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Attachment 7.g.iv. - Public Comments No 4
PUBLIC COMMENTS NO. 4 Caroline Youn From: Philip Ellsworth Sent: Sunday, September 29, 2019 5;14 PM To: Caroline Young Subject Psych Hospital Warning; External Email I'm a resident of eastern Chula Vista I see nothing wrong with the proposed hospital for Eastlake area. Please count this as a yes vote for it. Philip Ellsworth Caroline Youn From: Jennifer Abengcza , , Sent: Friday, September 20, 2014 2.53 PM To: Mary Salas; It It Galvez; Steve C. Padilla; Mike Diaz; Kelly Broughton; Patricia Salvacion; Caroline young; montano,moiiica@scrippshealth.org Subject: Opposition to Eastlake Psychiatric Hospital z ming: In Hello, il I am writing you regarding the proposed Eastlake Psychiatric Hospital for 830 & 831 Showroom Place. I am a Rolling Hill Ranch resident and this hospital will be in clear view from my driveway. I am greatly concerned for the safety of my family and neighbors. I do not believe this is an appropriate site for this kind of facility. It is in close proximity to residents, schools, daycare centers, parks. I believe those who will be discharged without a ride from this hospital will pose a risk to the neighborhood. In addition, Acadia Healthcare has several civil cases against them by former employees. I cannot place my faith and trust In a company like that. This facility will also cause an Increase in emergency call volume which will result in an Increase response time from ambulances, police, and firefighters. Chula Vista already does not have enough police to patrol the city. I greatly oppose the building of this facility. Please do not approve this proposal. Regards, ✓enndfLr Caroline Young From: hinds colarusso - Sent: Friday, September 27, 2019 5:34 AM To: Caroline Young Subject: Re: Meeting regarding hospital last night Warning: Eatemal. Hello Caroline, I went to the meeting last night and I am surprised that the city and Scripps would consider Email - allowing a company like Arcadia to be In charge of this hospital. I did my own research and came up with many articles outlining the terrible practices of this company. Please read this article. How can the city consider Arcadia as a partner In this project?? Please help me understand?? http'Jiw i surelivavalma romlresgarchlacadia-healthcare) Thank you. Linda Colarusso Acadia Iteaittrca re: Destructive Greed - Marcus Aurelius Value Page 1 of 36 MARCUS AURELIUS vatuE— RESEARCH ABOUT CONTACT (� Acadia Healthcarpal OF SERVICE JOIN THE LIST Destructive Greed Enteremail... 1011 OCTOBER 11, 2018 1 ACHC MORE COMPANY COVERAGE IMPORTANT - Please read this Disclaimer in its entirety MDXG (8) before continuing to read our research opinion. The information set forth in this report does not constitute a BOR (4) recommendation to buy or sell any security. This report HIIQ (4) represents the opinion of the author as of the date of this BANC (3) report. This report contains certain "forward-looking PME (2) statements," which may be identified by the use of such words as "believe," "expect," "anticipate," "should," "planned," CIA (2 ) "estimated," "potential,' "outlook," "forecast," "plan" and other KGJI (1) similar terms. All are subject to various factors, any or all of PETS (1) which could cause actual events to differ materially from EGBN (1) projected events. This report is based upon information reasonably available to the author and obtained from sources AVAV (1) the author believes to be reliable; however, such information ACHC (1) and sources cannot be guaranteed as to their accuracy or VNDA (1) completeness. The author makes no representation as to the INS (1) accuracy or completeness of the information set forth in this report and undertakes no duty to update its contents. The TEUM (1) author encourages all readers to do their own due diligence. VSLR (1) You should assume that as of the publication date of his reports and research, Aurelius and possibly any companies affiliated with him and their members, partners, employees, consultants, clients and/or investors (the "Aurelius Affiliates") have a short position in the stock (and/or options, swaps, and other derivatives related to the stock) and bonds of Acadia Pulpa/www.auieliusvalue.eom/reseurcirlascedia-hcahlsare/ 10/14/2019 Acadia ticalthcare: Destructive Greed - Marcus Aurelius Value Page 2 of 36 Healthcare. They therefore stand to realize significant gains in the event that the prices of either equity or debt securities of Acadia Healthcare decline. Aurelius and the Aurelius Affiliates Intend to continue transactions In the securities of Acadia Healthcare for an indefinite period after his first report on a subject company at any time hereafter regardless of initial position and the views stated In Aurelius' research. Aurelius will not update any report or information on this website to reflect such positions or changes in such positions. Please note that Aurelius, the author of this report, and the "Aurelius Affiliates" are not in any way associated with Aurelius Capital Management, LP, a private investment firm based In New York, and any affiliates of or funds managed by the latter company. Summary We are short Acadia Healthcare (NASDAQ: ACHC) because the company has concealed widespread patient abuse and neglect that results from pervasive understaffing at its facilities. At Acadia, cutting staffing costs to the bone is the "secret sauce" used by management to inflate short term profits. Acadia's existence makes the world a worse place because its business model depends on acquiring new facilities and then degrading care, a losing proposition that victimizes patients. We believe the fundamental problem for investors is that Acadia's slash and burn approach to behavioral healthcare is Inherently unsustainable and increasingly at risk of unraveling. CEO Joey Jacobs and his management team first used this recipe at Psychiatric Solutions (PSI) a decade ago, where Investors sued for fraud alleging that Jacobs had "downplayed the alarming incidents of abuse, neglect, and even death" at company facilities, ultimately winning a $65 million settlement. After selling PSI to competitor UHS in 2010 amidst regulatory investigations, Jacobs reassembled his PSI http./Avww.aurol itisvatue.com/resouch/acadia-healthcare/ 10/14/2019 Acadia I t©altheare: Destructive Greed - Marcus AwrollLIS Value Page 3 of 36 executive team at Acadia to replicate this approach, once again, we believe Jacobs has misrepresented the true nature of his company to investors. Over several months, we gathered and reviewed thousands of pages of public documents including over 600 slate and federal Inspection reports as well as court records, media reports, lawsuits, and police records. We found that numerous patients, including children and teenagers, have died due to alleged negligence or malpractice at Acadia facilities. We found recurring reports of sexual abuse and physical assaults on vulnerable patients that have allegedly been perpetrated by Acadia employees or unmonitored patients. We found repeated instances of patient neglect or deficient care linked directly to staffing problems at Acadia facilities. We found a pattern of whistleblower allegations made by former employees who say Acadia retaliated against them after they reported fraud or misconduct. Acadia's undisclosed problems are not isolated to just a few bad facilities or a handful of rogue employees. We found Indications of understaffing or deficient care at over 75 Acadia facilities in 24 states. Not only did we uncover problems at the majority of Acadia's U.S, Inpatient hospitals, which in aggregate generate 439/o of the company's U.S. revenue, but we also flagged significant issues within Acadia's national network of outpatient addiction facilities. We have posted extensive source documents at www.acadiaexposed.com, where we will individually profile 30 of Acadia's most problematic facilities in a series of additional releases. Some of these facilities are also reportedly under government investigation, have received patient referral holds, or are being permanently closed. Acadia's true business model Is premised on borrowing billions of dollars to acquire behavioral health facilities, then wringing out profits by cutting staffing expenditures while increasing beds. Underspending on staffing temporarily juices httpdfwww.auretiusvah e.com/research acadia-healnc�a+rel 10/14/2019 Acadia Healthcare: Destructive Greed -Marcus Aurelius Value Page 4 ol'36 profits, because it's the company's largest expense, but it leads to chaos, violence, and deficient care since many patients are vulnerable or dangerous and need substantial direct attention. That's why government Inspections have repeatedly attributed patient death and neglect at Acadia facilities to problems with both the quantity and quality of staff. Up until now, Acadia was able to conceal the extent of Its problems because most Investors hadn't connected the dots between the vast number of disparate public documents and local news reports that repeatedly detail deaths and assaults at problematic Acadia facilities across the country. Also, many of Acadia's victims are young, disabled, or suffer from serious disorders that makes It difficult forthem to sue the company or publicize what happened to them. Now that the truth has emerged, we anticipate that Jacobs will attempt to falsely depict these problems as isolated and sensationalized or the product of past issues or difficult patients - this is exactly what he tried to do after journalists exposed similar problems at PSI. The truth coming out hurts Acadia because it contradicts Jacob's claims and leads to Increased public scrutiny. The stock price of competitor American Addiction Centers has lost nearly 75°% of its value since a short seller reported that the company was covering up patient deaths. Former employees, including that company's President, were criminally indicted by the State of California for second degree murder in 2015 for the death of a patient (the murder charge was later dismissed). At Acadia, not only are there undisclosed criminal Indictments and convictions of former employees for the death or assault of patients, but we found allegations that Acadia has: Destroyed evidence • Falsified documents http://www.arrreliusvnlue+,cont/reuearah/stadia-healthem•e/ 10/14/2019 Acadia Healthcare: Destructive Greeil - Marcus Aurelius Value Page S of 36 Duped regulators during audits Covered up Incidents of patient abuse Submitted fictitious billings to the government Failed to disclose regulatory investigations Involving certain facilities Retaliated against multiple whistleblowers As undisclosed problems have mounted, Acadia's four top officers dumped over $40 miffion worth of stock last year—with Jacobs divesting half of his stake and later purchasing a portion of the Nashville Predators professional hockey team. Acadia's top five officers have received more than $63 million in compensation over the past three fiscal years under the watch of a Compensation Chairman, Wade Miquelon, who was charged by the SEC last month for "misleading investors' during his tenure as Walgreens CFO. We believe Acadia's profits are largely fleeting. History demonstrates that roll -up business models like Acadia unravel when the underlying financial engineering driving the reported financials loses momentum. This is precisely what we see starting to happen. Because Acadia's costs have already been cut to the bone, the company has exhausted its primary means of driving profits from existing facilities. Acadia has missed earnings estimates two of the past four quarters and same facility revenue growth is slowing while facility expenses have started to increase. We believe staffing expenses are likely to Increase significantly as scrutiny from the public and regulators intensifies because Acadia will face increased pressure to improve patient care. But Acadia has over $3.2 Billion in debt It needs to service, which leaves the company little room to weather increased expenses or reduced revenues. We therefore see significant downside potential in Acadia shares. A video presentation on Acadia Healthcare can be found here. http;/Jwww.aurel iusvalue.con>/reseun}r/acadia-healtPmm'o/ 10/ 14/2019 Acadia flcalthcare: Destructive (h'ueci - Marous Aurelius Value Page 6 of 30 Systemic Patient Abuse, Neglect, and Understaffing Infects Acadia Facilities Across the Country, Acadia investors have been led to believe the company is isolated from the fraud and patient care scandals that have historically plagued other publicly traded behavioral health companies such as Psychiatric Solutions (PSI), Universal Health Services (UHS), and American Addiction Centers (AAC). CEO Joey Jacobs has publicly claimed that "everybody wants to be Acadia', while the sell -side, for example, has touted that "claims about understaffing typically are focused on ACHC's competitors" and "fraud, abuse in behavioral industry mainly limited to the addiction segment, where ACHC has a small presence'. But this narrative is simply false. Because staffing is Acadia's single largest expense, currently representing roughly 53% of total revenues, we believe that Jacobs and his team have inflated short-term reported profits by cutting staffing expenses at Acadia facilities to unsafe levels. Yet having appropriate staffing, in terms of both quantity and quality of people, Is critical because some patients are dangerous to themselves and others, requiring intense supervision and precise administration of treatment. A senior industry executive with over 20 years of experience told us that "the way to think about it is that if you cut staffing or hire the wrong people, you're more likely to have an adverse event". This Is exactly why we believe underspending on staffing makes it so difficult for many Acadia facilities to properly supervise and protect vulnerable patients, much less treat them effectively. The nexus between understaffing and deficient patient care at Acadia is demonstrated by our analysis of Centers for Medicare & Medicaid Services ("CMS") inspection reports. Although Acadia operates 209 behavioral healthcare facilities nationwide, 43% of its US revenue (over $775 million) comes from acute inpatient facilities. CMS typically inspects http://www.ameli�esvaluo,e<mr/research/ecudiu-healtPrcare/ 1 Dl l4/2(119 AcUdIR faal theare: 17estructive Greed - Marais Aurelius Value page 7 of'36 hospitals at least every four years but will conduct more frequent inspections in the event of complaints or problems. We located CMS inspection reports for 31 of the 40 US hospitals listed on Acadia's website. Federal Inspectors uncovered staffing deficiencies at a of the 31 Acadia hospitals we reviewed including repeated violations for not having enough nurses or qualified practitioners on hand. Of the 28 hospitals that had staffing deficiencies, 25 were also cited by inspectors for having deficiencies related to patient safety or care, including violations involving patient deaths, suicides, elopements (escapes), improper or erroneous administration of medications, Improper use of restraints, and physical or sexual assaults. Inspectors also found managerial deficiencies at 27 of the 31 facilities we reviewed, which includes failures to report Incidents to law enforcement or even investigate patient abuse allegations, and failures to provide proper oversight or follow or establish appropriate patient safety protocols. Our analysis indicates that Acadia's hospitals are also measurably worse than its publicly traded competitor UHS. We compared the results of 70 CMS inspection reports of Acadia facilities from 20152017 to 153 CMS Inspection reports we found for 58 different UHS behavioral hospitals over the same time period. The Acadia facilities averaged 4.8 violations per inspection, 60% higher than the 3 violations per inspection averaged by the UHS facilities, Our review found that Acadia facilities also received more violations per inspection Involving patient safety or care deficiencies (double) and staffing problems (quadruple). We consider this performance especially poor since some UHS facilities have well known problems that have attracted significant media scrutiny as well as multiple criminal and civil government investigations. http:Nwww.aurcliusvalue.eomA'escarch/acedia-healthosre/ 10/14/2019 Acadia Healtlicare: 14estrudiva Greed - Marcus Aurelius Value Paige & of } f; Source: Internal analysis of CMS inspection data. The conditions inside Acadia's facilities claim real victims. Examples of undisclosed incidents include: Note: This report references numerous lawsuits, regulatory documents, and criminal proceedings. You should assume that Acadia or the referenced defendants deny all allegations. Some of the referenced lawsuits hove been settled, dismissed, or removed. A five-year-old boy was killed in June 2017 at Acadia's Ascent Children's, a chain of youth facilities in Arkansas. Staffers left the boy inside a hot van with a disabled safety alarm, resulting in felony manslaughter indictments of four former Acadia employees. This month, the faciljjv abruptly announced it wod permanence close all of Al seven facilities State officials had launched an additional investigation in Irttp://www.aureliusvalue.com7research/acadia-healthcare' 10/14/2019 Acadia Helihcare; Destructive Greed - Maims Aurelius Value Pagc 9 of 36 December into incidents of alleged child maltreatment at the center. Police are investigating two recent patient deaths and a sexual assault at Acadia's Park Royal Hospital in Florida, according to a February 2018 media report. Federal Inspectors have flagged patient safety issues at the hospital, which has a pattern of patient abuse that has already seen one former Acadia employee imprisoned for raping 11 patients. Patient referrals to Acadia's Ohio Hospital for Psychiatry were temporarily halted In May 2018, after patient safety and staffing issues were revealed on a website created by an area rights group. A sexual assault allegedly perpetrated by an Acadia nurse with a history of disciplinary actions is the latest following what a local news outlet reported as "years of complaints, state investigations and violations of safety and care standards". Acadia staff members allegedly assaulted children and "would encourage kids to fight for their entertainment" according to a February 2018 local news investigation into Acadia's Resource Residential youth facility in Indiana. The Indiana Department of Child Services placed a referral hold at the facility in April 2018, according to a local news report, meaning That they will not send any more kids to the facility. In June 2018, CMS inspectors declared Immediate Jeopardy, commonly interpreted as a "crisis situation", at Acadia's Lakeland Behavioral hospital after CMS directed an unannounced inspection that found "the facility failed to protect two patients from sexual misconduct". Inspectors had previously declared Immediate Jeopardy in 2017 after finding the facility failed to prevent patient assaults, Federal Inspectors last yeardiscovered that 26 patient deaths went unreported to the governing body of http:/Iwww.zureliusvalue.crmih'eaearcPdacadia-healthcare/ 10(14/2019 Acadia 11caldxare: Destructive Geed - Marcus Aurelius Value Page 10 of 36 Acadia's Rolling Hills Hospital in Oklahoma in 2016 alone. According to a lawsuit, reports of sexual assaults against young patients triggered government investigations "which resulted in the removal of all DHS [Oklahoma Department of Human Services] children" from the premises. At Acadia Montana, state inspectors documented "728 patient assaults"that occurred during a 13 week review period in 2016. According to inspectors, "Staff reported the facility is understaffed" and one resident reported that staffers watch porn in front of the kids. Multiple instances of child abuse by staff at Acadia's Capstone Academy in Michigan have been substantiated by state child welfare investigators. We obtained a December 2017 letter (see page 41) to the facility from the Michigan Department of Health and Human Services which demands, in bold print, "an explanation whyprevious corrective action plans have not obtained and maintained compliance forrules found in repeat noncompliance". After a vulnerable child was assaulted by an Acadia staffer at Sonora Behavioral in Arizona, federal inspectors found that the facility failed to report the incident to the parents or police in 2016. A string of young patients have died at the facility and inspection reports detail numerous other violations including understaffing, medication errors, and failures involving patient injuries. Two patients died due to allegedly being improperly treated with dangerous medications at Acadia's Seven Hills Hospital In Nevada, according to two wrongful death suits (here, here). The doctor accused of the misconduct is still practicing at the hospital. Arkansas regulators reportedly opened an investigation Into Acadia's Piney Ridge Treatment Center in 2016 after parents and former patients told http:/hvww.aurehusvalue.00n�lresearchlaeadiu-healthcare/ 10/14/2019 Awclia Healthcare: Dcstrucrive Greed- Marcus Aurelius Value Page I I of 36 local reporters the facility actually operates "more like a kid's fighting ring". A former facility staffer was arrested in April 2018 and charged with one felony count of engaging children in sexually explicit conduct. Former employees told a local news stations that Piney Ridge overlooked the misconduct and had attempted to "sweep it under the rug". Undercover footage of patient brutality at an Acadia facility In the UK was aired on Dispatches in February 2018 including evidence of severe understaffing and improper safety practices. A teenage girl was violently raped by another resident at Acadia's Valley Behavioral facility in Arkansas because of low staffing at the facility, according to a negligence suit filed in 2016 against Acadia, A 10 year old patient was raped in the presence of a van driver who has subsequently pleaded guilty to a felony, according to a lawsuit filed against Acadia and the van company that is reportedly headed to trial in late 2018: A malpractice suit filed in 2017 states that "a detective threatened to shut down the Longleaf Hospital", an Acadia facility in Louisiana, after an adolescent patient was assaulted by Acadia representatives who then "obstructed and prevented several law enforcement officers from entering the facility". Violations surrounding a patient's death and incidents of abuse and neglect are highlighted in a series of recent federal Inspections of Acadia's Cross Creek Hospital in Texas. Inspectors found that a patient who staff "failed to monitor" died after a series of falls at Acadia's StoneCrest Center. Federal Inspectors were told by a patient hat "all the staff were sleeping, even the nurse" and uncovered numerous patient safety deficiencies including "unmet care needs'. They also found Indications that patients were "coerced into taking IMP: //wW W,GIIL'el i usvalue.arm/research/acadia-f realdreare/ 10/14/2019 Acadia Healthcare: Destructive Greed - Marcus Aurelius Value 114ge 12 of 36 medications or receiving treatment that they did not agree to" by the nurses. Two patients committed suicide In a five day period last year at Acadia's Belmont Behavioral Hospital, according to a state Inspection and a lawsuit that blames understaffing. In addition to Instances of abuse, federal Inspectors report that senior citizens failed to receive basic care such as baths and wound treatment at Acadia's Delta