Media Statement Provided to BuzzFeed
From Steve McCabe, CEO

November 9, 2017

Hill Crest’s History of Service to our Patients
Since 1935, Hill Crest Behavioral Health Services has proudly served the Birmingham community and the
state of Alabama. As a longstanding behavioral health resource, we are the only freestanding, fullservice psychiatric hospital in the Birmingham area. Our behavioral health hospital serves adolescents
and adults suffering from significant mental illness, emotional problems and behavioral issues. With
more than 400 employees, Hill Crest is the largest psychiatric patient-care facility in Alabama and
provides superior quality care to more than 1,000 patients annually, across 62,378 patient days.
Hill Crest is licensed for 219 beds across nine programs consisting of three distinct and separate acute
units for adolescents and adults (which can be flexibly configured consistent with our licensing as two
adolescent and one adult unit – or alternatively, one adolescent and two adult units – but never
comingling patient populations), four residential units for adolescents and two group homes for
adolescents. We converted the previous child unit to an adolescent unit earlier this year based upon
patient and community need.
Hill Crest is licensed for 94 acute care psychiatric beds and these beds can be utilized flexibly in
accordance with state guidelines to meet the needs of the community. The third floor of the hospital is
generally dedicated to our adult patients, with two nursing stations and three dayrooms. In the event
we use part of the third floor to care for adolescent patients due to the needs of the community,
adolescent patients have their own designated and assigned clinical staff, dayroom and nurse’s station.
They have no interactions with adult patients and are on their own secure unit.
Our Commitment to Quality Care
The medical, clinical and administrative staff aims to provide compassionate, quality care and
treatment. We believe that caring for our patients is a sacred trust, and our goal is to help and heal
those who come to us at their most vulnerable times in their lives.
Multiple external government agencies rate the hospital highly.
 Hill Crest is certified by Centers for Medicaid and Medicare Services (CMS) and accredited by
The Joint Commission (TJC), a national nonprofit that accredits hospitals and named Hill Crest as
a top performer in recent years.
 We are also licensed by the State of Alabama Department of Mental Health (DMH), which
awarded Hill Crest a score of 100% across six of seven categories in its most recent site survey in
May 2017.
 The Department of Human Resources (DHR) found no major deficiencies in site visits, as recently
as March of this year.
Consistent Patient Satisfaction
Quality care is our priority, and we continue to receive high marks from our patients and regulators. Our
decades of experience position our facility to consistently provide the best care for those in need of
behavioral health care services.
 Between 2013 and 2017 YTD, the aggregate score for inpatient satisfaction surveys was 4.49 out
of 5 based on feedback from more than 4,000 patients who received care from Hill Crest.
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We consistently receive positive feedback on patient satisfaction surveys:
 94% of our patients say that they felt better when discharged from inpatient care after
treatment.
 93% of patients say that they were satisfied with the treatment they received.
 89% would recommend this facility to someone else.
 Hill Crest has outperformed the CMS national AND state rates for quality care for all eight
Inpatient Psychiatric Facilities Quality Reporting Measures.

