New London - An investigation of leadership and turnover issues at southeastern Connecticut's largest provider of adult outpatient mental health services is under way in response to concerns raised by 21 former employees.

The group of former Sound Community Services staff described "a pattern of hostility toward employees" by Gail Lawson, the chief executive officer since 2005, in a July 25 letter to the board of directors of the nonprofit agency. Editor's note: This corrects the date of the letter as given in an earlier version of this article.

On Aug. 3, board members agreed to hire a consultant to conduct the investigation.

The letter states that Lawson's "divisive behavior" has led to a "revolving door of clinicians, prescribers, nurses, managers and support staff" and has had a "detrimental effect on clients." Jean Miner of Lyme, a clinician who left the agency last spring, wrote the letter and contacted former colleagues about signing it.

"We have absolutely nothing to gain other than a clear conscience," said Miner, adding that most of the signers have gone on to other jobs. Several other former employees, she said, wanted to sign but feared retribution or that signing would harm their chances of finding another job.

With about 700 clients, Sound Community Services has an annual budget of about $10 million and is supported mainly by state and federal funds.

Even members of the public with no connection to the agency, she said, have a stake in how it is being run.

"As a taxpayer," she said, "I'm very concerned, because Sound gets money from the state for programs, and the state should care how Sound is being run. It's wasteful of money and resources, and the clients are paying the biggest price."

K. Michael Talbot, the board chairman, declined to discuss issues raised in the letter relating to Lawson's conduct with the 130 full-time and part-time employees, citing confidentiality concerns. Other board members would not comment.

"It is unusual," Talbot said of the letter. "Everything's going to be checked out."

This is the second time in two years that employees have gone to the board with complaints about Lawson.

In 2010, the union that represents a majority of Sound's employees wrote in a letter to the board that they had a "lack of confidence in the leadership of Dr. Gail Lawson," and cited a "management style that has led to low morale and high staff turnover." Seven employees who represent various units within the New England Health Care Employees Union signed the letter.

Talbot said he had not seen the 2010 union letter until a copy obtained by The Day was shown to him during an Aug. 6 interview.

The board also received a letter in April from a Sound client asking for an investigation into the causes of the high turnover.

'Fiscally sound and innovative'

State and federal grants and Medicare and Medicaid reimbursements are the main sources of Sound's funding, but officials at the state Department of Mental Health and Addiction Services said their oversight authority extends to ensuring compliance with state contracts for client care, not to the agency's leadership.

"They're meeting their contractual obligations, and serving who they're expected to serve," said Claire Burchfield, associate director of the Southeastern Mental Health Authority, which administers DMHAS funds in this region.

Cheryl Jacques, executive director of the authority, said she's seen no evidence of problems with the care provided. The agency, she said, is viewed as fiscally sound and innovative in areas such as its early implementation of electronic medical records and its establishment of an in-house pharmacy.

"Isolated complaints" DMHAS has received about high turnover and management issues, she said, have been checked out, and do not appear to be evidence of a systemic problem.

"They're holding people to very high standards around quality of care and new initiatives," Jacques said, "and some people are not happy with that. Everyone is working hard when we go down there" on inspections.

Despite that, DMHAS is investigating in response to allegations raised in recent email messages and an anonymous letter, James Siemianowski, department spokesman, said Monday.

"These are allegations that have to be taken seriously, and we have initiated an investigation that will involve an auditor into fiscal management and patient care issues," said Siemianowski, who is also director of DMHAS' division of evaluation, quality management and improvement.

Financially stable

In an Aug. 6 interview, Lawson, who earns about $135,000 in annual salary and benefits, defended her leadership, quoting from recent DMHAS client surveys and accreditation reports that have consistently given Sound high marks.

In its most recent three-year accreditation report by the Commission on Accreditation of Rehabilitation Facilities, the agency is praised as being "financially stable" with "outstanding and proactive leadership." There are few recommendations for improvement.

High turnover, however, was cited as a concern in a 2008 client survey. The mental health field nationally has an annual turnover rate of about 22 percent, and Lawson said she believes Sound is within that range but could not provide a specific percentage.

"This agency has a reputation for providing the highest level of service by objective measures of quality," she said. "Any actions we take are designed to assure quality of care across time. All our contracts are in full compliance."

She said she holds staff to high standards of accountability that are necessary in the changing health care environment.

"This is an organization that has clear (personnel) policies in place," she said. "Nothing is random. Nothing is arbitrary. We have extremely well documented personnel files."

She added that she had no concerns about the state inquiry.

"Our records are in pristine order," she said.

The agency's administrative offices moved recently from downtown into a medical office building at 21 Montauk Ave., and offices for client appointments in the Harris Building on State Street are also slated to be moved there, Lawson said.

Interviewed in her office with Sound's attorney, Michael Kurs of Pullman & Comley, and Talbot, Lawson would not agree to have the session recorded. When asked to repeat specific answers to ensure accuracy, she refused, declaring, "You only get it once."

Lawson also cited state laws protecting confidentiality.

"I cannot discuss any disciplinary issues that may or may not have arisen with any of the individuals who signed this letter," she said, adding that some of the signers left the agency more than six years ago.

Miner and other former employees, however, said Lawson's attempt to point the finger back at them is unjustified.