Medical Center. Our investigation also found problems within Acadia's national network of addiction centers, treatment clinics, and residential facilities. Acadia is soliciting taxpayer funds by promoting itself as a solution to America's Opioid addiction crisis. Jacobs has told investors that "we have lobbyists in every state, working with states and communicating our position on how we think this money [opiate crisis funding] should be used". But our analysis of inspection reports for outpatient facilities in various states indicates that Acadia is providing deficient care to many of these patients. To illustrate this point, we reviewed inspection reports for 36 Acadia addiction facilities in Pennsylvania, which we chose to sample because Acadia derives 70% of Its total revenue from Pennsylvania, more than any other state. Pennsylvania inspectors uncovered 542 violations at these Acadia addiction centers since 2015 including deficiencies related to patient safety, treatment and/or staffing at 97% the loc io , Not only did inspectors find that patients often lack basic treatment, but Acadia invests se little in some of these facilities that that inspectors found locations infested with rodents, mold, and even bullet holes in the windows. Slash & Burn; The True Nature of Acadia's Business Model http;//www.aweiiunvaluo.conilreseareh/acadia-hoaltlmare/ 10/14/2619 Acadia frcultheare: Destructive Greed - Marcus Aurelius Value Page 1.3 of 36 Acadia's CEO Joey Jacobs and his management team previously ran PSI which pursued a roll -up strategy focused on aggressively cutting costs at acquired facilities. ProPublica and the LA Times published an investigative series on PSI a decade ago which exposed patient deaths, assaults, and how "poor patient supervision, understaffing and inadequate worker training have led to instances of chaos and brutality". The Department of Justice and other regulators opened investigations into PSI and at least four whistleblowers filed lawsuits alleging misconduct or fraud at the company. PSI investors sued Jacobs and the company for fraud in 2009 alleging that Jacobs had "downplayed the alarming incidents of abuse, neglect, and even death" at company facilities because PSI had become "addicted to debt" and needed to cover up its operating problems: hltpalwww.aureliusvalue.comhesearchlacadin-healthcare/ 10/14/2019 Acadia I3ealthcare: Destructive Greed - Marcus Aurelius value Page 14 of 36 Above: Civil Action No. 3:09-cv-00882-WJH. The suit was settled by UHS for $65 million without admitting guilt, Jacobs and PSI denied the allegations. After selling PSI to UHS In 2010, Joey Jacobs founded Acadia in 2011 with five other former PSI executives. Jacobs has replicated PSI's roll -up strategy at Acadia, thus far acquiring over $5 Billion worth of behavioral healthcare facilities while hiring certain former PSI lieutenants to run and oversee them. Like PSI, our research demonstrates that cutting staffing expenses is the heart of Acadia's business model. Acadia's financials show that the company's staffing expenditures have declined sharply over the past eight years. Acadia's reported same -facility salary, wages, and benefits ("SWB') expressed as a percentage of revenue, essentially an "apples to apples" comparison of facility level staffing expenditures, has declined from 62.1 % of sales in 2010 to 51.2% in in June 2018. SWB expenses had declined 6 of the past 8 years, but began to increase slightly in 2017 and so far this year. ON http://www.aureliusvalue.com/research/acadia-healthcue/ 10/14/2019 Acadia Healthcare: Destructive Greed - Marcus Aurelius Value, Page 15 of 36 Source: data from Acadia SEC Filings Staffing problems at Acadia are consistently detailed in CMS inspection reports. CMS requires staffing to be based on the needs, or "acuity," of the patient population. More staff per patient is required when the facility has more patients requiring intense, at times one-on-one, care than others. For instance, the Behavioral Health Executive explains that facility policies typically call for checks on suicidal or dangerous patients at least every 15 minutes and "the failure could be that you haven't hired enough staff to do the check'. Federal Inspectors have repeatedly attributed patient deaths to Acadia's failures to properly perform such checks: http://www.aureliusvalue.com/researchlacadia-healtheme/ 10/142019 Acadia Healthcare: Destructive Greed - Marcus Aurelius Value - Page 16 of 36 Source: CMS Inspection of North Tampa n Source: CMS Inspection of Sonora http://www.aureliusvalue.con/researeh/acadia-healthcare/ 10/14/2019 Acadia Healthcare: Destructive Greed - Marcus Aurelius Value Page 17 of 36 Source: CMS Inspection of Park Royal Inspectors have also repeatedly found that Acadia facilities simply don't have enough nurses or staff to properly care for patients. For instance, after inspectors found Acadia's Options Behavioral did not come close to meeting the required 1:6 licensed nurse to patient ratio in 2017, the Director of Nursing admitted that "she was aware of the shortstaffand the management was also fully aware regarding the short staff issue". http-//www.auTeliusvalue.com/resewelVacadia-heatthc=/ 10/14/2019 Acadia'Healthcare: Destructive Greed - Marcus Aurelius Value Page 18 -of 36 Source: CMS Inspection of Options Behavioral During an April 2018 CMS inspection of Acadia's Cedar Crest Hospital in Texas, inspectors found that "units were not staffed to facility staffing standards, often resulting in injuries to both patients and staff as well as patient elopements". Staff members told the Inspectors that "it's terrible here, There's no staff. It's not safe", "we have begged for hely., "there's never enough staff to take care of the patients". Another staff member explained that "ft's outrageous... patients physically intervene because we don't have enough staff on the unit. Sometimes Interns are used as subs for staff coverage... sometimes we breakdown and cry._ the CEO knows what is going on In this hospital He knows we are understaffed Fol http:/lwww.aurellusvalue.com/reseerch/acadia•healthoare/ 10/14/201.9 Acadia Healthcare: Destructive Greed - Marcus Aurelius Value I. I Page 19 of 36 Source; CMS Cedar Crest Inspection Acadia also appears to increase profits by crowding more beds into facilities without adding enough staff. For example, the CEO of Acadia's Longleaf Hospital admitted to inspectors he "ceras aware of the 'broken system' of the hospital". Longleaf Medical Director told inspectors that "it became difficult to staff" the facility because "since the current owners ]Acadia] acquired the hospital, they have grown and increased beds by 24. As soon as more beds became available, there was more pressure to admit more patients". When inspectors asked a nurse if patient safety incidents at the hospital are connected to inadequate staffing, she stated "it's absolutely horrendous, they put people on the schedule they know won't show up, people who aren't even there". Inspectors also found Instances of alleged patient abuse and wrote that Longleaf "provided the opportunity for alleged perpetrators to continue to provide direct patient care'. When inspectors spoke with the facility's risk manager she "indicated she 'could cry right now' -she had only been in the position manager of Risk Manager for 5 months and had a 3 day training with corporate staff'. http://www.aureLiusvalue.wm/mware.b/aoadia-healtheare/ 10/14/2019 Acadia flealthcare: Destructive Greed, Menus Aurelius Value Page 20 of 36 Source: CMS Inspection of Longleaf At Harbor Oaks, an Acadia facility in Michigan, former employees say that Acadia deceived regulators by increasing staffing levels immediately prior to audits before quickly reducing it again after the inspectors left. A detailed recent investigation of Harbor Oaks aired by WXYZ News in Detroit featured interviews with four former employees who described how Acadia understaffed the facility to maximize profits. The WXYZ investigation detailed multiple alleged instances of patient neglect and violence, including "scores" of police reports regarding physical and sexual assaults as well as 76 OHSA reports of workplace violence. One whistleblower says that she was tasked with overseeing 32 patients by herself and sustained severe injuries after being attacked by a large patient. hup:/,'www.aurcllusaaluu.com/researcWemadia-heolthesu'e/ 10/14/2019 Acadia Healthcare: DCA4 ucrive Greed - Mimeos Aurelius Value Page 2 f of 36 Inspections we reviewed also repeatedly suggest that Acadia has limited the availability of medical professionals or hired unqualified or improperly trained staff, further degrading patient care, This is a serious Issue because patients suffering from psychological disorders or addiction often require skilled and personalized care to get better, A former senior employee of CRC Healthcare we spoke with explained that after Acadia acquired the company in 2015, Jacobs and his team cut millions in costs by gutting successful corporate programs specifically designed to track and Improve patient outcomes: GGWhen Acadia acquired us they dumped it all.. In service of the bottom line, they decided to let all the clinical work that we had done go— Do 1 think the quality of care has gone down in many of the facilities there? I absolutely do, Do l think the outcomes aren't as good as they were? I absolutely do, For example, after multiple young patients died at Acadia's Sonora Behavioral, inspectors found that the only Acadia staff person working in the unit during one of these deaths "wad not fl alified" and "his/her only documented prioremplvment was as a'driver " (below), A local news investigation from May 2018 identified other staffing problems including "a nurse h[tp�/lwww.uureliusvrdus.cun�Iresearcfdacadia-healthcare/ 10/14/2019 Acadia Healthcare: Destructive Creed - Marcus Aurelius Value Page 22 of 36 without a valid license to work in Arizona, a behavioral health technician who assaulted a child patient, and a nurse accused of being drunk on the job". Source: CMS inspection of Sonora Behavioral In February, a former nurse at Acadia's Resource Residential told a local news outlet investigating problems at the youth facility that "the majority of the employees are young and vastly underqualified". She also said she was aware of misconduct including a "mate staff member who engaged in sexual activity with the female residents": r htlp://www,aureliusvalue.com/research/aoadia-healthcare/ 10/14/2019 Acadia Fleahhcare: Destructive (Deed - Marcus Aurelius Valuo Paso 23 of 36 Similarly, a whistleblower suit (here) filed in August 2017 by the former Human Resources Director of Acadia's Pacific Grove Hospital. The suit alleges that she was fired after reporting "unsafe and Illegal practices within the hospital" including staff operating without requisite training, licensure, or background checks. We note that federal Inspectors declared an immediate jeopardy situation at Pacific Grove In 2016 after finding problems impacting the "safety of patients related to unsafe use of restraints and seclusion'. Staffing was so thin at Acadia's Fashion Valley Treatment Center in California "that non•medicalpemonnel such as the secretary were making treatment decisions", according to allegations made in a different whistleblower suit filed in May 2018 by a former nurse (here). The nurse explains that serious problems began to surface after Acadia began to slash the staffing at the facility while cutting corners " ec use Acadia wanted to Increase their total number of paClents and reach their ouotas". The suit also says that chaos ensued causing patients to become increasingly frustrated and violent while "Clinical and Regional Directors would make the nurses hup:Hwww,aureliusvalue.com/research/acadia-heattheare/ 10/I 4/2019 Acadia Ilealthewe: Destructive 0reed - Marcus Aurelius Value Page 24 of 36 back date patients intake and other forms". The nurse says she reported her concerns to Acadia's corporate office, but the company retaliated In "an attempt to silence" her before she was terminated. Similar allegations were made in an additional whistleblower suit (here) filed In September by a former Fashion Valley counselor who also says she was fired after reporting "unlawful andlor unethical conduct with respect to patient treatment" as well as " r c igen to_ioPlate the pati andlor billing figures". r Endres vs Acadia Healthcare Company (2018) At Acadia's Vermillion Behavioral inspectors noted "psychiatrists falling to participate In the patient's treatment team as stipulated in the by-laws". A psychiatrist told http:!/www.aureliusvahre.com/research/acadia-healthcare/ 10/14/2019 Acadia Healthcare; Destructive Greed - Marcus Aurelius Value . I Page 25 of 36 Inspectors that even though patients were being admitted under her name, In reality, "she had very little oversight at this hospital". An Acadia nurse explained that "patients are admitted under [the psychiatrist's] services, but she [the nurse] treats them". rXI ON http://www.auteliuwalue.com/msearcht&adia-healthcare/ 10/14/2019 Acadia Healthcare: Destructive Creed - Mucus Aurelius Value - Page 26 of 36 Source: CMS Inspection of Vermillion Behavioral As previously mentioned, Federal Inspectors last year discovered that 26 patient deaths went unreported to the governing body of Acadia's Rolling Hills Hospital in Oklahoma in 2016 alone. The Senior Industry Executive told us this is "a huge problem, that's mind-boggling". The Inspectors also found that "the hospital failed to ensure a registered nurse (RN) supervised and evaluated the nursing care for each patient... this occurred in 28 of 28 open and closed medical records reviewed". In total, inspectors have documented 64 separate violations at this facility since Acadia first acquired it in 2012, including "failed practices" related to patient care, staffing, and even failures to investigate allegations of patient abuse. Fal http://www.aureliusvalue.com/research/wadia-healthcare/ 1 10/14/2019 Acadia Healthcare: Destructive Greed - Marcus Aurelius Value Page 27 of 36 Source: CMS Inspection of Rolling Hills Two different lawsuits (here, here) were filed in December 2017 against Acadia by guardians of former Rolling Hills patients, one of whom allegedly suffered permanent brain damage after being violently assaulted at the hospital. The other suit describes how a boy was raped by another patient who had a history of alleged assaults (and has subsequently pled guilty) at an affiliated group home owned and operated by Acadia. The suit alleges that "Acadia ordered its employees to remove security cameras and to destroy video surveillance footage", failed to report the incident to police, and ejected a state case worker from the premises. Also, according to the lawsuit,,additional reports of sexual assaults triggered government investigations "which resulted in the removal of all DHS [Oklahoma Department of Human Servicesl children" from the premises Area media reports confirm that this Acadia facility has indeed been closed. bnt�:/Pov w.auraliusvulue.eonilrusearch;acudiirhet4rheare 10/10.12019 Acadia Healthcare: Destructive Greed - Marcus Aurelius Value Page 28 0£36 Joshua Edwards vs Rolling Hills Hospital (2017) Acadia facilities often treat children and teens, many of whom have been placed under Acadia's care after incidents of abuse by their former caregivers. But we found evidence of violence, abuse, and neglect at Acadia youth facilities driven by staffing problems, including previously mentioned episodes at Ascent Children's, Capstone Academy (Detroit Behavioral), Piney Ridge, and Resource Residential. At Acadia Montana, state inspectors documented "128 patient assaults and 26 incidents of residents causing property damage occurring during this 13 week review period" in 2016. This followed a 2019 "statement of deficiency report citing the facility is not providing a safe environment" issued by the department after Inspectors reported "the facility has had 132 patient assaults" during that 13 week review period. The Inspectors wrote "the facility failed to implement significant changes in programming in order to ensure patient safety and reduce the number of serious incidents as indicated in the plan of correction". According to inspectors "youth reported not feeling safe in the facility due to physical assaults by peers and lack of staff intervention" and "Staff reported the facility is understaffed". One resident reported that staff even watch porn in front of the kids. htip://www.aureliusvalue.00mhesearchlacadia-healthcare/ 10/14/2019 Acadia Healthcare: Destructive Oreed- Mai cus Aurnlins VBIuC Page 29 of 36 Source: Acadia Montana Inspection Report We also found indications that overtaxed Acadia medical providers resort to using chemical restraints—i.e, deliberately overmedicating patients for the convenience of Acadia's staff. For example, a state inspection of Acadia's Options Behavioral "determined that the on-call physician wrote orders for chemical restraints in conflict with the facility policy that restricted this practice". Federal inspectors also found that this facility "failed to have adequate numbers of licensed registered nurses to provide nursing care". ht[p://wevw.aurelivavaltre.cmnhaeearcA/acedia-healthcare/ 10/14/201() Acadia Healthme: Desiructive Greed -Marcus Aurelius Value , . Page 30 of 36 ' Source: Options Behavioral Inspection Reports (Here, Here) This practice appears to have been going on for some time. At Acadia's Red River Hospital in Texas, a whistleblower suit filed by a former employee in 2012 alleges that patients were neglected and references a recording of an elderly patient left strapped to a chair for an entire 12 -hour shift while being periodically injected with sedatives by Acadia staff. According to the suit, the neglect was the product of an allegedly fraudulent campaign to get more elderly Medicare patients In the door to increase revenues for Acadia even though the facility didn't have the resources to properly treat the patients. FEN http://www.aureliusvalw.com/resewchl=dia-healthcare/ 10/14/2019 Acadia Heahlicare: Destructive (freed - Marcus Aurelius Value Page 31 of 36 Source: Yvonne Downs v. Red River Hospital (2013) Afterwards, Red River allegedly implemented a new video retention policy, only retaining the most recent 14 days of footage. Other allegations of fraud at Acadia include: A whistleblower suit filed in June 2018 by a former nurse at Acadia's North Tampa Behavioral Health Hospital. The nurse says she was directed "to falsify medical documents" and was fired after reporting "inadequate staffing, patient safety, employee safety". http://www.aureliusvahie.eomlrasearaldacadia-healthcare/ 10/14/2019 Acadia HwIthcure: Destawtive Greed- Marcos Aurelius Val tic Page 32 of 36 Source: Young vs. North Tampa Behavioral Health (2018) A former employee at Acadia's Millcreek facility "was terminated after making her supervisor aware of multiple acts of Medicaid fraud", according to allegations in a lawsuit filed by a former employee in 2017. (Madeline McNease vs Acadia Healthcare Company Inc.) A 2015 whistleblower suit states that Cedar Crest was billing Medicare, Tricare, and private insurers for phantom services. The whistleblower alleged thatthe hospital falsified patient records before state audits and experienced retaliation after reporting the malfeasance to Acadia's corporate compliance department. http://www.auroliusvalue.com/res€arch/acadiry-healthcare/ 10114/2019 Acadia 1-lealdreare: 1)ustrucdw 6rced - Marcus Aurelius Value Pace 33 of 36 Russell vs HMIH Cedar Crest (2015) We See Substantial Downside Potential in Acadia Shares Acadia's business model is premised on borrowing billions of dollars to acquire behavioral health facilities, then wringing out profits by cutting staffing and patient care expenditures while adding beds. The fundamental problem, in our opinion, is that this model is inherently unsustainable because it depends on degrading patient care -a losing proposition. The consequences of Jacob's slash and burn approach to behavioral healthcare, which has caused many of the problems we found at Acadia facilities across the country, now appear to be spilling over into Acadia's financials. The true nature of Acadia's business practices finally coming to light hurts the company because It contradicts management's public claims and increases public scrutiny_ The former UHS facility CEO told us that after Buzzfeed published articles exposing patient safety issues at UHS, there was an "Immediate impact" and "Once an article like that goes out, first of all, any provider in the local market won't hardly dare send you a patient, because they don't want to be associated with It." Loved ones also become less likely to send family members to facilities associated with patient safety scandals or misconduct. This dynamic already appears to have begun at Acadia's Ohio Hospital of Psychiatry, where http:/hvww.nurelinsvalue.cainlresearch/acadia-healthcaml 10/ 14/2019 Acadia I lealtheare: Destructive Greed - Marcus Aevehus Value Page 34 of 36 referrals were temporarily halted earlier this year after an area rights group released a report. Similarly, the Indiana Department of Child Services placed a referral hold at Acadia's Resource Residential youth facility In April 2018, meaning that they will not send any more kids to the facility. Based on the recurring problems in inspection reports we reviewed, we find it likely that state and federal regulators have already begun to scrutinize Acadia's business practices. The former UHS facility CEO also explained that increased inspections, investigations, and potential fines or facility closures is why "It's a painful sentence once you're on the [regulatory] radar. Plus, it's worth the extra bodies [proper staffing] to stay off the radar, it's worth it." AAC's stock price has lost 75% of its value since news of criminal indictments broke, while UHS has closed over 20 facilities since 2011 amidst myriad government investigations. Just this month, Acadia's Ascent Children's announced that it would permanently close all seven of its facilities after Arkansas regulators opened an investigation into child maltreatment and four former employees were criminally indicted for the death of a young boy. Furthermore, the Department of Justice and other regulators have historically charged operators for billing for deficient care (here, here, here), which strikes us as a particularly acute risk for Acadia given that multiple whistleblowers have accused the company of fraudulent practices. We believe Acadia's profits are largely fleeting. Since Acadia's costs have already been out to the bone, the company has exhausted its primary means of driving profits from existing facilities. As scrutiny from the public and regulators Intensifies, we believe Acadia will likely be pressured to improve patient care, driving up operating costs significantly. This dynamic already appears to have started. hu p://www.ru reliusvalue.com/research/aeadia-healthcare/ I W 1412019 Acadia Healthcare: Destructive Greed - Marcus Aurelius Value _ Page 35 of 36 Acadia has missed earnings estimates two of the past four quarters and same facility revenue growth is slowing while facility expenses have started to increase. We estimate that Acadia will need to increase staffing expenditures by at least 10-20% to improve patient care, which would cost Acadia approximately $150 to $300 million In incremental annual expenses and reduce reported EBITDA by 25.50%. For context, we spoke to the CEO of a privately -owned facility who has over a decade of experience, Including at UHS. The Private Facility CEO estimates that his current facility has 40 to 50% more staff relative to patients than the former PSI facility he managed at UHS (which we believe approximates the staffing levels at Acadia). Unsurprisingly, he believes the patient care at his facility is much Improved and patient safety issues are now limited because he has more staff than before. Acadia has little room to weather increased expenses or reduced revenues because it has over $3.2 billion in debt it needs to service. Leverage stands at more than 5x Debt/EBITDA, already at the high end of Jacob's stated objective of "operating not much higher than the 5 times [Debt/EBITDAI". Acadia is also significantly more levered than PSI was, which was operating at approximately 3.7x Debt/EBITDA in 2009 according to Bloomberg data. We therefore see substantial downside potential in Acadia shares. VIEW ALL RESEARCH. MORE ACHC ITEMS http://www.aureliasvaluc.com/researcWacadia-healthcare/ - 10/14/2019 North Tairipa Behavioral Health is cashing in on Florida's Baker Act I Investigations I Ta... Bage I or26 North Tampa Behavioral Health in Pasco County JOHN PENDYGRAFT I Time How one Florida psychiatric hospital makes millions off patients who have no choice Editor's note: This story contains descriptions of self -harm. If you or someone you know is contemplating suicide, call the 24-hour National Suicide Prevention Lifeline at (800) 273-8255 or the Crisis Center of Tampa Bay by dialing 2.1-1. By NEIL BEDI Times Staff Writer Sept. 18, 2019 littNv://projecls.tampabay.com/projects/20 t 9/rovetigations/itortli•tampa•beliavioral-licalth/... 