Thursday, December 30, 2010

Nashville Biz Journal Picked Up FORBA's Name Change

I guess my work is done.

Small Smiles parent company changes ways, name following scandal

Date: Wednesday, December 29, 2010, 2:34pm CST
Management at FORBA Holdings LLC say the Nashville-based dentistry company has changed its ways. It is also changing its name.
Beginning Jan. 1, FORBA becomes Church Street Health Management, a reference to the company’s corporate headquarters at 618 Church Street.

Senior Vice President Todd Cruse said the name change better reflects the company’s “overall purpose and mission” of providing dental care to underserved communities. FORBA operates 68 Small Smiles Dental Centers in 22 states, none of them in Tennessee.

In the last 12 to 18 months, FORBA has expanded beyond providing dental services to children and now treats adults, Cruse said. Its also has begun offering other lines of oral health treatments, including oral surgery and orthodontics, and has struck up relationships with outpatient surgery centers for more complicated procedures, he said.

The name change is also a fresh start of sorts for FORBA, which in January 2009 agreed to pay $24 million over five years to settle charges that it billed Medicaid for unnecessary dental procedures on low-income children.

Read Complete Article Here

Monday, December 27, 2010

FORBA Holding, LLC Changes Name Once Again ; Now Church Street Health Management, LLC

Another name change for FORBA!
No Big Surprise, most companies who end up with a horrible reputation do a name change, but the leopard never changes it's spots.  They can change their name weekly if they want, but what they do and how they do it isn't changing.

Look for your "One Call Sees All" card in the mail, advertising they are accepting adult patients.

Wonder what happened to the sales pitch surrounding FORBA - For Better Access?
FORBA Holdings, LLC is now
Church Street Health Management, LLC  or CSHM

The name changed was filed today, in Colorado, December 23, 2010 at 2:24PM 

Look For Letter Head and Business Card To Be Ready To Go By January 1, 2011
Big Smiles and Small Smiles, since they are treating adults now.

Monday, December 20, 2010

LSU Study On Behavioral Management - 2005

What about a MotivAider instead of Papoose Board, however, it might take longer than 10 minutes!

LSU study on Behavioral Management in the dental setting.

Sunday, December 19, 2010

"Operating As" "But not Really"

I've noticed a lot of ads in the past few months have the phrase I've highlighted.  "Operating as"  Sounds to me that is only the first part of the phrase, the omitted ending would be "but not really".  I just love how creative they get with their wording.  They imply they are operating individually knowing they are not.


Ad for Dental Assistant in Muncie, Indiana

Small Smiles Dental Centers, the nation's most experienced dental provider to children who qualify for government insurance and has been named one of Fast Company Magazine's 2007 Fast 50 Companies doing good in the world. We have over 60 dental centers in the United States operating as individual practices where each team member takes our mission seriously. In order to accomplish that assignment we must hire great people! And we have an excellent opportunity for an ambitious DENTAL ASSISTANT to grow our state-of-the-art dental center.

Friday, December 10, 2010

How To Have Perfect Chart Audits

When Corporate sends the list of 10 “random” case files for their audits, here is what to do:

Step 1 -  Pull the charts.

Remember, Corporate already knows exactly which charts to pull as they get a report every day on who was treated, what was done, why treatments were done, or why patients did not wait to be “converted” from Hygiene to Operative, etc.

Every day, they know how many appointments were scheduled and how many canceled.  They know what patients they saw, how many crowns were placed on each patient and who treated the patient.   I am sure they know where the treatment took place (i.e. the OR or clinic).  They know if treatment was not completed and they know why.

Each day, Corporate knows how many patients are on the appointment schedule a month or more in advance.  It is all in the computer.  It is even broken down by the department; the exact number scheduled for Hygiene\Operative\ and the Total, no doubt.  After all, this is a For-Big Profit organization.  Clinics and the employees within are answering to a “higher power” and it is not a divine being.

  • Actual revenues for the week
  • Who was off from work that week or day and why
  • Number of customers that week, in this case patients.
  • How many were new, how many were reschedules, how may kept their assigned appointment, how many did not.
  • Amount of supplies used and the difference from what was budgeted.
  • How many morning “huddles” for the week, who was there and who was not.
  • The number of returns, in this case redos.
  • Likely to include customer comment cards, the good ones, as the bad ones get tossed.
  • Any new hires, any fires.
  • Problems that need to be address, such as Nitrous Oxide levels too high in the clinic.  Those sort of things.

Step 2 - Immediately print out the account information on each chart pulled.

Step 3 - Make photo copies of everything in the chart, include a copy of the x-rays.

Step 4 - Give to the HBIC (Head Bitch In Charge).

Step 5 -  HBIC will review each file to make sure everything documented in the chart matches what the computer said was done to that patient

HBIC makes sure if the computer statement said tooth A (upper right baby tooth) but the chart said it was tooth M (lower left) that entry was corrected.

But which was true?  Without recalling the child for a look-see, who actually knows.

If they do not match, make them match.  Either by rewriting the treatment plan or correcting the record in the computer.

Maybe they will make a note to check the actual child when he or she comes back for the next visit and it will be corrected again, then maybe it will not even be checked and life goes on.

How can the chart be changed, you ask?

It is only my opinion, I would say, adjust the chart would be much easier since the account has already been billed out and you would have to add to the billing or make other  billing corrections.  So chart changing might be the best choice.

With such a high turnover at these places, it seems it would be difficult to correct chart notations to match the original hygienist, dental assistant’s and dentist’s notations. 

Maybe the best would be a whole new document.

Except when one forgets, that the new handwriting belongs to a new employee who was not there when this patient was seen, but who is going to look at that, right?

If the original employee is still there, the HBIC could just approach the hygienist, assistant or associate dentist and threaten them with their job, if they do not fill it out or at least sign the new and improved treatment plan and charting.  Talk about being put on the spot, it is not like the employee would have a couple of days to think about it.  After they sign it, what do they do then?  You do as you are told if you want to keep your job, feed and clothe your family and keep a roof over your children’s head.

Maybe you also forgot to have the parent sign the treatment consent form.  What about the “It’s Ok To Strap My Child Down, Man Handle Them, and Send Them Back To Me Covered in Puke and Urine” form.  Ooops. 

That would be easy to correct, especially if they have the parent’s signature on other forms.  Just trace it, right?  not send it.

Again, who is going to check?

Of course, there are times when things are crazy in the clinic and treatments completed will get left off the chart.   But how did the treatment get on the computer account if it was not charted?  Hmmm…

The dentist is supposed to review the chart of the patients they saw at the end of the day.  Ideally, the dentist should be doing a quick review of the chart immediately, as the patient is being cleaned up and walked out. 

I think it would be good, to do as my doctor does and as soon as he steps out of the room with my chart in hand, out comes his recorder and he immediately records in his very own voice what treatment was done, what diagnosis was made and when he wants me back.

Mistakes happen and agreed, many of the assistants are not trained and most likely worked at the local 7/11 last week.

Step 6 - The copies of the charts are put into a Fed-Ex package and shipped off for analysis.  In about a week or so, a grade is handed out, just like in school, and points given toward your bonus for doing such a marvelous job.

I bet if you can ask, the office staff will know how well they do on chart audits, and whether they are at the head of the class or sucking hind tit.

Of course this is no way to do a chart audit.  The Regional Manager should be doing this, if he had a clue what he was doing and not a former mortician or something.

Better, would be the company Compliance Officer  off his or her ass or Assistant Compliance Officer, if there was one, to fly around from clinic to clinic and do the audits.  What about an outside objective party do the chart audits?

Surprise visits are the ticket to proper chart audits.  An auditor marches in, briefcase in hand, and start pulling charts.

When chart audits are done in this manner it means nothing when told how fantastic Compliance is within the company, in fact, it is laughable.

I have heard FORBA has an in-house specialist on this matter.  They may even give “webinars” on the best possible signature forging technique.  Who knows.  I guess you could just leave that document out and

Wednesday, December 08, 2010

Head Start Dental Home Initiative Ripped From The Grip Of The AAPD

In February 2008, just months after Arcapita, American Capital Strategies, Carlyle Group, CIT, Michael Lindley, Al Smith and others bought all the assets of the Small Smiles Dental Clinics from the DeRose "family", the American American Academy of Pediatric Dentistry (AAPD) was awarded $10 million dollars and a 5 year contract to manage the newly created Head Start Dental Home Initiative. 

Don't tell me this had nothing to do with the sudden surge of dental mills across America.  Of course it did.

