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Doctors: Johns Place is unsafe; director disagrees
DiPolito says unit meets state guidelines
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    Citing an unsafe work environment and inadequate staffing, three doctors, including the medical director, resigned earlier this month from John's Place, a mental health and addictive diseases treatment center in Statesboro. Official complaints were filed with the overseeing state agency and an investigation is under consideration.
    June DiPolito, executive director of Pineland Mental Health/Addictive Diseases/Developmental Disabilities, disputed the doctors’ assessments, and said John's Place, which operates as one of Pineland's many programs, is safe and in compliance with state requirements.
    John's Place has received state recognition for its programs and success stories. Its crisis unit is for clients with serious mental, emotional or addiction issues that could make them dangerous to themselves, as well as others around them.
    Former medical director Dr. Robert Bryan, Dr. Greg Fortner and others said the clinic needs additional staff to provide a safe environment for its clients, and said DiPolito has consistently refused to heed their pleas.
    Lisa Archer, Georgia's Inspector General, confirmed official complaints were filed with her office against DiPolito and Pineland in July regarding John's Place, and said the complaints are under review for possible investigation.
    Drs. Bryan and Fortner aren't alone in their concern for what they say are unsafe staffing issues. Three other John's Place employees agreed to speak with the Statesboro Herald under condition of anonymity, fearing for their jobs.
    And in addition to Bryan and Fortner, Dr. Dan Weathers resigned, along with John's Place nurse manager Diane Neville and two nurse counselors, Bryan said.
    Weathers was not available for comment, and Neville declined to comment on her resignation. However, both Fortner and Bryan spoke about why they resigned, including inadequate staffing and lack of cooperation from DiPolito.
    "My resignation occurred as a result of not being able to obtain support from the CEO (DiPolito) to hire enough staff ... to feel the (John's Place) crisis unit would be safe for staff and consumers," he said.
    DiPolito provided the Statesboro Herald with copies of state audit results, as well as staffing documentation showing that much of the time, staff to consumer ratio was well above the state minimum. Audit reports listed the facility as being in compliance with state requirements, but Bryan said the paperwork does not reflect reality.
    State staffing requirements mandate at least one staff member to eight consumers, according to the fiscal year 2010 Provider Manual. However, staffing is also determined according to acuity level - or level of crisis, Bryan said.
    "The state minimum is not enough," he said.  The manual "says we should staff to acuity, and we should staff based on historical data (regarding the level of crisis for consumers)."

    The John's Place crisis unit has consumers with severe addiction issues as well as anger, mental and emotional health issues, and consumers undergoing detoxification can be violent or require intense supervision during the detoxification process, Bryan said.
    Situations requiring more than one staff member to care for a consumer often resulted in inadequate staffing to meet other patients' needs, he said. He cited numerous incidents that have happened at John's Place - including inappropriate fraternizing between male and female consumers because there was not enough staff to supervise; not enough staff to adequately monitor incoming consumers who may have contraband - and in one case, an unsuccessful hanging attempt because the "ceiling could not support" the consumer.
    DiPolito shared documentation with the Statesboro Herald that showed few reported incidents, and none of a serious nature, since 2007. Bryan said the reports are not an accurate recording of the actual incidents. Just because there were no reports of serious and dangerous occurrences "doesn't mean there weren't any," he said.
    It was not unusual for reportable incidents to become minimized, he said. "By the time it filters through the many hands... it doesn't make it to the reportable column," he said.
    Bryan said he resigned because he realized things were not going to change. He discussed resigning before with DiPolito, and said he was promised that the staffing issue would be addressed and rectified. It never was, he said.
    But after unfulfilled promises to correct problems, "it became abundantly clear to me that the only ones who are really exposed to risks from inadequate staffing and care) from a medical and legal standpoint are the doctors," he said.
    He said DiPolito told him there were financial reasons the additional staff would not be hired, and "said she did not feel additional staff was warranted," he said.
    DiPolito, who met with the Statesboro Herald along with attorney Steve Rushing, who serves with the Community Service Board that governs Pineland, said Bryan's demands were not feasible and unwarranted.
    State audits - including one as recent as April - prove the facility is in compliance, she said.
    "They have a PRN pool (a pool of staff on call)," she said.  If they keep that well stocked, that's fine with me."

Second doctor resigns
    But Fortner, whose resignation followed Bryan's, echoed Bryan's reasons for leaving the facility.
    "When the medical director resigned, I didn't feel I could be there if he wasn't there," Fortner said, citing staffing concerns and inadequate care for consumers.
    DiPolito "was given a long time to work on (a request for more staff), with no resolution, no improvement," he said. "I felt unsafe putting my name on it if she was unwilling to do (what was necessary for a safe environment.) We have had problems with staffing for at least a year."
    DiPolito said Fortner never tendered an official resignation.
    Fortner has worked for Pineland MH/DD/AD in the past and returned, and said problems have existed throughout the entire agency for some time.
    "Pineland is micro managed and service is nonexistent" at John's Place at the time he and Bryan left, Fortner said. "There are little counselors and no doctors - the director has to review everything (before any action is taken)."
    Both Bryan and Fortner said DiPolito has said Pineland has a surplus of money - around $7 million. If that is so, "Why are we not able to hire techs to ensure patient safety?" Fortner asked.
    DiPolito confirmed Pineland has a reserve fund of about $7 million, but said the state and solid business practices require the agency to maintain "one to three months' operating expenses" in reserve in case of emergency. The state cut Pineland's funding by more than $660,000 this year and by more than $1 million last year, she said.
    With the economy, everyone is cutting back, but Pineland has not suffered layoffs or furloughs, she said.
    DiPolito also provided a copy of a signed statement by Dr. Galen Huffman, who was asked by former Pineland Community Service Board chairman Susan Radovich to serve as a consultant.
    In the statement, Huffman said Radovich asked him to examine the credibility of the allegations made by Bryan and others. Huffman said he investigated June 15-25 and found John's Place to have adequate staffing.

