Under pressure, Friends Hospital replaces CEO

Friends Hospital, the historic psychiatric treatment center in Northeast Philadelphia, has replaced its chief executive officer after state and city regulators accused the facility of inadequate oversight of patients, including one who committed suicide.

The officials' concerns focused on the hospital's "crisis response center" - the equivalent of an emergency room - where the patient committed suicide in April. Separately, Delaware County stopped referring patients to the inpatient unit at Friends because of the suicide, general security concerns, and "allegations of inappropriate sexual behavior," a county official said.

County behavioral health administrator Jonna DiStefano declined to elaborate, citing patient privacy rules. But an Inquirer review of police records shows that at least three rapes of patients were reported last year. One, in which the alleged victim was a 13-year-old girl, has led to the arrest of a teenage boy who was also a patient, police said. The other two cases remain active, said police Capt. John Darby.

In addition to hospital CEO Arris Veronie, vice president Diane Carugati and chief medical officer Marc Rothman are no longer working at Friends. None of the three could be reached for comment. A hospital spokesman declined to comment on staff departures but said the facility was being run by interim CEO Fran Sauvageau pending a national search.

In interviews before he was replaced, Veronie denied that there was any problem with the quality of care at the hospital, the nation's oldest private psychiatric facility. He said Friends was being unfairly singled out by regulators.

"A lot of patients leave the hospital saying 'Thank you' on the way out the door," Veronie said. "That tells me we do good work here."

The hospital was founded in 1813 by Quakers, and long enjoyed an excellent reputation. In 2005, a for-profit company purchased an 80 percent stake in the hospital. That stake was then sold again in 2007 to Tennessee-based Psychiatric Solutions Inc., which has come under fire from regulators in other states.

Since then, Friends has invested more than $5 million in infrastructure improvements, and hired 19 additional staff for clinical care, "to ensure that Friends Hospital has the highest quality care in the region," said spokesman Greg Matusky.

The remaining 20 percent share of the hospital is owned by the Quaker-affiliated Scattergood Foundation, which is not involved in hospital operations.

The current regulatory scrutiny was triggered by the April 6 suicide of Daniel Lebens, 21, who had gone to Friends' emergency room the night before.

Suicides are not unheard of at psychiatric hospitals, and their occurrence does not necessarily mean the facility is at fault. But in this case, officials at the state Department of Public Welfare said, there was insufficient oversight.

A security camera in the patient's room had been "soiled" so that images could not be seen on a viewing monitor at the nursing station, said Aidan Altenor, director of the department's Bureau of Community and Hospital Operations. Moreover, state inspectors found that some staff did not know how to toggle to see images from different rooms on the monitor, Altenor said.

In an interview this month, Veronie said the cameras were not intended for real-time monitoring of patients, but to record the care in case anyone were to challenge it later.

Altenor disputed that characterization because "the monitors are located in the nurses' station, where the staff are."

Veronie said that hospital staff checked on the patient in person once an hour - a statement that was met with disbelief by psychiatrist Daniel Gruener, a former medical director at the hospital.

"To go to that standard would be negligent," said Gruener, who left in 2003. Depending on the severity of the case, suicidal patients should be monitored continuously or at least every 15 minutes, Gruener said.

Veronie said that since the suicide, the hospital had increased patient checks to every 15 minutes for all crisis-center patients.

Lebens' aunt Donna Herberth, who took her nephew to the hospital, said he was a warmhearted and creative man who worked as a roofer and was "severely depressed."

"I never thought taking him there would be the last time I would see him," Herberth said. "I took him to what I thought was a safe haven."

A hospital physician called Herberth the next morning at 5:30 to tell her Lebens had hanged himself with bed linens, she said.

Philadelphia officials said their investigation revealed more concerns about patient supervision. Also, Altenor, the state official, said initially that the hospital took inadequate steps to respond to another suicide last year; in a subsequent interview, he said that he misspoke and that the event last year was an attempt.

Veronie said even that was an inaccurate characterization. The patient last year tried to "elope" - the clinical term for "escape" - by jumping from a window that was 11/2 stories from the ground, Veronie said. The glass in the window he broke through was replaced with more durable laminated material, Veronie said.

Yet on May 21, the city told the hospital that as of July 1, it would stop referring Medicaid-insured patients to Friends' crisis center.

That arrangement typically funneled 6,500 patients a year to the center, at a cost of $2 million.

Those patients will now be referred to Temple University Hospital's Episcopal Campus or the Germantown campus of Albert Einstein Medical Center.

Asked about the alleged rapes, Veronie said that he believed only one had been "substantiated" and that the hospital had reacted properly.

In an interview, one of the women who charged that she was raped said it happened in part because of poor oversight by hospital staff.

"They weren't paying attention to the patients," said the woman, 39, of Philadelphia, who told police that her attacker was another patient. "The only thing they come and do is they give you more medicine."

She said she was in the hospital for depression, and did not report the incident for several days because she feared doing so while the other patient was still there.

Hospitals run by Psychiatric Solutions have been accused of mismanagement in other states. This month, Nevada officials suspended the license of one such hospital, saying it failed to ensure patient safety. Last year, Illinois stopped sending children to the company's Riveredge Hospital near Chicago, alleging that it failed to prevent sexual assaults of patients.

The staff departures at Friends are a positive step, said Gary Brown, a spokesman for the city's Department of Behavioral Health and Mental Retardation Services.

"We support the decision," Brown said. "There are long-standing concerns with quality of care that were not addressed."

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