Indian Health Service examines issues at Unity Healing Center

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Indian Health Service examines issues at Unity Healing Center

Unity Healing Center, a 16-bed rehabilitation center for troubled teens, has been running significantly below capacity for years. Holly Kays photo

The Unity Healing Center in Cherokee has become the subject of intense focus from the U.S. Indian Health Service’s regional office in Nashville following a June report from The Wall Street Journal alleging that suspected sexual abuse at the facility resulted in a suicide attempt by one of the teenaged residents — but no report to law enforcement.

According to an April 15 letter sent to tribal leaders in the Indian Health Service’s 24-state Nashville Area, an anonymous report of sexual abuse at Unity was made to tribal law enforcement and child protective services in May 2017 about an incident that occurred in 2016.

Unity is a residential facility operated through IHS serving Native American youth ages 13 to 18. It’s aimed at “breaking the cycle of addiction and restoring hope and wellness to Native American youth, their families and communities,” according to the facility’s website. Residents typically stay for 80 to 90 days.

“In 2016, an incident occurred at the facility between a staff member and an adolescent resident where there were reasonable concerns about the staff member being alone with the adolescent resident. This incident was initially investigated by Unity leadership. To my knowledge, this incident was not reported to law enforcement or to any investigative entities at the time,” Beverly Cotton, director of the Nashville area since January, wrote in the April 15 letter.

Following the subsequent report in May 2017, she wrote, “The report of sexual abuse was not substantiated. The adolescent did not disclose any sexual contact and no criminal charges were filed. Additionally, we do not believe that any charges are expected to be filed.”

However, the U.S. Department of Health and Human Services’ Office of the Inspector General did investigate Unity Healing Center, said OIG spokesman Todd Silver, and that investigation is ongoing.

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The allegation

The incident in question occurred in September 2016, when a 47-year-old maintenance man and a female resident, 16 at the time, entered the bathroom adjoining her bedroom.

According to Tawna Harrison, who was the teen’s therapist, she later saw security footage showing Nathanial “Bunsey” Crowe and the girl walk toward the bathroom and remain there for about four minutes. Later, the teen was taken to the hospital after attempting to hang herself on a shower curtain, Harrison said.

The security footage was concerning not only because it was against policy for staff members to be alone with residents in their living quarters — except in some select circumstances, in which case the door would still be required to remain open — but because of previous interactions Harrison said she had witnessed between the two.

“He gave this girl extra attention,” said Harrison. Crowe would stop by to talk to her, or hang around and play cards with her, she said. He would hold her hand in the hall, swinging it playfully up and down like one might do with a child. Two other former Unity employees who spoke to The Smoky Mountain News on condition of anonymity said they witnessed similar behavior.

“I had reported this to my supervisor Tracey (Grant) and she — it’s been so long I can’t quote her on what she said but basically, ‘Maybe he’s trying to be a grandfather figure to her,’ and all of these kinds of things,” said Harrison. “I said, ‘Well, that’s a liability issue for him.’”

The teens at Unity often come from troubled backgrounds, and for the staff trying to help them, maintaining good boundaries was key. Even hugging, other than side hugs, wasn’t allowed, and hand holding was definitely out, said Harrison.

When Harrison saw the footage from the bathroom, she spoke to Grant again.

“I said, ‘Look, we need to report this. Who do you want me to report this to?’” said Harrison. “And she said, ‘No, you don’t report it to anybody but me. I’m handling this. I will take care of this.’”

Harrison would later find out that Grant did not pass the report along for investigation.

“I look back, I should have reported it,” said Harrison. “I was new to this job. She swore me to secrecy. She told me she was handling it, and that’s how things were there.”

Harrison, a therapist since 2009, had arrived at Unity just months earlier, in March 2016. A member of the Standing Rock Sioux tribe, she’s not from Cherokee and was still learning her way around her new community. She left the job just two years later, in March 2018, to take a position in New Mexico.

“There were a lot of ethical things going on there, and I wanted out,” she said of Unity.

There was no further investigation into the bathroom incident until May 2017, when Christopher Herndon, a therapist at Unity who arrived on staff after the September 2016 incident, reported it to the OIG’s office upon hearing staff members talk about the apparently unresolved incident.

Crowe’s response

Crowe disputes that version of events, contending that he never showed the teenager any special attention, that the two were never in the bathroom alone with the door closed and that she never attempted suicide. The teens at Unity come from troubled backgrounds, he said, and sometimes they react strongly and form attachments when staff show them simple kindnesses.

“I can’t help that people attach themselves,” Crowe said in an interview over coffee, accompanied by his wife Trudy. “The incident, what happened, I don’t know all the full thing on it. It was fully investigated. I volunteered to take a polygraph to clear my name and I passed my polygraph.”