Staff concerns
    Under condition of anonymity, three other Pineland MH/AD/DD employees spoke with the Statesboro Herald about concerns with the agency, specifically but not limited to, John's Place.
    The three each expressed concerns with what they consider inadequate staffing at John's Place.
    "We have a critical shortage of staff - medical, and nurses," said one. "(DiPolito) tells us we don't have the money, but we are a not-for-profit agency and we have ... money in the bank."
    Another employee said, "This is in every area of Pineland. When a key position is open, (DiPolito) doesn't fill it.
    "Every last one of them (departments under Pineland's umbrella) is begging for staff," the third employee said. "Our concern has been the liability it puts our consumers and our staff in."
    All three sources agreed with Bryan's and Fortner's concerns about the John's Place crisis unit being understaffed, and not being safe for consumers or employees.
    They also said complaints were filed not only with the Office of Inspector General, but with Wage and Hour and the Office of Constituency Services.
    Calls were made to the Governor's office and to Sen. Jack Hill as well, they said.
    Perdue's office did not respond to queries, but Hill verified having been contacted by people with concerns about Pineland and John's Place.
    He said he referred callers to the Inspector General and other state offices, but "I heard the existing channels don't work" in filing complaints, adding that callers have expressed frustration in trying to seek help for their concerns.
    "I've had some conversations with some folks and I trust what they say," Hill said. "But I don't feel it is my place to start umpiring."
    Concerns also were raised about a recent policy change that prevents Community Service Board members from discussing issues related to Pineland. The board exists to govern and advise Pineland and includes members from all counties served.
    The policy dictates that board members must refer all questions about Pineland issues to DiPolito.
    Kathy York, a Bulloch County member of the board, declined comment on the situation at John's Place, stating that all inquiries about the agency be directed to "our CEO, June DiPolito."
    Both DiPolito and Rushing said the policy addresses personnel issues and consumer privacy. However, the confidentiality agreement board members are required to sign prohibits them from disclosing any "confidential and/or sensitive information about the agency ... which could adversely affect Pineland's image or reputation..." during or after serving on the board.

Disgruntled employees?
    The employees also spoke about concerns that John's Place did not have a doctor in place to treat consumers after Bryan's, Fortner's and Weather's resignations. Doctors were on call, but there was a scramble to secure a doctor, they said.
    DiPolito said via e-mail to the Statesboro Herald that John's Place now has two full time doctors, six part time doctors and a full time physician assistant. She said she hopes to bring another doctor on board soon.
    The allegations by Bryan, Fortner and others are merely a case of disgruntled employees, she said.
    Two current employees voiced confidence in DiPolito and approval of John's Place, Pineland MH/AD/DD and the staffing situation.
    Shaneka Brown said she has worked at John's Place for 10 years.
"We all pull together as a team," she said. "We have the staff there and we are trained to handle situations. I think Pineland and John's Place as a whole offer good services."
    Health service technician Melanie Melvin said the facility was not dangerous.
"Absolutely not," she said. "We are very well staffed and have security here."
    But Dr. Bryan said he would not have resigned if his concerns were not serious and he did not feel consumers and staff were being put at risk.
    There were many times, he said, when there were no male techs on duty, causing female staff to be at risk when there were agitated consumers on the unit, he said.
    "We've dodged several bullets because we were lucky," he said. "Such as that person not being able to hang themselves because the roof did not support them."
     When asked about that incident, which took place a few years ago, DiPolito said the roof, which had collapsed, was repaired and the consumer involved "appeared to be fine and was talking afterwards."
    Bryan said he and Fortner both offered to stay at John's Place in different capacities in order to help out while DiPolito found replacements. Their offers were refused, they said.
    DiPolito did not verbally answer when asked about their offers, but shook her head "no."
    Fortner provided the Statesboro Herald with a letter he sent to DiPolito he said he sent July 26, in which he expressed concern for consumers and sought to work out a solution.
    In the letter, he wrote: "...had the opportunity to meet (a new doctor hired at John's Place recently.) He said he was there to make rounds with me but got up to leave after seeing only one consumer. I asked him to stay to see the type of cases we treat and he stayed for about two more consumers and left. We were not even half way done. He explained that he had no experience in detox and had worked at Georgia Regional hospital doing admissions but did not work on the wards managing the psychiatric patients.
    "My impression is that he is a very nice guy but he does not possess the skills necessary to treat the complex consumers admitted to a crisis unit with serious psychiatric and addictive disorders. He said he would not be taking calls and that admissions to John's Place would be approved by the ER physicians ... This will be an unqualified disaster ... They  ... are totally unqualified to triage which consumers are appropriate for our facility. It would quickly become dangerous for staff and others consumers if inappropriate consumers are sent to John's Place without proper screening."
    In an attempt to work out the problems, Fortner wrote: " ... I don't want to leave John's Place and my impression is that Dr. Bryan does not want to leave. My hope is that there could be a meeting of the minds and the hatchet could be buried and we could move forward; because, honestly, the admission plan and new physician are not viable solutions to meet even the minimum standard of care expected at John's Place.”

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