BANGOR, Maine — It has been just more than a year since David Proffitt, the much-maligned former president and CEO of The Acadia Hospital in Bangor, tendered his forced resignation.
Ever since, new upper management at the 100-bed psychiatric hospital has been striving to ensure the quality of inpatient and outpatient programs that have been affected by a three-year wave of staff turnover at the facility.
With the Proffitt era now a year behind it, Acadia Hospital continues to address workplace safety issues, confront physician recruiting challenges and implement new strategies for managing psychotic and potentially dangerous patients with minimal use of physical restraints and patient isolation. An investigation by the Bangor Daily News reveals the effort to stabilize and maintain the quality of care provided by the facility’s inpatient and outpatient programs remains a work in progress.
Within weeks of Proffitt’s resignation, his position was filled by Daniel B. Coffey, chief financial officer of the Brewer-based Eastern Maine Healthcare Systems, which operates Acadia Hospital and six other regional hospitals. Not long after assuming his new position, Coffey found himself at the epicenter of upper-management turnover and the resignations of six staff psychiatrists.
According to Coffey, Acadia’s operational priorities include decreasing reliance on high-cost, temporary psychiatrists, known as “locum tenens,” who were used to fill the jobs of staff physicians who resigned.
According to one longtime staff psychiatrist who since has resigned, Acadia experienced a 70 percent turnover within its medical staff, and those who resigned collectively took with them hundreds of years of front-line clinical experience.
Coffey also faced in-house challenges related to workplace safety. Among Proffitt’s institutional priorities was reducing the physical restraint of patients and the use of seclusion.
“We can create coercion-free care environments and injury-free worksites in the same facility,” Proffitt told his staff in a five-minute in-house video. “And that facility will be Acadia very soon.”
While the video recently was removed from the hospital’s website, it can still be viewed online at bangordailynews.com.
Proffitt’s hands-off approach to patient care prompted staff concerns about being exposed to injuries inflicted by patients who were out of control. A federal investigation later showed those concerns were not misplaced.
Just three months before Proffitt stepped down, the federal Occupational Health and Safety Administration fined the hospital $11,700 after an investigation into employee complaints determined that there were “serious” violations of safe workplace standards. The OSHA investigation corroborated worker claims of an increase in the number and severity of patient assaults on staff.
The OSHA report notes that from 2008 through 2011, violent patients assaulted staff at least 115 times, resulting in injuries that required 1,741 restricted duty days and approximately 570 days lost to injury.
Among those injured on the job was Robert Patterson, a psychiatric technician from Bucksport. While on the job in the summer of 2010, Patterson was severely beaten by an out-of-control Acadia patient, suffering facial and other injuries that put him out of work for 10 weeks. Patterson said this of The Acadia Hospital in an interview with the BDN in January 2011: “I think conditions will improve.”
While Patterson declined to be interviewed, an Acadia Hospital spokesperson said the standing orders on restraint and seclusion have not changed since Proffitt’s departure. Coffey reports that the number of employees missing work because of job-related injuries has declined significantly during the past year.
“During the past six months, 98 percent of Acadia employees have completed intensive, two-day training to learn techniques for management of aggressive behavior,” Coffey said. “In one of our inpatient units, the number of serious employee injury cases during the most recent four months dropped from 12 last year to one this year.”
Trouble followed Proffitt
Proffitt came to Bangor in October 2008 after four years as CEO of the state-funded, 92-bed Riverview Psychiatric Center in Augusta. He held Acadia’s top job for 29 months, leaving the hospital in turmoil given the fallout from what has been described as his “caustic” management style and well-documented concerns about the physical safety of the staff and patients at the private, nonprofit facility.
After leaving Bangor, Proffitt accepted a similar position in August 2011 at the Minnesota Security Hospital in St. Peter. Located about 70 miles southwest of the Twin Cities, the hospital is Minnesota’s largest mental health facility, treating nearly 400 patients considered mentally ill and potentially dangerous.
Proffitt now finds himself unemployed again, having lasted only eight months at his Minnesota job. When he was fired on March 22, 2012, Anne Barry, assistant commissioner of the Minnesota Department of Human Services, said Proffitt proved “unable to build the level of trust with staff needed to foster the environment necessary for the very significant changes that need to occur.”
Similar problems swirled around Proffitt during his tenure in Bangor. There were workers at all levels of The Acadia Hospital staff who described his management style as “toxic” and “confrontive.” Many staff were — and some still are — unwilling to be critical of Proffitt publicly, or even in-house, out of fear of losing their jobs. Those fears, it appears, were well-founded.