Many of our patients suffer from psychiatric conditions resulting from severe trauma, which can
manifest via reactive and violent behavior that can endanger the patient, other patients and staff.
Restraint and seclusion techniques are options of last resort when all other tools, including verbal deescalation or “talking the patient down,” have failed and the patient is at imminent risk of hurting
themselves or others. All allegations of potential harm are thoroughly investigated and addressed as
appropriate.
We emphasize best practices and thorough consistent training. All facility clinical employees are
required to be trained in an accredited or certified program for physical management.
Use of restraint and seclusion techniques at Hill Crest is rare:
 Hill Crest has had zero seclusions in 2016 or 2017.
 Hill Crest reports lower rates of restraint and seclusion than the national averages as publicly
reported by CMS’ Inpatient Psychiatric Quality Reporting System (IPFQR) in 2015 (the most
recent year tracked).
 Our usage rates for these strategies are low, in part, because like many high quality Behavioral
Health hospitals, Hill Crest endorses the Six Core Strategies for Restraint Reduction© developed
by the National Association of State Mental Health Program Directors as our guide for assisting
facilities in reducing the use of these interventions.
About Higdon Hill School
A critical component of Hill Crest is our Higdon Hill School, where youth come to learn, grow, and heal.
Higdon Hill School is a unique place because we not only treat the behavioral health challenges the
teens face, but we also work to help ensure that they continue to receive an excellent education despite
the fact that their local schools are unable to meet their specialized academic needs.
We adhere to stringent curriculum requirements, document grades, and school is in session 186 days
per year. Class sizes are small for the best possible learning environment. This also allows each student
to learn and achieve at his or her own pace. Based on this model of care and education, Higdon Hill
School consistently achieves a 100 percent graduation rate. Over the past three years, Higdon Hill
School graduated the following number of students with high school diplomas: 2017 – 15 students; 2016
– 18 students; 2015 – 15 students.
Higdon Hill School received accreditation from AdvancED in 2017 for a period of five years. AdvancEd is
a nationally recognized accreditation program that allows for children and adolescents enrolled in the
school to receive credits which are transferable to home schools. The allegation of non-educational
activities is patently false. AdvancEd would not authorize this accreditation without a rigorous review of
the education provided to students and to the caliber of the educators and staff providing this
education.
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 Response to BuzzFeed’s Allegations:
The framework of BuzzFeed’s research appears to characterize Hill Crest in a misleading and inaccurate
manner, citing many anonymous and unreliable sources, including disgruntled former employees.
As previously addressed, we condemn the use of patient information acquired unethically and further
propagation of records and videos violating patient privacy rights. Without the written patient consents
we requested of BuzzFeed, we are severely constrained in our ability to provide the complete set of
facts regarding patient care episodes in order to refute incomplete, unsubstantiated and in some cases
completely inaccurate accounts. Consistent with their past practices, BuzzFeed has made no effort to
obtain valid patient authorizations that would allow Hill Crest the opportunity to fully and completely
refute the inaccurate accusations of patient care encounters.
Sadly, BuzzFeed’s reporting only further contributes to the stigma and misconceptions surrounding
psychiatric treatment.

With regard to specific questions raised by Rosalind Adams via email:
Surveillance Videos – Use of Restraint
Surveillance cameras are in place in common areas for the safety of both patients and staff. We
condemn the misappropriation of video clips improperly taken from our facility. Video clips shown to
the public without context or knowledge of the patient’s specific course of care serve only to
sensationalize episodes, spread misconceptions, and misrepresent the environment at Hill Crest. The
video clips fail to depict the efforts of staff to de-escalate patient situations prior to employing physical
management techniques.
In the instances when physical restraint episodes do occur, a debriefing is held following the episode
which includes conversations with staff and patients involved to review and develop strategies to
diminish the possibility of similar events re-occurring. The Hill Crest Risk Manager also reviews all events
requiring restraints via video and interviews all involved patients and staff. Any allegation of improper
restraint technique is swiftly investigated and reported to appropriate authorities in accordance with
regulations and laws.
Hill Crest does not condone nor tolerate utilization of chokeholds or intentional twisting of patients’
arms or legs during physical restraint episodes. To be clear, Hill Crest’s policy on restraint use is
consistent with all applicable regulations—used as a last resort when a patient’s behavior is dangerous
to him or herself and to others.
Relative to the five video clips provided, an internal investigation was conducted and documented in
each case. We regret and are disappointed in the instances of inappropriate conduct by our employees,
which was inconsistent with the facility’s policies and their training. These isolated incidents are not
indicative of the quality of care provided at Hill Crest.
We follow all regulatory and accreditation requirements regarding the reporting of restraint episodes,
including those resulting in injuries to patients and staff. Where necessary, we conduct mandatory staff
retraining focusing on therapeutic interaction techniques with patients. In cases where staff members

