youths.
On the other hand, Good, from the District’s child-welfare agency, still expressed confidence in the facility. “We feel like the kids that are there are safe,” she said last week. But she also said that the agency would make its oversight more robust.
The Pines insists things will be different now. “The Pines looks forward to working in partnership with all of the regulatory agencies during this process of transition and beyond,” its statement says. “The facility is fully dedicated and committed to its mission of providing the highest quality of care for children and adolescents with special, and sometimes difficult, mental health needs while maintaining compliance with all federal and state regulations.”