On April 13, 2009, Dr. Paul Tisher, the hospital’s long-term chief medical officer, submitted a letter critical of Proffitt’s management style to Acadia Hospital’s board of trustees and to Eastern Maine Healthcare Systems CEO Michelle Hood. Within 10 days, Proffitt fired Tisher, who had been a staff psychiatrist for 15 years.
Tisher’s firing further alienated the facility’s medical staff, prompting a meeting with Hood on April 24, 2009. Among those expressing concerns was Dr. Don C. Payne, who had been on staff for nearly 12 years. In a letter sent to Hood within days of Proffitt firing Tisher, Payne suggested that Tisher be quickly reinstated.
“All that Acadia has worked to be over 17 years is disappearing,” Payne said in his letter to Hood, which he also shared with his medical staff colleagues. “If [Tisher] is not supported and returned to his position quickly, it will take years for Acadia Hospital to recover. Dr. Tisher has been crucial in bringing Acadia Hospital to its current standing. Why would you kill the goose that laid the golden egg?”
Tisher’s threat to legally challenge his firing was resolved within weeks. It also was resolved quietly. Tisher’s wrongful termination dispute with Acadia was settled out of court, with both parties agreeing not to discuss settlement specifics.
A former staff psychiatrist who left Acadia amid the turmoil describes a gradual decline in quality of care driven by the exodus of key top managers and clinically experienced health care professionals. Now working at another Maine hospital, the physician, who asked not to be identified out of fear of professional retaliation, describes Tisher’s firing as the watershed event that triggered a changing of the clinical guard.
“We all had a great deal of professional respect for Dr. Tisher, and, as our chief medical officer, he was a great source of encouragement and advice on how to handle difficult cases,” the physician told the BDN. “I think morale hit bottom when he was replaced as CMO by Allen Schaffer, a psychiatrist who was just out of residency training in Vermont. Two other highly experienced staff psychiatrists, who were both well-respected, were passed over for the job by David Proffitt. The medical staff felt disenfranchised.”
In-house distress and outright contempt for Proffitt, the physician said, resulted in the medical staff referring to him facetiously behind his back as the facility’s “CEO in training.” And after Schaffer’s hiring, “we weren’t too happy with working for a chief medical officer in training.”
Schaffer declined to be interviewed.
“When the medical staff finally met with Michelle Hood about Dr. Tisher’s firing, we predicted then that the quality of care would decline,” the physician said. “Three years later, we were right, considering the devastation left behind.”
Among the points made in letters of concern read to Hood at a medical staff meeting with her after Tisher’s firing was this one: “The medical staff has come to the conclusion that Dr. Proffitt’s approach to clinical matters at Acadia hospital is not compatible with a well-functioning medical staff. The patients we serve need you to take swift and decisive action to prevent further deterioration of the clinical integrity of Acadia Hospital.”
DHHS investigates, cites Acadia
Proffitt’s tenure at the helm of Acadia Hospital also involved allegations that a psychiatric technician who worked in an inpatient children’s unit was a pedophile. A recent investigation by Minnesota Public Radio reporter Madeleine Baran into Proffitt’s professional background revealed that a 27-year-old Acadia patient recognized the technician as the same man who had fondled him and had sex with him over eight years when the patient was between the ages of 7 and 15.
Tisher insisted that Acadia had a legal obligation to report the allegations of abuse to the Maine Department of Health and Human Services. The allegations never were reported by Acadia but subsequently were investigated by DHHS after they were reported by an unnamed clinician. In September 2009, DHHS found that Acadia Hospital had violated Maine law by failing to immediately report a case of suspected child abuse.
The DHHS investigation, which at one point involved Old Town Police Detective Tom Adams, determined that Acadia Hospital “failed to provide a safe environment for vulnerable children in its pediatric outpatient services program,” according to the department’s report. DHHS also found that, after what was termed an “incomplete investigation” of a sexual abuse report, the alleged perpetrator was allowed to return to work with children ranging in age from 5 to 17.
“Some in the administration had a strong positive opinion about [the alleged abuser] and also dismissed the allegations,” the DHHS report states. “They did remove him from his job responsibilities for a period of three weeks but then the decision was made … to allow him to go back to work on the pediatric outpatient program.”
The report says the alleged perpetrator refused to be interviewed by DHHS or by police about the allegations. At the advice of his attorney, he declined to take a polygraph examination. No charges were ever filed.
Detective Adams told the BDN that the investigation was dropped by the Maine attorney general’s office because of a lack of evidence.