SMN does not have records relating to any polygraph test Crowe may have taken, as those records would be part of an investigative file. However, said Silver, while the OIG does not conduct polygraphs, it does partner with other agencies that may conduct polygraphs in the course of an investigation.

According to Harrison, Crowe was often showing the teenage girl special attention that crossed the threshold of appropriateness, an assertion echoed by other former employees. But Crowe said that’s not the case. He was kind to the residents, he said, but worked to keep interaction to a minimum, and he didn’t show any particular resident more attention than any other.

Crowe said he entered the bathroom that day to fix an electrical outlet that the residents said was emitting shocks. The bathroom door was open, he said, and another employee, an engineer, was standing outside when Crowe went in to inspect the outlet. There were multiple outlets in the bathroom, so he asked the girl to come in and point out the one she was talking about. Nothing about the interaction seemed out of the ordinary at the time.

There wasn’t a suicide attempt, said Crowe, and there couldn’t have been because the bathrooms had just been remodeled with anti-ligature curtains. The teen was taken off-site for counseling, not for medical attention, he said.

“She was upset because they were trying to make her say something that didn’t happen,” said Trudy Crowe, a nurse who works for a different agency in Cherokee.

When asked when he found out that the bathroom interaction might become a problem for him, Crowe said it was probably about a week later.

“They said that she was getting obsessed with me somehow and to avoid her, so I started avoiding her,” he said.

Harrison, as well as a former employee who worked there at the time of the incident but asked not to be named, disputed Crowe’s version of events. They averred that the girl had indeed attempted suicide, and that there was nobody else standing outside the bathroom door. While the door itself is out of view in the video, said Harrison, she knows that it was, in fact, closed.

Of the anti-ligature curtains, said Harrison, “OK, that is true. There was no way she could have committed suicide. Those would have broke off. But she tried. That’s why she was at the hospital.”

None of the former Unity employees who spoke with SMN for this story said they knew for sure that something sexual happened in the bathroom that day. However, they said, the time alone, out of view of the camera, raised a red flag, especially when coupled with behavior allegedly observed previously between Crowe and the girl.

“I don’t know what happened in that bathroom, if anything happened other than just bad judgment being in there, but it merited a look,” one former employee said.

Nobody interviewed for this story, including Crowe himself, indicated that Crowe was ever disciplined in relation to anything that occurred on that day in September, though he was reassigned from Unity twice. In October 2016 he was sent to the Mashpee Wampanoag Health Service Unit in Massachusetts for four weeks, and in October 2018 he went to the Micmac Service Unit in Maine for two weeks. While the 2016 detail came shortly after the incident, Crowe said the two were not related, and that the detail to Massachusetts had been planned before the incident occurred, as the facility needed help to get ready for accreditation. However, he said, he was placed on paid leave from spring 2017 to spring 2018 while the OIG conducted its investigation. Investigators took everything from his office, interrogated him for two days and administered a polygraph test, but they never found evidence of wrongdoing, said Crowe, adding that he was afterward allowed to return to work. IHS does not comment on disciplinary actions taken against its employees.

Crowe, who began his career with the Indian Health Service in April 2000 as a maintenance mechanic at the Cherokee Indian Hospital — before the tribe took over management of the facility — had been working at Unity since May 2011. He left that job on March 13, 2019, two days before filing closed for the tribal elections.

Crowe said he left his job so he could stand for election, not due to any allegations against him. He is a candidate to represent Wolfetown on the 2019-2021 Tribal Council, having placed third out of 10 candidates in the June 6 Primary Election. He will run against three other contenders for one of two seats during the Sept. 5 General Election.

“I didn’t leave because of this,” said Crowe. “It was a planned exit from my job.”

Crowe said he believes coverage of the 2016 incident is tied to tribal politics, writing in a statement on his Facebook page the day after the Wall Street Journal article was published that he “refuse(s) to be a pawn in a bigger political agenda.” To support that theory, he points to the timing of the article’s publication — the day after the Primary Election — and says that some of his political opponents have supporters who work at Unity.

“It was too convenient,” said Trudy Crowe.

“There’s so much stuff on the (Qualla) Boundary. This is just an example of it, how they do people,” she added. “They tear each other down.”

Former employees involved in reporting the incident, meanwhile, say they have no stake in the outcome of the tribal election. None of the former employees interviewed for this story are tribal members.

Tracey Grant did not return a request for comment.

New leadership in Nashville

Even aside from anything that did or did not happen between Crowe and the 16-year-old resident, former employees say that Unity was a difficult place to work.