In 2009 the AAPD hired a huge PR firm, the MWW Group, to drive home the importance of pediatric dentistry.

In June 2010, the AAPD received the Award of Excellence from the 2010 Associations Advance America Awards program.  This AAAA sounds a bit sinister to me.  Sounds like an award for their success in being hijacked or something.

By November 2010 the Office of Head Start notified the AAPD their services were no longer needed and would be taking control of the Head Start Dental Home Initiative.

Did we get our money back?


FORBA's Small Smiles Clinics Playing Catch Up To Kool Smiles In 2011

NCDR's Kool Smiles Dental Chambers pulled ahead of FORBA's Small Smiles Dental Chambers in 2010 but FORBA  is planning on a big come back by April 2011.
FORBA's Small Smiles Washington DC # 2 is now up and running. 


I wonder how many of the bright smiling faces will be there in 60 days? 

I bet by Christmas these two dentists will be crying in that bed they just crawled into.
Not sure which on is the lead dentist, Dr. Siobhain Sprott and which is Dr. Takeisha Presson.

Think either of these two dentists had their credentialing papers forged by Janelle?  Would they even know if they had?

Muncie, Indiana is not far behind this one.  It may  be open already.  Employment ads have been out for a while on these two clinics. (Indiana is a hot bed for Kool Smiles and Small Smiles, Texas as well)

They are already advertising for employees for the Mission, TX Small Smiles clinic set to open the end of January 2011.

By the first of May 2011, plans are to open a second clinic in Hartford, CT, a third and fourth in Baltimore, Maryland, with another Maryland location and two more in Indianapolis, Indiana.
Imagine the number of children to be herded through another 8 more clinics?

New Clinics To Open In:

Muncie, Indiana
Washington DC #2
Mission, Texas
Baltimore, Maryland  #3
Baltimore, Maryland  #4
Indianapolis, Indiana #3
Indianapolis, Indiana #4
Mystery Maryland Location
Merry Christmas, Y'all!

Tuesday, December 07, 2010

This Is What A Tangled Web Really Looks Like

updated 12/27/2010

Monday, December 06, 2010

Massachusetts New Dental Laws and Regulations Have Dentist Concerned

A wonderful letter from a dentist who is very concerned about the state of dentistry in Massachusetts.   I hope they don't mind that I shared this.


Dear Debbie,
I hope this e-mail finds you and your loved ones in good spirits and good health.

Over here in MA the state dental board passed a host of new dental laws and regulations this past August. While there are a few new laws that at least give a nod towards promoting public safety, when I read many of the laws, I saw many regulations written with dollar signs in mind.

Three of the laws (Public health center, dental director, and public health hygienist laws.) will further entrench the unscrupulous Medicaid mills already present in this state. On top of this horror, a host of sedation laws will allow dentists to be, for all intents and purposes, anesthesiologists.

Deep sedation, whether one is working on the heart or in the mouth, functions the same in both patient populations. In other words, although the specific purposes are different (heart surgery vs dental work), the physiological mechanism is the same, and the risks are the same. Unfortunately, these risks involve death and/or brain damage.

Where things are now different in this state, and where things have gone horrifyingly awry, is that with a brief (and expensive, of course.) period of training, some of my colleagues will be able to place patients under deep sedation. In medicine, MD anesthesiologists and nurse anesthesiologists must go through a rigorous residency program lasting for years. (4 years for MDs and 2 years for nurse anesthesiologist practitioners.)

On a functional level, medicine has recognized that it is better to have a specifically-trained person in a proper setting to perform anesthesia. Medicine recognizes that it's not a good idea for the surgeon to try to sedate the patient, monitor the patient's life signs and breathing, and also perform surgery. The only "positive" side to this hypothetical medical scenario is that the surgeon could make out like a bandit by doing everything him/herself.

Debbie, my deep and abiding fear is the day when the new dental mill-enabling laws in this state converge with the new sedation laws in this state. Imagine what Small Smiles would do with a state-sanctioned sedation carte blanche. Now, it's only a matter of time before the carnage starts. Kids shouldn't die for the profit margins of the ruthless. Goddamn them.
Please be well Debbie.

Saturday, December 04, 2010

30 Year Old Describes Trauma From Being Papoosed At 3

Meridith L.
Posted 05/15/2010

As a person who had a root canal done on a papoose board as a 3 year old, please do not have major dental work done on your child without general anesthesia or conscious sedation.  At 30 years old, I still have nightmares about the experience and have to be sedated for even the most routine work.  At 3 years old, I couldn't tell the dentist that the numbing medications were not working and that I could feel every second of the root canal.  They dismissed my crying as fear and not true pain.

Find a dentist and an anesthesiologist who you love and trust and who will let you be there with your child so that it is calm, peaceful, and a good-as-the-dentist-can-be experience for your child.

Bad, painful, and scary experiences now can lead to a lifetime of fear, trauma, and distress, but good experiences can lead to a healthy smile, good oral hygiene, and improved overall health.


To read for yourself click here

Friday, December 03, 2010

New Fool On The Block In Youngstown, OH Small Smiles Clinic

Looks like we have another change of faux ownership for the Youngstown, Ohio clinic.  Yes, it’s true!  I know, amazing, right?  This is the clinic who had the idiot dentist fall asleep during a procedure.

I know, I know, he says he was dozing while the assistant was doing something, but that assistant says that is a total lie!  I believe the assistant.

The latest foolish dentist to add his name to the Secretary of State’s LLC documents as “owner” of this clinic is….

drum roll please….

Dr. Michael Crites! 

Dr. Michael Crites should know better by now, he’s been there for just over two years.  Maybe being “owner” is his reenlistment bonus.  If so, it is NO bonus!  It’s more like putting your head in the guillotine. 

However, Dr. Crites is no stranger to the Ohio dental board.  There are 16 pages of “actions” against him.  That explains why he fits right in at Small Smiles of Youngstown. 

I find it hard to believe (no I don’t) that he has credentials with any state or and especially any company that manages Ohio’s Medicaid Dental Program.  Geez!

History of this clinic

First registered as an LLC in Ohio February 2007, Joseph Bower the authorized representative, (Agent).  Name- Small Smiles of Youngstown, LLC –Kenneth E. Knott, DDS and Robert F. Andrus, DDS.

Knott and Andrus were “fired” because Kallene West (also let go) was taking their CE’s for them.  However FORBA didn’t have a problem with Kallene taking the CE’s for Dr. Bridgett Merritt-Brooks.  Dr. Bridget is still working her little fingers to the bone in South Bend.  In my opinion Dr. Bridgett is practicing without a licenses in Indiana…but heck, who am I to judge right?  More on this a bit later. 

Back to Youngstown:

Apparently Dr. Michael Crites can’t wait to be added to the next lawsuit.

February 2007
- Small Smiles of Youngstown, LLC- Dr. Robert E. Knott and Dr. Kenneth Andrus.

September 2007- Trade Name - Small Smiles Dental Clinic of Youngstown

September 17 2008- Small Smiles of Youngtown, LLC- Jodi Kuhn, DDS and Patricia Nicklas, DDS.

February 4, 2010 - Small Smiles of Youngtown, LLC – Jodi Kuhn and Olivia Croom, DDS

October 4 2010 - Small Smiles of Youngtown, LLC-Michael Crites, DDS

Where are those documents of the sale of this clinic?
Someone needs to send out the “Prove It” letter to Dr. Michael Crites.

Anyone, Bueller, Ohio Dental Board?

Monday, November 29, 2010

Seven Years After First Reports–Dr. Tish Ballance Appears To Still Be Raping Medicaid System in North Carolina

WCNC TV-Stuart Watson's January 2010 report
Link to report

It has been seven years after Stuart Watson first reported on Doctors Tish Balance and Michael DeRose and their chain of dental clinics in North Carolina abusing children for financial gain.  It has been two and a half years since Tish and Meatball Mike settled with the government for $10 million dollars, yet Dr. Tish appears to still be doing her best to rape the medicaid system and abuse children doing it.
Who in North Carolina is NOT doing their job and protecting the children??  Who in North Carolina is turning a blind eye to Tish Ballance stealing your/our tax dollars? 
That is what is happening.  It has been reported right here for three years.  I know the agencies visit this blog.  I'm waiting on an answer.
What is the reason Dr. Tish Ballance is still allowed to steal money from us?  Why is she not been put on the "Exclusion" list; barred from participating in the Medicaid programs?   Meatball Mike finally made it, but not until 2009 and millions and millions of dollars later.
(of course we know there are ways around that little inconvenience don't we)
Here is a warning I received today from a parent:
I live in Hickory, NC.  I had heard about Tish Ballance on the news getting in trouble for Medicaid fraud, but did not remember her name. My son is 6. He went recently for a cleaning to a different dentist and they found a cavity. While I was waiting for his appointment, they did a free screening at his school which also detected a single cavity. When it came time to be filled, our dentist wanted to refer him to another dentist 30 miles away. i decided to find a local dentist that took Medicaid. i found Carolina West Dentist in Conover near my home. I took him there to Tish Ballance's new clinic for children with Medicaid. Just 2 weeks after 2 dentists had diagnosed him with a single cavity, she said he needed caps on 3 molars in addition to the cavity. That's when I checked into her office and found out she had been in trouble before. Beware of this office!!!

