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Prison contractor falsified records to conceal inadequate addiction treatment, sources say

Christina Jedra
The News Journal

Maranda Cekmecelioglu really could have benefited from some therapy.

The 28-year-old was sent to prison on drug-related charges and had just lost her father and brother within 11 months in 2017. The court ordered counseling for her through Crest, a taxpayer-funded program designed to help drug offenders with addiction and behavioral health issues.

But Cekmecelioglu, who goes by “Cek,” said she didn’t get any help at Crest South, which is run by Connections Community Support Programs in Georgetown.

Documents Cek shared with The News Journal indicate she received two treatment plans, and presumably counseling, on November 28 and December 28.

But the records are a lie, Cek said. In over three months there, Cek said she didn't get any one-on-one counseling. She said she received both treatment plans in January 2018 right before she was discharged. The plans, Cek said, were made up and backdated.

"I never had any actual formal counseling," she said. "It was just like: How are you? This is your treatment plan. I need you to sign these papers."

Cek is not alone.

A News Journal investigation found Connections has failed to provide adequate addiction treatment for female inmates at Crest South.

The investigation, based on interviews with 22 former employees and program participants as well as email conversations, also found that in dozens of cases, the program falsified patient records.

Former Crest South inmate Maranda Cekmecelioglu claims she received no counseling while in the program and her counseling records were falsified by Connections employees.

This occurred in an environment in which Connections wrote its own quality standards and audited itself. The public does not have access to those audits. 

Four former Connections employees at Crest South told The News Journal they have direct knowledge that counselors fabricated notes of therapy sessions that never occurred, made up vague treatment plans to correspond with them and backdated records to appear as if Connections was providing monthly counseling.

Three former employees also said Connections counselors inflated the length of counseling sessions in patient records (10 minutes could become 45 on paper, one source said).

“I don’t think we need a Ph.D. in moral philosophy for this one,” said Dominic Sisti, assistant professor of medical ethics and health policy at the University of Pennsylvania. “This is obvious fraud if the allegations prove to be true.”

'A program that didn't happen'

The need for quality addiction treatment in Delaware is greater than ever.

Last year, Delaware hit the highest death toll for drug overdoses it has seen since it began tracking them: 400 people. A report commissioned by the attorney general's office estimated there are over 11,000 Delawareans who have a substance use disorder.

And 46 percent of Delaware prisoners – roughly 6,300 people – struggle with substance use, according to a report by the Pew Charitable Trusts.

Connections, which receives more than $15 million a year for its mental health and substance abuse services for Delaware inmates, disputes the claims of record falsification. The organization said it is not required to provide monthly counseling sessions but strived to do so anyway.

“We did investigate these claims as they’ve come to us and until this moment, we haven’t found any evidence to suggest that is happening," said Connections Chief Psychologist Robin Belcher-Timme.

Shannon Lasek, a former substance abuse counselor at Crest South, said she knows firsthand that Connections falsified records because she did it herself.

In November 2018, she said her bosses explicitly instructed her to “catch up” the empty files of inmates who were about to be released from the program and hadn’t received treatment. Over several interviews, Lasek described making up and backdating at least 30 fake counseling sessions and generic treatment plans for inmates, some of whom she'd never spoken to. 

Lasek said she quit in mid-December because she couldn’t do it anymore.

“I had to pretty much create a program that didn’t happen,” Lasek said.

Former substance abuse counselor at Crest South Shannon Lasek stands for a portrait Thursday, April 25, 2019. Lasek said she quit working for Connections in December 2018 after her bosses instructed her to falsify inmate counseling records.

Following a scathing resignation letter from Lasek in December, Connections investigated its files for signs of record falsification and said it found “no evidence” that it occurred. The Department of Correction examined only electronic records, not the paper ones that Lasek said were faked, and found “nothing special."

The DOC recently launched a deeper investigation after Lasek contacted politicians and The News Journal with her story.

In its program manual, Connections claims it provides monthly one-on-one counseling and individual treatment plans for all substance abuse clients in the Crest program.