9/27!2019 North Tampa Behavioral Health is Bashing m on Florida's Baker Act I Investigations I'I a... Page 2 ol'26 WESLEY CHAPEL — More than two thousand people arrive eachyearat Norah Tampa Behavioral Health in extreme crisis. They are checked in under a state law that lets mental health centers keep people who might hurt themselves or others for up to 72 horns. But when that time is over, some patients find themselves held captive by the place that is supposed to protect them. Priya Sarran-Persad had a psychologist threaten to commit her a second time if she didn't volunteer to stay longer. Michael Jenkins hired a lawyer to help him get out but couldn't for a week because the hospital never sent his paperwork to a judge. Robert Allen was held an extra three days for not participating in group therapy. His family was shinned. Allen is deaf and wasn't given his hearing aids. Each night they stayed, more money flowed into the psychiatric hospital. Priya Sarran-Persad, Michael Jenkins and Robert Allen were unable to leave North Tampa Behavioral after 72 hours. The hospital used different techniques to extend their stays. YALONDA M. JAMES, Special to the Times; JOHN PENDYGRAET and LUIS SANTANA I Times https://projects.lampabay.com/projectsl2ol9/investigations/north-tampa-beliavioral-lie.altIV... 9/27/2019 North'Taiiip'a Behavioral Health is cashing in on Florida's Baker Act I Investigations I Ta.'. Page 3 of 26- i A Tampa Bay Times investigation has found that North Tampa Behavioral makes huge profits by exploiting patients held under Florida's mental health law, known as the Baker Act, The hospital illegally cuts patients off from their families. Then it uses loopholes in the statute to hold them longer than allowed, running up their bills while they are powerless to fight back. Powerless The problems with Florida's Baker Act In the coming months, the Times will explore the unintended consequences of Florida's mental health law. This is the first in an occasional series. Some patients describe getting virtually no psychiatric treatment. Meanwhile, people at risk of suicide have been allowed to hurt themselves, and helpless patients have been attacked on the ward. For this, the hospital charges up to $t,soo per night. The Times analyzed thousands of hospital admission records and reviewed hundreds of police reports, state inspections, court records and financial filings. The documents — and interviews with 15 patients and their families or advocates -- show the hospital uses a variety of tactics to keep patients beyond 72 hours. Some are tricked into thinking they've waived their right to leave. Others are forced to wait for court hearings that never happen. haps:llproj ects.tampabay.cotWprojmtsl20l9linvestigations/north-tampa-behavioral-health/... 9/27/2019 North Tampa Behaviorat$ealth is cashing in on Florida's Baker Act I Investigations I Ta... Page 4 of 26 The patients' stays are typically stretched just a few extra days. But keeping all of the hospital's Baker Act patients even one additional night would add about $1.4 million in annual revenue, according to figures provided by the hospital. Support investigative journalism Times reporter Neil Bedi spent months on this investigation. He tracked down patients and families from across the region, wrote computer code to analyze the hospital's billing data and unearthed thousands of pages of documents that showed what was really happening inside North Tampa Behavioral Health. Work like this is only possible thanks to the support of readers like you. Click here to subscribe today. subscribe North Tampa Behavioral hasn't escaped the notice of state regulators. Since 2014, it has been cited 92 times for unsafe conditions and code violations, more than all but one other psychiatric hospital in Florida. Inspectors have zeroed in on unqualified and undertrained staff members who have put patients in danger or denied them basic rights. Even still, the Wesley Chapel hospital has grown and thrived. It made $17 million last year in net annual revenue, mostly from taxpayer -funded https t//projects.tampabay.com/projeeLv2019/investigations/north-tampa-behavioral-health/.,. 9/27/2019 North Tampa Behavioral Health is cashing in on Florida's Baker Act I Investigations Ta.. Page 5 of M insurance programs like Medicare. In recent years, it has had one of the highest operating profit margins of any free-standing psychiatric hospital in the state, Of the 26 facilities in Florida, half couldn't break even. Hospital leaders declined multiple interview requests. In a statement, CEO Bryon Coleman Jr. called the Times' findings a "highly distorted and sensationalized portrayal that absolutely does not reflect NTBH's overall record" across thousands of patients, The hospital "strongly rejects any claim that it deliberately or willfully holds patients against their will absent a legitimate, clinically based determination," he wrote, adding that decisions to extend stay$ are never "driven by financial motivations and/or any type of nefarious intent:" [ p _stClick hereto read the hos ital's full statement] _ _ _ Coleman said the hospital's average operating margin since 2014 was "well below" the average for all psychiatric hospitals in Florida. But he calculated North Tampa Behavioral's figure using 2014 data, which brought it down because the hospital was new and operating at a loss. In 2015 and 2016, North Tampa Behavioral was one of the state's eight most profitable psychiatric hospitals. It was in the top four in 2oi7, the most recent year for which statewide data is available, although its margin dropped in 2018. i Experts say North Tampa Behavioral isn't the only place in Florida that has violated the Baker Act, which has provided life-saving support to people with mental illness for decades. But the psychiatric hospital stands out both for its success making money from Baker Act cases and the frequent problems with its care. https:llprojects.tampabay.con/projectsYl019linvestigatioiminorth-tampa-behaviprdl-healtIV... 9/27/2019 North Tampa Behavioral Hcalth is cashing in. on Florida's -Baker Act I Jnvestigatiom I Ta... Page 6 of 26' Profits and problems In recent years, North Tampa Behavioral has been one of the most profitable psychiatric hospitals in Florida. It's also been cited by state regulators for unsafe conditions and code violations more often than almost any other facility. North Tame " Other IL NEILBEDI I Times Source: Times analysis of Florida Agency for Health Care Administration records Martha Lenderman, an expert on Florida's mental bealth law and a former director of the state's Baker Act program, described the way the hospital routinely extends patients' stays as a "red flag." Some of the hospital's tactics she called "shocking." Kendra Parris, an Orlando attorney who specializes in mental health patients' rights, has represented five North Tampa Behavioral patients in the past year alone. The most recent was held at the hospital for five days in. April. Parris said the reason was simple; "She has great insurance." https:/lprojeets.tampabay.com/projects/2019/investigations/north-tampa-behavioral-healtW... 9/27/2019 North" aixipa'Beh'avioral Health is cashing in on Florida's Baker Act I Investigations l Ta... Page 7.of 26. North Tampa Behavioral opened in 2013 and grew rapidly. By 2010, it had more beds than its two competitors in Pasco County combined. JOHN PENDYGRAFT I Times Explosive growth North Tampa Behavioral sits on a desolate stretch of State Road 56 near the southern border of Pasco County. Stout palm trees line its well - manicured yard. Tall white columns give the entrance a stately feel. Need help? If you are in crisis or concerned about a loved one, click here for resources that can help. The hospital opened in October 2013 as part of a chain called Acadia Healthcare. Five months later, it was approved to treat Baker Act patients. https i//prgi ccts.tampabay.cotelptojectsl2Ol9linvestigations/north-tampa-behavioral-health/... 9/27/2019 North Tampa BehavioralHealth is cashing in on Florida's Baker Act I Investigations I Ta... Page 8 -of 26 The Baker Act lets judges, police officers, and mental health practitioners commit people with mental illness if they threaten to seriously hurt themselves or somebody else. The mental health center has 72 hours to do an evaluation. Over the next two years, Baker Act patients became an essential part of North Tampa Behavioral's business model, accounting for more than two- thirds of its admissions. Revenue soared. A recipe for growth Beginning in 2014, North Tampa Behavioral quickly increased the number of Baker Act patients it admitted. The hospital's revenues grew at the same time. MW AN,YYIMM,ww NEILBEDI I Times Source: Florida Agency for Health Care Administration Because of negotiations with insurance companies, hospitals rarely collect the entire amount they bill. But on average, North Tampa Behavioral still receives $670 for every night a patient stays, the hospital said. https://projects,tampabay.com/projectsl2019/investigations/north-tampa-behavioral-health/... J/27/2019 North Tampa Behavioral Health is cashing in on Florida's Baker Act I Investigations I Ta... Page 9 of 26 Ht 2017,.the hospital posted a 13.9 percent operating profit margin. Only three psychiatric hospitals in Florida performed as well or better. ,None generated as much business from Baker Act patients. Amid the success, North Tampa Behavioral broke ground on a new wing. By the end of 2017, it had 126 patient beds — almost as many as the two other Pasco County hospitals that take Baker Act cases combined. North Tampa Behavioral CEO Bryon Coleman Jr. Twitter But there was turmoil behind the scenes. The hospital cycled through four CFOs in as many years. Last year it hired Coleman to be the fifth. In a video interview with Ute Flernando Post, an online publication that focuses on "positive" business news, Coleman conceded the frequent leadership changes had left the hospital "broken." He described the workforce as "unstable" and "unsure" and said employees had not been held accountable by the tipper ranks, "I knew I'd be inheriting a leadership group that would have a lot of questions," he said. "Who is this person? What does he have that I don't have?" https:I/projects.tanrpabay.eomlprojects/2019/investigations/norih-tatnpa-beliavioral-health/.,. 9/27/2019 North `Pampa Behavioral Health is Dashing in on Florida's Baker Act I Investigations I .., Page 10,of 26 In his statement to the Times, Coleman said he had experience in logistics, financial forecasting and customer service, as well as "valuable, transferable skills and attributes including team leadership, situational analysis and sound decision-making." Coleman, 31, had been a quarterback on the Green Bay Packers practice squad and played a few snaps in the 2012 and 2013 preseasons. After that, he signed with an indoor professional football team, was the vice president of sales for a Tennessee -based trucking company, played for a Canadian football team and managed employee benefits for BB&T Insurance Holdings. He had no background in healthcare. Bryon `ed" Coleman was named CEO of North Tampa Behavioral In 2018. He previously https://proj ects.tampabay.wm/projects/2019/investigations/north-tampa-behavioral-healdil.,.. 9/27/2019 North Tanfpa Behaviord Healthis cashing in on Florida's Baker Act I InvestigationvI .., Page 11 of 26 played professional football, worked for a trucking company and consulted on employee benefits. Associated Press (2013) Longer stays, higher charges When Coleman arrived at North Tampa Behavioral, the hospital had already managed to boost an important metric. From 2014 to 2017, the average length of stay climbed from 6.5 days to 8.8 days, an analysis of state data shows. Its two competitors in Pasco kept patients an average of 5.2 days. To forcibly hold a Baker Act patient for more than three days, a mental health center must file a petition in court. Under the law, a judge has five work days to rule on the case. North Tampa Behavioral filed 592 such petitions last year. But it dropped 86 percent of them before the hearing, records show. Hundreds of patients were stuck waiting to see a judge, but never saw one. Meanwhile, their bills grew. The other two Pasco hospitals that accept Baker Act patients each filed half as many petitions as North Tampa Behavioral, even though both admitted a similar number of people under the law. One dropped just two petitions; the other dropped none. The only other facility in Pasco County that admits Baker Act patients, a small mental health crisis center, withdrew about half Of its 242 petitions. Held without a hearing https:llprojects,tampabay.coni/projmtsl2019linvestigationslnorth-tampa•behavior4l healthl... 9/27/2019 North Tampa Behavioral Health is cashing in on Florida's Baker Act I Investigations I ... Page 12 of 26 North Tampa Behavioral asked judges for permission to hold Baker Act patients longer than 72 hours more often than any other Pasco County hospital. But most of the petitions were dropped before the patient ever had a hearing. NEIL BEDI I Times Source: Pasco County Clerk Robert Allen was a patient at North Tampa Behavioral this year. He thought about hutting himself after Christmas and knew he needed help. An emergency room doctor sent him to North Tampa Behavioral. The 89 -year-old said he didn't get the clothes his family brought him and had only a hospital gown. No one told him showers were available. Employees didn't give him his hearing aids. Allen asked to leave repeatedly, but staff members insisted he stay beyond the three days, his family said. The hospital's chief concern: He wasn't participating in group therapy. "That blew our minds," said Allen's son-in-law, Wayne Dowdy. "He can't hear." https:Uprojects.tampabay.coriVproj©cts12019/investigationshiorlh-tampa-be0avioral-health/... 9/27/2019 s � 11,141 9 NEIL BEDI I Times Source: Pasco County Clerk Robert Allen was a patient at North Tampa Behavioral this year. He thought about hutting himself after Christmas and knew he needed help. An emergency room doctor sent him to North Tampa Behavioral. The 89 -year-old said he didn't get the clothes his family brought him and had only a hospital gown. No one told him showers were available. Employees didn't give him his hearing aids. Allen asked to leave repeatedly, but staff members insisted he stay beyond the three days, his family said. The hospital's chief concern: He wasn't participating in group therapy. "That blew our minds," said Allen's son-in-law, Wayne Dowdy. "He can't hear." https:Uprojects.tampabay.coriVproj©cts12019/investigationshiorlh-tampa-be0avioral-health/... 9/27/2019 'North Tampa Behavioral Health is cashing in on Florida.'s.Baker Act I Investigations I Page 13 of 26 The hospital petitioned to keep Allen longer. Six days into his stay, a nurse told Allen's daughter, Jennifer Dowdy, that his case would be heard by a judge. Jennifer Dowdy took off from work to attend. On her drive over, she called to find out where the hearing would be held but was told there was no record of her father's case. Hearings weren't even scheduled for that day. She pulled over in tears. As she sat in her car, North Tampa Behavioral called to say her father was being discharged and would be waiting for her in the reception area. Allen was charged $9,000 for the six nights. His insurance paid much of the cost. In July, he received a bill for the remainder: $1,465, Jennifer Dowdy and Robert Allen pose for a Robert Allen is still traumatized by his stay at family photo. Courtesy of Jennifer Dowdy North Tampa Behavioral, LUIS SANTANA I Times Other patients were held with a simpler method. Eight told the Times that they felt tricked or pressured into signing voluntary commitment forms. Four of them said they were told the documents would expedite their release. In reality, the forms let the hospital hold them longer than 92 hours without a judge's consent. https://proj ects.tampabay,com/proj acts/2019/investigations/north-tmpa-behavioral-health/... 9/27/2019 North Tampa Bohavioral'Health is cashing in on Piorida's,13a6r Act I Investigations - Page 14 of 26 Priya Sarran-Persad was sent from a hospital emergency room to North Tampa Behavioral after attempting suicide in 2015. When the 72 hours were up, Sarran-Persad was woken in the middle of the night by a nurse and escorted to a doctor's office. His first question: "What insurance do you have?" After Sarran-Persad named her private insurance company, the doctor said she had a "flavor of bipolar disorder" and needed to stay at North Tampa Behavioral longer, she recalled. He insisted she sign a voluntary commitment form — and threatened to "re -Baker Act" her if she didn't. The law does not allow doctors to re -commit someone without a petition unless they're experiencing a new crisis. Sarran-Persad refused to sign, but the hospital still took two additional days to discharge her. She said a psychiatrist who treated her after the incident determined she had depression, not bipolar disorder. httpsJ/projeots.tampabay.com/proj ects/2019/investigationslnorth-tampa-behavioral-health/.,. 9/27/2019 North Tampa Behavioral Health is cashing ir•oh Plorida'ls Baker Act I Investigations I... Page 15 of 26 Priya Sarran-Persad said she spent most of her time at North Tampa Behavioral in a hospital gown, staring out a window in the common area. YALONDAM.JAMES I Special to the Times In the hospital's statement, Coleman said the average length of stay at North Tampa Behavioral is lower than the average for Florida mental hospitals. But the figure he used included hospitals that mostly provide lengthier treatments to patients who aren't admitted under the Baker Act. He also pointed out that in 2018, the hospital's figure fell to 7.4 days. The state hasn't yet published comparable data for other hospitals. Coleman said "confrontations and disagreements" sometimes happen because psychiatric patients can't always make rational decisions about their care. httpsdlpmj ects.tampabay,co Wproj ectsl2019linvestigationsltiorth-tampa-behavioral-healthI... 9/27/2019 North "ratnpa Behavioral Health is cashiiig'in on Florida's Baker Act I ILnostigations I — Page 16 of 26 But in one extreme instance, North Tampa Behavioral was accused of kidnapping. In that case, first reported in the Miami Herald in 2015, the hospital refused to discharge an intellectually disabled woman for three weeks. Throughout, the woman's longtime patient advocate argued that an extended stay could make her condition worse. "They basically held her hostage," the; advocate, Nikki Drake, told the Times. The woman, Cindy Mertz, was eventually returned to her group home, Drake said. But she was traumatized by the incident and later committed to a state mental hospital. She's been there ever since. "They just did her in," Drake said. https://projec¢s.tanspabay.com/projectsl2U19/invrstigatians/north-tampa-behavioral-heaLPh/... 9/27/2019 North:Tamps Behavioral Health is cashing in on Florida's Baker Act I Investigations I ... Page 17 of 26 North Tampa Behavioral refused to discharge Cindy Mertz, left, for three weeks in 2015. Her patient advocate, Nikki Drake, fought to have her released. Courtesy of Nlkkl Drake Cut off with little care To help prevent these types of problems, the Baker Act guarantees family members "immediate access" to patients. But the families of to former patients told the Times that they weren't allowed to see their relatives, which experts say is illegal. Four families said their calls went unanswered or straight to voicemail as they attempted to check on loved ones. When they called from a different line, some said, their calls went through. The law allows hospitals to deny access only if a doctor determines the visit would harm the patient. But that's not what happened to any of the families. Instead, the hospital insisted they come during one of the two hour-long windows reserved each week for visitors. The law doesn't specify how often a hospital should hold visiting hours. But Lenderman, the Baker Act expert, called the schedule "totally inappropriate" and "overly restrictive." In other cases; state inspectors found that North Tampa Behavioral didn't tell patients' representatives the details of their care, even for patients who couldn't speak or make independent medical decisions. Many of the North Tampa Behavioral Baker Act patients who spoke to the Times said they rarely saw medical professionals and the therapies they received were unsophisticated or nonsensical. One patient remembered -https:llproj ects.tampabay.corn/projects/2019finvesdgations/north-tampa-behavioral-health/... 9127/2019 North Tampa Behavioral Health is cashing in on Florida's Baker Act I Investigations I.;. Pa je 1 & of 26 being told to smell an orange to ease her anxiety and depression. Another recalled having to watch an educational video on electricity. In the statement, Coleman said the hospital's visiting hours are scheduled around the treatment day and employees work "in good faith" to accommodate visits. He disputed that patients don't see doctors often enough and said the hospital's therapies use "evidence -based techniques That wasn't Michael Jenkins' experience. Jenkins, 37, was committed last July after attempting suicide. His parents and his wife tried to see him but were told they would have to return during visiting hours. A lawyer later helped Jenkins file a petition to argue for his release before a judge, records show. But state inspectors discovered that the hospital never sent the petition to the court. By law, requests must be sent to court the next day. After a state investigation, the hospital confirmed it broke the law by not submitting the court filing on time and promised to fix its process. Jenkins spent a total of seven days in the hospital. He said it felt like a prison. He received no psychiatric care and bad to beg employees to let him get some air, he said. "I wouldn't even wish my worst enemy to go there," he said. https://projects.tampabay.comlprojects/2019/investigation/north-tampa-behavioral-health/... 