December 2009 Report on Dr. Tish and her horror house

Wednesday, November 17, 2010

Devore v. Keystone Education and Youth Services, LLC $9.5 Million settlement–January 2011

From UHS Annual Report
Devore, et. al. v. Keystone Education and Youth Services, LLC:
Alicante School (Keystone School Carmichael)  in California was acquired by a subsidiary of ours in October, 2005. Prior to our acquisition, two former employees of the facility filed a false claim act qui tam action and a gender discrimination/whistleblower claim in Sacramento County Superior Court. The plaintiffs allege that the Alicante School improperly billed subdivisions of the state of California based upon services provided at the school and that the plaintiffs were discriminated against based upon their gender and as a result of their objection to these practices. In June, 2008, we entered into an agreement with the former owners of the facility whereby they agreed to defend the case, indemnify us and hold us harmless for any damages that may result from this case. The former owners of the facility had been funding the legal defense of this case since that time. Recently, the court approved the agreed upon $9.5 million settlement of this matter which we paid to the plaintiffs in January, 2011. Since we have made a demand on the former owners of the facility for repayment, and intend to pursue collection of the $9.5 million pursuant to the June, 2008 indemnification agreement (although we can provide no assurance that we will collect the entire $9.5 million), the settlement amount and related receivable is reflected in other current assets and other accrued liabilities on our Consolidated Balance Sheet as of December 31, 2010.
October 2005 8-K
Universal Health Services (UHS)
Below are the companies and the facilities UHS purchased from Harbinger Private Equity Fund I, L.L.C., Keystone Group Kids, Inc., Michael Lindley (“Lindley”), Marty Weber, Ameris Healthcare Investments, LLC, Rainer Twiford, Al Smith (“Smith”), Mike White, Rodney Cawood (“Cawood”), Buddy Turner, Jeff Cross, Gail Debiec, Brad Gardner, Brad Williams, Don Wert, Rob Minor, Mike McCulla, Jim Shaheen, Rod Gaeta

Keystone Nevada, LLC
Keystone Memphis, LLC
Keystone Education Transportation, LLC
Elmira NPS, LLC
Alicante School Elk Grove, LLC
Keystone Savannah, LLC
Keystone Newport News, LLC
Keystone Marion, LLC
Keystone WSNC, L.L.C.
Keystone Oklahoma City, LLC
CCS/Altacare of Arkansas, Inc.
Chad Youth Enhancement Center, Inc.
CCS/Bay County, Inc.
CCS/Meadow Pines, Inc.
Ventures Healthcare of Gainesville, Inc.
CCS/Little Rock, Inc.
CCS/Rivendell of Kentucky, Inc.
CCS/Lansing, Inc.
Associated Child Care Educational Services, Inc.
American Clinical Schools, Inc.
Alabama Clinical Schools, Inc.
Pennsylvania Clinical Schools, Inc.
Tennessee Clinical Schools, Inc.
Keystone NPS, LLC
Keystone Continuum, LLC
Keystone Detention, LLC
Keystone Richland Center, LLC
Keystone DJJ, LLC
Keystone Charlotte, LLC
Keystone JJAEP, LLC
Here are the facilities that each the above companies owned, subsequently now UHS purchases.

Alabama Clinical Schools
Tennessee Valley Juvenile Detention Center
Tuscaloosa Juvenile Detention Center
Bristol Youth Academy
Jacksonville Youth Center
The H.O.P.E. Program
Nueces County Juvenile Justice
Cedar Grove
Chad Youth Enhancement Center
Cherokee Park Youth Center
Compass Intervention Center
Hermitage Hall
McDowell Center for Children
Natchez Trace Youth Academy
Upper East Tennessee
Old Vineyard Youth Services
The Keys of the Carolinas
Keystone Newport News Youth Center
Marion Youth Center
Pennsylvania Clinical Schools
Children’s Comprehensive Services of Ohio
Turning Point Youth Center
Highlander Children’s Services
Keystone Carmichael (Alicante School)
Keystone Desert Hot Springs
Keystone Elmira
Keystone Grand Terrace
Keystone Hemet
Keystone Highlander
Keystone Laguna
Keystone Mar Vista
Keystone Ramona
Keystone Rancho Cucamonga
Keystone Riverside
Keystone Steele Canyon
Keystone Vallejo
Keystone Van Nuys
Keystone Victorville
Keystone Ventura

Monday, November 15, 2010

Is Your Dental Office Prepared For Disaster?


Will another parent going home today without their child? 

Wednesday, November 10, 2010

“Prove It” Letter of Inquiry For Use By State Dental Boards

In an attempt to assist state dental boards I have taken the lead of the Kansas Board of Dentistry and created a form letter.  This letter is available for download and can be customized as needed.

You can download the free “Prove It” document by clicking here.

If any boards need assistance in who should receive these letters, please email me, I would be more than happy to provide that information if available.

You are most welcome,

Debbie Hagan

PS. You may also copy and paste from this blog post:


Here is a form letter designed to assist state dental boards with investigations of corporate owned dental clinics operating under the disguised of being dentist owned clinics. Such as Aspen, Kool Smiles, Small Smiles, Dental Dreams, etc. It can be customized to fit your needs.

[State dental board letter head]

Dear Dr. [dentist name here]

The Dental Board requests [dentist’s name inserted here] provide a written response explaining how your association with [corporation name i.e. FORBA] corporation is not creating a violation of the dental practices act of the state of [enter name of state], specifically, [enter state practice act number and section forbidding or limiting corporate dentistry].

In the written response, we respectively request you provide all of the following:

1.  A copy of your purchase agreement or ownership documents of the clinic.

2.  An employee handbook.

3.  A copy of advertisements published to hire dentists or other employees.

4.  If a PC or LLC provide a list of all member with % of ownership interests. Include address and all contact information for the members and a full copy of your “Operating Agreement”.

5.  An Operating Agreement or Contract between yourself and [enter the name of the corporation in question] showing the services they provide and the cost to your practice.

6.  Attach your personal and business FEDERAL, STATE and LOCAL income tax returns with attachments, including Schedule C with W-2’s or 1099’s.  If you are a PA, PC PLLC or LLC include returns for you personally and for the business entity.

7.  Attach five payment reimbursement forms from Medicaid and five from insurance companies.

8.  Attach copies of promissory notes or loan agreements with amortization schedule used.

9.  Attach a copy of the last 6 bank account statements for the business.

10. Attach a copy of your last three Federal 941 forms and copies of checks included with Federal form 941. Include copies of checks if you made periodic payroll deposits. Include copies of the last three 941-V vouchers, if any.

11. Attach copies of your last three Federal 940 FUTA forms and copies of checks showing payments made.

12. Include copies of checks showing all of the following payments:

· Building and/or Equipment loan or leases

· Employee payroll

· Utilities

· Liability Insurance

· Malpractice Insurance and Workman’s Comp Insurance

· Insurance on building and/or equipment

13.  Do you own the fixtures and equipment?  ___ Yes  ___No

        If “No” state from whom it is leased: 

        Business Name:________________________

        Contact Person: ________________________



If “Yes” include copies of checks showing local/state personal property tax.

14. Do you own the building? _____Yes ____No

       If “No” state from whom it is leased:

       Business Name:_________________________

       Contact Person”_________________________



15.  List dates of employment, names and contact information of all dentists, hygienists, and dental assistants employed by the clinic.

16. Provide a copy of your EIN application.

17.  If you own or operate more than one clinic, provide the legal name and dba name of each clinics, as well as its physical location include ALL states.

Please add the following statement, sign and date:

“I attest the above to be a true and accurate statement including all attachments”

Provide the above information within ten(10) days from the receipt of this letter.


[Signature of Investigator]

New Medicaid Services Director for Kentucky and State Auditor Report on Passport Health Not Good

Kentucky looking for new Medicaid Services Director 

Maybe I should apply!