“That will involve the counselor and the client sitting down together to review their last treatment plan to talk about any current issues or concerns, to talk about things they’ve accomplished and figure out a plan like, where do we go from here?” said Crest South Director Gail Reid.

The DOC’s chief of healthcare services said the state expects them to deliver that service at least monthly.

But emails obtained by The News Journal between a former employee and the employee’s superiors show the program was struggling with a months-long backlog. In one email, the supervisor directs the subordinate to create a treatment plan for a patient over a month after it was supposed to be completed. The News Journal is not publishing the emails to protect the source who fears retaliation.

In separate interviews over several weeks, 12 former inmates who completed the program in the last four years said they did not receive any individual counseling whatsoever. Three others recalled having one session, and two others remembered having multiple sessions — but all of them said those sessions lasted about 10 minutes or less. 

Of those 17 people, five said counselors gave them backdated, cookie cutter treatment plans and instructed the clients to sign them. Many referred to the program as “a joke.”

One former client, Brandi Killinger, recalled receiving treatment plans throughout the program last year with dates on them from weeks prior: an October treatment plan in November, a November treatment plan in December and a December treatment plan the week before she was released that month.

An employee wrote them without ever speaking with her one on one, Killinger said.

“Not one time did I get to sit down with a counselor and talk to them,” she said. “They tried to say my anxiety was the reason for my drug use and the reason I was in jail. It’s definitely not. There was no session. Just: Here you go.”

Kenyanna Suarez said she received only one treatment plan over nearly four months in the program. During her last few days, Suarez said the program supervisor, Carolyn Seaton-Scott, asked her to sign several treatment plans she’d never seen before. There was “a date for each month,” she said.

“She didn’t have my signature for a couple of dates for my treatment plan, and if I didn’t sign them, I wasn’t going to be completed,” Suarez said, meaning she wouldn’t be able to go home.

Connections CSP's own program manual says "DON'T back date" and that client records are "legal" documents. (Highlighted by News Journal)

Lasek said she falsified records at the direction of Supervisor Seaton-Scott and Director Reid.

“I was supposed to create a counseling session with people from three months ago, two months ago and a month ago that I never had any conversation with,” she said. “And (Seaton-Scott) said: Just read the past notes. Talk to them in group (therapy) or pull them aside after group to get information to fill in.”

She added: “(Seaton-Scott) made it very clear that if I didn’t do it, I wasn’t going to have a job. I valued my job. So I did it.”

Reid denies Lasek’s claims. When a reporter called Seaton-Scott’s direct line for comment, a woman who answered said, “You’ve reached her, but you’re not going to speak with her,” before hanging up. Frances Marti, Connections' director of behavioral health, said on Seaton-Scott’s behalf that she denies Lasek’s allegations.

“She said she did ask staff to catch up the charts that were not in compliance, however that term ‘catching up’ seems to have been misunderstood,” Marti said.

Until this week, the DOC hadn't called Lasek to ask which patients' records she says she falsified. The agency did call after a reporter asked about the lack of communication. Lasek said Connections still hasn't called her at all. 

Why not?

“I don't know,” Connections' Belcher-Timme said. “It’s a good question.”

'Not a treatment program,' clients say

As Delaware’s addiction crisis has grown, so has Connections. It is far and away the largest behavioral health provider in the state. 

Since July 2012, Connections has run all mental health and substance use treatment for the Delaware corrections department. In 2014, the organization signed another contract to provide physical health services for state correctional facilities.

Cathy McKay, CEO of Connections, photographed in March 2017.

Under the leadership of CEO Catherine McKay, the nonprofit has become a healthcare empire that earned over $72 million in state contracting jobs last year, according to the state finance department. In its most recent fiscal year, Connections brought in over $124 million before expenses, according to its latest tax filings.

McKay did not respond to multiple requests for comment for this story, but her organization said it is helping to treat addiction in Delaware.

“What we know is recovery looks different for every single person and there are a lot of unique factors that go into human behavior, addiction and recovery,” Belcher-Timme said. “And so we have to take a very tailored and individualized approach.”

Connections’ last formal mental health and substance abuse contract was valid through June 2016. Instead of going through a bidding process after the contract ended, the state opted to extend the agreement and has done so every year since. The corrections department is signing on for another year of these services through mid-2020.