“Working with a vulnerable, at-risk population, you would expect the hardest parts of the job to be working with those high-needs young people, but dealing with the dysfunction in the organization and the inappropriate behavior of other staff was far more challenging than any other interaction I ever had with the residents,” said Jennie Sorrells, a social services assistant at Unity from October 2012 to August 2015.

Sorrells, who left a year before the September 2016 incident, described a workplace where employees regularly came to work under the influence of drugs or alcohol, were verbally aggressive with residents or other employees, or behaved in other ways inappropriate to a professional environment. The facility was chronically understaffed, she said, and when an employee left Unity it might be a year or even two before the position was filled again.

“There were times I would have to call HR for weeks on end before I would ever get a call back or we would hear about a position that was ready to post, but we wouldn’t see it for four to six months,” said Sorrells. “And then after the position has posted and they get qualified candidates, it takes months to hire and then onboard anybody, so it drags on and on.”

Perhaps knowing how long it might take to hire a replacement served as a disincentive to seek termination for employees who deserved it, Sorrells said. She said her experience with the supervisors at Unity — Grant and Tiara Ruff, CEO through Aug. 27, 2018 — was positive, and that she found them to be helpful and responsive. However, she said, the way things were structured wasn’t conducive to good management.

“It’s a very complicated process to remove a permanent federal employee, and for the supervisors at Unity it’s almost like there were two different groups of people that they were trying to serve,” she said. “One of those was our residents, so serving residents, taking care of them, and the other was the employees, and they were almost competing or noncompatible. It seemed like two really different things to be asking people to do.”

“I was surprised just how lazy everybody was,” said another former employee. “I’d never had a job where you could just basically not do anything, and I really didn’t like not doing anything.”

Sorrells eventually left Unity for another position in the area. In the years since, much has changed at both Unity and in the Indian Health Service’s higher leadership.

In January, Cotton — who holds a doctor of nursing practice, which is a Ph.D. in nursing — came on board as the new Nashville Area director, and neither Ruff nor Grant work for IHS any longer. Grant’s last day with Unity was July 31, and in April Joni Lyon began work as the new CEO at Unity.

“Of course, right after I started the issue that happened in 2016 and 2017 was shared with me, along with many of the steps that had already been taken by leadership previous to my tenure,” Cotton said in a phone interview.

The challenges at Unity have “risen to the top,” she said.

Upon taking the job, Cotton asked for a review of what steps had been taken at Unity and what had yet to be done. Last week, the agency put out a request for proposals for a quality assurance medical review of Unity in which an outside vendor will look into actions from 2016 up to now and deliver recommendations back to Nashville. In April, Cotton sent the letter to tribal leaders informing them of the incident and the Wall Street Journal’s investigation of it. Her office has also been reviewing the model of care used at Unity in order to see if changes should be recommended.

“Our government to government relations with tribes is just foundational to why we exist and so one of my top actions was increased communication and then a level of transparency around it,” she said.

In addition, Cotton has been working to revise and clarify policies to ensure that proper reporting occurs in the future, across the Nashville Area with targeted work at Unity as well. National headquarters recently released a new policy on protection of children from sexual abuse by healthcare providers, and Nashville recently finished a policy specific to Unity, which clarifies exactly how and to whom to report suspected abuse — “The supervisor is not there as the gatekeeper,” said Cotton — and also stipulates that there should be no retribution for reports made in good faith.

As of now, said Cotton, 60 percent of Nashville area employees are trained on the new agency-wide reporting policy, with a goal of reaching 100 percent by the end of September. She’s also working to train managers on equal employment opportunity responsibilities, how to take proper disciplinary action and employee engagement.

Her office is working on two other Unity-specific policies as well, which deal with ethical boundaries and codes of conduct. Those policies are now under internal review waiting to be finalized.

“That really leads back to those parameters that a resident should not be alone with a staff member, especially in a personal living quarters, and sets guidelines and expectations for staff at Unity,” said Cotton.

In the wake of the issues at Unity, she said, the Nashville office has made an effort to be more present at that facility, with the office’s director of field operations visiting the site at least once or twice a month. Currently, there are 24 employees and five vacancies at Unity, as compared to 21 employees and 11 vacancies in September 2016 — IHS has decided not to fill positions for one maintenance worker and two cooks.

Cotton said she looks forward to the day that the facility has a full census, providing sorely needed services to Native American youth from across the eastern U.S. It has been years since the 16-bed facility has been anywhere near capacity, but with five residents accepted into the current cohort, Cotton is hopeful for what the future holds.

“I think we’re in a really good place at Unity right now,” she said.

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