In other news:

A 200 plus page report,  Kentucky State Auditor Crit Luallen calls for much stricter oversight and accountability for Passport Health Plan, the managed care company overseeing 164,000 people in Louisville and surrounding counties.  Luallen reports had not referred the findings to any law enforcement agencies, I ask, why not?

The report found:

  •   VP being a partner in a Passport contractor
  •   One Executive's salary raising 33% in a two year period
  •   Execs spent almost $230,000 on travel, staying at high-end hotels, used limos and huge dinner bills.
  •   Lobbying expenses
Passport CEO Larry Cook, said the report was misleading, they rented a sedan from the limo service, not the limo because the taxi drivers were on strike in two of the cases.

Passport receives $793 million in state and federal taxpayer funds last year.

Terminology To Sell It To The Kids and Parents

Stainless Steel Crowns – Hats for teeth

Papoose Board – Blanket

Pulpotomy – Medicine for the tooth

Guaze – Band-aide

Blood – Heme

Shots – Sleepy juice

Needles – Needs

X-ray – Taking pictures

Fluoride – Vitamins

Tylok Dental Cement– Glue

Etch – Soap

Small Suction – Mr. Thirsty

Large Suction – Vacuum

Curing Light – Tooth Dryer

Extraction – To wiggle out the tooth

High Speed Drill – Mr. Whistler

Slow Speed Drill – Mr. Bumpy

Bite Block – Pillow for sleepy teeth

Amalgam – Silver stars

Tuesday, November 09, 2010

American Securities Backing Out Of Kool Smiles Purchase?

It appears American Securities has seen the light!  Maybe they had a "come to Jesus moment".  Whatever the case, its reported to me Kool Smiles will not be sold, not right now anyway!
Knowing the lawsuits coming down the pipe is believed to have had a great influence in this decision.  Huge argument on whether it's "pike or pipe", but none the less, it's coming.
I would also assume the fact most of these clinics are  illegal operations in most states might have some influence as well.
I can see the headlines now:
“American Securities Buy Illegal Dental Clinics for $700 Million Dollars” or “Dental Clinics-Operating Illegally-Sold for $700 Million; Top Executives Say It Was a Great Deal”
along side
Couple Has Crack House For Sale, includes falsified licenses, and all other bogus documents, insurance is transferable.  Asking price, average of last 5 years revenue.”
However, we can’t dismiss the Early Termination Request granted from the FTC on October 29, 2010, between American Securities Partners V Limited Partnership, Friedman, Fleischer and Lowe Capital Partners Limited Partnership and Kool Smiles Holding Corporation.
Huge argument on whether it's "pike or pipe", but none the less, it's coming.
I guess we will just have to wait and see if Kool Smiles can be marked “Sold”.  If it is, I am sure it should be marked “Sold As Is” and “All Sales Final”.

