Treatment and Recovery Center nurses call for new leadership, policies to improve safety, patient care

Five licensed nurses who’ve worked at the Douglas County Treatment and Recovery Center are speaking out after recent injuries and security breaches — including one involving a loaded gun — have increased their fears for the safety of staff and patients.

A group of current and former staff at the Douglas County Treatment and Recovery Center are demanding reform at the 24/7 facility, which opened 15 months ago.

The five licensed nurses interviewed for this story said a lack of leadership and inconsistent policies and procedures have plagued the TRC since the beginning, but recent injuries and increased fears for the safety of staff members and patients have led them to amplify their voices and share their concerns with news media.

Some of the nurses interviewed were hired before the TRC’s phased opening began in April 2023; all were employed by the opening of the center’s observation and stabilization units in May 2023. They’ve requested anonymity and the use of pseudonyms because they have fears about possible repercussions for speaking out. Former employees said they felt either “forced out” of their jobs or were suspicious about the reasons given for termination.

Documents and audio recordings provided to the Times show TRC nurses and behavioral health services staff members pleading for reform with management for months. Staff direct the bulk of their concerns to Stephen O’Neill, chief operations and strategy officer for Bert Nash Community Mental Health Center, which operates the TRC, and Bri Harmon-Moore, director of the TRC since September, while simultaneously calling for the replacement of the TRC’s medical director, Dr. Cord Huston.

When Dr. George Thompson resigned as executive director and medical director in November 2022, Huston was named interim medical director at the TRC with backup support from Dr. Nana Dadson, chief medical officer for Bert Nash. Huston has since dropped the interim title. Huston’s title on Bert Nash’s website lists him as medical director of crisis services. In addition, Huston has been employed as medical director of Valeo Behavioral Healthcare in Topeka since Sept. 29, 2016, according to Sara Weaver, human resources director for Valeo.

Safety, the absence of consistent policies, patient care, a lack of effective leadership, acuity and nurse-to-patient ratios were concerns nurses brought up repeatedly during interviews and in communication about management practices, according to documentation provided to the Times.

“Nurses are patient advocates,” Clara, one of the nurses, said. “It is our responsibility to address anything concerning patient safety and wellness, and we are not taken seriously.”

‘More patients means more money’

The nurses characterized Huston’s work behavior as unpredictable with a micromanagement style. They said Huston won’t give qualified, capable staff autonomy and instead insists on making decisions but isn’t always reachable even when he’s the on-call provider. Internal incident reports allege multiple staff members made repeated attempts to reach Huston while on call — one showed 19 attempts via Microsoft Teams, another a dozen.

Clara and Edith, also a nurse, said Huston could also be unkind at times. Clara said she’d heard Huston refer to TRC nurses as “C+ at best,” while Edith said Huston had asked her during a slow workday if she knew any “psychotic people” she could bring into the TRC from Mass Street.

“More patients means more money,” Edith said.

When asked if she reported the alleged incident, Edith said she didn’t report it to management but had mentioned it to some of her coworkers after it happened.

“I didn’t report it I think because it took me a while to realize the gravity of what he said, but also because I was tired of reporting things and nothing being taken seriously I was saying,” Edith said in an email. “And knowing so many other staff have reported him for months and nothing ever came of it. I honestly think it came down to I didn’t want to waste more of my time.”

The Times emailed on Monday a list of questions about this article to Jeff Burkhead, communications manager for Bert Nash. Huston, Harmon-Moore and O’Neill were also copied. Burkhead responded via email Wednesday morning.

In response to TRC nurses’ calling for Huston’s replacement, Burkhead wrote, “Our policy is to respect the privacy and confidentiality of current and former team members, aligning with standard industry practices by refraining from public comment on such matters.”

‘These safeguards are not in place’

When community members gathered for a ribbon-cutting ceremony in June 2022 at the TRC, 1000 W. Second St., they celebrated years’ worth of efforts to launch the first center of its kind in Kansas. Douglas County voters approved a quarter-cent sales tax in 2018 to help fund the center, which had been touted as an alternative to expansion of the Douglas County jail. It would be 10 more months before the TRC would fully open.

Meanwhile, staff worked behind the scenes, and administrators cleared licensing hurdles and other punch-list items. Services that would eventually be handled through the stabilization and observation units continued through LMH Health, Bert Nash and across Douglas County via the mobile crisis response team and other organizations. The TRC also operates an Urgent Care Unit open to anyone in need, adults and children alike. It offers clients the opportunity to participate in an initial assessment to determine whether treatment and further evaluation are recommended.

Today, the nurses question how administrators could’ve overlooked crucial patient needs when numerous delays gave them additional time to prepare.