"I'm not surprised that Gail is trying to discredit us," Miner said, adding that a client's lament about high staff turnover prompted her to write the letter. "I had an unblemished record at Sound, as I'm sure others did. But actually, Gail is helping to make our point. We want the board of directors to thoroughly investigate why, how and under what circumstances such an inordinate number of employees with previously good work records end up leaving Sound under duress."

In April, Lori Tibbens of Gales Ferry wrote to Talbot, the board chairman, with concerns about the effects the high turnover was having on Sound clients such as herself.

"The constant turnover is affecting my well-being and that of other clients," she wrote. "I hope that the Board of Directors will take this situation seriously and find out why staff are so unhappy. You have a special responsibility, because there are few alternatives to Sound for people of limited means."

In a phone interview, Tibbens said she is comfortable advocating for herself and others with mental health needs, but many others are not willing to speak frankly.

At Sound, she said, appointments frequently would be canceled because of staffing issues. Because no physician or advanced practice registered nurse was available for an extended period to check her medications, she ended up going to the emergency room at Lawrence & Memorial Hospital, she said.

"I know I'm not going to stay well unless I have support," she said. "I went through so many therapists, and the minute I would start to feel good about how the therapy was going, they would leave."

Lawson said Sound is seeking to hire a physician or advanced practice registered nurse to prescribe and check patient medications, and that the situation is a reflection of a national shortage, not anything specific to her agency.

Complaints of hours cut

Former employees, however, insist otherwise.

One signer of the letter, Marie Salvemini of East Lyme, said she left after 18 months as manager of the intake department at the agency after being harassed, unofficially demoted, having her benefits cut substantially and, while she was taking a sick day, having her office unexpectedly relocated to a dark, dingy space barely big enough for herself and a client. She said an attempt also was abruptly made to cut her hours but was rescinded after she complained. She said she was told she was not allowed to talk to the human resources staff, the payroll staff or to any other employees about her situation.

"And I still don't know what I did," she said. "But this whole thing isn't about the treatment of employees. It's about the injustice to the patients."

Former employees say the positive evaluations cited by Lawson and the state depict a sanitized view of the agency.

"On paper it probably does look good," said Kathy Lavoie of Quaker Hill, who left in 2006 after 20 years with the agency. She had been director of case management and employment services.

Lavoie said she went to the board to describe how she suddenly fell out of favor and became the subject of harsh and persistent criticism.

"I spoke to the board members after I left, but it fell on deaf ears," she said.

Another former employee, Jill Millea of New London, said she was ostracized for speaking out about problems with the new electronic medical records system.

"All of a sudden, I was not a team player," said Millea, who resigned in 2010 after five years as a clinician, taking a one-third cut in pay at her new job. She said she was "nitpicked" and unjustly accused of committing fraud on her time sheets, then forced to take a week off without pay.

"She (Lawson) said she was considering going to my licensing board," she said.

Miner, Salvemini and other former staff interviewed said the issues with Lawson's leadership reached a critical point earlier this year after the sudden exodus of 10 employees, some of whom had worked there for many years.

One of the recent departures was Carla Arrindell, who had worked in the medical records department since 2007.

"I left in May, after a three-month period of harassment because I had become a union representative," she said. "I just walked out of there. I liked my job, but all of a sudden I had my job cut to 20 hours, with no justification."

Staff are currently working without a union contract since the previous one expired more than three years ago.

"We are trying to get the employer back to the table but that's hard to do forcibly," said Deborah Chernoff, union spokeswoman. "It's not a situation where people want to force the issue by going out on strike. There's a real sense of discouragement there."

'Exacting standards'

In a March email to Sound employees obtained by The Day, Lance Niles, the agency's corporate compliance officer, notes "a great deal of pessimism and negativism" among the staff and that "there have been some partings of the ways in recent weeks that some may feel have weakened the agency..." He goes on to reassure staff that despite "budget shortfalls, a shifting of leadership responsibilities," the agency remains committed to its mission to serve the mental health needs of the community.

In a phone interview, Niles said he has "great confidence in the leadership" at Sound and the agency's ability to weather changes in the health care industry and the loss of longtime employees.

"The vision is consistent, and didactic," said Niles, who began working at the agency in January. "Does everybody buy into the vision? No. Those are people probably not suited to be here long term."

The situation at Sound Community Services is complex, according to Robert Davidson, executive director of the Eastern Regional Mental Health Board, a Norwich-based nonprofit agency that evaluates mental health programs for DMHAS in a 39-town region.

In recent reviews of its drop-in center and case management, for example, the agency fared well. The Sound Community Services board has continued to support Lawson, he said, because she has kept the agency financially strong and has brought it prestige for implementation of electronic medical records and in other areas. The morale issues, he said, have been festering for a few years but escalated with the sudden and surprising departures of key people.

Lawson, Davidson said, "has very exacting standards. Not just high, but exact. Some are performance standards around productivity and how many patients you see, and some seem to be attitudinal.

"What I have heard and seen to some extent is that when you question the leadership of the executive director, she turns on you and either fires you or forces you out. She has done it through cutting people's hours, or threatening their licenses. She can get moralistic and portray herself as upholding professional standards. There's a climate there that intimidates people."

j.benson@theday.com