“It was an old case,” Adams said. “It was hard to pursue without any real evidence. What we had was totally circumstantial. The alleged victim’s information was totally credible, and I believed it to the point where I attempted to interview the alleged abuser.”
Coffey recently confirmed that the employee who was investigated was “promptly terminated.”
Between April 1, 2011, when Proffitt stepped down, and March 31, 2012, the Licensing and Regulatory Services Division of the Maine Department of Health and Human Services has investigated 10 complaints related to Acadia Hospital and two incidents reported by the hospital itself.
“Of the 10 complaints, five were substantiated for issues with patient rights, physician services, pharmaceutical services and cleanliness of the facility,” according to Alelia Hilt-Lash, the division’s health services supervisor. “DLRS issued Statements of Deficiency and received Plans for Correction from The Acadia Hospital.”
Among the substantiated complaints was an allegation made in July 2011 of a violation of a patient’s right to be free of abuse. Specifically, the allegation claims that Acadia staff failed to declare a psychiatric emergency before restraining a female patient and giving her an intramuscular injection of medication in her buttocks without her consent.
Another complaint investigated by DHHS alleged that patients were forced to take medications against their will and that dosages were increased without patient consent. Also substantiated by DHHS was a complaint investigated in February 2012 that Acadia failed to develop an adequate discharge plan for a patient and that lack of referral “may have contributed to readmission for re-occurrence of psychiatric symptoms based on noncompliance with medications.”
Five complaints were found to be unsubstantiated after being investigated, including one in which a child’s room was described as “filthy and disgusting.” A facility survey conducted in November 2011 by the federal Centers for Medicare and Medicaid Services found Acadia to be in compliance with its standards.
The 10 complaints and two incidents investigated by DHHS during its 2011-12 reporting period compare with 23 complaints reported between April 1, 2010, and March 31, 2011, the last year of Proffitt’s tenure at Acadia. Five other incidents were reported by the hospital itself that year. Five complaints were substantiated by DHHS. The year before, between April 1, 2009, and March 31, 2010, none of six complaints was substantiated, although there were 16 incidents reported by Acadia Hospital.
Financial stress on Acadia
Acadia Hospital’s recent annual filings with the Internal Revenue Service show that among the drains on Acadia’s finances are the expenses of recruiting, housing and paying temporary physicians to fill in after the wave of medical staff vacancies that occurred during Proffitt’s tenure as CEO.
IRS filings show the hospital spent $212,335 on temporary physicians in fiscal year 2008. That figure jumped to $622,431 the next year, and, by the budget year that ended in 2010, Acadia Hospital was spending $2,244,304 on temporary physicians, more than 10 times what it was spending two years earlier — Acadia Hospital’s most recent Form 990 filing with the IRS is accessible at http://www.emhs.org/990.aspx.
“The number of [permanently] employed psychiatrists at Acadia Hospital has more than doubled, from 10 to 21 since 2009,” Coffey said. “Acadia has reduced temporary psychiatrists from a high of nine to two today, with expectations to have no long-term temporary physicians within four months.”
Despite the turmoil of the past four years, the nonprofit Acadia Hospital has been able to finish each budget year in the black. When Proffitt came on as the facility’s president and CEO in October of 2008, Acadia was coming off a budget year that saw revenues exceed expenses by $1,473,615, according to records on file with the IRS. A year later, revenues exceeded expenses by $2,123,966, an increase attributed to $250,000 in additional grant funding, a $250,000 boost in investment income, and revenues from higher inpatient and outpatient volumes. By October of 2010, the year-end budget surplus had dropped to $1,646,275.
The Acadia Hospital’s IRS filing for the budget year that ended in September 2011 — the same year Proffitt left Acadia in April — has not yet been made public, and won’t be until August. When the numbers are released, Coffey said the balance sheet will show a $2.1 million year-end surplus, generated through what Coffey termed “several recovery initiatives.”
Those cost-cutting initiatives allowed Acadia Hospital to bounce back from losses during the first six months of its 2011 budget year. Coffey said Acadia Hospital also ran a deficit during the first six months of the current 2012 budget year, but not to the degree it did a year ago.
One recent effort to expand patient care offerings didn’t go so well, winding up a money loser. A decision to hire a geriatric psychiatrist who specializes in treating dementia and other mental health problems associated with aging prompted renovation of an existing ward at a cost of $50,000, according to Coffey. The new geriatric inpatient service lasted six months and was closed after failing to attract the revenue required to sustain it.