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 have demonstrated significant deviations from policies and standards of care, we take disciplinary
measures, specifically suspension followed by termination and referral to appropriate law enforcement
authorities if required. Per policy, in the case of minors, a parent or legal guardian is contacted.
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Video 1 […Ycfg]: Rounds were properly conducted. Patient was not on 1:1 at the time of the
incident depicted in the video.
Video 2 […yhQm]: Employees received mandatory retraining. Incident reported to applicable
state regulatory agencies. State undertook inspections and full review of the incident and
confirmed that Hill Crest’s disciplinary actions were appropriate.
Video 3 […Igyn]: Employee received mandatory retraining. Incident reported to applicable state
regulatory agencies. State undertook inspections and full review of the incident and confirmed
that Hill Crest’s disciplinary actions were appropriate.
Video 4 […AGg9]: Please refer to a statement that outside counsel will be providing to you, as
this matter is currently pending litigation.
Video 5 […Iw43]: Employee was terminated.

Allegations by former disgruntled employees
Sadly, BuzzFeed relies on a non-representative handful of often unreliable sources with uncorroborated
and misleading allegations that do not align with the factual record. Stephanie Jenks was no longer
employed on 4/13/15, and, as such, was not present for the incident depicted in the videos. Hill Crest
strongly disputes Ms. Jenks’ portrayal, including her alleged interactions with the Director of Clinical
Services and CEO. Hill Crest also vigorously disputes Ms. Jenks’ and other anonymous sources’
contentions regarding any purported pattern or practice of staff “purposefully provoking patients to get
them to react so staff members could restrain them.” Such systemic behavior would represent a serious
violation of Hill Crest policies and practices enforced by numerous outside agencies and accreditation
organizations that regularly inspect Hill Crest. No practice of this kind has ever been documented by any
state or federal regulator or accreditation organization nor has Hill Crest been subjected to any citations
or investigations alleging such behavior.
With regard to restraint and seclusion, our policies clearly dictate that they are to be used as a last
resort when a patient is at imminent risk of hurting themselves or others. It is undertaken for the
patient’s protection and used only when all other tools have failed including verbal de-escalation. All Hill
Crest clinical employees are trained extensively in accredited Crisis Prevention Institute (CPI) nonviolent
intervention techniques at new employee orientation. They also receive annual refresher courses for the
duration of their employment. Retraining and education is available to employees requiring additional
training, whether by request of employee or the employee’s supervisor. Verbal de-escalation is a core
component of that training. It is always preferable and recommended that staff utilize those techniques
to assist a patient in regaining control before a physical intervention.
Federal and state guidelines govern the use of these interventions. Psychiatric facilities are required to
report the frequency of restraint and seclusions to TJC as part of its Hospital Based Inpatient Psychiatric
Services (HBIPS) core measures and CMS’ Inpatient Psychiatric Facility Quality Reporting System (IPFQR).
Hill Crest’s measures related to restraint and seclusion utilization are dramatically below the national
and Alabama average—which is our constant goal.