For example, when the TRC opened in 2023, diabetic patients had no access to sugar-free solid snacks, according to Suzy, a nurse. And 15 months later, the TRC still doesn’t have a system to scan patient bracelets for dispensing medication accurately, the nurses said.

“There have been many medication errors at the TRC and the purpose of scanning medication is to avoid these errors,” Edith said. “These safeguards are not in place.”

“We are a crisis center that deal with suicidal patients, why don’t we have suicide blankets?” Suzy asked. She estimated it had been at least three months since employees had suggested to management that the center provide paper-like blankets that can’t be bound together.

Burkhead addressed those concerns in his response, saying the TRC was “committed to accommodating the dietary needs of all our patients.”

“We adhere to the state of Kansas best practices for suicide precautions, which includes allowing safe comfort items for patients,” he wrote. “Also, we use electronic patient medication administration records to ensure the accurate dispensing of medications, verifying the correct patient and medication in the patient’s presence.”

Lisa, also a nurse, said the TRC leaves much room for improvement in patient safety and comfort. Recently, nurses alleged, the facility has had mold in its ice machine, and patients have not had access to hot water for warm showers.

“That is just horrible,” Lisa said. “That’s mean, that’s torturous to only have cold water for patients to shower in.” She said she wouldn’t recommend the facility to her friends if they were in crisis.

“I would refer them somewhere in Kansas City, to their regular doctor, or somewhere else besides that place.”

Burkhead disputed the nurses’ accounts.

“As of mid-June, the TRC is currently operating with one functional water heater,” Burkhead said. “Despite this, no patients have been or are without hot water, as the system is still able to maintain 108-degree water circulation. The second heater is awaiting repairs due to a required blower assembly that is delayed by 4-6 weeks from the manufacturer.”

The nurses stuck to their original claims during a follow-up interview Wednesday morning via text messaging.

“They’ve absolutely been without hot water,” Edith said.

Lisa said she’d felt the water herself.

“Ice cold,” she said.

‘We have no voice at the table’

An April 2023 operating agreement between the Douglas County Commission and Bert Nash shows the center’s observation and stabilization units began serving up to 10 patients in Phase 1 and were projected to reach a capacity of 24 patients by October 2023 during Phase 4. On Wednesday, Burkhead said the facility’s current capacity was 16.

The observation and stabilization units serve adults experiencing mental health, addiction and chemical use crises. Patients can stay up to 23 hours in the observation unit and 72 hours in the stabilization unit before being discharged or referred to another facility. Burkhead said since the facility’s opening in April 2023 through the end of June, the TRC had provided services to 1,730 distinct individuals.

“Of these, nearly 600 (specifically 599) individuals have experienced more than one crisis episode, indicating repeated needs for intervention,” Burkhead said. “Additionally, 328 individuals have required readmission for observation and/or stabilization, which means they have had multiple admissions since May of the previous year.”

Acuity, according to the nurses interviewed, should be considered when deciding how many patients the center admits. Clara described high acuity patients as those who require higher levels of care. She provided a few examples: patients who’ve attempted suicide or are at high-risk for suicide; those who have been admitted involuntarily; those at risk of having seizures, including those who are detoxing; patients experiencing psychosis; and those who’ve exhibited violent behaviors currently or in the past.

“We have no voice at the table, when it comes to whatever they’re doing,” Clara said, referring to management decisions on whether to admit certain patients or cap the census, which means to stop admissions. “They don’t get it. They don’t get patient ratios and safety and acuity.”

Suzy said she was told by management during the TRC’s infancy that she’d never be assigned to more than six patients at a time.

In reality, according to the nurses, nurse-to-patient ratios constantly flux. Suzy said as many as eight patients have been assigned to charge nurses at the direction of Huston. She called that practice “unheard of” and said “The charge nurse should not be taking any patients.”

“There have been times where nurses have felt like they’ve had no choice and they’ve taken nine or 10 patients. I have been very adamant and I will not take more than eight,” Suzy said.

“You can’t take care of a patient in active psychosis and have seven others and do a good job. You can’t do it.”

Recently, a high-acuity patient required at least six employees to help restrain them, Emma said. She said multiple employees were injured as a result of what she described as “an unsafe situation.” She said it highlighted the importance for management to consider acuity and to cap the census when the TRC was understaffed or overwhelmed and to listen to its nurses.

“There was no reason,” Emma said, referring to the patient’s admittance at the TRC rather than the emergency room at LMH Health. “We have another facility right across the street in the city of Lawrence where people who are in a mental health crisis are safe to go.”

Burkhead said in his response the TRC maintains “a commitment to assessing all patients for treatment and admitting all patients excepting those who have a medical concern that cannot be effectively treated by the team at the TRC.”