9/27/2019 North Tampa Behavioral Health is cashing in on Florida's Baieex Act I Investigations ... Page l9 of 26 Michael Jenkins spent seven days at North Tampa Behavioral Health last July, Since then, he says his three children have been afraid he'll leave and not come home. JOHN PENDYGf1AFT I Times Left in danger North Tampa Behavioral promotes itself as one of the safest psychiatric hospitals in the Tampa Bay area. But the hospital has repeatedly failed to protect its patients, police reports and inspections show. At least six people committed under the Baker Act have been able to escape. Two hopped over the fences during monitored recreation time. One kicked through the security doors and left. Another found an employee key card hanging from a door and showed himself out. https://projects.tampabay.com/projectsl20l9linvestigationslnorth-tampa-behavioral-healtlil... 9/27/2019 Not th't'ainpa Behavioral Heatlh is dishing in on F'lorida's Baker Act I hivesiigat ions I ... Page 20 of 26 Patients have also been hurt inside the hospital. In July 2014, one smacked a disabled man in the face with a chair while he was sleeping. The victim needed Jr stitches. Later that year, a mental health technician punched an autistic man and kicked him in the head repeatedly. The employee was arrested and fired. Michael is. IW kod so he WI. -mg Michael NiO m es nwm. M oast Umr:, loss:ph Cdnw UP h11114T1 Amt POncUW Michael IhrcxUimes is the ribs and kncul his thigh. Michael fell to the ground and Jammic told Joseph to slop. Jommic yelled In Joseph, "What am you doing?" As Michael,JvM tyypy,pp his ideaaF.h, MyIet,cunt!RII MIrbacCg upf Iwdv and Jeredewntrclled his leas Jmumie ablulr' NL' 1oP'd`ek Walnlr the ebuPJa'�.'do'ioelhrac!'daeEBB e iino the Joseph's kicks to Michal's hhx: caused Michael's head to "wme off the a blanket which was needed to costa up Micbuel. When hrxph returned, Joacph December 2014 police report Pasco Sheriff's Office In 2o16, two suicidal patients were able to hang themselves, even though North Tampa Behavioral is supposed to provide special monitoring. Both survived. Two patients reported sexual assaults at the hospital in 2018. When police arrived to investigate one of the cases, hospital leaders couldn't provide any video footage. The cameras hadn't worked for weeks. r�{nmm}who edvlseo�waa a a.,,.....,uwm.a Risk Man iter) pmvid d me wdh the hdlowmt, slalemems: toy vt�pt J lt�clid2d5;$h4advi; rcganliag Ilea iuddmn nisl per Avui, opcnNt r) 17_8 a rylnrt would not ba, as a Raker Act due ht autistic lomdrncics and vas a baker not from a August 2018 police report Pasco Sheriff's Office That ,hme, another patient needed emergency medical care after he found a piece of metal and used it to cut himself. A nurse told police North Tampa Behavioral employees had been conducting the required checks. But the https://prujaots.tanipabuy.cnm/projects/2019/investigations/north-tamps-behaviorat-healthl... 9/27/2019 'North Tempa Behavioral. Health is cashing in on Florida's Baker Act I Investigations I'... Page 21 of 26 patient, Kevin Roach, told the Times that wasn't true. He said he sat alone, bleeding, for at least half an hour and lost almost 2 liters of blood. In the statement, Coleman, the CEO, called the incidents "regrettable but wholly non -representative temporary departures from the overall high level of quality clinical care." Coleman touted North Tampa Behavioral's low frequency of serious incidents like assaults, injuries and runaway patients. But he provided a rate of incidents per patient -day that showed the hospital had experienced roughly 75 serious incidents — on average, one a month since it opened. Coleman also said that North Tampa Behavioral had not been "subject to any fines or licensure actions" by the government. Later, when the Times pointed out state regulators had fined the hospital to times in the past six years, he conceded he was wrong. Regulators have continued to find safety issues. In December, they cited the hospital for not having a working defibrillator. During the investigation, the supervising nurse said the hospital didn't have a team for medical emergencies. The plan, she said, was to call 9 -t -i. A profitable chain North Tampa Behavioral is one of 595 facilities owned byAcadia, a Tennessee -based chain that specializes in psychiatric care. The companybrought in $3 billion in revenue last year. But serious safety problems, including rapes and patient deaths, have been alleged at Acadia - ran facilities across the country. https:/Iprojects.tampabay, corn/proj ects/2019/investigations/north-tampa-behavioral-healthL.. 9/27/2019 Nvrlh Tampa Behavioral Nealth is ca6ing in on Florida's Baker Act I Investigations I ... Tape 2'2 of 26 .lust this year, an employee at an Acadia -run rehabilitation center in Chicago was accused of sexually ahusing,six patients, At least two Acadia facilities were shuttered: one in Montana that used dt ugs to -restrain, children and one in New Mexico, where employees were accused of threatening and abusing children and orchestrating fight clubs among patients. Another Acadia hospital in Florida — Park Royal in Fort Myers — has paid more than $3 million in settlements to eight former patients who said they bad been sexually abused by an employee. Park Royal is the only Florida psychiatric hospital with more citations than North Tampa Behavioral. It has been cited by state regulators more than too times since 2014. Since 2014, Park Royal in Fort Myers has had the most citations in Florida. It is also owned httpsJ/projects,tanipabay.com/projectst2Ol9/itivestigations/north-tamptmbehavioral-heattlJ... 9/27/2019 North"Tarnpa Behavioral Health is cashing in on Florida's Baker Act I Investigations I ... Page 23 of 26' by Acadia Healthcare. SARAH COWARD I The News -Press Acadia declined requests, In a re multiple interview statm „ erit, the company P 4 ?... said serious and grave incidents made up an `infinitesimally small percentage" of patient encounters. There have also been allegations of fraud. Most recently, investigators said Acadia -run mental health and addiction centers in West Virginia had charged Medicaid millions for lab tests they had actually outsourced at a settled for $i7 million. bargain. The chain _ _. In its statement, Acadia said it was "pleased to have reached this resolution" and pointed out that the settlement did not include an admission of liability on the company s part. But the scrutiny hasn't stopped. In its July financial statements, Acadia said nine of its U.S. facilities are under investigation by the Department of Health and Human Services. Another is being investigated by the U.S. Attorney's Office for the Middle District of Florida. The U.S. Attorney's Office won't name the hospital. In each of the cases, Acadia said in the financial filings, the federal government is probing issues related to patient care, improper admissions and the length of time patients are kept. In a July call with investors, none of these problems were mentioned, https:llprojects.tampabay.com/proj ects20l9linvestigationslnorth-tampa-behavioral-health/... 9(27/2019 North Tampa Behavioral tleakh is cashing in oti I lot ida's Baker Act Inves[igatitais I ... Page 24 ca' 26 Acadia CEO Dabble Osteen Instead, Debbie Osteen, Acadia's new CEO, said she was pleased with the company's performance. Revenue grew across its facilities. About 3oo beds were added in the past six months. The number of billable patient days increased. Later, a caller asked Osteen if she expected the number of days patients stay to decline in the future. She touted the company's success keeping the statistic stable, noting that it hadn't dropped in years. She said she didn't expect anything to change. Photojournalist John Pendygraft and data reporter Connie Humburg contributed to this report. Contact Neil Berl at nbedl@atampabay.com. Click here to read the full statements from North Tampa Behavioral and Acadia. ............................. Neil Bed! https:Upxijectslampabay.cum/projects%20191investigutnms/nm3h-Iampa-behavioral-health/... 9/27/2019 Patient bund in £reezer, child loses toe: 46 clahns of abuse invcs-tigatAd at mental heahh f.-. Page I of 4 IT* LIVE Patient found in freezer, child loses toe: 46 claims of abuse investigated at mental health facility By. Tony Thomas Updeled'. Sep 24, 2019 - 6:41 PM V u GWINNCTT COUNTY, Ga. -Polrco are Investigating a tots] of 46 oll of patient abuse and neglect at a Georger psyarlatne hospllal, one week after Channel 2 Actlon News Oret reported the complain Lakavlew tBdhavlorei Health le still opereling. and no chsses have been fled, but Gwlnnett County pa]ice aey they are eriao. a very large case file and Welsh for more viol,.& 'II kerpdaes me that It took this long for this to roma to light,° whisllnblawer Lenart. Heyns sa]d Content Continues Below IV Easily wd- and /✓re j Top Talent a�1 httpsl/www.wsbtv.coni/news/loca1/gwitinett-calnty/patient-Found-in-freezer-child-loses-t... 9/27/20t9 Patient found in h'BCZ.CI'r child loses toe: 46 claims of abuse investigated ai amental healthE.. Page 2 of 4 Er LIVE H..yneh worked as the direCior of hunch resource a m us fad Iity omit last Feathery. She said site IDH aeoauee ofind Constant problems lost.., ..at under lite reg. "There were years That I woultl talk about, that I feared coming An work and that a news matlon or a pdtca station would be at the front deal Baying we were met down ,° Haynes Cold. And, parent Kard Hitch reached Named she had w hi her son at the fachis this month, police said complaints hooded In. "There are more Sarloua issues going oo in this faollhy then what happened to on son ,"Hitch said There bra patients with unexplained irymles and Claims of physical and somal abuse, TRENDING STORIES Get zg4-yam-old man died after at least 3 ORICCI6 YSe Tasame 011 him at Same Und. Shwa never coming back': Family of missing women believes she was murdered Missing Calif .. ch small lather who sparked Amber Alert found dead, lenity says Haynes said she saw patlanls dragged down hallways, others who walked away unnoticed and one patient found In a geezer. In a freezer, crying. and someone bund him there Bit( as dracumenlalion said he was amounted log which is not cormel. It was covered no I m. said. i laynes also said there was an viddmu where At child lost a me. She Bald she believes many of Lek.A Wa workers Are but sheMmsls'lack of Irecoing or opriotale greed At residents' lives In danger. "We've Natl employees that work, and they are sleeping on the dock, and they Sint work there," Haynes said The woman said she IBX Lakeview on good term. and turned down a severance paCkagn because she knew this do, would coma. 'i think from the second day I was there. I was concerned," she said Haynes has spoken wdh detectives. Thornes has tried mpeatadty to at Commant from Laknone, leaving Rhone mewl antl sen hm, smalls 6n fag he has not gotten A...polio_ The bvestlgallan A ongoing. Trending - Most Read Stories https://www.wsbtv.conT/nows/tocol/g, vinnett-county/patient-found-in-freezer-ehild-loses-t... 9/27/2019 u ��""4.yad ts^s�r • CITIZENS COMMISSION ON HUMAN RIGHTS INTERNATIONAL Established in 1969 by the Chwch of&lentoloSy to imesHgwe and expose psy hlatrlo vloJatlau afhuman rlgh s September 23, 2019 Mr. Gary halbert Chula Vista City Manager 276 Fourth Avenue Chula Vista, CA 91910 RE: COMPLAINT AGAINST ACADIA BUILDING A PSYCHIATRIC FACILITY IN CHULA VISTA Dear Mr. Halbert, I am writing with concern about Acadia Healthcare's plan to build a psychiatric facility in Chula Vista's District at Eastlake area. CCHR has filed a complaint in June of 2019 directly with the individual members of Chula Vista's zoning and planning commissions. We have since been apprised that our complaint and supporting evidence should have been addressed to you as the person with the authority to direct an investigation. Since we have filed the above referenced complaint there has boon more investigative reporting and information available to CCHR regarding Acadia's behavioral -psychiatric facilities, Specifically, an article published on September 18, 2019 by The Tampa Btry Times which states: • Patients are held captive and cut off from their families. Then using loopholes, Acadia holds patients longer than allowed, running up their bills while they are powerless to fight back. • Thousands of hospital admission records, police reports, state inspections, court records and ,financial filing were reviewed by The Times. • Since 2014, North Tamps Behavioral, one of Acadia's behavioral -psychiatric facilities, has been cited 72 times for unsafe conditions and code violations. • Martha Lenderman, an expert on Florida's mental health law, described the way North Tamps Behavioral facility routinely extends patients' stays as a "red flag" and some of the tactics the hospital uses she called "shocking." • At least six people committed under Florida's Baker Act have been able to escape. • In 2014 a mental health technician punched an autistic man and kicked him repeatedly in the head. • Two patients reported sexual assaults at the facility in 2018, 66169UN9aTa0ULrVY . LOa ANGFil5a,CAL1MRNIA90026. (323)46142/1 . FAX(323)/61.3MO MI~Addreet: hllpl/µ .Mhrinta . F�HAd reu: hwnanrshis@mk, rg Mr. Gary Halbert Chula Vista City Manager Re: Acadia Healthcare of Chula Vista 21'age • In Acadia's July financial statements, it was repotted that nine of its U.S. facilities me under investigation by the Department of Health and Human Services. Another is being investigated by the U.S. Attorney's Office for the Middle District of Florida. o In each of these cases, the federal government is probing issues related to patient care, improper admissions and the length of time patients are kept. (See Tab A) CCHR's research has additionally found that Acadia's application has not been properly fitted out as required and thus shouldjust be rejected. No names were provided as required in Appendix B, point number three. Instead, the reply was to be determined. (See Tab B) Additionally, local homeowners are very wncemed about this type of facility operating in their neighborhood. CCHR opposes Acadia's application. Given the complaints about these behavioral/psychiatric facilities, we urge you to take into account Aondia Healthcare's history and present adverse reports on it. please conduct your own investigations with regard to the documented events in order to oppose the application for a psychiatric facility to be constructed in Chula Vista. Very truly yours, Ivana Foley Legal Coordinator Citizens Commission on Human Rights international CC: Mayor: Mary Casillas Sales References: ' blips :l/protects.tamoabay.mmlomiecls/2019/investigations/north-tamp behaviorelfieahlb/ CHILD RAPES, SUICIDES, DEATHS, AND HUNDREDS OF MILLIONS OF DOLLARS IN HEALTHCARE FRAUD BY THE FOR-PROFIT BEHAVIORAL INDUSTRY— Restoring Effective & Accountable Oversight: What is Needed December 2018 e A public interest report by Citizens Commission on Human Rights International A 50 -year Mental Health Watchdog 6616 sunset Blvd., Los Angeles, CA 90028 Tel: 323-467-4242• Website: www.cchnntorg • Email: humanrights®cchr.org INTRODUCTION For three decades, the Citizens Commission on Human Rights (CCHR), an international non-profit mental health industry watchdog, has investigated widespread patient abuse and fraudulent billing scams In the for-profit behavioral system. Since 2015, especially, we have brought evidence of such abuse to the attention of state and federal legislators, the Centers for Medicare and Medicaid Services (CMS), Attorneys General, Medicaid and Medicare Healthcare Fraud units, Health and Human Services, Child Protective Services and more. Our evidence repeatedly shows that patients are at risk in for-profit psychiatric facilities that lack effective oversight. The largest U.S. psychiatric hospital chain, owned by Universal Health Services (UHS) has approximately 200 behavioral facilities in the U.S. alone. As of September 2018, UHS had set aside $90 million in reserves to potentially settle a Federal Department of Justice (DOJ) Investigation into its billing practices involving 30 behavioral facilities and UHS headquarters.' UHS continues to come under scrutiny for patient abuse, yet is allowed to purchase or build more psychiatric hospitals. anomer major oenaworai nospaw chain is owned by Acadia Healthcare, which has 586 mental health and substance abuse facilities nationwide.2 Both these chains capture billions of dollars in Medicaid and Medicare funding In an overall $220 billion - a -year U.S. behavioral health industry. An Investment banking report estimated the 17,000 mental health and substance abuse facilities In the U.S. represent nearly a quarter of it (combined revenue of $50 billion.)3 Mental health facilities comprise "Individual victims of health care fraud are sadly easy to find. These are people who are exploited and subjected to unnecessary or unsafe medical procedures." - National Health Care Anti -Fraud Association 2.6 percent ($3 billion) of Medicaid long-term care (LTC), providing psychiatric services for children up to age of 21 and mental health facilities for those 65 and older.4 Psychiatric Times estimates that between 10 and 20 percent of state mental health funds are lost to fraud, waste, and excess profits to for-profit managed care companies—representing $5 billlon4iO billion? UHS behavioral facilities bring in net revenues of over $4.6 billion a year. Acadia reported a $3.8 billion market value, In 2015, these two companies' 786 facilities represented an 8.3 percent share of the mental health and substance abuse clinics market -4,6 percent of the total number of facilities.e The potentialforfraud in these two chains alone could be upwards of $230 million to $460 million. (Over the past decade, UHS has already accounted for about $37 million in False Claims Acts [imposes liability on persons and companies who defraud governmental programs] settlements, fines etc.) The National Health Care Anti -Fraud Association (NHCAA) points out the human side to this: "Individual victims of health care fraud are sadly easy to find. These are people who are exploited and subjected to unnecessary or unsafe medical procedures, Or whose medical records are compromised or whose legitimate insurance Information Is used to submit falsified claims."r In 2014, Richard Kusserow, a former 11 -year Department of Health and Human Services Inspector General, noted: "Many health care fraud Investigators believe mental health caregivers, such as psychiatrists and psychologists, have the worst fraud record of all medical disciplines."s CCHR is providingthis report on behalf of hundreds of thousands of consumers, including foster care children, forced Into "mental health" treatment, who are not being adequately protected. In the effort to provide mental health care, regulators may fall prey to the rhetoric of for-profit behavioral providers that abuses covered in this report are "an "unfortunate but common reality facing the healthcare provider industry," it's "just the way that it is," or these are "isolated Incidents." They are not. They are systemic. K b d d CCHR is seeking support for regulations that wil I provide better oversight and accountability, with greater criminal and civil penalties for continued violations of standards of care, including patient safety infringements and especially where patient suicides have occurred while patients were not properly supervised. Every patient restraint death should be subject to police investigation and prosecution. Tougher penalties are needed for fraudulent billing practices, Including hospital closures for repeated abuse and/or fraud. eepmg u gets own by def erring mental health treatment to for-profit businesses has meant robust profits for the businesses and abuse and harm to the patients—in the end a greater cost to both government insurance programs and to patients' lives. CCHR is seeking support for regulations that provide better oversight of this industry and accountability. (1) Greater criminal and civil penalties for continued violations of standard of care, including patient safety infringements, especially for patient suicides occurring while patients are not property supervised and damage Inflicted from dangerously administered treatment, Including for electroconvulsive therapy, (2) Police investigation and prosecution of every patient restraint death, as indicated; (3) Tougher penalties for fraudulent billing practices, including cancellation of CMS funding and hospital closures for repeated abuse and/or fraud. Jan Eastgate, President, Citizens Commission on Human Rights International BEHAVIORAL PROFITS CREATE HARM Often, government agencies merely fine behavioral -psychiatric facilities responsible for fraud and patient abuse. These facilities commit Medicare and Medicaid fraud, they agree to non -prosecutable settlements or CMS Correction Plans and/or Corporate Integrity Agreements (CIAs), but then continue to be repeat offenders. For example, CMS investigated Park Royal, an Acadia Healthcare facility In Fort Myers, Florida, for poor staff ratio and Ignoring patient complaints. It was fined only $2,000 for falling to treat three patients. Yet allegations have Included patient suicides and sexual abuse of patients, with one employee Jailed for sexual abuse of several patients.e In an article about healthcare fraud, the National Health Care Antl-Fraud Association (NHCAA) cited an example of a psychiatrist who "The pattern of conduct [at UHS behavioral facilities] described by the [BuzzFeed] report paints a picture of greed and raises serious questions about patient safety." - Senator Chades Grassley, 2016 fabricated diagnoses for his patients—many of them adolescents—for which he forfeited $1.3 million when convicted. "The, phony conditions he assigned to them included 'depressive psychosis,' suicidal ideation, 'sexual Identity problems' and'behavioral problems in school,'" according to NHCAAO Diagnostic procedures have come under scrutiny in for-profit behavioral hospitals. SuzzFeed News' exploslve 2016 report about UHS, which spotlighted Investigations into its behavioral sector, found "Current and former employees from at least 10 UHS hospitals 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."u In 2017, at least six Federal and state legislators, a State comptroller and State Attorney General (representing Alabama, Iowa, Massachusetts, Michigan, Oklahoma, Pennsylvania, and Tennessee) called for investigations into UHS. Two dozen current and former employees from 14 UHS facilities told BuzzFeed that the rule was to keep patients until their insurance ran out in order to get the maximum payment. An inspection of the for-profit industry finds this regularly occurring. In 2017 alone, at least six federal and state legislators, a State comptroller and State Attorney General (representing Alabama, Iowa, Massachusetts, Michigan, Oklahoma, Pennsylvania, and Tennessee) called for investigations into UHS. A lawsuit filed against UHS in 2018 alleged: "The enterprise works to admit people to facilities, whether they need to be admitted or not. Then, once admitted, the enterprise goes to extraordinary lengths to ensure that a patient is kept as long as a payer will pay or, upon suspicion and belief, until such time as a replacement patient or set of patients can be obtained. In furtherance of this scheme, admission documents are forged; documents to secure