Asked if the allegations of record falsification make the state hesitant to renew an extension, DOC Healthcare Services Chief Marc Richman said: “Absolutely not.”

“We’re going to continue to monitor the contract and learn from whatever we learn from the investigation,” he said.

The Crest program was designed as a residential treatment and work release program. Clients are court-ordered or otherwise classified to be there, according to Connections. Crest South is supposed to be a “therapeutic community” on the Sussex Community Corrections Center campus.

Program graduates said it was anything but therapeutic.

One former client, Beckie Steiner, said she received no individual counseling and was given a bogus treatment plan within days of her discharge last December.

She said her counselor, Lasek, asked her to sign it to certify she’d received one-on-one counseling weeks earlier, but she hadn’t. Steiner said she had to sign the paperwork twice because she didn’t backdate it the first time.

“This is not a treatment program,” Steiner said. “I’ve seen people come out and overdose. I want to see these people get the help they need.”

Sussex Correctional Institution in Georgetown, Del.

Female client access to Crest South counselors is limited because the women are locked in a part of the building away from counselors’ offices, multiple sources said. Counselors are more accessible to male clients who are able to walk into their offices, the sources said. 

Chelsea Sample said she arrived at Crest South in the summer of 2017. She said she attended one session with a counselor for less than 10 minutes. During her last week, though, she said she signed two treatment plans she’d never seen before.

“I didn’t say much because I was in a rush to go home," she said. "They pretty much told me that I had to sign them. It was a requirement. I had to sign them in order to leave.”

Many former participants interviewed by The News Journal said Crest South — often the last stop for inmates before they return to the outside world — does more harm than good.  

Kaylin Murray said she was emotionally vulnerable when she was at Crest South in the summer of 2016. One day, she got the news that she was losing custody of her daughter, she said. She was walking down the hallway with mascara-blackened tears streaming down her cheeks when she saw a counselor.

“I’ll never forget it," she said. “I said to my counselor, ‘Can I please speak to you?’ She was walking down the hallway and said, ‘Not right now, I’m busy.’”

Murray said she had individual counseling sessions every couple weeks that lasted "two to three minutes" each but didn't recall seeing a treatment plan until she was about to leave. She said the overall lack of support is damaging to patient recovery.

“When people are in programs and they don’t get what they need out of it, nine times out of 10, what do they do? Leave and relapse. And that’s exactly what I did. I relapsed.”

The News Journal asked Connections multiple times for relapse data on its Crest South clients and did not receive a response. But former inmates said that anecdotally, the outcomes are bleak.

“There were probably about 30 of us that came out within a month and there are six of us that haven’t relapsed,” said Steiner, who left Crest South late last year.

Before entering Crest South, Cek went through Key, another substance abuse treatment program run by Connections often as a precursor to Crest. At Key, she said she did receive some counseling that she found helpful. Without that foundation, she believes the Crest South program could have led her to relapse.

“I’d probably still be on the street getting high,” she said. “It actually makes you backslide from all the treatment you got.”

Several former clients said they found real help at Connections’ Crest North program, which they described as stricter and more structured than its southern counterpart. There was actual counseling and updated, individual treatment plans, they said.  

“It made you think about what you’ve done to get here, what your addiction has done to your life,” said Jaimie O’Connor, who finished Crest South in early 2018. “Downstate, it was no longer like that and people were going back to their old ways, acting with addictive behaviors.”

Lindsay Fabiszak, who completed Crest South in July 2018, feels the same way.

“Crest North taught me how to live a better life,” she said. “Crest South took that all away.”

Crest South did hold group counseling sessions, but according to several sources, they were sometimes informally done “in the hallway” and run by the inmates themselves. Several former clients recalled listening to music and “talking about boys” during group therapy, which involved a repetitive and meaningless curriculum, according to former clients and counselors.  

“They send all these people to this program expecting results and they look at us, the offenders, like we don't try,” said former participant Brittany Seiders. “There needs to be some kind of reform in this program in order for anyone to succeed. There needs to be accountability for people who run it.”

