Fairview’s new mental health partner faces investigation for holding patients against their will

CATHY WURZER: Now we’re going to turn to a national investigation that could have implications here in Minnesota. Acadia Healthcare is under scrutiny after New York Times reporters found some of its psychiatric hospitals were holding patients against their will, even when it wasn’t necessary. Acadia agreed to pay nearly $20 million to settle its practices last month, and now faces a new federal investigation, according to the Times.

The company operates mental health hospitals in 19 states. Minnesota is not yet one of them, but Acadia is partnering with Fairview Health Services on a new hospital currently under construction in St. Paul. The 144-bed facility is part of an effort to address what the State Department of Health calls a mental health bed capacity crisis. Because of these plans, we wanted to learn more about research. So we called New York Times reporter Jessica Silver-Greenberg, and she’s on the line. Jessica, thank you. I know you are busy. Thanks for making the time.

JESSICA SILVER-GREENBERG: Oh, no, it’s my pleasure. Thank you for having me.

CATHY WURZER: As you know, there’s always something that motivates a reporter to get involved in a story. What was the seed of this reporting project for you?

JESSICA SILVER-GREENBERG: Well, my reporting partner, Katie Thomas, and I have been writing about health care with a focus on a lot of health care research. And last year when we were reporting on a completely different project, we heard whispers, something like, you should check out this company, Acadia Healthcare. And at the time it didn’t mean much to us.

And earlier this year we started learning, and we started to — just for people who don’t know Acadia Healthcare, the company is the largest for-profit company focused solely on behavioral health. , and it has. mental hospitals across the country. As you said in your introduction, it hasn’t come to Minnesota yet, but it already has a joint venture with another hospital system to open an inpatient psychiatric hospital. So the company has a large footprint.

And what we’ve started doing is asking for information, things like complaints, health checks, complaints filed with state and federal authorities, like state attorneys general, and state health checks and government. In order to understand, because we didn’t know anything at that time, what the company’s business practices were like. And our findings ultimately led to research published last month.

CATHY WURZER: Hmm. OKAY. So what did you hear from patients about what they felt at some of these hospitals?

JESSICA SILVER-GREENBERG: We heard from patients who, regardless of the condition they were living in, had remarkably similar stories, and the stories went like this. They went to Acadia Hospital, sometimes to inquire about outpatient psychiatric treatment. Sometimes they wanted medication adjustments, because the mental illnesses were under control but they just needed help adjusting their medication.

And sometimes they went to the emergency department of a non-Acadia hospital to seek treatment for a mental health episode, only to find themselves sent against their will to an Acadia facility, admitted, then they were held there — we heard all kinds of different stories, but some people were held for a week, some longer. And they couldn’t get out, even though they didn’t want to be there and needed medical help to be there.

CATHY WURZER: That’s illegal.

JESSICA SILVER-GREENBERG: Yes. Yes, the methods we found that this company, which Acadia uses the rules of engagement are not consistent. So those laws mean that a person can be arrested without choice against his will, if he is a threat to himself or others immediately.

And what we found in our research, which was based on many internal and external reports, as well as interviews with more than 50 current and former employees of this company, we found that although those laws were intended for people who pose an imminent danger. they or others, that Acadia was holding patients who did not appear to meet that legal standard. So yes, it was holding people who shouldn’t have been there longer than allowed under these state laws.

CATHY WURZER: Was there an economic reason for that?

JESSICA SILVER-GREENBERG: Yes. We found that in fact, that is the whole reason. That it wasn’t a medical decision, it was a financial one. So Acadia makes more money from insuring patients when those patients stay longer, even a day or two can make a big difference, because Acadia can charge up to $2,200 a day for some patients.

So the company has used a lot of strategies to get insurance companies to cover those long stays, and they’ve done things like over-diagnose patients, improved their drug rates and claim to insurance companies that patients need to stay longer. , it is argued that the patients are not well enough to leave because they have not eaten any. These practices were prevalent in 12 of the 19 counties where Acadia operates psychiatric hospitals.

And patients in mental health crises often don’t know their rights, so they don’t know how long they’re allowed to stay there. And we found that unless their families, or unless they were able to hire lawyers, which is a huge obstacle for many people, they were stuck there. They were stuck inside, which you can imagine is a horrible situation for someone who had no purpose, who was just trying to get help from the outside patients.

CATHY WURZER: Yes. I don’t think so. What have you heard about this company?

JESSICA SILVER-GREENBERG: So the company, in response to what we found – we sent them, as we do with any article, we sent them a full list of what we found and we asked for feedback on that. And they declined to comment on any of the patient examples we highlighted throughout the article, citing patient confidentiality laws. But they said the samples were not representative of patients, many of whom say they have had positive experiences with the company.

But they said any event– I think, reading from their comments– “any event that does not meet our strict standards is unacceptable and steps are taken to it solves.” However, we do know, and have reported, that they are under new investigation from federal authorities regarding the practices we uncovered in our latest article.

CATHY WURZER: And what will you be looking at with that investigation?

JESSICA SILVER-GREENBERG: We’re going to watch to see how that investigation works, and whether other countries decide to investigate. Because so far what we know, because of what Acadia told its investors last month, we know that federal prosecutors in Manhattan have requested information from the company and that the company has also received subpoenas from a Missouri federal grand jury. And finally, we were told that Acadia told its investors to expect similar questions from the Securities and Exchange Commission.

So those are three new investigations right now, and what we’re going to want to see is how they play out. And whether other states, like I said, decide to investigate Acadia hospitals in their own backyards, as we speak.

CATHY WURZER: Well, Jessica, thank you and your partner for the report, and for your time today. Thank you very much.

JESSICA SILVER-GREENBERG: Thank you.

CATHY WURZER: Jessica Silver-Greenberg is an investigative reporter for the New York Times. Now, MPR News reached out to Fairview for a statement, and they said, and I’m quoting now, “We are taking our part in the Capitol Park Mental Health Hospital joint venture and we intend to provide the high quality care our community expects and deserves.”

They also said Fairview providers will oversee patient evaluations and treatment, including decisions about whether patient care is necessary in accordance with state regulations, and the hospital’s chief executive officer will be employed by Fairview and not Acadia, but selected by both companies.