that a patient will remain in a facility are falsely notarized and then filed into the state court system; and, in some cases, a person's medical record is written to reflect that services were provided or that certain events occurred, when, in fact, they did not occur." Further. "UHS and its affiliates will enter in clandestine Joint ventures with physicians, predicated upon increasing referrals, increasing admissions and increasing lengths of stay."'2 "[A]dmission documents are forged; documents to secure that a patient will remain in a facility are falsely notarized and then filed into the state court system; and, in some cases, a person's medical record is written to reflect that services were provided or that certain events occurred, when, in fact, they did not occur" - Lawsuit flied against UHS, 2018 UHS officials once told investors that by reducing staffing costs and keeping occupancy rates high in its behavioral health division, this helped generate robust proflts.Ul it was reported that Acadia is $3.2 billion in long-term debt. Penn Little, who runs his own investment firm in Chicago, believes Acadia would have a hard time paying this off, In the wake of allegations against the company's facilities, stating: °Many patients and families are alleging various incidents of misconduct, which Include wrongful death, sexual assault, and abuse/neglect of patients, some of whom are under 18."14 UHS officials told investors that by reducing staffing costs and keeping occupancy rates high in Its behavioral health division, this helped generate robust profits. In June 2018, Acadia's United Kingdom interests came under scrutiny for psychiatrists allegedly getting kickbacks as a reward for referring rich patients to one of Its drug rehab facilities, Life Works, part of The Priory Group that Acadia acquired. The payments, which are prohibited under General Medical Council (GMC) rules, are blamed for Increasing the cost of private care in the UK. (The Priory Group denied it paid referral fees,) '5 On 10 November 2018, UK media exposed both Acadia and UHS as part of I U.S. owned for-profit seven providers described as a "cluster of behavioral facilities in the UK, 'fat cat' private operators" that are "creaming off hundreds of millions of including UHS and Acadia, are pounds from the NHS (National Health being exposed as °'fat cat' Service) after muscling In on the cruel but private operators" that are lucrative trade in locking up people with 'muscling in on the cruel but autism and learning disabilities." Further, seven providers "are charging taxpayers up lucrative trade in locking up to £730,000 ($938,309) a year for each people with autism and patient held in controversial and secretive learning disabilities." secure psychiatric units." £7.5 million ($9.6 Families say they are m) was reportedly taken home bythe boss °profiteering from misery" and of Acadia, which In 2016 bought Priory Group, with 10 UK hospitals "holding people children are seen as °cash with autism and learning disabilities," cows," according to The Daily Mail. Priory made £62.2 million ($79.9m) last year. it also The Daily Mail, 10 November 2018 reported that the boss of UHS had made - - - -- £39,528,000 ($50.8 m) in a single year. UHS's UK operations are run by Cygnet Healthcare. The WHY Mail reported that "furious families say they are 'profiteering from misery'" and complain their "children are seen as'cash cows' and are milked by private providers that can charge the NHS more than £14,000 ($18,000) a week and whose own staff help make decisions on sectioning [involuntarily detaining] people under mental health laws.'16 The questionable practices reported in these companies' for-profit behavioral facilities in the UK are strikingly similar to those in the U.S. Although abuse and fraud In the U.S. facilities is widespread, only a small handful have shutdown and there have been no prosecutions (other than for staff sexually assaulting patients) --sending the wrong message to an out -of -control system that puts profit before patients. Repeated Allegations of Sexual and Other Abuses of Patients Exposes of abuse by for-profit psychiatric facilities continue: • Insufficient staff (violating patient safety requirements) which has led to patients committing suicide while supposedly under suicide watch. • A review of lawsuits and allegations against about 20 UHS facilities between April 2017 and October 2018 revealed: Child Abuse, Including abuse of foster care children; internal surveillance videos showed foster children being tackled, dragged, and choked by staff members; The rape of two girls aged 13 and 16; a 12 -year-old boy sexually assaulted; a sexual abuse patient roomed with a known sex offender; assault and battery of an 11 -year-old girl; and the restraint death of a 15 -year-old boy. Allegations that a staff member in a South Carolina UHS facility grabbed a child in a headlock and punched him, while other children were repeatedly bitten, A review of U.S. lawsuits and allegations against about 20 UHS facilities between April 2017 and October 2018 revealed: - Child Abuse, including of foster care children; internal surveillance videos showed children being tackled, dragged, and choked by staff members; - The rape of a 13 and a J.6 - year -old girl; a 12 -year-old boy sexually assaulted; - The restraint death of a 15 - prompting the state's regulatory agency to accuse the facility of failing to provide basic protectionY UHS's Anchor Hospital in College Park near Atlanta, Georgia was accused of negligence after a 16•year-old sexual assault victim said she was raped. Her mother's attorney, Chris Stewart said: "Once we started digging Into it, we just saw how bad their history Is over there." The lawsuit said the hospital has a history of failing to have adequate staff and has been cited by the federal government for Violations. People who are abused 'shouldn't be tortured at a place that they go to get help,'. Stewart stated.0 UHS'S Rock River Academy In Illinois closed in 2015 after allegations of staff raping and abusingjuvenile residents; On September 9, 2015, a lawsuit was filed against Rock River on behalf of five adolescent females alleging sexual abuse and rape by staff. Hours that were billed as 'group therapy" for girls with troubled "Once we started digging into it, we just saw how bad their history is over there [UHS's Anchor Hospital, Georgia]." People who are abused "shouldn't be tortured at a place that they go to get help." - Chris Stewart, attorney, representing 16 -year-old sexual assault victim who said she was raped at the facility histories instead were spent watching movies in a common area, with no discussion afterward, according to a state monitoring report and interviews with former workers and reported by Chicago Tribune. IS H novemoer zulo report in the Naples Dally News showed Park Hours that were billed as Royal Hospital hired a Benjamin "group therapy" for girls Bland without checking his with troubled histories at credentials and put him over the UHS's Rock River Academy care of patients despite having in Illinois Instead were been twice arrested in the previous six years, had been fired from a job spent watching movies in a over accusations of sexual common area, with no harassment and theft, and had discussion afterward, admitted to choking a woman. according to 8 State Instead, Park Royal allowed him g access to nearly a dozen mentally monitoring report and disturbed women who alleged he interviews with former sexually assaulted them within the workers. hospital's walls In 2013. Depositions and court records - Chicago Tribune, suggested Park Royal Hospital staff 29 February 2015 members made several missteps— and might have lied to police and lawyers — in the case of Bland, who in April 2014 pleaded guilty to sexual assault charges and received five years in prison.N In 2016, former patients of Park Royal Hospital settled a lawsuit over the sexual abuse of them.2'i Park Royal was also the subject of a scathing federal report that questioned its patient safety and quality control policies. 22 • A Disability Rights group, formed as a non-profit corporation with a mission to advocate for the human, civil and legal rights of people with disabilities in Ohio, Investigated Acadia's Ohio Hospital for Psychiatry (OHP), a 130 -bed, inpatient psychiatric hospital located in Franklin County. 23 The group found substantiated allegations of sexual and physical abuse and the use of seclusion in an unsafe manner, among other abuses. 24 In November 2018, an I -Team 8 News WISH -TV investigation in Indianapolis, Indiana followed up on abuses it had previously found in Acadia's Resource Residential Treatment, which calls itself a "life -changing psychiatric residential treatment facility for children and young adults In Indianapolis.' Multiple former and current employees and residents reported fights, assaults, understaffing inappropriate relationships between employees and residents, and kids kicking down doors and walls to escape.25 • At least three UHS facility staffs were convicted of sexual abuse of patients, including child, with two staff serving a combined 35 years In jail. Profiting from Involuntary Commitment Laws The use of Involuntary commitment laws, such as Florida's Baker Act, to detain patients against their will; e.g., a woman went voluntarily to a UHS facility but once there was involuntarily committed for longer than the legal 72 -hour hold and her insurance company was charged thousands of dollars. She told reporters "You sat around all day doing absolutely nothing. I can say I'm actually worse. It was very traumatic."m In January 2017, the Lee County Sheriffs Office investigated an alleged sexual assault on a patient at Acadia's Park Royal Hospital in Florida. Itwas also looking into the deaths of two patients who had recently been brought to the facility for Involuntary mental health evaluations under the Baker Act: One, a 53 -year-old man, was found dead in For-profit behavioral facilities have used involuntary commitment laws, such as Florida's Baker Act, to detain patients against their will for their Insurance. The average stay in a mental health facility for someone Baker Acted (involuntarily committed) in Florida is 4.5 days, at a potential cost of $9,000 his room on January 27 from undetermined causes and a 55 -year-old man died after going Into cardiac arrest27 • The average stay in a mental health facility for someone Baker Acted is 4.5 days, at a potential cost of $9,000 per person?a • Potential fraud alleged from admitting and detaining patients; refusing to allow voluntary patients to leave; forging documents; and paying kickbacks to doctors for admissions. • "Telemediclne'fraud: Psychiatric facilities have used "telemedicine" to detain patients against their will: One woman visited a facility as a voluntary Psychiatric facilities use "telemedicine" to also detain patients against their will; one woman visited a facility as a voluntary patient and without her knowledge a "doctor" whom she never saw or spoke with recommended her Incarceration and she was not allowed to leave. patient and without her knowledge a "doctor" whom she never saw or spoke with recommended her incarceration and she could not leave. WFAA News in Texas did an expose, "Against Their Will," alleging that a mother took her 11 -year-old son to UHS's Millwood hospital seeking help and the hospital then detained him without her consent. As WFAA News detailed: "[The door locks behind you. You're told you can't leave. Stripped of your clothes, given a new bed. You have no idea when you'll see your family again." The facility billed his mother's insurance company more than $11,000 for the unwanted stay. • In February 2016, Timberlawn Behavioral Hospital, Texas closed after several years of high-profile exposes of abuses at the facility and state officials threatened to shut it down because it was too dangerous for patients.3c This included the rape of a 13 -year-old girl at Timberlawn that treated children as young as 12.31 The girl's father told The Dallas Morning News, "This can't happen to anyone else, The place needs to be shut down."m In 2017, an Oklahoma state agency that monitors child abuse determined there had been 30 Incidents of neglect or abuse at UHS's Shadow Mountain behavioral hospital in the previous three years. Police records, state inspection reports, and lawsuits, as well as BuzzFeed News interviews with more than 15 current and former employees, including administrators d ch' tr' is r d th t aisrs evea en psy , a Shadow Mountain was "a profoundly troubled facility where frequent violence endangers patients and staff alike, where children as young as five are separated from their parents and held in dangerous situations ...."33 • On April 10, 2017, the state of Massachusetts filed a suit against UHS in federal court, accusing it of illegally charging Medicaid for outpatient mental health care by unqualified staff. Modern Healthcare reported, "UHS this year has faced scrutiny" over allegations that the "for-profit hospital UHS has faced scrutiny over allegations that the "for- profit hospital operator kept psychiatric patients longer than necessary to milk their insurance." operator kept psychiatric patients longer than necessary to milk their insurance." Massachusetts asked for treble to damages on the just over $94.2 million in reimbursements it made to UHS between 2005 and 2013, as well as civil penalties, or a total of more than $282 million.34 • In October, 2018, Acadia announced the closure of 10 of Its childcare facilities In Arkansas, claiming budgetary reasons, yetthe announcement came after manslaughter charges had been filed against several of its staff for leaving a five-year-old boy strapped in a carthat reached temperatures of 141 -degrees that killed him. 35 Arkansas regulators reportedly opened an investigation into Acadia's Piney Ridge Treatment Center in 2016 after parents and former patients told local reporters the facility actually operated "more like a kid's fighting ring." Afamily said their daughter was forced to fight by staff. Former Piney Ridge patient Isabella Cudmore said what they called the'Plght club' was going on when she was a patient seven years earlier. "I just feel that that treatment facility isn't a treatment facility it's all. Its more like a kid's fighting ring and that's how I feel about It," she said. 36 Rodney Dewayne Thomas, a former Piney Ridge Treatment Center staffer was arrested in April 2018 and charged with one felony count of engaging children in sexually explicit conduct, 31 Former employees told a local news station that Piney Ridge overlooked the misconduct and had attempted to "sweep it under the rug." They said Thomas was notorious for inappropriate behavior with kids.38 In 2018, a Capital Forum investigation into Acadia Healthcare uncovered "a pattern of patient care and safety violations at its behavioral health facilities that could put the company at risk of federal Investigation or losing Medicare or Medicaid funding. The company's strategy of rolling up [become larger by successive accumulations] new facilities then slashing costs may make It difficult at many of its locations to ensure that patients are managed safely and given adequate care."m A review of state Inspection records for In 2018, a Capital Forum investigation into Acadia Healthcare uncovered "a pattern of patient care and safety violations at its behavioral health facilities that could put the company at risk of federal Investigation or losing Medicare or Medicaid funding." Acadia Healthcare facilities revealed a history of violations in safety procedures, medical care, and patient rights. Capitol Forum obtained inspection records for nine of the 12 facilities which were cited for violations leading to lapses in safety or direct patient harm? According to Capital Forum, "Acadia and/or its facilities have been the target of lawsuits over Injuries and deaths occurring at the facilities." 11 In December 2017 WXYZ 7 (ABC) Detroit news reported the results of its month-long Investigation Into Harbor Oaks Behavioral Hospital that revealed "a pattern of assaults on staff at one Acadia behavioral center dating back years, repeated allegations of physical and sexual abuse Involving patients."41 The facility was accused of rampant patient and staff abuse and inflated staffing levels only when hospital watchdogs visited, according to current and former employees. The allegations against Acadia were just "the latest in a string of revelations calling into question the safety of those inside Harbor Oaks Hospital," according tothe news report.42 • Employees sued three Acadia facilities In Texas for allegedly retaliating after the employees reported Medicare fraud. The suit against one of the facilities, Red River, resulted in ajury verdict in favor of the former employee.43 There are repeated allegations of physical and sexual abuse involving patients in other for profit facilities: Sundance Behavioral Healthcare System (SAS Healthcare Inc.): In November 2018, SAS Healthcare Inc. was indicted on nine criminal counts of violating the Texas Mental Health Code, accused of holding four patients involuntarily and illegally at its Arlington facility. The indictment also accused the corporation of refusing to allow two voluntary patients to leave the facility even though they'd repeatedly Informed the hospital of their desire to leave. "People turned to what they thought was a trusted medical facility and were not allowed to leave as the law requires," said Criminal District Attorney Sharen Wilson. "These offenses were a corporate failure, and the corporation must be held accountable."" Sundance Hospital provides 24-hour Inpatient care for children ages 5 to 17 and adults 18 and older.45 Scott Faciane has served as an attorney ad litem for Sundance Behavioral Health System, Texas and psychiatrist Sreenath Nekkalapu were indicted on criminal counts of violating the Texas Mental Health Code, accused of holding four patients involuntarily and illegally. "People turned to what they thought was a trusted medical facility and were not allowed to leave as the law requires... These offenses were a corporate failure, and the corporation must be held accountable." 18 years, representing patients in thousands of cases involving proposed mental health commitments. He said Sundance has had a history of filing for orders of protective custody—also known as mental health warrants — for patients who had come voluntarily to the hospital and where It was unwarranted 46 12 In addition to SAS Healthcare Inc., hospital psychiatrist Dr. Sreenath NekkaIapu was also indicted for the involuntary detention of one of the four patients. The punishment range for the charges against Sundance carries up to a $100,000 fine for each day the offenses were alleged to have been committed (33). The punishment range for Dr. Nekkalapu's charges Is up to 2 years in Jail for each day the offense was alleged to have been committed (18) and up to a $50,000 fine for each day the violations were committad?r Aurora Behavioral Healthcare/Signature Healthcare Services: On November 30, 2018, ProPublica Illinois reported that Federal authorities announced they were pulling funding from the Aurora Behavioral Healthcare's Chicago Lakeshore Hospital which was under investigation following numerous allegations of sexual abuse, assault and patient safety violations. w Aurora Chicago Lakeshore Hospital has been under Federal and state investigation over allegations that children were raped and sexually abused by staff and other patients, physically assaulted and inadequately supervised. The Illinois Department of Children and Family Services had investigated 16 allegations of abuse and neglect in 2018 alone. In addition to child welfare investigations, the Illinois Department of Public Health conducted a series of inspections on behalf of federal authorities since July 2018 that found the hospital had failed to ensure the safety of suicidal patients, obtain consent before giving patients — including children — powerful drugs and sufficiently monitor patients. 49 Aurora Behavioral Health Care, a companywhich was developed In September of 2000 and originally made up of acute psychiatric hospitals based in California, which now and has facilities also in Arizona, Illinois, Nevada and Texas.EO Psychiatrist Dr. Soon Kim started the company.51 He is also the President and CEO of Signature Healthcare Services, the parent company of Aurora,52 Allegations In a U.S. government lawsuit against a California Aurora behavioral facility included the facillty billed the federal government for high quality care but delivered "minimal, substandard care," the owner "drained assets" and "cut critical services for patients and employees," staff failed to monitor a patient who was found dead in his room, a patient hung himself on the hospital campus and a 14 -year- old girl 4year- oldgirl was raped at the A 2003 Metro News investigation alleged that a web of for-profit companies affiliated with Kim collected at least $23 million from the hospital in a span of four years. 