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 Hill Crest strongly disputes the account of the disgruntled former employee who was terminated for
falling asleep on the job. Instead of taking responsibility for the actions that led to his dismissal, he has
sadly elected to lodge self-centered attacks on Hill Crest without any evidence to support his claims.
Specific Patient Accounts and Allegations
Regulatory agencies frequently visit Hill Crest, including for unannounced inspections. No inspection or
citation has ever alleged or revealed any evidence that improper restraints are conducted in patient
rooms away from cameras. Any allegations of such conduct would trigger an immediate investigation
and report to appropriate regulatory authorities, including conducting interviews with all relevant
parties to access the veracity of such claims and whether remedial action is required. None of the
patients referenced in these questions made any such allegation during their stay at Hill Crest.
Additionally, leadership regularly conducts unscheduled rounds of the facility, during all shifts.
Additionally, while every allegation is thoroughly reviewed (including by outside regulatory authorities),
it is important to note that many patient allegations are ultimately revealed to be unsubstantiated,
inaccurate or incomplete.
Regarding the teen whose phone call was interrupted: the portrayal of events is inaccurate, misleading
and incomplete. Once again, BuzzFeed’s failure to provide a valid, written patient consent prevents us
from providing the truth about this circumstance which would demonstrate that the allegations are
unsubstantiated.
As to the incident reported on the RISE unit, an internal investigation was conducted, the incident was
reported to DHR and the Alabama Disabilities Advocacy Program (ADAP). After a thorough investigation,
DHR concluded that abuse and neglect did not occur. ADAP did not require additional follow-up.
Elopement
Hill Crest maintains established policies to prevent and respond to unauthorized departures from the
facility to help ensure the safe return of all eloped patients and we adhere to all applicable regulatory
requirements governing the reporting of these events to the appropriate authorities.
The referenced patient who eloped from Hill Crest during the early evening of 5/26/16 was escorted
back to the facility by law enforcement later the same evening. Because the patient returned to the
facility before midnight and was not discharged, Hill Crest was not required to file a formal report with
DHR. Nevertheless, Hill Crest did in fact voluntarily notify the patient’s case worker of the incident
within approximately one hour of the initial elopement.
Inquiry Escalation & Communicating with Parents and Legal Guardians
As discussed earlier, it is Hill Crest’s consistent policy and practice to report to DHR and other regulators
all significant events and incidents. We also understand the importance of keeping parents and other
legal guardians informed regarding treatment progress and any issues that may impact care and
wellbeing. To this end, Hill Crest’s leadership works closely with our Clinical Services team to maintain
regular communication and to promptly respond to all pertinent inquiries. Our goal is to resolve issues
and concerns quickly in a manner consistent with clinical best practices and patient safety.
It is important to note that a significant number of Hill Crest patients are within the custody of the DHR
of their local county and therefore Hill Crest is required to communicate primarily with the legally

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 recognized guardian. It is then the primary responsibility of the guardian to communicate information to
the parents or other family members of minor patients. Notwithstanding these obligations and to
further the healing process, Hill Crest makes good faith efforts to facilitate communications between
minor patients and their parents wherever appropriate. These efforts include proactively updating
parents on significant treatment milestones and events affecting their child’s care and extending
invitations to participate in counseling sessions and school events. In these situations, we work closely
with the legal guardian to determine the appropriate scope of communication and interaction based on
the patient’s family history, diagnosis and treatment plan. In each patient case queried, we confirm that
contact was made with the patient’s family or legal guardian.
Integrity of Medical Records
As per hospital policy, Hill Crest strictly prohibits any employee from falsifying medical records. During
orientation, each employee receives training in and attests to their understanding of the Code of
Conduct and has an obligation to report any such activity to our local compliance officer, UHS’ Corporate
Compliance Officer, and/or they can make anonymous reports on the toll free UHS Compliance Line.
Also, it is the responsibility of each employee to use their professional judgment in ensuring their
documentation is accurate and reflects the services they provided to the best of their knowledge.
March 2016 CMS Survey
The survey found the facility to be in substantial compliance with all Medicare/Medicaid conditions of
participation. The standard-level issues that were mentioned in the report were remedied without the
need for follow-up visit by CMS.
Medication Administration
Hill Crest follows long established evidence-based behavioral health clinical practices and we constantly
endeavor to provide care in the least restrictive setting possible. All medications administered at Hill
Crest are done so under the specific order of a licensed, experienced psychiatrist. As part of the
treatment program/protocol, a patient may be prescribed medications consistent with their admission
presentation, particularly when they are deemed to be a danger to themselves or others. Consistent
with Alabama regulations and clinical best practices, it is Hill Crest policy to avoid chemical restraints.
However, when a patient presents as an imminent danger to themselves or others, our approach is to
always offer a patient an oral medication first. Hill Crest wholeheartedly rejects any allegations that it
inappropriately administers medicines for any non-clinically justified purpose and it has never received a
citation alleging or revealing such conduct.
Employee Education & Training
Hill Crest prides itself on being an employer of choice in the Birmingham community and providing
rewarding and challenging career opportunities. We utilize thorough hiring standards to ensure that
only appropriate and qualified candidates are hired, notwithstanding the well-documented shortage of
mental health workers in Alabama and across the entire behavioral health industry. All offers of
employment are contingent upon successful completion of a comprehensive background check to
include criminal history, education verification, professional license verification (if required), prior
employment references, sexual offenders and predator registries as administered by ABI/FBI, Alabama
Department of Human Resources, and other third party agencies. Hill Crest disputes the false
characterization that our hiring standards and training programs are deficient and we have never been
cited by any regulatory or accreditation body for hiring or training related shortcomings.