The counselors: 'Made-up treatment'

Tajammal Taylor, who worked for Crest South in early 2018, said he knows that records were falsified during his employment, which predates the timeframe of Lasek’s allegations. Another counselor had fallen behind on her caseload, according to Taylor, and Supervisor Seaton-Scott instructed the counselor to fill in the gaps.

“Treatment plans had to be put in for these clients in order for them to leave, and they’d bullshit all the treatment plans,” Taylor said. “They didn’t even meet with the client.”

Former counselor Michelle Zwally, who worked at Crest South for nearly two years, alleges Seaton-Scott falsified records for clients, and directed others to do so, during “the whole entire time” of Zwally's employment. This included SOAP notes, an acronym for a healthcare documentation method: subjective, objective, assessment, and plan.

“She would make up SOAP notes stating she saw these people and met with these women and they’d come to me and say, ‘Counselor Zwally, Supervisor Seaton-Scott is supposed to be our counselor and we haven’t met with her,’” Zwally said. “I would pull their chart and there would be a made-up treatment SOAP note in there about having a session with these inmates.”

Lasek remembers being assigned to complete discharge paperwork for clients who hadn’t been seen individually since they arrived at Crest South months earlier. According to Lasek, Seaton-Scott gave her a flash drive with generic phrases to use for any client's treatment plan, such as “Come up with your triggers” or “Find ways to increase your support network and discuss with counselor.”

“Everything was ‘discuss with counselor,'” Lasek said. “No matter what the problem was, it was always ‘discuss with counselor.’”

At home, Lasek confided in her longtime partner, Tasha Eddy, who said Lasek returned from work "extremely stressed" and conflicted about the falsification she was being asked to do. Lasek once asked Eddy to remind her when the couple went on vacation out of state so that Lasek wouldn't backdate records to a time when she wasn't working, according to Eddy. 

"She had a moral struggle with all of it," Eddy said. 

Zwally said Seaton-Scott asked her to falsify records, but she refused.

“She just went and asked somebody else,” Zwally said. “These poor inmates aren’t getting any treatment they need.”

Sussex Correctional Institution in Georgetown, Del.

The length of counseling sessions was also exaggerated, Taylor said.

“Even if we spent five minutes with them, it’s going to be on there as 15 minutes,” he said. “A treatment plan session is supposed to be an hour.”

Connections officials said the organization has “no incentive” to overstate the length of counseling sessions but defended the idea of brief but effective therapy.

“We could have a really good session with someone with a serious mental illness and we might sit there for five minutes and have a really really good session,” Marti said. “The quality has nothing to do with the amount of time you’re spending with the patient.”

According to Sisti, the University of Pennsylvania expert, there is no such thing as a five-minute counseling session.

“Counseling sessions for five minutes are not counseling sessions. They’re greetings,” he said. “The idea you’re going to provide evidence-based talk therapy in five minutes is laughable.”

Edward Wilkowski, who worked at Crest South from June 2017 to March 2018, confirmed the length of counseling sessions was inflated in patient records. He said the caseload for counselors was “incredible” and that it was impossible to meet demands without sacrificing quality. What mattered was looking good at face value, he said, even if that didn’t reflect reality.

“Everything had to be the way it was supposed to be when it was submitted,” he said. “It’s like looking at a Porsche and saying, ‘Oh, I love it,’ and you lift up the hood and there’s no engine.”

Lack of oversight and standards

Connections’ mental health contract with the state says the corrections department will conduct quality assurance audits of its work.

But the agreement puts a major restriction on the state’s ability to watch what Connections is doing. It says that “under no circumstances shall DOC utilize data or information” that Connections has already covered in its reviews of itself.

When asked for copies of the audits the state has done, the DOC said none exist.

“If you’re looking for an independent audit report, no, we don't have that,” said DOC Healthcare Chief Richman. He said he didn't know why the state would agree to limit its own auditing operations.

Asked for copies of Connections’ self-audits, DOC refused, citing a “peer review” privilege.

So, Connections audits itself. And those audits are private.