'That windfall came at a heavy cost, say critics, who point to government reports that show patients at Aurora suffered from inadequate care while an undermanned staff struggled to do its Job," according to Metro News. 13 Mel Ravitz, a former Detroit city councilman who served on the Aurora board for more than a year before resigning in protest, told Metro News: "Dr. Kim milked Aurora for all he could. What happened there is scandalous." Kim, along with his wife, Bouh, also a psychiatrist, amassed a net worth of $40 million, according to an unaudited financial statement submitted to Illinois regulators.53 In 2009, Kim agreed to pay a $350,000 settlement to Michigan state health officials regarding patlent-privacy lawsuit Then -Attorney General Mike Cox asserted that patient records were being burned at three of Kim's hospitals, possibly as far back as 2006.5+ In 2010, the U.S. Department of Health & Human Services collected a $104,747 fine from Signature for employing someone who "was excluded from participation in Federal health care programs," a release stated. Also in 2010, the U.S. government and a mental-health worker sued Aurora's hospital in Pasadena for fraudulent Medicaid and Medicare billings. The complaint depicted a poorly run and sparsely staffed enterprise that contributed to eight patient deaths and "several rapes," dating back to 2003.55 Allegations included the facility billed the federal government for high quality care but delivered "minimal, substandard care," the owner "drained assets" and "cut critical services for patients and employees," staff failed to monitor a patient who was found dead in his room, a patient hung himself on the hospital campus and a 14 -year-old girl was raped at the hospital.56 The case settled in September 2014.57 In 2010, the U.S. government and a mental-health worker sued Aurora's hospital in Pasadena for fraudulent Medicaid and Medicare billings. The complaint depicted a poorly run and sparsely staffed enterprise that contributed to eight patient deaths and "several rapes," dating back to 2003. In February 2018, a lawsuit was filed against Aurora and Signature Healthcare in Santa Rosa, California, on behalf of Teresa Brooke, the former Chief Nursing Officer at Aurora Santa Rosa Hospital, an acute psychiatric facility. It alleges Brooke was fired after making complaints both to the facility and to a government agency. The complaint details numerous examples of dangerous conditions at the hospital, alleging that staff and patients "were subjected to routine punching, kicking, choking, and, on one occasion, even a "full-blown patient riot" and that the staffing shortages "led to high incidence of patient self -harm and multiple occurrences of sexual violence involving patients, some of them minors," during Ms. Brooke's tenure.5b In 2016, Acadia Healthcare and UHS were both interested in bidding for Signature Health Services, 59 Aurora/Signature had $5.3 billion in assets and total operating revenue of approximately $5.1 billion for the year ended December 31, 14 2016.E In 2017, Medicare represented 27 percent of Aurora's Income and Medicaid 8 percent, while managed care and other patient service revenue represented 64 percent.61 Electroshock: Consumer Misrepresentation Children and adults ran be detained In for-profit psychiatric hospitals and subjected to electroshock treatment (ECT), despite no clinical trials proving the ECT device is safe and effective and regardless of the long term memory loss and brain damage It can cause. CCHR has established that in some states, these facilities have electroshocked the developing brains of children in the 0.5 age group. CCHR's recent review of ECT promotion on psychiatric facility websites shows the Information provided is deceptive and misleading in order to gain consent. CCHR's review of ECT promotion on psychiatric facility websites shows how deceptive and misleading the information is minimized the risks and/or promoted theories that are unproven and, arguably deceptive. The adverse effects of ECT can prolong the length of a hospital stay, thus, its delivery can For example, three UHS psychiatric Increase profits. hospitals showed information that minimized the risks of ECT and/or promoted theories that are unproven and arguably deceptive. UHS's River Point Behavioral Health performs 9004000 ECT treatments a year and claims the 460 volts of electricity that ECT sends through the body is safe for pregnant women. Tenet Healthcare, which also has behavioral facilities (and has its own history of fraud and abuse investigations when it was National Medical Enterprises) announced in 2014 it was increasingthe number of patients to receive electroshock treatment in one of itsfacilities in Worcester, Massachusetts by 900 percent 62 The adverse effects of ECT can prolong the length of a hospital stay, thus, its delivery can Increase profits. 63 In August 2018, UHS revealed the average length of stay among Its behavioral health patients declined 2.3 percent on average compared with the same quarter in 2017, and patient days declined 1,2 percent UHS said it is workingto reverse the trend to justify longer stays.64 In October 2018, The Daily Mail quoted Joey Jacobs, CEO of Acadia, saying he hoped UK's National Health Service (NHS) would axe more NHS -funded psychiatric 15 facilities to boost Acadia's coffers, telling shareholders, "What we hope does occur is that they continue to close beds and have a need to outsource those patients to the private providers. We would be the big winner there."ss In October 2018, Acadia announced a joint venture agreement to develop a $26 million behavioral health hospital in Columbus, Ohio, which would include an "electroconvulsive therapy center."0 How many more child rapes and abuses? How many more children are to be raped and killed in for-profit "mental health" facilities? How many patients will be damaged by electroshock or restraint procedures? How many Americans have to lose their liberty because of coercive and Illegal Involuntary detainment? When will our legislatures enact effective and accountable state- and federal -oversight systems and regulations and hold the culpable facilities and treating doctors accountable both civilly and criminally? CCHR did an analysis of the fraud found In six chains of psychiatric faciltles and found how incestuous this industry is. The government Investigates and fines major behavioral for-profit chains over fraudulent scheme s. Those chains then II ff f How many more children are to be raped and killed in for- profit "mental health' facilities or patients damaged by electroshock or restraint procedures before an effective state-wide oversight and regulations are implemented and the culpable facilities and treating doctors held to account both civilly and as o their ac as to other chains, which come under further government investigation (usually over potential fraudulent practices" revolving door system. Six companles—NME, Charter Behavioral Health/Magellan Health Services (Charter), Hospital Corp. of America (HCA), Paracelsus Healthcare Corp., Psychiatric Solutions Inc. (PSI) and UHS—have accrued more than $3.7 billion in criminal and civil fraud settlements and fines that we know of since the early 1990s. CCHR investigated NME and other chain of "for-profit" hospital chains, Including Charter, Paracelsus and HCA in the 1990s, with Information turned over to the FBI and state authorities at the time. Dr. Robert F. Stuckey, a former medical director atone of NME's psychiatric hospitals, admitted that psychiatrists and hospital staff "were absolute geniuses at diagnosing Insurance." CCHR helped to obtain state government hearings and personally met with NME company executives about psychiatric fraud In their facilities. NME eventually dumped its psychiatric division (selling it mostly to Charter Behavioral Health). In 1995, NME changed its name to Tenet Healthcare and in 2014 said it was expanding again into behavioral health. 17 16 In September 2003, Senator Charles Grassley wrote to the CEO of Tenet Healthcare, which had been investigated and prosecuted for healthcare fraud, stating: "The $54 million settlement, as well as Tenet's failure to acknowledge any liability or wrongdoing, is further evidence, in my opinion, that Tenet views healthcare fraud settlements as the cost of doing business with the federal government, while profiting at the expense of innocent victims and America's taxpayers. It is long past due that Tenet, and its officers, directors and board members, be held accountable for the corporate culture and governance practices that resulted in healthcare settlements totaling over a billion dollars in the past decade."6 In 1998, the Houston, Texas-based Paracelsus Healthcare Corp. (PHC), which CCHR investigated, agreed to settle $7.3 million to settle allegations that two of its hospitals in Southern California defrauded the Medicare program. Two years earlier Paracelsus reached a separate settlement with Aetna Life Insurance Co. in a massive lawsuit in which the hospital operator was accused of fraudulent billing for psychiatric services for private patients in Orange and Los Angeles, California. counties.as Aetna alleged that the group systematically lured unsuspecting patients from throughout the country with false promises and improper perks, then tagged the patients with bogus diagnoses and stuck them in mental hospitals until their benefits ran dry.rc on September 15, 2000, the PHC parent company filed a voluntary petition for protection under Chapter 11 of the United States Bankruptcy Code, rl Aurora Behavioral Health Care, another for-profit psychiatric hospital chain in Arizona, California, Illinois, Nevada, and Texas is also underscrutiny. The Illinois state Department of Children and Family Services' put a hold on admissions to Lakeshore psychiatric hospital, alleging youths were sexually and physically abused due to lax supervision and improper staff -conduct. A 7 -year-old girl was sexually assaulted at the facility. Abuses are not limited to only the above for -profits. In November 2018, the American Civil Liberties Union (ACLU) of Illinois demanded the state Department of Children and Family Services' put a hold on admissions to Chicago Lakeshore psychiatric hospital, alleging youths were sexually and physically abused due to lax supervision and improper staff -conduct. Allegations under investigation include: • A 7 -year-old girl reported that a 12 -year-old boy sexually assaulted her. • Two young female patients accused a male staff member of touching them In a sexual manner. • A hospital staff member pleaded guilty to sexual abuse and was placed on the state's convicted sex offender registry, 72 17 Outside of Illinois, Aurora Behavioral Health Care, the owner of Lakeshore, has psychiatric facilities in Arizona, California, Nevada, and Texas. 78 In 2016, both UHS and Acadia were considering a takeover of Aurora.74 Government agencies place foster care children in private and state psychiatric hospitals; in Texas, for example, between 2009 and 2015 there were roughly 4,000 psychiatric admissionsfor foster care children each year, who are detained longer than non -foster care chlldren.76 Many people were outraged by the reports In 2018 of over 11,000 Immigrant children being ripped from their families, incarcerated in more than 100 facilities in 17 states with allegations that they were drugged, beaten, or violently assaulted.76 This must get corrected, yet the same abuse is occurring in behavioral -psychiatric hospitals across the country, Legislation Creates Fraud & Abuse In the book Mental Health Inc: How Corruption, Lax Oversight and Failed Reforms Endanger Our Most Vulnerable Citizens, published this year, Art Levine, a prize-winning investigative journalist and author chronicles at least six gory and preventable deaths at Acadia's Sierra Tucson facility in Arizona. He further discusses how "indifferent professional associations, pharmaceutical -subsidized patient advocacy groups and government regulators either push a drugandustry agenda or fail to haft what amounts to an epidemic of behavioral health malpractice." 77 "[I]ndifferent professional associations, pharmaceutical -subsidized patient advocacy groups and government regulators either push a drug -industry agenda or fail to halt what amounts to an epidemic of behavioral health malpractice" - Art Levine, Mental Health Inc: How corruption, Lax Oversight and Failed Reforms Endanger Our Most Vulnerable Citizens In 2016, David Wright, deputy �riiii�irri�rrlrrnswrrrr regional administrator for CMS in Dallas told The Dallas Morning News that "patient complaints against the company [UHS] aren't just isolated to one region, but extend across the country." According to the article, "Federal regulators usually focus only on incidents at Individual hospitals, not across chains, so government data is fragmented and you can't easily compare Universal Health to its peers. And the company operates hospitals under a variety of names that can make it difficult for patients and watchdogs to evaluate its overall Care." 78 Legislation has helped enable the culture of behavioral health malpractice we see reported today, especially the Mental Health Parity and Addiction Equity Act and Affordable Care Act which "were a mandate for the $3 trillion insurance industry to pay out unlimited reimbursements for a lifetime disease with no cost-effective 18 solution. Regulators had Inadvertently created an environment ripe for investment," according to Penn Little.79 Florida State Attorney DaveAronbergsald: "This is an entire industry that's been corrupted by easy money. Unscrupulous actors have taken advantage of well- intended federal law and a lack of any good law at the state level, to profit off people at the lowest stages of their lives.' Absent sufficient regulation, the industry saw nearly every publicly-listed behavioral healthcare provider's stock soar from 2012- 2015, wrote Little in a November 16, 2018 article on Acadia Healthcare.w • The Chicago Tribune reported that investors prefer the mental health industry because the profit margins are much biggerthan those at community hospitals. 81 • Alan Li. Miller, Chairman and CEO of UHS attributed the Affordable Care Act (ACA) for increasing profits. 8 In 2015, UHS's Chief Financial Officer also reported behavioral health contributes "much more to the bottom Ilne."88 Pension funds, government, insurance companies (a potential conflict of interest), and Investors, like banks, holding companies, and corporations together owned about 5.6 percent of UHS, according to Market Realist In 2015.m • Joey Jacobs, the CEO of Acadia Healthcare stated: "Mental health party was the beginning. We saw a big benefit And then the Affordable Care Act was very positive for our Industry."85 Acadia described the investment environment for behavioral facilities in the U.S. as a "large market with attractive trends."86 • In June 2016, National Public Radio (NPR) also reported that because of the ACA, "Suddenly there's a huge stream of cash for Acadia and other companies to tap into. m87 Opioid Crisis Creates Profit Penn Little further wrote: "The best natural target Ifor investment] was opioid addiction, with its high demand for substance abuse treatment services. This epidemic in the United States exploded throughout the mid-2010s, skyrocketing the number of Substance Use Disorder (SUD) centers, Many users were young adults and children on their parents' insurance plans. "Most drug addicts are treated through Substance Use Disorder centers. The concept of treating addiction Is broadly defined. No clear federal definition exists for what constitutes a SLID center, so some entrepreneurs started opening centers in strip malls, filling them with beds, signing users up - often through unethical methods."as 19 Acadia owns 119 methadone and Suboxone drug rehab facllitles in about 20 states, with the most clinics centered in Pennsylvania (15), Wisconsin (13), Massachusetts (12) and Oregon (6). Substance abuse treatment Is a profitable business for psychiatry and hospitals delivering Its treatments, and especially the cash cow treatment for oplold addiction: Suboxone (a mixture of buprenorphine and naloxone) is a form of oploid that is used in opioid withdrawal. ea UHS also has outpatient Suboxone programs. Little noted: "Unscrupulous operators resorted to extreme exploitation of minimal regulation via patient brokering or "junkie hunting," as it's often called, to increase revenues further. Prosecutors say thattreatment centers frequently - Illegally - waive capays and deductibles, telling patients and parents that Insurance will cover everything. Or they will rack up huge bills for patients, charging $4,000 for every unnecessary urinetest"� Solutions & Accountability Needed What Is needed Is legislation that provides not only more effective oversight but also stronger accountability measures: criminal and civli penalties, removal from CMS programs and their funding, and hospital closure where systemic abuse is found. Only such a comprehensive solution can begin to thwart the level of abuse, fraud and malpractice that is so widespread today in the for-profit mental health industry. 20 ABOUT CITIZENS COMMISSION ON HUMAN RIGHTS: The Citizens Commission on Human Rights (CCHR) was established in 1969 by the Church of Scientology and Dr. Thomas Szsaz, professor of psychiatry at the State University of New York Upstate Medical University In Syracuse, New York, to investigate and expose psychiatric abuses committed under the gulse of mental healthcare. Today, it has around 150 chapters in over 30 countries. Its board of advisors, called Commissioners, Includes doctors, lawyers, educators, business professionals, and civil and human rights representatives. CCHR has inspired and helped orchestrate many hundreds of reforms by testifying before legislative hearings and conducting public hearings into psychiatric abuse, as well as working with media, law enforcement and public officials the world over. MISSION STATEMENT: CCHR Investigates and exposes psychiatric violations of human rights. It works shoulder -to shoulder with like-minded groups and Individuals who share a common purpose to clean up the field of mental health. We shall continue to do so until psychiatry's abusive and coercive practices cease and human rights and dignity are returned to all. The Fon. Raymond N. Haynes California State Assembly "CCHR Is renowned for Its longstanding work aimed at preventing the inappropriate labeling and drugging of children.... The contributions that the Citizens Commission on Human Rights international has made to the local, national and international areas on behalf of mental health issues are Invaluable and reflect an organization devoted to the highest ideals of mental health services." U.S. Congressman Dan Burton "CCHR is a shining example of what people can accomplish in a free society. Through united action, effective education and advocacy, CCHR has helped to bring about critically needed healthcare reforms that make our society and country a better place." U.S. Congressman Ron Paul °CCHR efforts have been crucial to raising public awareness of the threat to liberty posed by the scheme to subject all children to Intrusive screening without parental consent. I congratulate CCHR for its efforts to protect individuals from cruel, Inhumane, and degrading treatment" Dennis Cowan, former healthcare fraud investigator CCHR shows "consistent work in exposing fraudulent and harmful practices in the field of mental health ... Their expertise, publications, and reports are a tool for any investigator conducting investigations into mental health fraud or other criminal activity in the system." For more Information, contact Citizens Commission on Human Rights International 6616 W. Sunset Boulevard Los Angeles, CA 90028 Tel: (323) 467-4242 or (800) 869-2247 Fax: (323) 467-3720 Website: www.cchrintorg; E-mail: humanrights@cwhr.org 21 REFERENCES: ,•oath uMc50n, vuaa einem. caay MOM,"WOINen aCgeCa(wtl gills center Tnenyintlatletl mrtoona,faketl leroNs; Chicago hWury, 20 FeG iOLT, hWB:�/VMVILAOBtWYNIM,Coln/n0M'bMe[GMAP/RNCC.IMJ(tVBMBfLMbrv6C-'101F0]2f1grN.Fnnl oatenb."Naoba 22 elln, o Chohot4 Haft an, Mark Smlth,Jason Trahan,Wilmst Their WIN: locked away h s mantel hosphaI afmrvoNinlally se eking help; WFAA News 8, 2B Jun 2015. Nos://ww.v.wlaamm/artltle/revanmanmastlema-e/aexlnerm.lrwu.w,�•n..w.uau.,mnrwavcnnac xe.. Miles Molfait,Tmberbtw psychlatUC Nspltelto oboe Feb. 18 130cb of "h nnrrN,u.wnirastbnner4cam/story/%847805/ByearuM lounddeatlondaymrebue/. °e Termer Plr,ry Rgge PaUent'ks More Llke a lib's NghIMB Piny" NWA Nexs, a MaY2018, htlps://www.nwehomepege.com/newsttov- 24/formarpine/rbgeyetlenLllsmorN6,askWafigMingaing/450406280 s"Former Plnay Pkga Bmpbree Fmin{ Chgd Pom Charge,' 6 News, 11 Am. 2018, Mq>//8newsanPrremm/2018/04/IyYormer-pMe)< Ybge6mpbealhoent Contldpornararge/ ore rygdh Trbahllent Center Repeatetly Alowed Ineppoorbm Behavior,"NWA ranvs, 12 Mr.2018. May Eo;,oso Co np., to Ross 14 Lege) ON Regulatory Rkk; Cephol Form, Vol. B, No. 400;28 Nov, W19. "Deanna Boltl,'NoM Teles hoaohal corparat h around of hdd Ing pat@ms Illegally Is iNioled; Star Telegram, 15 Nov. 2o1& '° Deanna Boyd, `She caught menW beets rare at PAingtw Ibsphal, but than'I was In JaU baeiaelty,'" Star Telegram, 20 Nov. 2018, h*v//wwA' Aekgmmsarn/neva/I Vnommunk/aNngte ./e 221%77 .htmMsN04nk= "'Hayllal Corporation, Dater IntictoOl In Tarrant Coany;8haren Wgson, Criminal DlaI MOrmYPress Rebase, 14 Nov. 201B; htrpa://WWillb,mtela{mm.mm/Hewn/bmVaommu ole Fort-woMuraing 1 rSaf5b4.Mml Duca F]delb,'A Chicago Poyahlebb ybapttel WIII Lose Fetlerel FuMbg Over Safety ON Abuse Issues InwNing Children In State Care; v Curt Guyana, 'A tale of law hcspbak,' Mmm News, 8Jr, 2008, blip¢�/www.mehdM�esmm/tlenoU/a+slooGtwo hoapllBLyConlemxk.3175zes re'NMh Becla'renW mbldenta Compal{n a{elial a mentaFneatth chain With atYObNatl peal,' NBwSfeVbW.COm, 24 Oct 2013, °r ht�e://wew.murtllotetwrmm/dxke(/6146613/aryileGstareaofamarlm,vaurora-lesendnee#e/lpege.q w'SenMd HelekY Sharp Plea WhkUablov/n RMslkdon Sul[ AgalnstAumra &havlmal HaalNaere-Soma Ppsa & SignaNre Heetthum 23 r r i °'l�Ma BenletG "MeVoWest Medlral, St Vlreanl Hcapifa' b eapard bellevbal heats nMres,' 6osMn Busltkss Joume Qumnftn&melts°catan=,apatbo MrlstroaHoevpand.htl G Doper B, Lhithy e G Ul;i- keSbn d factum mntdWling[c bngm of stay In an azure psyapogerlaVlC Wad. 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North Tampa Behavioral Health in Pasco County JOHN PENDYGRAFT I Times How one Florida psychiatric hospital makes millions off patients who have no choice Editor's note: This story contains descriptions of self -harm. If you or someone you know is contemplating suicide, call the 24-hour National Suicide Prevention Lifeline at (800) 273-8255 or the Crisis Center of Tampa Bay by dialing 2-1-1. By NEIL BEDI Times Staff Writer Sept. 18, 2019 I of 26 9/2212019,9:49 AM Notch Tampa Behavioral Health is cashing in on Florida's Baker Act l In— https://pmjects.tempaLay.com/projects/2019/investigations/north-tmpa-... WESLEY CHAPEL — More than two thousand people arrive each year at North Tampa Behavioral Health in extreme crisis. They are checked in under a state law that lets mental health centers keep people who might hurt themselves or others for up to 72 hours. But when that time is over, Priya Sarran-Persad had a psychologist threaten to commit her a second time if she didn't volunteer to stay longer. Michael Jenkins hired a lawyer to help him get out but couldn't for a week because the hospital never sent his paperwork to a judge. Robert Allen was held an extra three days for not participating in group therapy. His family was stunned. Allen is deaf and wasn't given his hearing aids. Each night they stayed, more money flowed into the psychiatric hospital. Priya Sarran•Persad, Michael Jenkins and Robert Allen were unable to leave North Tampa Behavioral after 72 hours, The hospital used different techniques to extend their stays. YALONDA M. JAMES, Special to the Times; JOHN PENDYGRAFT and LUIS SANTANA I Times A Tampa Bay rimes investigation has found that North Tampa Behavioral 2 of 26 922/2019, 8:49 AM North Tampa Behavioral Health is cashing in on Florida's Baker Act I In... haps://projects.tampa6ay.com/projects/2019/investig Uona/north-tmpa-... makes huge profits by exploiting patients held under Florida's mental health law, known as the Baker Act. Then it uses Powerlea The problems with Florida's Baker Act In the coming months, the Times will explore the unintended consequences of Florida's mental health law. This is the first in an occasional series. Some patients describe getting virtually no psychiatric treatment. Meanwhile, people at risk of suicide have been allowed to hurt themselves, and helpless patients have been attacked on the ward. For this, the hospital charges up to $1,500 per night. _ and their families or advocates — show the hospital uses a variety of tactics to keep patients beyond 72 hours. Some are tricked into thinking they've waived their right to leave. Others are forced to wait for court bearings that never happen. The patients' stays are typically stretched just a few extra days. But keeping all of the hospital's Baker Act patients even one additional night would add 3 of 26 9/22/2019, 9:49 AM North razors Behavioral Health is cashing in on Florida's Baker Act l In... https:/Iprajwts.tatnpabay.comlprojects/2019/investig.tions/north-tamps-.,. { 3$ according to figures provided by the hospital. Support investigative journalism j Times reporter Neil Bed! spent months on this investigation. He tracked down patients and families from across the region, wrote computer code to analyze the I hospital's billing data and unearthed thousands of pages of documents that showed what was really happening inside North Tampa Behavioral Heatth, Work like this Is only possible thanks to the support of readers like you. Click here to subscribe today. i, i Subscribe North Tampa Behavioral hasn't escaped the notice of state regulators. Since 2014, it r'^;more than all but one other psychiatric hospital in Florida. Inspectors have zeroed in on unqualified and undertrained staff members who have put patients in danger or denied them basic rights. Even still, the Wesley Chapel hospital has grown and thrived. It made $17 million last year in net annual revenue, mostly from taxpayer -funded insurance programs like Medicare. In recent years, it has bad one of the highest operating profit margins of any free-standing psychiatric hospital in the state. Of the 26 facilities in Florida, half couldn't break even. 4 of 26 9/22/7019, 8:49 AM North Tarimpa Behavioral Health is cashing in on Florida's Baker Act I In... httpsV/projects.tunpabay.wm/PmjccW20t9/inv"tigations/north-tempa-,., Hospital leaders declined multiple interview requests. In a statement, CEO Bryon Coleman Jr. called the Times' findings a "highly distorted and sensationalized portrayal that absolutely does not reflect NTBH's overall record" across thousands of patients. The hospital "strongly rejects any claim that it deliberately or willfully holds patients against their will absent a legitimate, clinically based determination," he wrote, adding that decisions to extend stays are never "driven by financial motivations and/or any type of nefarious intent." [ Click here to read the h, ospital's full statement ] Coleman said the hospital's average operating margin since 2014 was "well below" the average for all psychiatric hospitals in Florida. But he calculated North Tampa Behavioral's figure Using 2014 data, which brought it down because the hospital was new and operating at a loss. In 2015 and 2016, North Tampa Behavioral was one of the state's eight most profitable psychiatric hospitals. It was in the top four in 2017, the most recent year for which statewide data is available, although its margin dropped in 2018. Experts say North Tampa Behavioral isn't the only place in Florida that has violated the Baker Act, which has provided life-saving support to people with mental illness for decades. But the psychiatric hospital stands out both for its success making money from Baker Act cases and the frequent problems with its care. Profits and problems In recent years, North Tampa 5 of 26 9/222019, 0:49 AM North Tampa Behavioral Health is cashing in on Florida's Baker Act l In— https://pmjeets.tmnpabay.com/projecW2019/investigafions/north-tempa-... Behavioral has been one of the most profitable psychiatric hospitals in Florida. It's also been cited by state regulators for unsafe conditions and code violations more often than almost any other facility. aw.rrrwwMYinmr rm..,.