Shortly after 7 a.m. on Oct. 25, Austin State Hospital Superintendent Carl Schock was preparing to suspend a longtime child psychiatrist with a once-sterling history of service.
Dr. Charles Fischer, a well-regarded doctor with a seemingly unblemished 20-year career at the psychiatric hospital, had been under investigation for more than five months by the Department of Family and Protective Services over accusations that he abused patients in his care. Now the agency's report was in: Investigators believed that Fischer had sexually abused two teen boys at Austin State Hospital.
Schock had to take action.
"I need Dr. Fischer in my office at 8:30 this morning," he wrote in an email to several staffers at 7:07 a.m. that October day. "I will need someone to take him back to the unit, get his keys and badge and let him get the essentials out of his office (he can return at another pre-arranged time to get the rest)."
That email — released last month to the American-Statesman by the Department of State Health Services — is among hundreds that paint a behind-the-scenes picture of how agency officials responded to one of the biggest crises to hit the state hospitals in years.
In the days and weeks after the news broke, department officials scrambled to field media inquiries, provide information to advocacy groups and develop "talking points" for anxious parents calling to see if their children were safe. They drafted new patient safety policies, then had to sort through the logistics of those decisions.
Fischer, 59, has publicly denied all of the allegations against him through his attorney. Although law enforcement agencies such as the Austin Police Department and the Texas Rangers are investigating, the psychiatrist — whose medical license was suspended by the Texas Medical Board in November — has not been charged with any crime.
But the emails illustrate just how much fallout the agency faced from the allegations alone.
"Our hearts broke," said Carrie Williams, spokeswoman for the Department of State Health Services, which oversees the 10 state-funded psychiatric hospitals. "It was a very sad time for us, very difficult to wrap our minds around. We were shocked and sad and mad all at once."
On the afternoon of Oct. 24, a Protective Services investigator drove to Austin State Hospital and hand-delivered the state report that confirmed the abuse allegations against Fischer. A "confirmation" means that investigators have determined that a preponderance of evidence indicates there is reason to believe the purported abuse occurred.
A confirmed sexual abuse complaint at a state hospital is grounds for automatic termination.
After Fischer's Oct. 25 meeting with Schock, the doctor was taken back to his office by his supervisor, Christine Laguna. Then, Williams said, Laguna escorted him outside, walked him down the sidewalk and watched him get in his car and leave the Guadalupe Street campus. Fischer was officially fired on Nov. 14.
By then, the rumor mill had been churning for weeks. Though a few doctors had received an email about Fischer's termination, most employees were relying on gossip to explain their former colleague's absence. Laguna didn't know what to tell people.
"I really need to know what I can say since this email was sent and some info is out," she wrote in a Nov. 16 email to the hospital's medical director. One employee "said she knows the reason and that people ... are talking. I know we can't control that, but I would suspect there is some truth to what is being said."
Later that day, supervisors were told that they could confirm to employees that Fischer was no longer at the hospital and that Protective Services had confirmed abuse allegations against him.
On Nov. 17, the Statesman ran its first story on the Fischer case. Suddenly, parents of current and former patients were calling for answers. Schock told staffers to assure families that patients were receiving "safe care" but to limit the amount of information they provided because of patient privacy rules.
"So a sample conversations may go like this," Schock wrote in an email. "Question — My son was a patient there in 2005 — was this doctor my son's doctor? Could he have been abused? Answer — Ms. A, as you know, the hospital is bound by very strict laws related to confidentiality, so I can't discuss specifics about your family member's care here. I can tell you what I would tell a person who had received services here and believed they might have been abused and that would be to report it immediately to DFPS at 800-252-5400 and APD by calling 9-1-1."
Parents weren't the only ones with questions. Disability Rights Texas, a federally funded advocacy group that has access to hospital records, wanted the names of every patient that had made allegations against Fischer. Television and newspaper outlets across the state were calling for comment. Employees were reeling.
Schock sent an email to the entire hospital staff, praising their work in the face of a difficult situation.
"I want to encourage everyone to remember that the sun will rise tomorrow and we will continue our work to ensure effective, safe and essential services to all of our consumers, their families and our community," he wrote.
While chaos was erupting at Austin State Hospital, the Department of State Health Services was moving fast to make changes.
