(12-30-16) My grandmother used to say there is a special place in hell for people who commit especially heinous acts. I always thought it was a bit of overkill to condemn someone already destined to an eternity in hell to even worse abuse. But her comment popped into my head when I read a Buzzfeed News Report by Reporter Rosalind Adams called “Locked On The Psych Ward.”
The article alleges that America’s largest psychiatric hospital chain, Universal Health Services, or UHS, is keeping psychiatric patients longer than necessary to milk their insurance, putting profits above patients’ needs. The allegations against UHS, which has denied any wrongdoing, should alarm mental health advocates in states where UHS operates — and there are a lot of them, exactly 37 to date. (The Buzzfeed expose lists where UHS hospitals are located.) The company operates 230 psychiatric facilities across the country, admitting nearly 450,000 patients last year alone. According to the Buzzfeed expose, UHS reported almost $7.5 billion in revenues from inpatient care last year with profit margins of around 30%. More than a third of the company’s overall revenue — from both medical hospitals and psychiatric facilities —comes from taxpayers through Medicare and Medicaid.
This expose is especially unnerving because many of us have been pushing for the construction of more crisis care hospital beds. In some areas, there can be as long as a week before someone can get a bed in a hospital. This shortage has lead to psychiatric emergency room boarding and contributes to the inappropriate incarceration of persons who need help. I was outraged last week when I heard that a local hospital here in Fairfax County called the police and had a patient arrested for trespassing because he had a mental illness and kept coming into its emergency room seeking help.
The Buzzfeed expose also provides ammunition to groups that view all mental hospitals as being both unnecessary and evil by definition.
Reporter Adams wrote that former UHS workers and administrators that she interviewed in nine states said they were “under pressure to fill beds by almost any method — which sometimes meant exaggerating people’s symptoms or twisting their words to make them seem suicidal — and to hold them until their insurance payments ran out.”
According to a follow up story in Modern Healthcare:
The share price of Universal Health Services plunged 12% (the day) after BuzzFeed published (its) investigative story …The investigation has as its subhead: “Lock them in. Bill their insurer. Kick them out. How scores of employees and patients say America’s largest psychiatric chain turns patients into profits.”
If the allegations in the article prove true, a drop in stock is not the only punishment that is warranted. State and federal officials should impose hefty fines along with criminal charges against the UHS employees responsible. Unless there are fines and jail times, unscrupulous individuals will continue to take advantage of those who often can’t protect themselves.
Stories about patient abuse and horrific conditions in psychiatric hospitals prompted Congress to pass the Protection and Advocacy for Individuals with Mental Illness Act of 1986. That law created what became known as P & As or PAIMIs in every state. Simply put, the feds pay law firms that were created in each state specifically to insure that patients are not being abused. The firms have the authority to investigate patient neglect, abuse and civil rights violations specifically in institutions and community programs.
PAIMIs came under fire during recent hearings held by Rep. Tim Murphy (R-Pa.) who charged that many of them had morphed into something Congress never intended — advocates for anyone with a disability. Rep. Murphy, and PAIMI critics such as D. J. Jaffe and Dr. E. Fuller Torrey, complained that PAIMI law firms had lobbied against passage and implementation of Assisted Outpatient Treatment laws, which was outside their purview. PAIMI firms also were chastised for advising clients on ways to avoid hospitalization and helping patients get discharged even if they were not ready for release. Such was the sad case of William Bruce in Augusta, Maine, who PAIMI lawyers helped free even though his doctors’ were against his release. He went home and killed his mother with an ax.
While weakened by Democrats, the PAIMI reforms that Murphy got passed into law earlier this month put some restrictions on PAIMI firms in an attempt to return their focus on persons with mental illnesses and institutional abuses.
In May, the South Carolina Protection and Advocacy for People With Disabilities (PAIMI) law firm ended a long-standing civil suit against the state’s Department of Corrections. The judge in that case found that mental health care in South Carolina prisons was so “inherently flawed and systemically deficient in all major areas” that it violated the prisoners’ fundamental constitutional rights. The judge called the lawsuit the most troubling of the 70,000 cases that he had adjudicated in the past 14 years.
That was an excellent example of a PAIMI law firm doing exactly what Congress had intended.
A recent incident in Virginia reveals the flip side of the coin.
It was mental health advocacy groups, the ACLU and the NAACP that convinced the U.S. Department of Justice to investigate the death of Jamycheal Mitchell. He was the 24 year-old African American with schizophrenia who suffered a heart attack caused by starvation while waiting 101 days in the Hampton Roads Regional Jail to be transferred to a state hospital. You might recall that he was arrested after allegedly stealing $5.05 worth of snacks and was supposed to be under constant watch in jail by correctional officers and a nurse while incarcerated. In previous blogs, I’ve criticized the the Richmond-based disAbility Law Center of Virginia, as well as, other state watchdogs for failing to investigate Mitchell’s death. The disAbility Law Center declined to join seven advocacy groups in signing a letter to the Justice Department demanding an investigation after news reporters raised troubling questions about how Mitchell was treated. On the day when the Justice Department announced it finally had agreed to investigate the Hampton Roads jail, the disAbility Law Center issued a press release about how to communicate with someone who is deaf. (As someone who had a deaf sister-in-law, I understand the importance of guaranteeing accommodations for the deaf under the ADA. But I do not believe Congress intended PAIMI groups to focus their resources on developing videos about deafness when it passed a law that was called Protection and Advocacy of Individuals with Mental Illness.)
If you care about persons with mental illnesses, you should check to see if there are UHS hospitals operating in your area. You should also identify the PAIMI law firm in your state to learn if it is aware of the allegations against UHS and if it is spending your tax dollars as Congress intended to protect persons with mental illnesses who are in hospitals and other institutions.