Chad Youth Enhancement Center
Handle With Care: The state continues to license a Midstate youth treatment facility where two have died and many others have been abused
By Elizabeth Ulrich, Nashville Scene, November 8, 2007
The Chad Youth Enhancement Center is a privately owned residential treatment facility nestled in the rolling hills off of a winding, two-lane road just southeast of Clarksville. Barns fashioned out of untreated wood and horses tucked behind white fences dot the pristine grazing land that leads to the facility’s 20 tree-lined acres.
Just a few yards from an empty pasture marked by a few intermittent hay bales, Chad’s gym, school building and three dormitories sit, looking clinical and quite unremarkable. Chad is a place where kids—some criminals or drug addicts, or with serious emotional and behavioral disorders—go to get help. All are between the tender ages of 7 and 17, and most have problems so severe that other facilities will not admit them. It’s what Chad prides itself on: taking the most troubled and disadvantaged children “to overcome those obstacles that may be hindering their healthy emotional growth.”
Chad is also a place where two teens have died in two years. And where allegations of excessive use of force, and verbal and physical abuse at the hands of the facility’s staff have slowly piled up in the offices of Tennessee state regulators for nearly a decade.
Linda HarrisIn 2005 medics arrived at Chad to find the body of Linda Harris, a 14-year-old resident from Amityville, N.Y., limp on the floor of the hallway outside of her room.
According to a brief police office report, Harris had“become unruly by not staying in bed and was flashing the boys”when Chad staff pulled the girl’s arms behind her back and escorted her to a time-out room. It was at this point that Harris “became limp and fell on the floor”and the Chad staffers sat down next to her and held her arms behind her back as she lay on her stomach.
After approximately 30 seconds, according to the report, staff let her go as Harris remained belly down and appeared to be crying. A few minutes later, the Chad employees noticed that her breathing had slowed, so they rolled her over and called 911. While an ambulance was en route, Harris stopped breathing. She was pronounced dead after arrival at Gateway Medical Center in Clarksville.
But law enforcement told a different story: a local sheriff’s official said their office received a call that night saying that Harris had stopped breathing after being physically restrained by a male Chad staffer who fell to the floor with the girl while redirecting her to the time-out room.
Either way, Harris died only a few days after a New York judge sent her to Chad for emotional problems that had become too much for her father, a single dad, to handle. And either way, Tennessee medical examiner Dr. Bruce Levy ruled Harris’ death “natural.” After all, she was morbidly obese: Harris carried an estimated 400 pounds on her 5-foot-6-inch frame. Plus she was asthmatic.
While the Montgomery County Sheriff’s Office investigated Harris’ death, they didn’t bring any charges against the Chad staffers who restrained her. Levy ruled that her death was a result of cardiac hypertrophy—an enlarged heart because of her chronic bronchial asthma. Harris’ weight was a contributory cause of her death, Levy found.
So life at Chad moved along.
In a November 2005 visit to the center, Department of Children’s Services (DCS) licensing consultant Linda McLeskey noted that more Chad residents felt unsafe at the facility than at other programs DCS had encountered. Less than one month had passed since Harris met her death at the hands of the very people enlisted to help her. And the effect it had on the resident psyche was lasting. “When asked why they felt unsafe, [residents] often reported they were afraid to be restrained because they didn’t want to be hurt,” McLeskey wrote.
Sue Marshall—not her real name—worked as a licensed practical nurse at Chad for roughly one year and recalls the effect that Harris’ death had on residents. “A lot of girls were having nightmares at night after that because probably none of them had seen another person die,” Marshall says. “And you know, of course the first thing they are going to assume is that the staff was at fault.”
According to one expert on restraint asphyxia, those girls may have been right. After reviewing Levy’s autopsy report and police files on Harris’ death, paramedic and author Charly Miller concludes, “It doesn’t fly that her death was natural.”
Though Levy says he stands by his original findings, he tells the Scene that “to some extent that we can’t quantify,” Harris’ death was caused by “the stress of the situation she was in.”
Miller says it’s quite possible that it was the restraint that killed Harris, especially because Chad staff held her on the floor—belly down. Miller says patients with abdominal fat have an increased risk of restraint asphyxia for one simple reason: when an obese person is forced to lay on their belly, the excess stomach fat pushes up into the lungs, making it difficult to breathe until finally, the lungs give.
“But they can keep moving because their extremity muscles are still working after their diaphragm gives out,” Miller says. “And uneducated restrainers think,‘Oh, well, they must be breathing because they’re moving.’ That’s not true.”So Chad staffers might not have realized that Harris had stopped breathing until it was too late, Miller says.
Before Levy even ruled that Harris died of natural causes, DCS—the department that, along with Tennessee’s Department of Mental Health and Developmental Disabilities, was licensing Chad—stopped placing Tennessee children there. New York stopped too. “All we knew was that a child had died under unknown circumstances,” says DCS spokesman Rob Johnson. “The department already had some concerns, so they just elected to go ahead and pull the remaining children out.” Most of those concerns were about Chad’s use of restraint.
But Tennessee regulatory agencies did not revoke Chad’s license, which meant that other states—Kentucky and Pennsylvania, for example—continued sending children there. When asked why Tennessee regulators would keep Chad’s doors open when they wouldn’t even send the state’s own kids there, Johnson says it was simple: Chad met the state’s licensing standards.
“It’s somewhat akin to, does a restaurant pass standards for health inspections when they go in there?” Johnson says. “Yes, they may pass the standards, but it may be that the health inspector may not choose to take his own family there to dine. It’s somewhat analogous. Tennessee has its standards for how it wants its children to be treated when they’re in state custody.”
Chad is where DCS sent Sharon Pruett’s 16-year-old son, John Boy, for rehab in 2004. It’s where Pruett says her son became a broken boy after a counselor pushed him up against a wall, kneed him in the groin and strangled him until three staffers pried the man off of the teenager.
When Pruett moved her family from Chicago to rural Tennessee, she had grand visions of her two kids growing up in a small town in the friendly South, away from the hustle of big-city life. But even in the town of Hurricane Mills—home of Loretta Lynn’s Coal Miner’s Daughter Museum—Boy, a baseball player who did well in school, found trouble.
Before he was 16, Boy was addicted to methamphetamine. Pruett suspected that he was using drugs, and she says state officials told her that she could not get him into a treatment center unless she filed charges against him for being unruly. When she did, a judge ruled that Boy was a danger to his mother and younger sister and, against Pruett’s wishes, placed him in DCS custody. Soon after, Pruett says DCS put her son on house arrest for a 90-day, in-home treatment.
When Boy overdosed in September 2004, Pruett took him to the emergency room. DCS caseworkers soon followed to take a scared, sobbing Boy away to Chad in the wee hours of the morning. It was his first time away from home.
DCS officials told Pruett that her son would stay at Chad only temporarily—until they could place him in another drug treatment program. Pruett couldn’t understand why Boy would be living in a facility—and sharing a bedroom with—children those in the mental health world dub “level three” residents, kids who are a mere step away from being locked down in a detention center or placed in a full-on psychiatric ward. “My son was never arrested,” she says. “My son is not a bad boy. He did not burn houses. He did not hurt anybody. He was hurting himself with a drug problem. I questioned, I begged, I cried, I did everything [to keep him out of Chad].”
Less than three weeks into her son’s stay, Pruett got a call from her son and his therapist. “Mom, I was attacked last night,” Boy said over the therapist’s speakerphone.“You need to get me out of here.This man attacked me, and he broke my glasses.”
Pruett just began to cry. But Boy wouldn’t go into more detail, Pruett says, because he was scared it might happen again. He didn’t tell her that he hadn’t slept much since the attack the night before, which began after Boy called counselor Calvin Nelms a “f**king dick” when the man accused Boy of stealing another resident’s toiletries.
He didn’t say that Nelms had grabbed him by his shirt collar, pressed his hands against Boy’s throat, lifted him up off the floor and slammed him against the wall before throwing Boy down, kneeing him in the groin and strangling him until three employees intervened.
But Boy did tell his mother that his attacker was still working at Chad. Pruett says the facility acknowledged that they couldn’t fire Nelms because they were understaffed. Later, the family found out that Nelms, who admitted that he overreacted, had been placed on probation for his involvement in two or three similar incidents in the year-and-a-half he had worked at Chad, according to DCS files.
When Boy appeared in court a day after the attack, a judge ordered his immediate removal from the facility. Two months later, a Montgomery County court issued a warrant for Nelms’ arrest in the assault. But Pruett never received a subpoena to appear in court on Nelms’charge. His case was dismissed. Photo
Sharon Pruett Photo:
Pruett says Chad was the beginning of the end for her son. Before Chad, Boy was committed to getting better. But when he got home, he just didn’t care anymore. “He was just a different person when he came out of Chad,” she says. “He lost interest. It was like he didn’t trust people. He was just angry.”
She finds it ironic that Chad is dubbed an “enhancement center.”
“This doesn’t improve a child,”she says.“They’re just babies, and they’re going to come out being 10 times worse.”
Things did get worse for Boy. After bouncing among treatment programs for several years, he was shot to death in an unrelated incident in September of last year. But Pruett says she’s still committed to seeing Chad shut down. “How many lives have to be ruined, threatened and how many people have to be killed before they finally shut it down?” she says. “This facility is horrible. And I don’t see that it has changed at all.”
Omega Leach came to Chad from Pennsylvania—one of several states that still sent its most troubled children to Chad after the death of Harris. Leach arrived on May 2, 2007. One month later, he would be dead.
The online message board that accompanied one news story of his death was besmirched with comments keyed in by outsiders—people who dubbed Leach a bad kid who probably would’ve died on the streets anyway. “People out in the general population can refer to a kid who we now know was murdered as being a thug and saying he deserves what he gets,” says Holly Lu Conant Rees, chair of the Disability Coalition on Education of Tennessee. “And what difference does it make whether he dies in a facility or, you know, he gets in a gun battle out on the street? There seems to be a lack of empathy and understanding about the circumstances that led a child to be placed in a facility like Chad.”
To most, he was, quite simply, a delinquent—a boy with a criminal record stretching from his early teens. Leach grew up in Southwest Philadelphia, a rough-and-tumble neighborhood marked by abject poverty and violent crime. In the handful of years before his short stint at Chad, police arrested Leach twice and dubbed him “out of control.” His first offense—threatening students and teachers at his middle school and telling one teacher he would “shoot him full of shells”—landed Leach in a private facility in Virginia before he was even 15.
By 16, he was home again, only to be arrested months later for speeding through Southwest Philly in a stolen Nissan. This time, a Philadelphia judge thought a psychiatric program in the pastoral lands of Middle Tennessee, more than 800 miles from Leach’s home, might do the trick. And Leach wasn’t the first Philly kid to find his way to Chad. The city’s Department of Human Services had been sending children from neglectful or abusive homes there since 2001. And in 2006, the city’s judges began to follow suit, sending a new crop of kids to Chad: those with criminal records.
omega leachBut Leach grappled with severe emotional issues too. State records show that he had been diagnosed with mood disorder, oppositional defiant behavior and conduct disorder, a condition marked by aggression, the propensity to initiate physical fights and to seriously violate rules and societal norms—such as those you might find in a rigidly structured treatment program.
The American Psychiatric Association would characterize Leach as someone who suffers from a “disruptive behavior disorder.” According to a 2000 report by Wanda and Brian Mohr in the Archives of Psychiatric Nursing, children with conduct disorder share remarkably similar risk factors, such as histories marked by trauma, physical abuse or neglect.
Janice LeBel, director of program management for the Child and Adolescent Division of the Massachusetts Department of Mental Health, has worked 20 years in the oversight of residential programs for children with the most severe mental and behavioral disorders, and she says she’s yet to see a youth with Leach’s diagnosis who doesn’t also have a history of trauma.
And according to the Mohrs’ research, children in treatment facilities who suffer from such disruptive behavior disorders also have another commonality: they’re more likely to be placed in some sort of restraint.