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 Upon hire and successful completion of all background checks, new employees receive 40 hours of initial
training utilizing a best practice curriculum. The training includes classes covering relevant topics such as
HIPAA, Confidentiality, Behavior Management, Therapeutic Communication, Facility Policies and
Procedures, Service Excellence, Age Specific Training along with Non-Violent Crisis Intervention and
Verbal De-Escalation.
The CPI developed Non-Violent Crisis Intervention is an 8-10 hour course and consists of lecture, film,
written material, role-play and physical skill demonstrations. The emphasis is on preventative measures
such as early recognition of agitation, avoiding power struggles, and verbal de-escalation because
physical interventions should be the last resort. CPI recommends teaching from their workbook that
follows their film for consistency and continuity of the information in the course. Students may refer to
this workbook during exams. No clinical care employee goes to a patient care unit without completing
all elements of new employee orientation, including proper restraint techniques. Specifically, employees
demonstrate their ability to place the Trainer in a two-man hold to show their understanding of the
appropriate physical management technique. If they are unable to successfully accomplish this task,
they receive additional training until proficiency is achieved.
Apart from the CPI Non-Violent Crisis Intervention course, all competency tests are administered at a
computer terminal. As is common in many types of professional and job training settings, employees are
permitted to repeat a test if they do not attain the minimal passing score of 90%. If a question is missed,
the testing software highlights the incorrect answer in red then explains why it is incorrect. If the Trainer
notices that the employee does not fully understand why the answer is not correct, he intervenes to add
clarity prior to the test being retaken.
When first beginning on the patient care units and still on orientation, all new employees receive
continuing supervision and training by a staff mentor, typically a senior Mental Health Tech or Lead. This
mentor demonstrates skills and offers support and encouragement to the new employee who is
encouraged to ask questions and ask for help or further instruction at any time. A Nursing supervisor is
also available for support on each shift. Mentoring occurs throughout the duration of employment.
It is not uncommon or surprising that some new staff may not feel immediately comfortable or
confident performing physical interventions and Hill Crest is certainly sensitive to such concerns when
they initially begin their duties. It is for this reason that trainers and supervising mentors routinely clarify
to new employees that like many newly acquired professional skills, long term confidence requires an
ongoing learning process beyond the initial proficiency stage demonstrated during the class. These
techniques and skills take time to master and that is precisely why all new employees work with
experienced mentors. Physical interventions are understandably emotional and intense for all parties
involved and therefore are used as a last resort but are nevertheless necessary to ensure the safety of
our patients and staff. Hill Crest also maintains a consistent policy of Open-door Training whereby any
staff member can request additional training at any time for any reason.
Job requirements for Mental Health Techs (MHT)
Qualifications for MHTs are as follows:
 Minimum of High School diploma or equivalent
 One year of experience in a psychiatric setting / patient care preferred
 Experience leading basic group or Master Treatment Plan preferred
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Good communication skills, i.e., reading, writing, and speaking
Ability to follow both written and verbal instructions
Strong leadership qualities which includes self-control, patience, and empathy