Mike Maples, assistant commissioner for mental health and substance abuse services, issued more than a half-dozen new rules designed to improve patient safety. He also directed the hospitals to send all Class 1 abuse allegations to his office for review. Class 1 complaints generally involve sexual abuse or very serious physical abuse.
But Maples' new rule brought some confusion, as an email by Rusk State Hospital Superintendent Ted Debbs illustrates.
"The allegation is of a broken jaw, but our examination shows no apparent injury," Debbs wrote in a Nov. 23 email. "So not only is the class questionable, it might not be classified as abuse at all. In any case, we will do our best to keep you informed as directed by the memo. Just trying to let you know it's not an exact process."
State officials advised superintendents to err on the side of caution.
"We realize it's not always black and white, so our guidance is, when in doubt, report it," Williams recently told the Statesman. "If it looks like abuse or sexual exploitation in any way, shape or form, agency leadership has to be notified."
Hospital superintendents were also struggling to comply with Maples' new directive to put all staffers accused of sexual abuse on emergency leave or transfer them to another unit. How did they know which action to take? What were the guidelines?
"OK, so now I have two allegations of sexual abuse against an RN and an LVN (separate incidents and different patients)," Schock wrote on Nov. 30 to Peggy Perry, who supervises all the hospital superintendents. "Do I send them both home on emergency leave?"
"Don't send home, just reassign for the time being," Perry wrote back. "Will get right back with you."
One employee was sent home on emergency leave; the other was reassigned. Those decisions, and others like them, are based on factors such as witnesses, video evidence, history of allegations against the alleged perpetrator and whether the injury is consistent with the allegation, Williams told the Statesman.
Emails also provide glimpses into another potential problem at Austin State Hospital. In one email, a lawyer for a local advocacy group complained that staffers at the hospital's adolescent unit did not routinely report abuse allegations to the Department of Family and Protective Services — a concern echoed by Avril Hunter, a state employee who reviews rights complaints made by hospital patients.
In an early December exchange, Schock, Hunter and Disability Rights Texas advocate Veronica Longoria discuss a situation in which a nurse failed to contact Protective Services after a child said a staffer threw him on a bed by his arm. When questioned about the incident, the nurse "stated that she did not call DFPS but that they always provide the DFPS toll-free hotline number to any individual ... that may express a concern/complaint regarding some service or treatment issue at the hospital," Hunter wrote.
The fact that the nurse said her response was "standard practice" raised red flags for Longoria.
"In completing our own facility observations and interviews, the Austin State Hospital adolescent unit staff have not consistently provided answers indicating they understand the duty to report any incidents of abuse, neglect, exploitation, i.e. verbal, physical, sexual, etc.," Longoria wrote, emphasizing the word "any" with bold type.
Schock responded by saying the facility would immediately review the reporting rules with staff.
"I frankly believe that the staff are well-aware of the reporting requirement," he wrote. "We will ensure they are all well-aware."
Since then, staffers have received more training, Williams said. Disability Rights Texas has not issued any further complaints on that matter.
The agency has learned a lot about weaknesses in its system over the past five months, Williams said. Since the Fischer allegations emerged, officials have added windows to treatment room doors, changed safety procedures and participated in a work group designed to tighten abuse and neglect rules. Those kinds of changes will continue as needed, she said.
"We had to try to come together and pick up the pieces," Williams said.
"It was all hands on deck, asking questions, scrutinizing ourselves, looking for patterns. ... We're not perfect, we can always do more, and this situation is not lost on us."
Contact Andrea Ball at 912-2506
About this story
On Jan. 2 under the Texas Public Information Act, the Statesman requested Fischer-related emails sent between Oct. 1, 2011, and Jan. 3 by four staffers at the Department of State Health Services: Mike Maples, assistant commissioner for mental health and substance abuse services; Peggy Perry, section director for state hospital services; Kerry Raymond, assistant director of state hospitals; and Emilie Becker, behavioral health medical director.
The newspaper also asked for emails from Austin State Hospital Superintendent Carl Schock; Christine Laguna, service director for Austin State Hospital's child and adolescent psychiatric unit; and Jim Wilson and Sue Schrader, both clients rights officers at the hospital.
State Health Services has gone to the attorney general's office to fight releasing some of the desired documents, saying they must be protected because of the ongoing criminal investigation into Fischer's case and other privacy rules.
CORRECTION: This story has been updated to correct Veronica Longoria's position with Disability Rights Texas.