“If that’s written into the contract with the state, that’s a red flag right there,” said state Sen. Brian Pettyjohn, a member of the Senate Corrections & Public Safety Committee. “When the state agrees they’re not going to audit, and they’re going to trust the fox to audit the henhouse, that’s not a good way to do business. That’s not a good way to give public confidence in what this outside agency is doing for the state of Delaware.”

Richman said the state allows Connections to audit itself because of a technological limitation. The state’s electronic system is "built around care, not quality assurance," he said. He also cited limited staffing as a restriction on the state being able to audit the organization that receives tens of millions of taxpayer dollars each year.

“We need to improve it,” he said. “I’m not denying we need to improve.”

In the meantime, DOC has “a ton of quality assurance activities that get at the care that Connections is doing,” according to Richman.

“We audit the audits,” he said. “That’s what we try to do.”

When the DOC contracts with a mental health contractor in the future, Richman said the self-auditing provision in the agreement may be reconsidered.

Marc Richman, Chief of the Bureau of Correctional Healthcare Services for the Delaware Department of Correction.

In addition to allowing Connections to audit itself, the DOC and Connections also tossed the quality assurance standards it agreed upon as part of its 2012 contract. The list of specific quality indicators was “abandoned” soon after the contract was signed, Connections and DOC officials said.

The DOC said it was replaced by a program manual written by Connections. The manual states each Crest resident is required to attend one individual counseling session every month. Connections said if it fails to provide those sessions to clients, it would only be violating its own internal standards, not its state contract.

One reason Crest South counselors may be falling behind that goal is chronic understaffing.

Crest South shares its Georgetown facility with Aftercare, Connections' outpatient treatment program. There were supposed to be eight counselors between the two programs in November 2017. But five positions were vacant, according to reports the DOC provided to The News Journal. At some point, Reid’s administrative assistant had to fill the role of a part-time counselor “to fulfill the needs of the site.”

A year later, in November 2018, the problem persisted. There were four vacancies between Crest South and Aftercare. One of the four filled positions was a weekend counselor. Lasek and one other counselor were assigned to Aftercare and weren't supposed to manage residential Crest clients. 

That left only one counselor to handle all group sessions and individual counseling for up to 90 clients. The secretary continued to act as a part-time counselor for group therapy.

In December 2018, Lasek left. Again, there were five vacancies.

A Connections representative said the nonprofit is paid a flat rate every month regardless of staffing levels. When a position is vacant, it’s unclear where the money budgeted for it goes. Despite repeated requests, Connections did not provide an explanation.

Connections’ staffing records also reveal a lack of licenses and certifications among its counselors. The state contract states all substance abuse counselors must be Certified Alcohol and Drug Counselors or working toward that credential.

In months of Connections' staffing spreadsheets, the column for “licenses/credentials” is mostly left blank.

“Have you ever tried to hire someone to work in a prison after there was a massive overtaking and paying them $30,000 a year to entice them to work in a prison?” Marti asked, referring to the 2017 prison uprising at the James T. Vaughn Correctional Center.

“As long as you’re working toward getting it, whether you’ve passed the test or not, we don’t terminate our employees.”

‘Addicts are people’

Stories of correctional healthcare employees falsifying inmate charts have been reported across the country.

Earlier this year, one worker told Arizona radio station KJZZ that providers in a state prison had a practice of "filling in the blanks" on neglected medication logs and backdating patients visits that never occurred.

Three former employees of a prison healthcare contractor in New York said in a lawsuit last year that the company told them to falsify medical records to pass state accreditation and fired them when they refused, The Press & Sun-Bulletin reported.  

Sometimes falsification can lead to criminal charges.

Last year, prosecutors in Milwaukee charged the state's health care contractor with falsifying health care records. Investigators compared inmate medical records with jailhouse video footage and found employees did not provide services when they said they did, the Milwaukee Journal Sentinel reported. Some entries were "complete fabrications," the criminal complaint said. The probe came after an inmate died of dehydration while in custody.

It wouldn’t take much for an oversight body to see something is wrong in Delaware, according to Zwally, the former counselor.

“I pray every day that someone would go in there and observe,” she said.

When confronted with direct allegations of record falsification, both Connections and DOC took a surface-level approach to investigation.

