BANGOR, Maine — The blast of criticism being leveled at David Proffitt, CEO of The Acadia Hospital, is nothing new.
Angry complaints about employee and patient safety were brought before Maine lawmakers during Proffitt’s four-year tenure as superintendent of the state-run Riverside Psychiatric Center in Augusta, the position he held immediately before coming to The Acadia Hospital.
His professional judgment and educational credentials were questioned. A number of staff members left the hospital for less embattled working conditions.
Proffitt has come under fire in recent weeks from current and former Acadia Hospital employees who say the incidence and severity of staff injuries have risen since he initiated a policy that essentially eliminates the use of mechanical and physical restraints with mentally ill patients who become violent.
Others have taken aim at Proffitt’s administrative skills, criticizing an authoritarian leadership style they say has resulted in the erosion of employee morale and the loss of key clinicians and administrators.
Proffitt’s academic qualifications also have been questioned.
Proffitt’s education includes a 1984 bachelor’s degree in therapeutic recreation from the University of Nebraska at Omaha, a 1989 master’s degree in recreational administration from Arizona State University, and a 2007 doctoral degree in health administration from Warren National University, now a defunct, unaccredited on-line program. His academic career has been criticized as being inadequate to prepare him for the top-level positions he has held at both Riverview and Acadia, although neither position requires a doctoral degree.
Since the end of July, the federal Occupational Safety and Health Administration has been conducting an on-site investigation into employee complaints of unsafe working conditions at Acadia. The state Department of Health and Human Services also recently has investigated conditions at Acadia, with a report due later this month.
Despite the firestorm of criticism, Proffitt has his defenders.
Michelle Hood, CEO of the hospital’s corporate parent Eastern Maine Healthcare Systems, says that under Proffitt, Acadia is “moving in the right direction.” She lauded the progress he has made toward de-stigmatizing mental illness and ramping up Acadia’s outpatient and community services.
Carol Carothers, executive director of the Maine chapter of the National Alliance on Mental Illness, said this week that patient care improved at Riverview while Proffitt was in charge and praised him as a dedicated health care leader.
Carothers, who honored Proffitt in 2006 with NAMI’s “Heroes in the Fight” award, said this week that it was clear at the time that “he was a man who had devoted his entire career to working in state psychiatric facilities with a goal of improving the quality of care.”
The Acadia Hospital is a private, nonprofit, 100-bed psychiatric hospital that provides acute inpatient services and a range of community-based mental health and substance abuse programming. It employs about 700 people.
Proffitt says his goal at Acadia is to bring the treatment of mental illness into alignment with national standards. Those standards have their roots in the 1999 Surgeon General’s Report on Mental Health in America and are further developed in the 2004 report of the Presidential New Freedom Commission on Mental Health.
The federal Substance Abuse and Mental Health Services Administration has drawn on these guidelines to adopt policies that call for a less restrictive model of psychiatric treatment that minimizes the use of mechanical and physical restraints and seclusion while emphasizing therapeutic communication and the right of patients to participate in their own care.
“The call is to develop ways to treat people who ask us for help in a collaborative, respectful, sustainable and compassionate way that recognizes their own aspirations as cornerstones to their personal recovery,” Proffitt said Friday. That means helping patients identify their own goals and working with them to achieve those goals, he said.
But when patients are very ill and delusional, if they become violent toward themselves or others, he said, therapeutic communication may not work.
“Do we at times have to use restraints with people? The answer is, ‘Yes,’” Proffitt said. “Then, the challenge is to find the most dignified and sensible way to do it. It’s not tying people to their beds.”
Proffitt criticized at Riverview
Psychiatrists formerly employed at Riverview said this week that both patient care and employee morale eroded under Proffitt’s leadership there.
“Over the course of David Proffitt’s tenure at Riverview, a significant number of long-standing and experienced staff left and were replaced with less experienced or temporary people,” said Dr. Bryan Woods, who was employed at Riverview from 2003 to 2006 and now practices in Portland. “In my opinion, this resulted in a decrease in the quality of patient care.”
Woods said Proffitt’s management style was often in conflict with the collaborative “treatment team” approach commonly used in acute-care psychiatric settings.
“Ultimately, I left, because I simply could not work with him,” Woods said.
Woods’ colleague Dr. Dan Filene, who also worked at Riverview under Proffitt, said direct-care staff at the state hospital were placed at increased risk by a stringent policy that all but eliminated the use of any kind of restraints.