Given Leach’s diagnosis, it’s not a surprise that, when a Chad counselor confronted Leach and told him to leave his dorm room on the afternoon of June 2, Leach reportedly shoved and then tried to choke the counselor.
As the two struggled into the hallway, one of the facility’s surveillance cameras caught what would be one of the last acts of Leach’s young life. Sgt. Brian Prentice with the Montgomery County Sheriff’s Office says the tape shows Leach and the counselor rolling around in the hallway in a “full-on fight.”The pair then spilled back into Leach’s room—away from the camera’s eye.
Another counselor and a nurse then ran into the room as the first counselor walked out, seemingly exhausted. The rest of what happened in that room is speculative. According to statements, it seems that a counselor restrained Leach stomach down on the floor of his dorm room with his arms bowed behind his back.
The surveillance camera didn’t catch anything else—except the staffers later sprinting from the room in a frantic search for a defibrillator. Leach was dead.
But staff accounts of what happened in that room didn’t account for one thing: strangulation. When Levy performed an autopsy, he says Leach “had a series of superficial injuries from the struggle all over his body—kind of what you would expect from that type of a close physical struggle, falling on the ground, rolling around.” That accounts for the fight in the hallway.
But Levy also found “scattered superficial blunt force injuries” and “hemorrhages into soft tissues and muscles of the neck.” They were injuries that Levy says were “certainly consistent with some kind of strangulation.” Because of those findings, Levy ruled the death a homicide.
The two counselors involved in the restraint, Milton Francis and Randall Rae, have been suspended from Chad pending the results of a Montgomery County Sheriff’s Office investigation. Neither has been formally charged in Leach’s death. Photo Omega Leach Photo: Courtesy of the Philadelphia Inquirer/John Sullivan
Incident reports outlining Chad’s physical holds from the last two years alone stack inches tall. Most appear to be hastily handwritten, and many tell chilling, albeit scant, tales of run-ins with residents that resulted in “protective holds.” During a hold, at its least severe, a resident will be held upright with their hands and arms pinned behind their backs. At the worst, a hold can bring a swift and strong “takedown” to the ground, where a resident will be held, face down, arms bowed behind the back.
In May 2006, staff placed a boy in a hold, subsequently breaking the rotator cuff in the boy’s left shoulder—an injury that required a trip to the emergency room, but apparently did not require staff who recorded the incident to go into any great detail as to how the bone was broken when reporting the event to the state. The next month, another boy was “out of control and being aggressive to staff,” according to staff who placed him in a hold. But again, they left out details of how that hold put a gash in the boy’s chin that was severe enough to merit a trip to the ER for four stitches.
It’s not supposed to be this way. Chad adheres to the Handle With Care method of restraint. And according to its brochure, the program’s primary restraint technique—the method that Chad uses with residents in a standing position—gives staff an “unprecedented mechanical advantage without pain or injury.” In the event that staff find an upright hold insufficient and initiates a takedown, the brochure boasts, “there is no impact.”
Still, by many accounts, Handle With Care—at least as it’s used at Chad—is infused with anything but gentle care. When she worked at Chad, Marshall says she would see staff restrain residents “too hard and with anger vs. discipline.” In fact, the first time she saw one of the physical holds in action, it was more than she—a nurse of almost 20 years—could bear. “I ran out of the building crying because I didn’t know that kids—human beings—could be treated so forcefully,”she says.
The facility’s Behavioral Health Incident Report logs for 2006 show that staff physically restrained as many as 10 residents in a single day. In his investigation of Chad, Terry McMoore, director of Clarksville’s Urban Resource Center, found that Chad made 216 911 calls since October 2001, 33 of them for ambulances.
While experts warn that death can occur within six minutes of a hold, many Chad residents endured restraints—for three minutes, 15 minutes, 20 minutes or more—and escaped physically unscathed. While Chad’s own policy dictates that such holds can be used only if a resident’s behavior is violent enough to destroy property or harm the resident or others—never as punishment or retaliation—the facility’s own records tell a different story.
When a resident identified as a “little boy” left his bed in a wing of the facility that staff called the “Little House” one night in April, it wasn’t long before he found himself in a hold. One Chad staffer described it this way: “Little Boys [sic] not wanting to go to quiet time or bedtime. He came out of room again and was escorted by Ms. Jennifer but struggled with her.” Staff then placed the boy in a standing hold for three minutes.
Less than a month later, staff placed another resident, whose gender was not specified, in a hold for 15 minutes after the resident “began to escalate” when he or she wanted to retrieve a tennis ball in one of the facility’s classrooms. Marshall says such school-day restraints were common. “If [a resident] would continue to act up through the class period and so forth, it would end up a restraint,” she says.
According to Chad documents, residents were restrained for the simplest of childhood acts or missteps—even the proverbial glass of spilled milk. When one girl began crying alone in a corner of the facility in May, she refused to tell Chad staff what was wrong. Instead, she asked to speak to a supervisor. But when she grew weary of waiting, she walked out of the room and headed out of the building. Staffers put her in a standing hold for three minutes. When recording the reason for the restraint, a Chad employee checked the box next to “in danger or has harmed self, as evidenced by behavior or ideation.” The report failed to mention how the girl acted dangerously.
Three days later, staff restrained a boy when he walked up to a Chad employee, who already had another resident in a hold, and simply implored the staffer to “let him go.”
Other incident reports describe the facility as a chaotic place. In July, staff member Jermaine Clemmons was walking through the facility’s cafeteria where he found residents loud and out of their seats. He asked a female resident what was happening. The girl then threw milk at another Chad employee because, according to a report, the staff member was “saying things about her.” After one staffer unsuccessfully tried to escort the girl from the cafeteria, Clemmons placed her in escort and transported her to the education building, where she “was non compliant [sic] and was simply placed in a standing hold.”
That simple placement lasted 20 minutes. Clemmons didn’t provide any other details about the hold or any explanation as to exactly how the girl was noncompliant, or how she had become a danger to herself or others.
When the Scene asked if such force—and if as many as 10 restraints a day—in a therapeutic environment seems excessive, one industry expert offers an audible sigh. “That’s real violence going on,” Janice LeBel says. “That’s horrific risk for the youth and for the staff. And I think, over time, when staff aren’t given other tools, [restraint] becomes confused with a treatment intervention. But there is nothing therapeutic about it at all.”
But Tennessee’s Department of Mental Health and Developmental Disabilities has a different answer. Tracey Robinson-Coffee, director of licensure there, says she can’t answer questions about whether Chad’s restraint count is excessive because “to be fair, you know, you’re not dealing with the average population of youth out there....It’s not like everybody is doing as they’re being told: Get up, go to school, go to lunch, whatever. There’s things that happen in the facility, and I can’t say that one [restraint] a day is not excessive or it is excessive.”
There are many experts in the mental health field who believe that, for children who have been abused or have experienced some sort of trauma, physical restraint can be all the more agonizing. In testimony before the National Council on Disability, an independent federal agency, mental health service provider Marcie Kelley characterized her experience being restrained: “As a survivor of sexual abuse, I personally have found the use of restraints on me more traumatizing than being sexually abused. Being put in restraints is a much longer, traumatic ordeal than being raped.”
But Bruce Chapman, creator of the Handle With Care method, sees it quite differently. On his website,The Compassionate Neanderthal, and in a collection of his “unsolicited commentary,” Chapman writes that children in crisis “‘get the difference between doing something for a child and doing something to a child.” And where many advocates and abuse sufferers see restraint as traumatizing, Chapman writes, “On the contrary, it can be a moment of healing when the physical contact is initiated out of genuine concern and duty to the child.”
Even so, Chapman advises: “No person in his right mind wants to wrestle with a kid if he or she doesn’t have to....If you know childcare workers within your agency who routinely place themselves and children at risk, you have a bigger problem than Handle With Care training can fix.”
By DCS’s own account, Chad has had a constant turnover of employees, many of whom are college students and military personnel from the Clarksville area. And according to former Chad employees, it was these untrained applicants—those without any experience working in the mental health field or with kids with such extreme mental and behavioral issues—who would become the resident counselors who worked the most closely with Chad residents.
“They could have been someone who worked at Burger King and came out and put in an application to be a [resident counselor],” Marshall says.“These are the hands-on people who are with the kids 24-7.They’re people just right off the street that go through a week orientation program, and there were times when there were people there who weren’t over 20 or 21 themselves.”
There is little indication that Chad has been exceedingly selective in its hiring process. During its 2005 annual inspection of the facility, DCS reviewed nearly 20 staff files and found that only five contained documentation of references, but none had the required three references.
But all Chad employees are trained in Handle With Care—everyone from the nurses and teachers to the cafeteria workers, Marshall says. In fact, many are trained more than once, some on an annual refresher basis and others after particularly violent incidents of restraint. According to Chad’s policy, all employees undergo eight hours of training in Handle With Care upon hire.
In documents obtained by the Scene, nurse and former Chad employee Charles Wood wrote that most training in-services were “a joke” where “all answers were given at each booth,” so staffers had “no reason to learn them.” Wood reported that he attended all of the in-services, from Handle With Care recertification to suicide prevention, in approximately one hour. And Marshall says the initial week of orientation was the most—and often the only—training counselors had before working with residents.
LeBel says the behavior children can display in facilities such as Chad is absolutely frightening for staff who don’t have adequate training.“You can’t effectively ask people to step into a setting with children with mental health needs if they haven’t been educated,” she says. “Some providers require two weeks, one week [of training] and it varies...but until staff have been educated to understand what they’re looking at, particularly trauma and the impact of trauma, they can’t possibly know the needs of the youth that they’re serving.”
DCS had concerns about Chad’s staff too. In November 2005, McLeskey visited Chad on behalf of DCS and interviewed 55 residents. According to her report, residents said they heard staff call children “stupid” and “retarded.” Two staff members also reported hearing staff use derogatory names with residents. But it hasn’t been enough to stop licensing the facility.
McLeskey thought it necessary to remind Chad that “verbal abuse, ridicule and humiliation” are not acceptable forms of punishment, and she asked administrators to train employees to deal with resident behavior without resorting to abusive language. “Our impression is that there are a large number of immature employees who may not have the skills or the training necessary to deal with the issues and behaviors of the residents at Chad,” McLeskey wrote.
Denna Smith was 44 years old when she started working as a counselor at Chad in December 2005. Smith had been working 40-hour weeks at the center for less than two months, making $8.50 an hour, when she received a “corrective action notice.” Though the notice doesn’t detail Smith’s behavior, the supervisor outlines that she would be placed on “coaching status” so that she could learn to “remain calm and in control” when dealing with residents.
The supervisor writes that the “situation you’re being counseled on was handle [sic] the wrong way, especially when you know what kind of resident your [sic] working with.” Though the resident’s name is redacted, the supervisor identifies the child as “one of the most confrontational, defiant residents” at Chad.
The supervisor created an “action plan to achieve required performance” for Smith to follow: She would take a Handle With Care refresher course. About four months later, two Chad employees filed handwritten complaints about Smith, who, despite that refresher, didn’t seem to have calmed much.
According to one staff report, two girls began horseplaying in the cafeteria line when one employee reprimanded them. But Smith stepped in and yanked one of the girls out of the line and into an adjacent room, where another employee saw that Smith “threw her stuff out and was getting ready to fight.” Others reported seeing Smith moving toward the girl and saying, “You want to fight me? If you want to fight, let’s go.” In a report to Tennessee regulators, Chad’s risk manager wrote that Smith then shoved the girl.