“All are accepted and cared for through stabilization of their crisis or until we arrange for them to go to the next right place for their care needs,” Burkhead said, adding that this was a requirement of the facility’s agreements with Douglas County and Kansas Department of Aging and Disability Services.

Additionally, Burkhead said, the facility “adheres to the SAMHSA (Substance Abuse and Mental Health Administration) National Guidelines for Behavioral Health Crisis Care Best Practice Toolkit in determining our staffing ratios. Our nursing staff maintains a ratio of 1:8, while our Behavioral Health Services (BHS) staff operates at a 1:4 ratio.”

Burkhead said that includes provisions for at least one patient requiring 1:1 intervention.

“We have consistently upheld these ratios,” Burkhead wrote. “This does not account for the many other team members in the building such as therapists, unit coordinators, nurse practitioners, case managers and managers. It is not unusual for the total number of staff in the TRC to be more than the number of patients being treated.”

In addition, Burkhead said, the facility’s “Census is monitored and has been routinely capped to account for concerns around acuity. This has included holding on transfers from other facilities and diverting new patients to other facilities after they have been assessed for treatment.”

‘Really excited about the TRC’

Emma said she began her job there “really, really excited about the TRC and about the possibilities,” but has since grown frustrated. She said the delays in getting the TRC up and running should’ve provided ample time to create adequate policies and procedures. Emma said there’s a website through Bert Nash that outlines policies and procedures, including some for the TRC.

“Just not as many as there needs to be and they’re not … nobody who actually knows how to do what the policies are governing was consulted on the policies. They’re there, but a lot of time, they make zero sense or they’re not followed anyway,” Emma said.

She cited repeated problems with patients’ belongings being lost and patients or visitors bringing contraband into the unit — including a loaded gun with the safety in the off position, a knife, razor blades and medications. Rather than setting a policy and displaying it in a notebook or on a website, Emma said, multiple emails might transpire. If there was ever a place to compile those policies, Emma said, she’s never seen it.

“When somebody needs to know the answer to the policy, they don’t have time to go back and read the last 14 emails that you sent for updates,” Emma said. “As far as I know, there was never a place for that kind of stuff, compiled into a neat, official policy and procedure that you’d see at any level of organization.”

Burkhead said before the TRC opened all policies and procedures underwent review and approval by the state and county as part of the center’s licensing and contracts. He said all policies are accessible to employees 24/7 via an electronic policy management platform and have since been reviewed by the state for ongoing licensure approval and the Commission on Accreditation of Rehabilitation Facilities during accreditation review in November 2023.

“Whenever policies are updated or revised, we communicate these changes to our staff through all-staff meetings and emails. All updated policies are also available on our electronic policy management platform, available to all team members,” Burkhead wrote.

As for the loaded gun — which nurses said was in a patient’s bag during their meeting with a therapist and then made it all the way to the nurses’ station — they believe that wouldn’t have happened if policies and procedures were followed with consistency.

“The wand, if isn’t used correctly doesn’t pick up all objects,” Suzy said via text message.

Suzy said when nurses asked for large metal detectors, they were told that type of intervention wasn’t therapeutic. She said employees should require patients to place their belongings in a locker in the lobby and ask them if they have any weapons, but those procedures haven’t always been followed consistently.

Burkhead said about the incident, “safety is our utmost priority” and “we ensure it through handheld security wands by our team members and security personnel to detect metal objects.”

“We also provide ongoing training for both current and new team members to maintain our high safety standards. The incident referenced from December 2023 was managed appropriately and the object did not make it onto the unit. The contraband was inventoried and secured after the discovery. Following any incident, staff debrief and are offered After Incident Reviews to support their ability to process and learn from any situations.”

‘Feedbacked me into oblivion’

Nurses and behavioral health services staff attended a June 5 meeting led by O’Neill, Bert Nash’s chief operations and strategy officer, and Harmon-Moore, the TRC director. An audio recording of the approximately 45-minute meeting, one of two sessions, revealed staff members voicing concerns about leadership structure, safety and pay equity at the TRC.

Amid a recent personnel change in nursing management at the center, staff members urged O’Neill and Harmon-Moore to hire “one strong leader.” They asked O’Neill and Harmon-Moore to abandon their proposal to hire separate day and night shift nursing managers and insisted they “need a manager who is going to show up for both shifts and hold everybody to the same level of accountability.”

In response to similar concerns shared by staff at an earlier feedback session, O’Neill told staff the job posting for day or night shift nursing managers would be pulled.

“We don’t need to rush into that. I heard loud and clear, very compelling reasons why that was a bad idea,” O’Neill told staff members.