>•m„ I' "North' --tamp z: ---- otherFrora° NEILBEDI i Times Source: Times analysis of Florida Agency for Health Care Administration records Kendra Parris, an Orlando attorney who specializes in mental health patients' rights, has represented five North Tampa Behavioral patients in the past year alone. The most recent was held at the hospital for five days in April. Parris said the reason was simple: 6 of 26 9/22/2019, 9:49 AM -; Kendra Parris, an Orlando attorney who specializes in mental health patients' rights, has represented five North Tampa Behavioral patients in the past year alone. The most recent was held at the hospital for five days in April. Parris said the reason was simple: 6 of 26 9/22/2019, 9:49 AM North Tafnpa Behavioral Health is cashing in on Florida's Baker AN I In... https:l/pmjects.tampabay.mm/projectsl2619/investigations wrth-tampa-... North Tampa Behavioral opened in 2013 and grew rapidly. By 2019, It had more beds than its two competitors in Pasco County combined. JOHN PENDYGRAFT I Times Explosive growth North Tampa Behavioral sits on a desolate stretch of State Road 56 near the southern border of Pasco County. Stout palm trees line its well - manicured yard. Tall white columns give the entrance a stately feel. Need help? If you are in crisis or concerned about a loved one, click here for resources that can help. Five months latter, it was approved to treat Baker Act patients. The Baker Act lets judges, police officers, and mental health practitioners 7 of 26 9/22@019, 8:49 AM North Tampa Behavioral Health is cashing in on Florida's Baker Act l ln.., https://projects,=pabay.com/pmjccfs/2019/investigAtions/nofth.tampa-,,. commit people with mental illness if they threaten to seriously hurt themselves or somebody else. The mental health center has 72 hours to do an evaluation. Over the next two years, Baker Act patients became an essential part of North Tampa Behavioral's business model ft-wRevenue soared. A recipe for growth Beginning in 2014, North Tampa Behavioral quickly Increased the number of Baker Act patients it admitted. The hospital's revenues grew at the same time. aaerW,Aaro Naiw.Pee mu mis m�e mn mn mu mu mfa my mle NEIL BEDI I Times Source: Florida Agency for Health Care Administration Because of negotiations with insurance companies, hospitals rarely collect the entire amount they bill. But on average, North Tampa Behavioral still receives $670 for every night a patient stays, the hospital said. In 2017, the hospital posted a 13.9 percent operating profit margin. Only 8 of 26 9122/2019, 8:49 AM North Tampa Behavioral Health is cavhing in on Florida's Baker Act I In... https9/pro]=N.rampabay.com/projects/2019/inveatiga6ons/north-tamps-... three psychiatric hospitals in Florida performed as well or better. None generated as much business from Baker Act patients. Amid the success, North Tampa Behavioral broke ground on a new wing. By the end of 2017, it had 126 patient beds — almost as many as the two other Pasco County hospitals that take Baker Act cases combined. North Tampa Behavioral CEO Bryon Coleman Jr. Twitter But there was turmoil behind the scenes. The hospital cycled through four CEOs in as many years. Last year it hired Coleman to be the fifth. In a video interview with the Hernando Post, an online publication that focuses on "positive" business news, Coleman conceded the frequent leadership changes had left the hospital "broken." He described the workforce as "unstable" and "unsure" and said employees had not been held accountable by the upper ranks. "I knew I'd be inheriting a leadership group that would have a lot of questions," he said. "Who is this person? What does he have that I don't have?" In his statement to the Times, Coleman said he had experience in logistics, financial forecasting and customer service, as well as "valuable, 9 of26 9/22/2019, 8:49 AM North Tampa Behavioral Health is cashing In on Florida's Baker Act l In... hitps✓/projects.tampabay,mm/pmjmtsR019/investigations/north-tmpa-... transferable skills and attributes including team leadership, situational analysis and sound decision-making.' Coleman, 31, had been a quarterback on the Green Bay Packers practice squad and played a few snaps in the 2012 and 2013 preseason. After that, he signed with an indoor professional football team, was the vice president of sales for a Tennessee -based trucking company, played for a Canadian football team and managed employee benefits for BB&T Insurance Holdings. He had no background in healthcare. Bryon `BJ' Coleman was named CEO of North Tampa Behavioral in 2018. He previously played professional football, worked for a trucking company and consulted on employee benefits. Associated Press (2013) 10 of 26 9/22/2019, 9:49 AM North Tampa Behavioral Health is cashing in on Florida's Baker Act l In... haps;//pmjects.tampabaysom/pmjects/2019/investigationslnorth-tmpa-... Longer stays, higher charges When Coleman arrived at North Tampa Behavioral, the hospital had already managed to boost an important metric. From 2014 to 2017, the state data shows. Its two competitors inFr To forcibly hold a Baker Act patient for more than three days, a mental health center must file a petition in court. Under the law, a judge has five work days to rule on the case. North Tampa Behavioral filed 592 such petitions last year. But it dropped 86 percent of them before the hearing, records show. Hundreds of patients were stuck waiting to see a judge, but never saw one. Meanwhile, their bills _+ice even though both admitted a similar number of people under the law. One dropped just two petitions; the other dropped none. The only other facility in Pasco County that admits Baker Act patients, a small mental health crisis center, withdrew about half of its 242 petitions. HeW without a hearing North Tampa Behavioral asked judges for permission to hold Baker Act patients longer than 72 hours more often than any 11 or 26 9/22/2019, 8;49 AM North Tampa Behavioral Health is osshing in on Florida's Baker Act i in... httpsl//pmjects.t p.bay.com/projccta/2019/investigations/nor&ta pa... other Pasco County hospital. But most of the petitions were dropped before the patient ever had a hearing. ^i4�'111W •Y}4M.wMMNM NEIL BEDI I Times Source: Pasco County Clerk Robert Allen was a patient at North Tampa Behavioral this year. He thought about hurting himself after Christmas and knew he needed help. An emergency room doctor sent hire to North Tampa Behavioral. The 89 -year-old said he didn't get the clothes his family brought him and had only a hospital gown. No one told him showers were available. Employees didn't give him his hearing aids. Allen asked to leave repeatedly, but staff members insisted he stay beyond the three days, his family said. The hospital's chief concern: He wasn't participating in group therapy. "That blew our minds," said Allen's son-in-law, Wayne Dowdy. "He can't hear." The hospital petitioned to keep Allen longer. Six days into his stay, a nurse told Allen's daughter, Jennifer Dowdy, that his case would be heard by a judge. 12 of 26 9/27/2019, 9;49 AM North Tampa Behavioral Health is cashing in on Florida's Baker Act I In.,, hUps9/projects.t=pabay.com/projects/2019/investigafotislnaAh-tmpa-,,, Jennifer Dowdy took off from work to attend. on her drive over, she called to find out where the hearing would be held but was told there was no record of her father's case. Hearings weren't even scheduled for that day. She pulled over in tears. As she sat in her car, North Tampa Behavioral called to say her father was being discharged and would be waiting for her in the reception area. Allen was charged $9,000 for the six nights. His insurance paid much of the cost. In July, be received a bill for the remainder: $1,465, Jennifer Dowdy and Robert Allen pose for a family photo. Courtesy of Jennifer Dowdy Robert Allen is still traumatized by his stay at North Tampa Behavioral. LDISSANTANA I Times Other patients were held with a simpler method. Eight told the Times that they felt tricked or pressured into signing voluntary commitment forms. Four of them said they were told the documents would expedite their release. In reality, the forms let the hospital hold them longer than 72 hours without a judge's consent Priya Sarran-Persad was sent from a hospital emergency room to North Tampa Behavioral after attempting suicide in 2015. When the 72 hours were up, Sarran-Persad was woken in the middle of the night by a nurse and escorted to a doctor's office. 13 of 26 9/22/7019, 9:49 AM North 7klopa Behavioral Health is cashing in on Florida's Baker Act I In... httpg://pmjccts.t=pabay,w./projects/2019/investigathns/north, a pa.... His first question: "What insurance do you have?" Atter Sarran-Persad named her private insurance company, the doctor said she had a "flavor of bipolar disorder" and needed to stay at North Tampa Behavioral longer, she recalled. He insisted she sign a voluntary commitment form — and threatened to "re -Baker Act" her if she didn't. The law does not allow doctors to re -commit someone without a petition unless they're experiencing a new crisis. Sarran-Persad refused to sign, but the hospital still took two additional days to discharge her. She said a psychiatrist who treated her after the incident determined she had depression, not bipolar disorder. "a Sarran-Persad said she spent most of her time at North lamps Behavioral in a hospital gown, staring out a window In the common area. 14 of 26 9/22/2019,13:49 AM. North Tampa Behavioral Health is cashing in on Florida's Baker Act I In... https://prOJects.t=pabaY..WM/pMjecla/2019/]'AVstigatlone/north-t=pa.... YALONOA M. JAMES I Special to the Times In the hospital's statement, Coleman said the average length of stay at North Tampa Behavioral is lower than the average for Florida mental hospitals. But the figure he used included hospitals that mostly provide lengthier treatments to patients who aren't admitted under the Baker Act. He also pointed out that in 2018, the hospital's figure fell to 7.4 days. The state hasn't yet published comparable data for other hospitals. Coleman said "confrontations and disagreements" sometimes happen because psychiatric patients can't always make rational decisions about their care. In that case, first reported in the Miami Herald in 2o1g, the hospital refused to discharge an intellectually disabled woman for three weeks. Throughout, the woman's longtime patient advocate argued that an extended stay could make her condition worse. the advocate, Nikki Drake, told the Times. The woman, Cindy Mertz, was eventually returned to her group home, Drake said. But she was traumatized by the incident and later committed to a state mental hospital. She's been there ever since. "They just did her in," Drake said. 15 of 26 9/2212019, 9A9 AM North Tampa Behavioral Health is cashing in on Florida's Baker Act l In... https://projmts.tampabaymm/projects/2019/itvcstigaVons/north-tmpa-... North Tampa Behavioral refused to discharge Cindy Mertz, left, for three weeks in 2015. Her patient advocate, Nikki Drake, fought to have her released. Courtesy of Nikki Drake Cut off with little care To help prevent these types of problems, the Baker Act guarantees family members "immediate access' to patients. But the families of to former patients told the Times that they weren't allowed to see their relatives, which experts say is illegal. Four families said their calls went unanswered or straight to voicemail as they attempted to check on loved ones. When they called from a different line, some said, their calls went through. The law allows hospitals to deny access only if a doctor determines the visit 16 of 26 9/222019, 8:49 AM North Tampa Behavioral Ficalth is Gashing in on Florida's Baker Act 110... htos://projwts,tgmpabay.wm/projects/2019/investigatioos/north,l pa.... would harm the patient. But that's not what happened to any of the families. Instead, the hospital insisted they come during one of the two hour-long windows reserved each week for visitors. The law doesn't specify how often a hospital should hold visiting hours. But Lenderman, the Baker Act expert, called the schedule "totally inappropriate" and `overly restrictive." In other cases, state inspectors found that North Tampa Behavioral didn't tell patients' representatives the details of their care, even for patients who couldn't speak or make independent medical decisions.. Many of the North Tampa Behavioral Baker Act patients who spoke to the 7Ymes said they rarely saw medical professionals and the therapies they received were unsophisticated or nonsensical. One patient remembered being told to smell an orange to ease her anxiety and depression. Another recalled having to watch an educational video on electricity. In the statement, Coleman said the hospital's visiting hours are scheduled around the treatment day and employees work "in good faith" to accommodate visits. He disputed that patients don't see doctors often enough and said the hospital's therapies use "evidence -based techniques." That wasn't Michael Jenkins' experience. Jenkins, 37, was committed last July after attempting suicide. His parents and his wife tried to see him but were told they would have to return during visiting hours. A lawyer later helped Jenkins file a petition to argue for his release before a judge, records show. But state inspectors discovered that the hospital never sent the petition to the court. By law, requests must be sent to court the next day. 17 of 26 9/22/2019, 9:49 AM North Tampa Behavioral Health is cashing in on Florida's Baker Act l In... https://projects,tampabaywm/projects/2019/investipflons/notth-tampa-... After a state investigation, the hospital confirmed it broke the law by not submitting the court filing on time and promised to fix its process. Jenkins spent a total of seven days in the hospital. He said it felt like a prison, He received no psychiatric care and had to beg employees to let him get some air, he said. "I wouldn't even wish my worst enemy to go there," he said. Michael Jenkins spent seven days at North Tampa Behavioral Health last July. Since then, he says his three children have been afraid he'll leave and not come home, JOHN PENDYGRAFT l Times Left in danger North Tampa Behavioral promotes itself as one of the safest psychiatric 18026 9/22/20.19, 8:49 AM North Tampa Behavioral Health is cashing in on Florida's Baku Act I In... httpsJ/pr jecu.t pubay.=/projects/2019/invwtigedons/mrth-tamps-,.. hospitals in the Tampa Bay area. But the hospital has repeatedly failed to protect its patients, police reports and inspections show. �m ¢ "tvo hopped over the fences during monitored recreation time. One kicked through the security doors and left. Another found an employee key card hanging from a door and showed himself out. Patients have also been hurt inside the hospital. In July 20i4, one smacked a disabled man in the face with a chair while he was sleeping. The victim needed Ix stitches. Later that year, Via._. ..:.. r ...p.. The employee was arrested and fired. December 2014 police report Paseo Sheriffs Office In 2o16, two suicidal patients were able to hang themselves, even though North Tampa Behavioral is supposed to provide special monitoring. Both survived. When police arrived to investigate one of the cases, hospital leaders couldn't provide any video footage. The cameras hadn't worked for weeks. 19 of 26 9122/2019, 8:49 AM North Tampaaehavionl Heal this cashing in on Plodda'saakor Act I In.., https:/Iprcicc .tampabaytom/pmjmW2019/investigadonK/n.eh.tamp,.,, PI�is4J�,�*l�D.�'a:rinu.iulmaa August 2018 police report Pasco Sheriff's Office That June, another patient needed emergency medical care after he found a piece of metal and used it to cut himself. A nurse told police North Tampa Behavioral employees had been conducting the required checks. But the patient, Kevin Roach, told the Times that wasn't true. He said he sat alone, bleeding, for at least half an hour and lost almost 2liters of blood. In the statement, Coleman, the CEO, called the incidents "regrettable but wholly non -representative temporary departures from the overall high level of quality clinical care." Coleman touted North Tampa Behavioral's low frequency of serious incidents like assaults, injuries and runaway patients. But he provided a rate of incidents per patient -day that showed the hospital had experienced roughly 75 serious incidents — on average, one a month since it opened. Coleman also said that North Tampa Behavioral had not been "subject to any fines or licensure actions" by the government. later, when the Times pointed out state regulators had fined the hospital to times in the past six years, he conceded he was wrong. Regulators have continued to find safety issues. In December, they cited the hospital for not having a working defibrillator. During the investigation, the supervising nurse said the hospital didn't have a team for medical emergencies. The plan, she said, was to call 9-1-1. 20 of 26 9/22/2019, 8:49 AM North Tampa Behavioral Health is cashing in on Florida's Baker Act I In.., httpa:/iprojects.tampahay.wm/projects/2019/investigations/oolt"=pa-.,. A profitable chain MOO a Tennessee -based chain that specializes in psychiatric care. The company brought in $3 billion in revenue last year. Just this year, an employee at an Acadia -run rehabilitation center in Chicago was accused of sexually abusing six patients Another Acadia hospital in Florida — Park Royal in Fort Myers — has paid more than $3 million in settlements to eight former patients who said they had been sexually abused by an employee. Park Royal is the only Florida psychiatric hospital with more citations than North Tampa Behavioral. It has been cited by state regulators more than ioo times since 2014. Acadia declined multiple interview requests. in a statement, the company said serious and grave incidents made up an "infinitesimally small percentage" of patient encounters. There have also been allegations of fraud. Most recently, investigators said Acadia -run mental health and addiction centers in West Virginia had charged Medicaid millions for lab tests they had actually outsourced at a bargain. The chain settled for $17 million. In its statement, Acadia said it was "pleased to have reached this 21 of 26 9/22/2019,9:49 AM North Tampa Behavioral E calW is cashing in on Florida's Baker Act I In... https://pmjmts.=pabay.mm/projuts/2019/ift est"gatiorehwrth-t pa Since 2014, Park Royal In Fon Myers has had the most citations in Florida. It is also owned by Acadia Healthcare. SARAH COWARD I The News -Press resolution" and pointed out that the settlement did not include an admission of liability on the company's part. Office won't name the hospital. In each of the cases, Acadia said in the financial filings, the federal government is probing issues related to patient care, improper admissions and the length of time patients are kept. In a July call with investors, none of these problems were mentioned. 22 of 26 9/22/2019, 8:49 AM North Tampa Behavioral H"M Is cashing in on Florida's Baker Act I In... https://pmjtots,tempabay.w iVpwjcctg/2019/investigations/north-tamps-,.. Acadia CEO Debbie Osteen Instead, Debbie Osteen, Acadia's new CEO, said she was pleased with the company's performance. Revenue grew across its facilities. About Soo beds were added in the past six months. The number of billable patient days increased. Later, a caller asked Osteen if she expected the number of days patients stay to decline in the future. She touted the company's success keeping the statistic stable, noting that it hadn't dropped in years. She said she didn't expect anything to change. Photojournalist John Pendygraft and data reporter Connie Humburg contributed to this report. Contact Neil Bedi at nbedi tampabay_com. Click here to read the full statements from North Tampa Behavioral and_ Acadia. Neil Bedi 23 or26 9/2212019, 9:49 AM North Tgnpa Behavioral Health is cashing in on Florida's Baker Act I In... https://projecu.tempabay,wm/pmjccta/2019/investigations/nortMWnpa,... Investigative reporter Read more stories by the Times investigations team 24 of 26 9/22/2019, 8:49 AM North Tampa Behavioral Health is cashing in on Florida's Baker Act I In... httpa;//pmjem.