These requirements are consistent with or in many cases more rigorous than comparable facilities
treating similar patient populations. Many of our MHTs join us with significant health care industry
and/or educational experience and over 1/3 of Hill Crest MHTs hold a degree above high school diploma
or equivalent. Hill Crest offers incentives and educational assistance for employees to advance their
education.
Staffing Levels
Staffing is maintained at appropriate levels consistent with state and federal rules governing the levels
of care at Hill Crest. Staffing is evaluated daily and adjusted to accommodate patients’ needs and acuity.
It is important to note that there have been no deficiencies cited by any regulatory agency related to
staffing.
Regulatory Agencies and Accreditation Organization Oversight
Federal and state regulatory agencies regularly complete comprehensive site visits to ensure adherence
to various standards and conditions of participation in government insurance programs such as
Medicare and Medicaid. These site visits include, but are not limited to, reviewing current and historic
performance data, medical records reviews, facility inspections, patient interviews, employee
interviews, staffing sufficiency, etc. Regulators can make unannounced visits with or without cause at
any time of their choosing. We reject as baseless the accusation that we increase staffing or performing
extra cleaning before inspections since we do not know when surveys will occur. TJC accredits facilities
on a triennial basis and the process includes an unannounced site visit and detailed reviews of
processes, procedures and clinical practices.
Hill Crest fully cooperates with all regulatory agencies and accreditation organizations’ activities. We
view every survey inspection as an opportunity to continually benchmark and enhance our operations.
Below is a summary of recent surveys and accreditation visits:
a. Alabama DHR conducted a regular site visit on November 15-16, 2016 to monitor contract
compliance and provide technical assistance for the following contracts: RTC, Phoenix, RISE, CTeam, Higdon Hill.
b. Alabama DHR conducted survey on March 2, 2017 of Higdon Hill Croup Home and RISE, Phase II
to renew licenses to operate programs through March 30, 2019.
c. Alabama DMH conducted a site visit to certify the following programs at Hill Crest:
 Administrative Services through June 30, 2019
 Quality Assurance through June 30, 2018
 Mental Illness Program Staff through June 30, 2019
 Governing Body through June 30, 2019
 Child and Adolescent Restraint/Seclusion Center Wide through June 30, 2019
o Community Residential Facility (MI), Seventy Nine (79) Residents
 Rehab Intervention Service Enrichment (RISE) Program CRF through June 30, 2019
o Community Residential Facility (MI), Fourteen (14) Residents
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Child and Adolescent CRF through June 30, 2019
o Community Residential Facility (MI), Seventy Nine (79) Residents

d. Hill Crest is due for survey by TJC no later than March 2018.
Facility Maintenance
Any issues identified are promptly addressed. Hill Crest has contracted pest control with scheduled
weekly visits. Leadership conducts visual environmental rounds daily to identify maintenance needs
and they are addressed immediately.
Patient Personal Care, Hygiene and Nutrition
Upon admission, some patients arrive with little clothing, personal hygiene products, etc. In those
instances, Hill Crest provides them for patients. In the event an employee purchased items for
patients independently, it was not done out of a lack of resource available from Hill Crest. Hill Crest
maintains a central supply of personal hygiene products to meet the needs within the hospital.
Employees that choose to purchase items for patients have the ability to seek reimbursement if they
alert their supervisor and provide appropriate documentation. A Registered Dietician reviews and
approves the facility’s meal plans in conjunction with the Director of Dietary Services. Healthy meals
and snacks are provided to patients daily for the duration of their treatment at Hill Crest. Special
diets that include additional meals and snacks are provided at the recommendation of the dietician
and order of a physician.

In summary, BuzzFeed’s line of questioning relies upon a limited number of isolated, cherry-picked,
non-representative, and in some cases wholly inaccurate accounts while ignoring Hill Crest’s overall
80+ year record of quality care, compliance and patient satisfaction. It also fails to provide any
meaningful context regarding the complexities and challenges of the overall behavioral healthcare
and residential treatment delivery system.

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