Earlier in the meeting, a nurse with more than a year of experience at the TRC told O’Neill she’d heard from a recent hire with the same qualifications that the new hire had started at a higher wage than her current pay. O’Neill told staff he would have a discussion with Harmon-Moore after the meeting and individual meetings could be set up later to discuss compensation.

When another nurse started to explain she had already met with O’Neill, she was interrupted by him.

“And I hear that you want swift action. I hear. I hear you, (nurse’s name),” O’Neill said. “Frankly, I feel like you’re beating a dead horse, like you have feedbacked me into oblivion, I get it. Like, things need to change. I hear you. Like, I hear you. And I’m here, and I want to listen. And we will, and I will sit with each of you individually and explore these things. Again, we made a management change, like we’re moving quickly, as quickly as we can.”

Later in the meeting when a staff member expressed frustration toward O’Neill for telling the colleague they have “feedbacked you to death about something,” O’Neill apologized.

“I’m sorry that that was condescending, but I am a human being too,” O’Neill said. “And I can only process, like I get it. I understand that mistakes have been made. I understand that leadership has been poor. I apologize. I’m sorry. I’m frustrated, too, not with any of you. I’m frustrated with the situation.”

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When asked if Bert Nash’s representatives had anything to add regarding O’Neill’s exchanges with those employees, Burkhead provided this response: “We are committed to open dialogue and actively encourage discussions about workplace issues and challenges. We provided and continue to provide various opportunities for staff to engage with leadership and express their concerns, including focus groups, one-on-one meetings, and surveys.”

At the meeting, O’Neill asked Harmon-Moore to follow up with staff “on when they can expect to have a conversation,” adding inaccurate information about compensation had been shared in emails he’d received from staff. O’Neill also said Bert Nash employees don’t receive automatic annual raises.

“So, our compensation is tied to our Medicaid Cost Report,” O’Neill said. “Because, our revenue, that’s the only time our revenue changes materially, right?”

O’Neill ended the meeting by thanking employees for their feedback. Burkhead said compensation meetings were offered spanning three days the week of June 17.

“We provided 17 slots, of which seven were scheduled,” Burkhead said. “Additional meeting options were tailored based on individual needs and included opportunities to discuss compensation or other concerns, facilitated through direct outreach to our Senior Director of Human Resources. Jesse Belt, RN, conducted one-on-one meetings with each nurse, and we hosted focus groups throughout June. In addition, the TRC team members had and have access daily to leadership.”

‘I have never worked … where nurses report to a therapist’

Edith and Clara said typical management structures over licensed nurses at a medical facility like the TRC include a chief nursing officer at the top.

“Down from there, organizationally speaking is the director of nursing, and then under there is a nurse manager, and then you have your charge nurses,” Clara said.

Nurses said they’ve questioned why Harmon-Moore oversees nurses at the center. Before being named director of the TRC in September, Harmon-Moore was a TRC program manager and has been employed there since September 2022, according to a Bert Nash news release.

Behavioral Science Regulatory Board records show Harmon-Moore holds a permanent license in Kansas as a licensed specialist clinical social worker.

“I have never worked or heard of any job where nurses report to a therapist,” Edith said.

Clara described Harmon-Moore as “absolutely qualified to do her job overseeing therapy, social work, that aspect within the organization. Do I think she’s qualified to manage nurses? Absolutely not.”

Clara said she and her colleagues have urged TRC management to hire a chief nursing officer at the executive level and to do so long before more nurses are needed when a new treatment facility for youth is expected to open. That goal is set for 2026, according to a news release from Bert Nash.

Burkhead reiterated in his emailed response that Harmon-Moore is the administrative director for the TRC and oversees all operations and services. He said Huston and nursing managers provide medical leadership. TRC leaders, Burkhead said, have plans to add a nursing director to the staff this year. In the meantime, Belt is providing nursing supervision.

“This included meeting with each nurse individually and in small groups. We have also surveyed the nursing team to get their guidance and feedback regarding key issues with operations, particularly nursing leadership and nursing practice,” Burkhead said.

In response to a question asking how many nurses would be employed in 2026 when the youth and adult treatment centers were open, Burkhead said the staffing model for the Youth Recovery Center, or YRC, was still under development.

Currently, Burkhead said, the TRC employees 97 people. Of that number, 23 are nurses, and there are three openings for registered nurses/licensed practical nurses; 36 are behavioral health specialists, and of those there are eight open positions.

Find out what’s really going on in your town. Read The Lawrence Times.

Tricia Masenthin (she/her), equity reporter, can be reached at tmasenthin (at) lawrencekstimes (dot) com. Read more of her work for the Times here. Check out her staff bio here.

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