=pabay.mm/proje4ts/2019/iftvewl mions/nom-temps-... Comments We strive to provide a forum for civil conversations. That means you should: • Be courteous to one another; • Use respectful language; • Debate, but don't attack; • Avoid posting offdople comments, Please view our complete commenting guidelines hem. If you have any questions regarding our comments section, please send them to newsleeddbarkf&tamoabay.com Comments containing links must be approved by a human moderator, which will likely lead to longer waft times before they show up on our site For 7imes'subschbers, the login for commenting is different from your subscription login. We apologize for the temporary inconvenience but we are working hard to make it simpler for you, All Comments 4 Mewing Options . Didgeridoo t hourago Great Investigativejournalism by TBT! Like* Rephyw Sharer Reports Bethany_H 1day ago Behavioral Health is seen as a goldmine get -rich -quick scheme because they can lock people up as long es they want and charge over $i3Ooo per day. Its a huge conflict of interest. SOLUTION: Take people to court within 24 hours. No more 5.7 day "treatment plans." Liked Reply w Share. Reportrs Blteme2 t day ago Florida's state mental hospitals were often snake pits until the Baker Act helped dear out thousands of mental patients to be discharged to family members, group homes, nursing homes and sometimes to living under highway overpasses. This "modern" age of private facilities has industrialized mental heafth'YreabnenV end turned the focus to milking every nickel out of the payees and putting the patients' long tens care far unto the back bumer. The costs to the public skyrocket while patient care declines. Go figure. Somebody is making a hell of a lot of public money off this racket. Like61 Replyw Shared Reportp egmont I day ago (EdNeei) 31 years old (with less than 5 years of experience, little of which seems to be In the industry) is not 25 of 26 9/22/2019, 9:49 AM N40ft Tampa Behavioral Health is cashing in on Florida's Baker Act I In— httpsd/Pmjwts,tempabay.mni/projects/7019/investigations/nDrth-tamps..,, 02019 All Rights Reserved I Tampa Bay Times 26 of 26 9/2212019, 8:49 AM TAB -B Owwo Om*rRwlm pilk'. -- - nA Se V 0 1 :4U 4, & E # 4 't, 1 1(0 * J) 'I part 'fitgv R.ld G.m e::nt 9Ytvit Ys De pa rt m_r:nt pla"I" 01*4410n f basalae moot procitMdoo a IRATION Tei,. a Prr! I typaatw pta.�N�,1palNmt4i ® tll?' bIffi umw [7 Oona Up <*np.CaNu�M{Kd''W ;e1 iMova*"h 4"—" ....... h##To ntlal P0464, strgl oo. -�#tyr�'esidentitlC pnnilCt 5urrtmwtty "41Wwo w >a<6 cuwue�YwlNga� � cwlnntw �[i1N4rnIR. �''1HASC [ �&tYi'GIXI.MTpf sa�pa: D Nva I'. IV p rd A .n t 5,e r v Ire s 1) e p a e t M4 h: t' aarr61-Plannln9 Dlvkljor I D*vVjqpMjp,,Aj A#PiIL*AttOI4 lylve 4 Pert 1. 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From: Christopher Marshall Sent: Tuesday, September 10, 2019 7:37 PM To: John McCann <Jmccann@chulavistaca.gcv>; Patricia Salvacion <psalvacion@chulavtstaca.gov>; Mary Salas <MSa I a s @ch u lav istoca.gov> Subject: PSYCHIATRIC HOSPITAL EASTLAKE Warning: External, Hello, Email I am an Eastlake resident. I am writing to you to oppose the building of a Psychiatric hospital in Eastlake Chula Vista. This location in Eastlake is one of the worse locations you can put this hospital in. It is centrally located less than a mile away from many schools, about 0.9 miles away from Salt Creek Elementary school and just blocks away from the Eastlake Church School. The release of patients and risk of elopement will pose risk to 1,000's of children. As a security officer/protection specialist it is common knowledge that patients are discharged on the streets or leave against medical advice because they are refusing proper discharge placement and treatment who later become threats to businesses and family directly around them. I have seen them refuse transportation and seek to live on the streets and continue the very harmful addictions that have brought them to the hospital. This includes abuse of alcohol, drugs and other harmful addictions. This is an inherently dangerous risk of the safety of everyone around them especially our future which is the children in nearby in homes, schools, parks, businesses that are for childrens activities where you are planning to build this hospital. Please ask yourself if you have children, grandchildren, nieces or nephews, would you want a pyschiatric hospital less than a mile of their school? There are many alternatives to this location that would be more appropriate. Alternatives that are away from schools, parks and homes. Alternatives that have better public transportation to discharge these patients. We have seen the detrimental actions of mental disease on people, including children. Please do not risk their safety by building this hospital in this location. Please consider a different location. Thank you for your time. Very RespeCI RIlly, Chris Marshall Caroline Young From: John Roesli Sent: Wednesday, September 11, 2019 9:07 AM To: Caroline Young Cc: Heidi Subject: Proposed Behavioral Health Hospital Warning: External Email Caroline Young, I'm writing to you as a concerned local resident regarding the subject of the Behavioral Health Hospital in the Eastlake Business Park, I'm not specifically in favor of or against the hospital. What I do support is the property/building owners right to conduct business that is within the scope and intent of the city zoning codes. The first question is whether or not the proposed hospital operations are within the current zoning codes or have there been any waivers or modifications requested by the property owners, operators, and current or future tenants? If it is in scope, then the matter of zoning codes is closed. If it is not, what has been requested that deviates from the zoning codes? Assuming compliancy with zoning codes then it would be desirable to get either matching or a joint public statement for the record as to what class of behavioral patients will be cared for at the facility. Unfortunately, between private published media and social media I have read various statements that cite a range of patients from benign minor behavioral health issues up to and including patients with a violent history or predatory sexual deviances. This class or type of patient would not necessarily change my thoughts about supporting the operation, but an accurate and specific public statement regarding the nature of the hospitals patients would serve to build integrity between the public, the business community, and the city. Given the patient make-up of the facility, regardless of what level, I believe most of the public discourse against the facility is the concern about maintaining positive control over the patients. if the organization, along with the city, could provide a detailed summary of how patients are managed and monitored along with the procedures in the event of an unaccounted patient, it might mitigate many of the local residents concerns about the facility. For example, are there measures in place to notify the local community? Believe another concern is should the organization fail to meet the city, county, state, or federal requirements for safe operation what measures, if any, are in place to cease operation of the facility? Thank you for taking the time to solicit concerns from local residents and give them a voice. I won't be able to attend the upcoming meeting, but look forward to hearing the results. v/r, John Roesli Chula Vista, CA 91915 Caroline Young Subject- FW; °I oppose the Eastlake hospital location due to safety concerns, -----Original Message ----- From: John McCann Sent: Tuesday, September 10, 2019 1:18 PM To: Caroline Young <CYoung@chulavistaca,gov> Subject: FW: "I oppose the Eastlake hospital location due to safety concerns," -----Original Message ----- From: Marylupe Flores [mailto:: _. Sent: Tuesday, September 10, 2019 1:14 PM To: John McCann Subject: Re: "I oppose the Eastlake hospital location due to safety concerns." Warning: External Email Please vote against this developmentl Sent from my Whone Caroline Youn From: Mandie Waterman Sent: Tuesday, September 10, 2019 10:27 PM To: Caroline Young; Kelly Broughton; Patricia Salvadon; Mary Salas; John McCann; Jill Galvez; Steve C. Padilla; Mike Diaz; montano.monlca@scrippshealth.org Subject: Proposed Eastlake Psychiatric Hospital Vainintp External I strongly oppose the proposed location of the Eastlake Psychiatric Email 9 Y P P P y Hospital. There are better locations for a county hospital that will make the services more accessible to all. I recognize the need for this type of facility, but in the middle of our community, close to schools, homes, and children's entertainment is not the place. I have worked in law enforcement for many years and nothing good will result in bringing this facility into our community. While you may not care, because you are not affected by it; many individuals and your voters are affected by this and strongly oppose it. This hospital may increase police response times for neighbors, which is already an extreme need we face. I am also concerned about the kids in the neighboring schools. The street this hospital is being proposed on is on a street that is mostly made up of business geared for children. You are drastically increasing the possibility of a dangerous event happening by approving this facility in such close proximity to children's schools/activities. It is not a matter of if, but when. Just because the operator is touting this as a lock down facility does not mean patients won't escape or be released onto the neighborhood streets. Patients can decline care once they are stable and walk out into the neighborhood. Please do not approve the permits for this hospital at this location. Thank you, Amanda Waterman Caroline Young From: diana molina Sent: Tuesday, September 10, 2019 5:10 PM To: Caroline Young Subject: apposing psych hospital In my community W am writin to inform ou that I o ose the ro osed s chiaerlc In anent hos ital In 859 and 851 g Y oppose proposed psychiatric p P showroom, Chula Vista, ca, I am also requesting to be provided with accessto the results of the Environmental Impact Report Indicating how this would affect my community. In addition I am requesting a Town Council meeting asap so that you can hear our concerns In this issue thank you, Diana Molina 0 CITIZENS COMMISSION ON HUMAN RIGHTS INTERNATIONAL EOabllehed In 1969 by the Church of8cient40V rn 11.0gafe ad expos pryahlalrle vlalaNane of human rights June 6, 2019 Mr, Max Zaker Chula Vista Planning Commission 276 Fourth Avenue Chula Vista, CA 91910 RE: COMPLAINT AGAINST ACADIA BUILDING A PSYCHIATRIC FACILITY IN CHULA VISTA Dear". Zaker: 1 am writing with concern about Acadia Healthcare's plan to build a psychiatric facility in Chula Vista's District of Eastlake area. According to Fox News on 24 May 2019, a formal application has been filed for a 120 -bed psychiatric facility in a joint venture between Scripps Health and Acadia Healthcare. This will include treatment of children. We are wondering if the commission is fully apprised of the recent investigations into Acadia's behavioral -psychiatric facilities. On May 6, 2019, the Department of Justice, U.S. Attorney's Office Southern District of West Virginia published the details regarding a settlement for healthcare fraud against Acadia. Acadia will pay $17 million. This was noted as the largest healthcare fraud settlement in the history of West Virginia. It is twice the actual loss from the Acadia scheme that defrauded Medicaid of $8.5 million. United States Attorney, Mike Stuart, is quoted as saying "$8.5 million in Medicaid fraud means $8.5 million in fraud to taxpayers.... Medicaid fraud is not a victimless crime AI Additionally, in 2017, employees sued three Acadia facilities in Texas for allegedly retaliating after the employees reported Medicare fraud. The suit against one of the facilities, Red River, resulted in a jury verdict in favor of the former employee.' Public Opposition There is also strong public opposition to the Chula Vista's psychiatric facility opening. On May 1 a, before the formal application had been filed, residents of the area started a petition against having Acadia's psychiatric facility open, In twenty-four hours they had over 500 signatures on that petition. Three weeks later, when the formal 6616 SUNSET1W.mb A&ben �SJlwww cd GmdF E-MIaU Addma (72NwMWSh cW 0M (323)46'1-r126 Chula Vista Planning Commission Re: Acadia Healthcare of Chula Vista 21Page application was filed the people of Rolling Hills Ranch, had nearly 3,000 signatures on their petition opposing the opening of Acadia' facility.^ The citizens' concerns are justified based on reports from other locations where Acadia facilities are located; for example: In Blount County, Tennessee, 911 records showed that between 2016 and 2019, The village Behavioral Health Treatment Center, an Acadia facility in Louisville, had 43 reports of missingjuveniles. There were also 10 assaults and four thefts. In September 2018, three teenage boys fled the facility and were charged with vehicle theft and aggravated assault and kidnapping of a facility employee. Louisville residents have been victims of, or irritated by, juvenile runaways and related crimes emanating from The Village over the years. Pressure from Louisville citizens resulted in Acadia declaring that they would he moving the facility to a more secure location in another county within two years.' on September 11, 2018, six juvenile residents escaped the Acadia Montana facility in Butte by climbing over or going "through" a fence. Two of the residents returned on their awn volition, and four were returned by police. The residents broke through five doors inside the facility to gain access outside. A state inspection report found that the facility had prior knowledge that residents had the potential to escape from the facility but failed to implement adequate supervision of the residents to prevent 0 In November 2017, residents of an Indianapolis neighborhood were on edge after a series of break-ins. Juveniles from Aeadia's Resource Residential Treatment facility in Indianapolis was identified as the source. They routinely escaped by breaking through a facility wall or pulling the fire alarm so that the facility doors would unlock, and broke into a nearby vacant house, which became a hang-out for the escapees.7 Acadia Healthcare Closures, Citing of Abases, In 2018, a Capital Forum investigation into Acadia Healthcare uncovered "a pattern of patient care and safety violations at its behavioral health facilities that could put the company at risk of federal investigation or losing Medicare or Medicaid finding. The company's strategy of rolling up [become larger by successive accumulations] new facilities then slashing costs may make it difficult at many of its locations to ensure that patients are managed safely and given adequate care." A review of state inspection records for Acadia Healthcare facilities revealed a history of violations in safety procedures, medical care and patient rights. Capitol Forum obtained inspection records for nine of the twelve facilities which were cited for violations leading to lapses in safety of direct Chula Vista Planning Commission Re: Acadia HmIthcam of Chula Vista 31Page patient harm,8 According to Capital Forum, "Acadia and I or Its facilities have been the target of lawsuits over injuries and deaths occurring at the facilities." • A review of state inspection records for Acadia Healthcare facilities revealed a history of violations in safety procedures, medical care and patient rights. Capitol Forum obtained inspection records for nine of the twelve facilities which were cited for violations leading to lapses in safety of direct patient harm,9 According to Capital Forum, "Acadia and / or its facilities have been the target of lawsuits over Injuries and deaths occurring at the facilities." • In early February 2019, media reported that Acadia's Desert Hills, an Albuquerque, New Mexico child psychiatric facility, would close. Between 2016 and 2018, the state Children, Youth, and Families Department (CYFD) investigated the facility over serious allegations of assault and battery of patients. In December 2018, CYFD issued a cease and desist order on the facility. In early 2019, the state granted Desert Hills a temporary certification, which was set to expire on April 1st if they did not make the necessary corrections to keep children safe, as required by CYFD. Desert Hills' efforts did not meet CYFD's standards, which meant they would be de -certified and would not be able to receive new patients or federal health care reimbursements. As of Agril 1", the Desert Hills website homepage states "Desert Hills is now closed."' • In November of 2018, an I -Team 8 News WISH -TV investigation in Indianapolis, Indiana followed up on abuses previously found in Acadia's Resource Residential Treatment for children and young adults. Multiple former and current employees and residents reported fights, assaults, understaffing, inappropriate relationships between employees and residents, and kids kicking down doors and walls to escape.I I • A Disability Rights group, formed as a non-profit corporation with a mission to advocate for the human, civil and legal rights of people with disabilities in Ohio, investigated Acadia's Ohio Hospital for Psychiatry, a 130 -bed, inpatient psychiatric hospital." The group found substantiated allegation of sexual and physical abuse and the use of seclusion in an unsafe manner, among other abuses. 13 • In October of 2018, Acadia announced the closure of ten of its childeare facilities in Arkansas, claiming budgetary reasons, yet the announcement came after manslaughter charges had been filed against several of Its staff for leaving a five- year-old boy strapped in a car that reached temperatures of 141 -degrees that killed him. 14 Chula Vista Planning Commission Re: Acadia Healthcare of Chula Vista 41Page • In the book Mental Health Inc: How Corruption, Lav Oversight and Failed Reforms Endanger Our Most Vulnerable Citizens, published in 2018, Art Levine, a prize-winning investigative journalist and author chronicled at least six gory and preventable deaths at Acadia's Sierra Tucson facility in Arizona, IS • In January 2017, the Lee County Sheriff's Office investigated an alleged sexual assault on a patient at Acadia's Park Royal Hospital in Florida. It was also looking into the deaths of two patients who bad recently been brought to the facility for involuntary mental health evaluations. One individual was a 53 -year-old man, who was found dead in his room from undetermined causes and the other a 55 -year-old man who died after going into cardiac arrest, 16 • in December 2017, WXYZ 7 (ABC) Detroit news reported the results of it month- long investigation into Harbor Oaks Behavioral Hospital that revealed "a pattern of assaults on staff and repeated allegation of physical and sexual abuse involving patients.."' The facility was accused of rampant patient and staff abuse and inflated staffing levels only when hospital watchdogs visited, according to current and former employees. The allegations against Acadia where just "the latest in a string of revelation calling into question the safety of those inside..." according to the news report.i1s • Arkansas regulators reportedly opened an investigation into Acadia's Piney Ridge Treatment Center in 2016 after parents and former patients told a local reporter that the facility actually operated "more like a kid's fighting ring." A family said their daughter was forced to fight by staff. A former patient said that what they called the "fight club" was going on when she was a patient seven years earlier,lw Rodney Dewayne Thomas, a former Piney Ridge Treatment Center staffer was arrested in April 2018 and charged with one felony count of engaging children in sexually explicit conduct." Former employees told a local news station that Piney Ridge overlooked the misconduct and had attempted to "sweep it under the rug," They said Thomas was notorious for inappropriate behavior with the kids.21 CCHR Is a non-profit mental health watchdog that, for 50 years, has worked to protect patients' rights. To this end, CCHR receives numerous reports of alleged abuse or fraud committed within mental health facilities, including those owned by Acadia Healthcare. CCHR International addresses concerns of mental health abuse across the globe. CCHR has provided the attached report and research in an effort to provide regulators with an informed view of for-profit mental health care providers and what they bring to your state and county. Given the complaints about Acadia's behavioraVpsychiatric facilities, CCHR urges the Chula Vista Planning Commission to take into account Acadia Healtheare's Chula Vista Planning Commission Re: Acadia Healthcare of Chula Vista 5lpage history an present adverse reports on it. Please conduct your own investigations with regard to these documented events and oppose the application for a psychiatric facility to be constructed in Chula Vista. Very truly yours, Nana Foley Legal Coordinator Citizens Commission on Human Rights International References: httpsd/wwwjustice.gov/umo-sdwv/pr/united-states-ounmey-announces-l7-million-healthcare-fraud-selitement. ' "Acadia Healthcare: A Close Look at Alleged Abuses and Violations at Acadia Facilities; Use of PSI Playbook. May Expose Company to Legal and Regulatory Risk," Capitol Forum, Vol. 5, No, 400; 28 Nov. 2017, s https://fox5sandiego.com/2019,D5/01/proposed-behavioral-health-facitity- oncems-some-eastlake-residents/. 4 haps://fox5sam1egu.eom/2019/05x24/formal-application-Fled-for-mental-heal[&facility-in-eastlake/. "'Louisville behavior health center to relocate after assaults, neighborhood concerns," The Doily Times (Blount County, IN), 16 Feb. 2019, hltps://www.thedailytimes.cum!news/louisville-behavior-health-center-to-relocate-aaer- areaways, assaults, parent company's troubles among new Acadia CEO's challenges," The Apr. 2019, https://mtstmdard.com/news/local/oregon-complaint-runaways-assaults•paren Tong-new/article 3d090ebb-e804.54of-8152-f40c9b6al696.html. as, police say kids are escaping a psychiatric treatment center," Nish TV -R, 2 Nov, 2017, Up. cit., Capital Formnr, Vol, 5., No, 400. Op. cit., Caphol Foram, Vol. 5., No, 400. "New CEO makes changes to youth facility after [-Team 8 reports," Wish TV -N, 15 Nov. reports/1600177497; Stephanie Zepchn, "Former, were violent with kids," Nish 7V,8,13 Feb. 2018, �s http://www.dimbilityrightsohio.org/dro_report_problems_,a(_ohp. is http://wwetwtncactionnews5,com/story/35647605/6-year-old-found-dead-on-day-care-bus/. 's Martha Rosenberg, "Mental Health Inc: How Corruption, Lax Oversight and Failed Reforms Endanger Our Most Vulnerable Chizens('A(ternti, 8 Jan 2018, https:/lwww.allemet.org/mental-health-inc-how•comption-Iax- oversight-and-failed-reforms-endmger•our-mostvulnerable; Jake Grant, "Mental Health Inc. focuses on a real issue, but offirs failed solutions," Washington Eraminer, 1 Sept. 2018, haps;//www,washingtonexamineecoMopinion/mental-health•Ine•focuses-oo-a-raal•issue-but-oRers-fallad- solutions. Chula Vista Planning Commission Re: Acadla Healthcare of Chula Vista 61page 16 "Park Royal Hospital, Fort Myons' only psychiatric hospital, gots a new leader," News -Press Toby). 19 Feb. 2018, btW/www.newapress.comismry/newsn018102/191park-myabhospita inflated staffing levels when watchdogs visited Insiders oaks-intinted-sratrtng-IevaLs-when-watchdogs-visited-insiders-claim; Ross Jones, "8x -employees: Metrc psych hospital so understaffed Ws dangerous," WXYL Denit News (ABC), 14 Sept. 2017, btip://www,wxyzfiolNtkws/Imp-newsfmvestigWons/exemployaes-psych-bospital-so-understaffed-du workers-in-dangar, "Nd, WXFZ, 14 Sept. 2017 and 21 Nov. 2017. ""Fortner Piney Ridge Patient: `It's More Liken Kid's Fighting Ring,'" NWANews, 6 May 2016, https:/Iw".ftwah=Wgc.com/uws/fOx- 24/formar-piney-ridge-patient-its-more-likes-kids-fighting- ring/450406260. }e "Former, Piney R1dge Employee Facing Child Porn Charge," S News, l I Apr. 2018, https://5newsonlinacom2018/04/1IIfonner-piaoyridget ploym-facingchil4�pom-charge/. xl "youth Treatment Center Repeatedly Allowed Inappropriate Behavior," NWA News, 12 Apr. 2018,