When confronted about the incident, Smith denied it, became defensive and said, “I don’t have to take this shit” and quit. But it seems Smith had been verbally abusive long before she stormed out of Chad—the shoving incident was merely the catalyst for employee disclosure.
One staffer recalled a fight between Smith and another employee where the women exchanged insults, calling each other a “bitch” and “fat hog” in front of residents. Another counselor writes of an evening when a girl waiting in line for dinner asked what time it was, and Smith told her “that she was fat enough and that she was going to eat eventually.” The counselor said the girl went into the lobby for a timeout and returned crying.
Buddy Turner, divisional vice president at Universal Health Services (UHS), a King of Prussia, Pa., for-profit corporation that owns Chad and more than 100 other behavioral health facilities across the country, says UHS bought Chad in the fall of 2005 along with a handful of other facilities. When asked if it is indeed typical for Chad to hire counselors with little to no experience in the mental health field, Turner says they try to give priority to applicants with degrees and any human services experience. “There are employees that come to us that have not had experience working with kids, but again, those individuals, if they’re hired, go through an extensive state-approved training plan before they ever work with kids.”
But once they complete that training, virtually anyone at Chad can place a child in a physical hold. While Chad’s protective hold procedures outline that licensed practitioners (LIP)—doctors, nurses and licensed clinical social workers—must approve the use of a hold on a resident, any employee with a bachelor’s degree or two years experience working at a mental health inpatient facility will do the trick in the absence of an LIP.
Disability Coalition on Education in Tennessee’s Conant Rees bristles at the policy. “Good mercy,” she says. “I don’t see where there would be any preparation in completing...your bachelor’s degree in how to safely engage in a pretty intense, high-level behavioral intervention—one that has life-threatening implications.”
In 2005, the Montgomery County Sheriff’s Office called DCS to report that three of Chad’s male residents had beaten and attempted to strangle another male resident at the facility. Even though the state requires Chad to report incidents of harm immediately, this was the first DCS had heard of it.
Chad didn’t report the incident to law enforcement either. Sheriff’s officers got the news from the resident’s sister.
So DCS gave Chad 30 days to retrain its staff on the state’s reporting requirements for suspected abuse and neglect. Two days after the sheriff’s office made that call to DCS, Chad had a staff meeting to hand out a new reporting policy to its staff “to read and ask questions,” the center’s director of human resources reported. And Chad promised to teach new hires about the revamped policy.
The new policy outlined a clear chain of command for reporting harm or suspected abuse and neglect: notify the nurse on duty, who will then contact the Chad administrators, who should report the incident to DCS. At this point, staff are required to make documented attempts to reach the resident’s family. And the supervisor of nursing determines whether the resident should be transported to the emergency room.
It’s a familiar cycle that Tennessee regulatory bodies have developed with the facility: They identify the facility’s shortfalls, Chad responds—action plan in hand—and promises to fix said shortfalls. Inevitably, Chad continues to err.
State official Robinson-Coffee doesn’t see it that way. “It’s not like they were a red flag in our office,” she says. “We just go out and do our surveys and investigations when we got complaints, and they rectified whatever the situation was at that time. I mean, I wouldn’t put them in the category of a problem facility.”
She might not, but one Kentucky family would.
When the family of a 13-year-old boy placed their son in Chad on June 1, they were hopeful. Their son had never committed any sort of crime and, unlike many Chad youths, had not been ordered to attend treatment by a judge. His family enrolled him voluntarily for medical care.
On Aug. 26 of this year—less than three months after he began treatment—another 13-year-old male resident raped him.
According to a Chad incident report, the Kentucky boy was in a bathroom stall at the facility when he was approached by another resident who began banging on the door and threatening him. When the boy opened the door, the resident pushed his way into the stall and told the boy that if he didn’t pull his pants down, he would hit him.
When the boy refused, the resident hit him in the back and forced penetration on him while holding the boy’s mouth shut. Before leaving the stall, the resident threatened the boy and told him to stay quiet. And the boy did, for five minutes as he sat alone in the stall, before he cleaned himself off and told a friend what had happened. That resident notified Chad staff.
The victim’s mother was at the family’s Kentucky home on Sunday evening when she got a call from Chad: Her son had been raped. Rebecca Blair, a Brentwood attorney hired by the family, says her best estimate is that it took anywhere from one to three hours for the family to find out about the assault. Chad records show that it took nearly two hours.
When the boy’s mother asked if anyone had called police, Blair says the Chad supervisor told her it was not protocol. They called DCS— not the police. Then she asked if her son had been taken to the hospital for medical treatment, but she received the same answer: It was not Chad protocol.
The woman insisted that her son be transported to a hospital, and eventually, her pleas wore Chad staff down. Still, it took her nearly an hour to convince them. And by the time the boy arrived at Gateway Medical Center in Clarksville for examination, several hours had lapsed since the attack. And it wasn’t until after midnight that someone at the hospital called police to report the incident.
According to a Chad incident report, the boy returned to the facility a little after 3 a.m., and was transported to Nashville General Hospital and then to Our Kids, a Nashville treatment center for children who’ve been abused. It wasn’t until 9:45 the next morning that the boy made his way back to Chad.
The boy’s family removed him from the facility immediately and placed him at another treatment center closer to home. The suspect, who had come to Chad from Pennsylvania, has since been charged in the rape, taken into custody by Tennessee authorities and transferred back home, Blair says.
The family can hardly understand how such a thing could happen to their son in the first place. “They’re devastated,” Blair says. “And they’re just struggling to cope with this on a day-by-day basis.”
But according to one former Chad staffer, the fear of rape is common among residents. “They were afraid they were going to get hurt sexually by other residents...because they weren’t monitored closely enough, and it only takes a second for a young kid to get raped or for several to gang up on another kid,” Marshall says.
Chad is often understaffed on nights and weekends, Marshall says. Even during the daytime hours, she says Chad operated just at the minimum required staffing levels for the 85 or so residents who lived at Chad during the time she worked there. “You know, you’d call and beg and plead for people to come in and help, and nobody would,”she says.
Residents often told Marshall that they would find counselors sleeping on the job during the night shift. Some residents would use that as leverage. “The older boys would have cigarettes because the counselors at night would give them to them because they would fall asleep and the kids would catch them and they were going to tell on them if they didn’t give them some type of favors,” Marshall says.
Before any Google search of the Chad Youth Enhancement Center returned a multitude of reports on the death of Omega Leach, it wasn’t uncommon for families to research the facility and not find any red flags. “Even kind of knowing the key words to look for, I could find very little information about how this program functioned,” Conant Rees says.
The stress involved in making such a choice only complicates the process. Usually a child is either ordered to treatment by a judge or placed there by his family. And when parents decide to send their kid away from home and into facilities like Chad—centers that are, essentially, the last step before a psychiatric ward or jail—it’s a desperate measure. “Families are often exhausted and have used up their resources and don’t see any other options,” Conant Rees says.
She advises families to visit a facility’s campus before enrolling their child, to get that kind of gut reaction about what really happens behind closed doors. But when the family of the Kentucky boy visited the facility before admitting their son, no one told them that one resident had already died there. “They were shocked and very upset and alarmed that none of that had been brought to their attention when they were selecting this place as a treatment facility for their son,” Blair says.The family had even toured the facility and talked to Chad personnel “extensively before he was admitted.”
Of course, if the Kentucky family were to download Chad’s brochure from the KidLink Network website, a self-proclaimed leading referral source, they probably would’ve been all the more assured. KidLink is owned and operated by a subsidiary of UHS. And just like its UHS parent site, KidLink proudly states its mission: “Finding hope for youth and adolescents who are considered hopeless by others is something we do every day, because for us, giving up on a troubled child is simply not an option.”
Even if families take a closer look at Chad’s accreditation, they’ll find gold seals of approval and stellar marks.
The Joint Commission, a nonprofit group that regulates and certifies more than 15,000 U.S. health care programs, has awarded Chad its highest level of accreditation. And even after the two deaths at Chad, Tennessee’s Department of Mental Health and Developmental Disabilities (DMHDD), which is now the only state agency responsible for licensing Chad, still has not yanked the center’s license.
Mouthpieces for both the Joint Commission and DMHDD give the Scene similar explanations for why a handful of kids are still being treated at the facility today: Chad is trying to make things better.
Joint Commission spokeswoman Elizabeth Zhani says that after the death of Leach, Chad has worked within the commission’s requirements to develop an action plan for improvement. As long as Chad follows those requirements, its gold seal of approval won’t be stripped. “Organizations, when they take these steps, they learn from this,” Zhani says. “We don’t want to create a culture of fear where people are hiding things. We want to create a culture where people are learning from these incidents.”
Robinson-Coffee also seems to think that Chad is learning from its mistakes. She says it’s not the intent of DMHDD to shut it down. She’d much rather see the facility come back into compliance.“I think because Chad has kind of been in the media for so long, there just kind of seems to be a consensus that...there have been a number of incidents, but really in fact, they’ve been in compliance,” she says. “This has been a tragic incident, and they’ve been in the spotlight because of this incident. There are other minor incidents, but again, you have to put it in context of the type of facility they’re running and the population they’re dealing with.”
UHS feels that Chad might be getting an unfair shake in the media as well. In the first interview that the company’s Nashville office has grantedsince Leach’s death,Turner says,“We feel real strongly that thefacility and the company is committed to do the right things with kids.” He says UHS is interested in getting the story told about Chad, at least “the part about our facility treating really the most severely at-risk kids is a real statement about that facility…. We’ve got a successful history doing that, both at Chad and other places too.”
By those “other places,” Turner may be referring to the Compass Intervention Center in Memphis, another UHS-owned residential facility that is now treating an estimated 80 kids who are about the same age as Chad residents and who are generally treated for many of the same problems.
State files on Compass are disturbing. A 2006 report made by a DCS licensing consultant has one resident describing Chad as “better than Compass in Memphis” because “lots of kids get slammed down there.” Much like with Chad, stacks of reports detail resident complaints ranging from injuries sustained in restraint holds—Compass also uses the Handle With Care method—to allegations of staffers making sexual comments to residents. One girl reports that a male employee has asked her “to open her legs.” Other residents report being denied water or being threatened by a staffer who said she would “box [residents] like a grown woman.” One mother alleges that Compass staff laughed at her son and encouraged other residents to make fun of him because the boy had been placed in a private room because of excessive masturbation.
Robinson-Coffee says just as many issues from other facilities come across her desk. “I guess you can probably say it has to do with staffing and the proper training, and that’s something that we need to basically make sure that they’re doing properly,” she says. “But it’s kind of a tough situation all around. It really is.”
It’s an especially tough situation for parents such as Pruett, who don’t know if they will ever be able to move on from what happened to their children at Chad. And explanations from Tennessee’s regulatory bodies haven’t soothed uneasy minds. “Why can’t they just go and have these doors shut and locked up?” Pruett says. “If I were to commit that in my home, where do you think I would be? DCS would take that child out of my home...but [Chad] can do it and get a slap on the hand? I don’t understand why the doors are still open.”