“The staff at Riverview are heroic,” he said. “It’s not just dangerous; it is emotionally challenging, fatiguing, low-paying work. When they are actively being injured, it can’t help but affect patient care.” Filene stressed that most people with mental illness are not dangerous or violent.
Sen. Stanley Gerzofsky, D-Brunswick, is chairman of the Legislature’s Criminal Justice Committee. The committee oversees the locked forensic unit at Riverview, where criminals with severe mental illness are housed and treated. Proffitt’s policy of doing away with restraints for even the most dangerous patients prompted a number of complaints, he said.
“We heard concerns that staff members were being injured [by patients],” Gerzofsky said in an interview this week. “Staff were complaining that [Proffitt] didn’t have the right credentials and that he didn’t take the violence very seriously. We had him in front of our committee several times.”
Gerzofsky’s colleague on the committee, Sen. John Nutting, D-Leeds, said he heard from several Riverview patient families and staff members.
“Legislators were called to see if he could be replaced,” he said. “There was really just one single reason — he was telling doctors how to treat their patients. He was trying to get between the patients and their doctors.”
Nutting said parents of patients were especially concerned.
“They wanted their loved ones to get the care their doctors wanted them to receive, not the CEO of the hospital,” he said.
Proffitt’s degrees in recreational therapy and his online doctorate, Nutting observed, did little to reassure worried families.
Nutting and Gerzofsky said they met with Brenda Harvey, commissioner of the Department of Health and Human Services, to convey their worries. Still, nothing happened.
Nutting said pressure for ousting Proffitt from Riverview was building for at least a year.
“Then we read in the papers that he was leaving,” he said. Proffitt had accepted the job at Acadia.
Citing employee confidentiality protections, Harvey this week declined to comment on Proffitt’s job performance while at Riverview. State employee performance records are not public documents.
A good match for EMHS
At EMHS, Michelle Hood said Proffitt’s troubles at Riverview “did not come up” during his interviews for the position of CEO at Acadia.
One of 16 applicants in a nationwide search to replace outgoing CEO Dorothy Hill, he had appropriate letters of reference from former employers, she said. His educational credentials checked out, and his commitment to implementing new, least-restrictive inpatient policies and de-stigmatizing mental illness was a good match for the EMHS mission.
“We have committed to a very open and progressive approach to the services we provide [at Acadia],” Hood said. Under Proffitt’s leadership, she said, the hospital has partnered with several community agencies and established a more familiar presence in the Bangor area.
Asked about the loss of key clinical administrators at Acadia, including Vice President for Medical Affairs Dr. Paul Tisher and Chief Nursing Officer April Giard, Hood said “turnover is normal” with a new administration and that Proffitt has successfully recruited new talent and promoted qualified staff from within the organization. Neither Tisher nor Giard could be reached for comment.
Proffitt said Thursday that concerns raised during his tenure at Riverview have guided his administration of The Acadia Hospital, but he was unable to identify specific changes he has made in his management style. Riverview, he noted, was in court-ordered receivership when he took the reins. The receivership was released during his administration when the court master determined the hospital was in compliance with a 1989 consent agreement that protects the rights of patients in psychiatric care.
“I am very proud of the work I was part of [at Riverview],” he said. “I saw Acadia as a personal challenge and an opportunity for growth, but I hated to leave Riverview.”
Proffitt took evident offense at questions about his doctoral degree, calling the issue “irrelevant.” While Warren National University may not have been the best choice, he said, his education there did advance his expertise in health care administration.
“I find it ironic that people would criticize me for wanting to further my education,” he said.
A number of changes already have been implemented in response to employee safety concerns raised by the OSHA investigation, Proffitt said, and more will be forthcoming after the OSHA and DHHS reports are released.
In 2009, there were nearly 500 patient assaults on staff reported at Acadia. As of the end of August this year, there were 279 reported assaults, with a steady decrease from May through August. Further staff injury data will be released with the OSHA report.
Hood said Thursday that she attended a special meeting last week of The Acadia Hospital board of trustees convened to discuss the situation at Acadia.
Preliminary findings from the OSHA investigation will result in some immediate changes, she said, although she would not specify the nature of those changes. She said Acadia employees would be informed about some changes next week after a regularly scheduled meeting of the board.