Richman said that in DOC’s initial investigation in December, it completed only "a quick search" of electronic records. DOC did not pull corresponding paper charts which, according to Lasek and others, would have revealed records with dates older than the timestamp on the electronic record — a possible indication of backdating.

Richman said he was pleased, not concerned, when he saw several inputs marked “late entry” in patients’ electronic records. It’s “good” that Connections was acknowledging when it fell behind, he said.

“That would be what we want folks to do,” he said. “If it says ‘late entry’ then someone is being very upfront, saying, ‘I’m not entering this the day I saw somebody. I’m entering it today.’”

Lasek told The News Journal she purposely wrote “late entry” into the electronic records she falsified so that there would be an easily identifiable trace of her work. She said she was leaving bread crumbs for someone in the future to follow.

Connections and the DOC would have known that if they had called her, she said. But both agencies neglected to interview key witnesses like Lasek in their initial investigations. 

Asked why not, Richman echoed Connections: “I don’t know.” 

After Lasek wrote to several state legislators about her concerns, DOC has “really ramped up” its investigation, according to Richman. DOC Behavioral Health Director Aileen Fink is leading the probe.

In an effort to prove record falsification did not occur, Connections offered to share client records with The News Journal with patient permission. The News Journal provided Connections with written and verbal consent from two patients, Cek and Steiner. Connections representatives then stated the meeting must be “off the record,” meaning information gleaned from the meeting could not be published.

The News Journal declined, and Connections rescinded its offer. Belcher-Timme said an "on the record" meeting would present "too great a risk for public disclosure of private health information" but said both patients received treatment.

Connections said Cek received counseling after her brother died. Cek said she had a casual "talk" with the secretary and was denied the opportunity to talk further with a full-time counselor. She said it was "funny" that the interaction would be considered counseling.

Maranda Cekmecelioglu holds up her treatment plan given to her while she was at Crest South in Georgetown.

In interviews, Connections officials simultaneously stated there was no evidence of record falsification but suggested The News Journal should question Lasek’s character because of her conduct. They said Lasek was fired for failing to show up to work. Lasek said she quit after using paid time off. 

“If someone is admitting to falsifying a document, that’s very concerning to me and should speak to the credibility of these sources,” Belcher-Timme said.

Connections officials also questioned why employees never voiced their concern about falsification until recently.

“Counselor Lasek never approached me, she never emailed me about any concerns that she would have regarding clinical documentation,” Reid said.

Lasek said she did speak up. She claims she reported the backdating to David E. Johnson, a state probation and parole administrator, at a meeting in front of several other people late last year. Lasek’s account was confirmed by someone in a position to know who agreed to comment on the condition of anonymity. 

According to Lasek, she was reprimanded by Seaton-Scott and Reid after that meeting. Johnson did not return a request for comment, and Richman said he never heard about it.

Zwally, whose nearly two-year run at Crest South is among the longest for a counselor in recent years, said she didn’t report what she saw because she didn’t think anyone would listen.

“I was told so many times: You’re not going to win,” she said. “Connections is big and powerful.”

Lasek said it was difficult for her to speak out about what she experienced, including her personal actions, because Connections has a stake in so much of Delaware’s healthcare industry.

“Connections owns everything,” she said. “They’ve monopolized this entire state.”

She worries about how whistleblowing will affect her career, she said, but she felt it was the right thing to do.

“I’m talking because addicts are people who deserve the treatment they were sent to,” she said.

On Tuesday, Connections said Crest South staff is currently undergoing "retraining sessions" to ensure staff members know and understand policies. 

Former Crest South participant O’Connor said people shouldn’t be left with the impression that the program didn’t have any success stories. There were some.

“But it wasn’t because of the program. It was in spite of the program,” she said.  

“The whole state of Delaware is lacking addiction treatment. It’s sad that this is what we’re offering people at their lowest and expecting them to change because of it. As a state and as a prison system, if you’re truly trying to rehabilitate people and make them productive members of society, the treatment needs to be actual treatment.”

Contact investigative reporter Christina Jedra at (302) 324-2837, christina.jedra@gmail.com or on Twitter at @ChristinaJedra.

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