Linda Harris Death
Harris was a 14-year-old from Amityville, N.Y., whose developmental age was close to that of a 6-year-old. She lived with her father, a single dad—her mother, a reported drug addict and alcoholic, died when Harris was a girl. According to reports compiled by several New York state psychiatrists, in 2004 Harris struck up an Internet relationship with a 20-something man who later came to her home and raped her. While Child Protective Services and police became involved in the case after a doctor found evidence of the assault, one psychiatrist wrote that "there was no follow-up and the perpetrator was not caught."
Harris began to act out and "gained weight significantly" because of several medications prescribed to treat depression. Later that year, her disruptive behavior landed her in a New York treatment center. But in 2005, she ran away and was placed back at home with her father. At this point, psychiatric assessments describe Harris as a hopeless girl who felt that "no one would miss her if she was gone." When asked what she wished for most, Harris told one therapist that she just wanted a mother.
But Harris' father said he couldn't control her. A psychiatrist recommended that Harris be sent to a "highly structured residential treatment center," and a New York judge thought Chad was the answer.
A mere four days after arriving at Chad, Harris died. According to a brief police offense report—all that the sheriff's office had made public until now—Harris had been "flashing boys" from her bedroom when staff pulled her arms behind her back and escorted her to a time-out room, where she "became limp and fell on the floor." Chad staffers then sat down next to her and held her arms behind her back as she lay on her stomach, according to the report. Once they let her go, it took a few minutes for staffers to notice that her breathing had slowed. They called 911 and started CPR.
But the investigator's files, complete with statements from numerous staffers and children who witnessed the restraint, are much more grim. To punish Harris for acting out that night, staff said that Charles Garner, the counselor who restrained her, moved the girl's mattress into a time-out room, where she was going to be forced to spend the night alone, sleeping on the floor.
When Harris refused, Garner grabbed her and moved her toward the time-out room, where he said she "dropped her body weight," causing the two to fall onto the mattress on the floor—with Garner's 260-pound body pressing down on Harris. But residents who saw the incident didn't call it a fall. One girl told police that she saw Garner "body slaming [sic] her on the mattress."
After hitting the mattress, Garner said he turned Harris' head to the side to help her breathe and continued to restrain the girl belly down on the mattress for a minute. Other staffers can't confirm what happened during the restraint, though—Garner was the only one in the room. By the time several nurses and another Chad counselor did arrive, they found Harris still on her belly. Her face was bloody and she had soiled herself—details that weren't mentioned in the initial police report or even in some staff accounts of the incident.
But many of Harris' peers reported this to police. One resident said: "Someone came in [to my room] and said that the 'fat girl had crapped herself' and when I looked, I saw her feet sticking out of the time-out room. A couple of staff were laughing because she had [soiled herself]." Another girl said that "after a while we started seeing blood [on the floor] and the staff put paper over our window so we couldn't see what was going on."
Staff reports piece together the last few moments of Harris' life. When one nurse arrived in the time-out room and asked Harris if she "was hurting," Harris didn't answer. So the nurse walked out of the room. She told investigators that it was common for residents not to answer questions right after being restrained. One resident reported hearing a nurse tell Harris that if she didn't get up, "we are going to have Mr. Garner get back on you."
Staff reports conflict at this point. One nurse said that when she and other nurses checked on Harris a second time and found her unresponsive, a nurse brought in an ammonia stick to put under Harris' nose. The girl still didn't respond, so the nurse said they started CPR. Another Chad counselor made no mention of the ammonia, but said staffers couldn't find Harris' pulse and then rolled her over and began compressions.
Either way, when paramedics arrived on the scene, they discovered the girl's lifeless body on the floor outside of her room. Residents in the girls' wing of the facility were understandably rattled. Some reported feeling "really scared." One girl said her roommates started "singing soft songs to calm us down."
Still, as violent and traumatic as residents reported the event to be, state medical examiner Dr. Bruce Levy ruled the death "natural." In an autopsy, Levy found that a morbidly obese and asthmatic Harris had an enlarged heart that he says is to blame for her death. Once Levy released that report, investigator Larry Hodge met with Montgomery County assistant district attorney Dan Brollier, and shortly after, the case was closed. In a sheriff's office memo, Hodge wrote that Brollier told him it wasn't necessary to present the circumstances of Harris' death to a grand jury.
Limited Public Report on Investigation of Chad Youth Enhancement Center, now known as Oak Plains Academy.
Chad Youth Enhancement Center
1751 Oak Plains Road
Ashland City, TN 37015
Phone: (931) 362-4723/fax (931) 362-2816
Family Of Teenage Restraint Victim Settle With Facility
PHILADELPHIA, PENNSYLVANIA--The family of Omega "Manny" Leach, 17, a who was strangled after being placed in a restraint hold at a Tennessee treatment center, has settled a federal lawsuit against the facility for $10.5 million. The Philadelphia teenager's family agreed to drop claims against the city and its Department of Human Services, which sent the troubled teen to the Chad Youth Enhancement Center despite warnings that it was dangerous for him. A key piece of evidence was a photograph from a surveillance camera showing a Chad mental-health technician with both hands around Leach's neck as he pinned him to the floor.
Even though Mr. Leach's death was ruled as a homicide, no criminal charges were ever brought against the Chad Youth Enhancement Services employee.