Patient Abuse Survey
The purpose of this form is collect information from potential witnesses, additional victims, and to identify those guilty of criminal abuse, assault, and other crimes. Please complete this survey and share it in order to help improve the medical care in this community. The results of this survey will be cleaned (faulty responses, people attempting to tamper with results, etc will be removed), analyzed, and reported publicly.

Do not respond with specifics about your health that would be protected health information such as conditions, medications, etc. If you choose to share any of that information, you do so at your own discretion. We are not regulated by HIPAA. We do not provide any health services, insurance, etc.
Email address *
Name or Alias *
Are you a medical provider? *
Phone number
Email *
Do you work for Berkeley Medical Center? *
On a scale of 1 to 5, with 1 being very uncomfortable and 5 being very comfortable, how comfortable are you going to Berkeley Medical Center for emergency treatment? *
Very Uncomfortable
Very Comfortable
On a scale of 1 to 5, with 1 being very uncomfortable and 5 being very comfortable, how comfortable are you going to Jefferson Hospital for emergency treatment? *
Very Uncomfortable
Very Comfortable
Have you experienced or witnessed abuse at Berkeley Medical Center or Jefferson Hospital? If so please describe. *
Have you experienced or witnessed abuse of power or corruption by West Virginia State Police? If so, please describe. *
Have you experienced or witnessed abuse of power or corruption by Berkeley County Sheriff’s Department? If so, please describe. *
Have you experienced or witnessed abuse of power or corruption by Martinsburg City Police? If so, please describe. *
Do you believe that Berkeley Medical Center would try to keep staff quiet about criminal activity, abuse, and sexual assault? Would you be afraid of retaliation if you worked there and saw criminal abuse and sexual assault? *
Do you know anyone that was raped or claimed to have been raped by the Berkeley Medical Center emergency room? *
Did you witness crimes at Berkeley Medical Center in the Emergency Room on 6/3/20 and 6/4/20? *
If so, are you willing to come forward? *
On a scale of 1 to 5, with 1 being strongly disagree and 5 being strongly agree, how much to do you agree with the following statement: State police know about crimes being committed at Berkeley Medical Center and are involved *
Strongly Disagree
Strongly Agree
On a scale of 1 to 5, with 1 being strongly disagree and 5 being strongly agree, how much to do you agree with the following statement: City police know about crimes being committed at Berkeley Medical Center and are involved *
Strongly Disagree
Strongly Agree
On a scale of 1 to 5, with 1 being strongly disagree and 5 being strongly agree, how much to do you agree with the following statement: Berkeley Medical Center knows about crimes being committed at Berkeley Medical Center and is involved *
Strongly Disagree
Strongly Agree
On a scale of 1 to 5, with 1 being strongly disagree and 5 being strongly agree, how much to do you agree with the following statement: Berkeley Medical Center should suspend without pay all people on video committing crimes until a proper criminal investigation is conducted *
Strongly Disagree
Strongly Agree
On a scale of 1 to 5, with 1 being strongly disagree and 5 being strongly agree, how much to do you agree with the following statement: Anyone working at either Berkeley Medical Center or with law enforcement, who is aware about crimes committed at Berkeley Medical Center AND does not come forward immediately to cooperate with victims investigation, should have criminal charges pressed against them *
Strongly Disagree
Strongly Agree
How do you prefer to be contacted? *
Please provide any additional information as you deem relevant.
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