“A geriatric psychiatric inpatient unit was piloted for a few months over a year and a half ago and was discontinued because of very poor reimbursement,” Coffey said when asked about the unit. “Acadia instead began offering outpatient geriatric psychiatry services provided by a board-certified specialist. … That unit was converted to expand child and adolescent inpatient beds in response to a significant unmet need in our region and the state.”
‘Moving in the right direction’
Among those who contend that Acadia Hospital has weathered the turmoil of staff turnover and an era of battered morale are three members of the facility’s board of trustees: John Bragg, Richard Lyons and Dr. Tom McHugh.
A former Bangor mayor, Bragg has spent 12 years as an Acadia Hospital trustee and was board chairman during the turmoil that surrounded Proffitt’s tenure as CEO.
“Things are definitely moving in the right direction,” Bragg said in a recent telephone interview. “Certainly the environment of hostility and tension has been removed. I think Dan Coffey was a great choice to succeed David. He’s a very soft-spoken person with a calmer disposition that has helped in building back a level of camaraderie and teamwork that’s essential to any organization. I’m very pleased to see what’s transpired.”
Bragg was succeeded during the last year as Acadia Hospital’s board chairman by Richard Lyons, who is the superintendent of schools at MSAD 22 in Hampden. He told the BDN in a telephone interview that the board and executive staffs at both Acadia Hospital and Eastern Maine Healthcare Systems have been working with two different consultants — which Coffey said will cost $200,000 — to develop a new governance model that includes measurable benchmarks and objectives. Among those objectives, Lyons said, is less reliance on temporary medical staff.
“We’ve done a lot of strategic planning,” Lyons said. “With the help of Dan Coffey’s leadership, there has been a lot of focus on how we move forward from the tumultuous times of three or four years ago. The situation has stabilized, and Dan’s doing a great job as we recoil from the situation in the past.”
McHugh was a longtime critic of Proffitt’s “overbearing” management style. He gave Coffey high marks for his efforts to improve the situation during a recent job performance evaluation.
“They gave Mr. Proffitt every opportunity and considerable coaching to improve his performance, but he did not benefit from those opportunities,” McHugh said. “Since he left, the intramural dissension has gone away, and we’re doing very well. The atmosphere is much better. There’s still a lot to be done, but people are back in sync. It’s a much happier place.”
Despite the administrative instability that has enveloped the hospital for years now, Hood told the BDN in a telephone interview that she is pleased with the “strategic direction” in which Acadia Hospital is now headed.
“There is definitely a sense of teamwork and camaraderie among the senior staff that is very encouraging and very healthy. … I sense a level of participation that was absent in the past, and from that perspective I would say that it’s all good.”
Hood declined to discuss why Proffitt and Tisher were fired.
“I’m limited by what I can discuss,” Hood said. “And I’ve not speculated on the situation in Minnesota. There are a lot of different sides to the story.”
Hood said in a telephone interview that she did not write a “letter of recommendation” when Proffitt applied for the position he just left in Minnesota. That statement doesn’t square with an email sent on Aug. 8, 2011, by Philip Johnson, Eastern Maine Healthcare System’s vice president for human resources. Johnson’s email to Jennifer Service, who was then the Minnesota Security Hospital’s medical director, makes direct reference to an attached “letter of reference from Michelle Hood regarding David Proffitt.”
Through a spokesperson, Hood said that what was provided to the Minnesota Department of Health and Human Services were documents that confirmed Proffitt’s tenure at Acadia Hospital between Oct. 27, 2008, and April 1, 2011, and a summary of Proffitt’s “accomplishments” as president and CEO.
Among the issues that swirled around Proffitt in Minnesota was the validity of his academic credentials. While in Maine, Proffitt often identified himself in correspondence as “Dr. David S. Proffitt, PhD,” and his resume shows he earned a doctorate in health management from Warren National University. That online, unaccredited school no longer exists, having been shut down by the state of Wyoming in 2009.
That recent disclosure hasn’t changed how Eastern Maine Healthcare Systems verifies the credentials of job applicants, a spokesperson said. “We’ve made no fundamental changes to our process,” said Suzanne Spruce, an Eastern Maine Healthcare Systems community relations specialist. “But we also know that the process isn’t foolproof. There’s always a risk that something in the applicant’s past won’t show up.”
Multiple attempts by the BDN to contact Proffitt in Minnesota have been unsuccessful.
For now, the man at the helm of Acadia Hospital seems eager to put the troubled waters of the recent past behind him and to focus instead on the facility’s future.
“I am sorry for the way many current and former employees were treated in the recent past,” Coffey said in a recent email response to a series of questions posed by the BDN. “I am working to move Acadia Hospital forward to deal with challenges and change required for our future success.”