‘DON’T TAKE ME BACK!’
Texans foot bills for private mental hospitals with little oversight
Alex Blanchard heard her 5year-old son’s piercing screams even before paramedics wheeled him into the hospital room. “Don’t take me back! Don’t take me back!” Less than 24 hours had passed since she dropped off her son at Austin Oaks Hospital, a private psychiatric facility owned by United Health Services in Austin, court documents allege. Doctors told her committing him was necessary if she wanted to get his attention deficit hyperactivity disorder, or ADHD, under control.
Alex nearly collapsed when she saw him. His nose was bleeding; his forehead swelled with a goose egg. His arms and legs were covered in angry, red welts. Fingerprint-shaped bruises bloomed around his neck.
Her son fought off dizziness and nausea as he struggled to explain what had happened: how he was left alone in a room with an older boy; how he was playing with Legos when he felt the first kick to his head. She now alleges in a lawsuit that her son was assaulted by a 13-year-old.
Austin Oaks is one of 54 private psychiatric hospitals in Texas that receive taxpayer money to divert mental health patients — both youths and adults — from the burgeoning waitlist for state psychiatric beds.
Advocates of the program say it’s incredibly important — that it has helped thousands of indigent Texans receive care.
“The ability of Local Mental Health Authorities to purchase inpatient psychiatric care from local hospitals, for individuals experiencing acute symptoms of serious mental illness, is critical to providing access to needed care at the right time and reducing demand on limited state hospital beds,” said Danette Castle, CEO of the Texas Council of Community Centers.
But many of these hospitals, including Austin Oaks, have troubled track records.
Between 2014 and 2019, those hospitals racked up nearly 1,100 state and federal violations — including 47 at the 80-bed hospital where Alex’s son was committed. Those 54 hospitals also were fined $1.4 million by the state, a Houston Chronicle investigation found.
Police officers were called to those hospitals’ locations more than 31,200 times during that same time period, about 1,900 times for assault, about 380 times for sex offenses and about 280 times for possible suicides. There also were 15 deaths. Of the 54 hospitals, 14 are large facilities that are not singularly focused on mental health care and were not included in this count.
Steve Kelly, CEO of Austin Oaks, said the hospital is “committed to delivering high quality patient care,” including monitoring patients while they reside at the facility and overseeing individual treatment plans for every patient that includes, when necessary, parental involvement.
“We find that family involvement is critical in helping and supporting patients on their path to healing and growth,” Kelly told the Chronicle in a statement. He added that police may be called to the facility for routine matters and emergency detentions because “police are the authority for detentions in our state.”
At Westpark Springs in Richmond — which had one statefunded contract for beds in fiscal year 2019 — law enforcement was called to the 72-bed hospital’s location as many as 10 times per day.
In Texas, patients who are involuntarily committed to a psychiatric hospital must be accompanied by a constable, said Kelly Sorice, spokeswoman for Westpark Springs — and many of the police calls to that location are related to these types of commitments.
Occasionally, someone will walk into Westpark Springs and an involuntary admission process will be started, Sorice added. At that time, she said, the hospital also reaches out to the sheriff’s office as required to start the court process.
“In terms of safety, we are always extremely focused on providing a safe environment for both our patients and our staff,” Sorice said. “While we always look for ways to learn, we are very proud of our safety record.”
The state relies on Local Mental Health Authorities — also called community mental health centers — to provide, among other programs, medication, counseling, treatment and crisis services to Texas’ most needy in local communities across the state.
They act as middlemen and contract on the state’s behalf with private hospitals. The state established this program in 2011, but state officials said until last fall, they did not collect information on which hospitals are selected. They started that work in September, a spokeswoman said.
Some community centers use crisis funding to pay for beds in private hospitals as well.
The Houston Chronicle examined thousands of pages of documents detailing state and federal violations, some of which were found on hospitalinspections.org, an Association of Health Care Journalists website created after the organization reached an agreement with the Centers for Medicare & Medicaid Services to post reports online.
Violations included failing to investigate allegations of sexual abuse, administering medications in error and poor staffing levels, state and federal documents show. But some were more egregious:
• A suicidal patient — who should have had constant, oneon-one supervision — was left alone at Hickory Trail Hospital near Dallas for 11 minutes in 2017, enough time to wrench his left eye out of its socket and seriously damage the other, federal investigators found.
• A woman at Cross Creek Hospital in Austin that same year banged her head against the wall and threatened to kill herself if she was discharged to her uncle. Hospital personnel released her anyway. She escaped and hanged herself at a construction site nearby, where she was found the next day, federal documents state.
• A patient who’d previously attempted suicide was at Millwood Hospital in Arlington in 2016 for just 35 hours before hanging himself from the sprinkler system as several patients watched, according to state and hospitalinspection.org records. The hospital, which agreed to pay a $115,000 fine, did not respond to repeated requests for comment.
State Sen. John Whitmire, D-Houston, said the program needs significantly more oversight.
“When you’re in the business of caring for people for a profit, any time you cut corners you have more profit,” he said. “There should be more accountability and supervision, but that takes money, too.”
Local mental health authorities admit they often have to contract with any private hospitals that are willing because of location restraints and the fact that the state pays less for care than private insurers.
In fact, many of the private hospitals have multiple public contracts, often with vastly different rates.
It’s up to these community centers to negotiate the price of a bed per day, and though they provided the information, many were hesitant to share the costs for fear that hospitals might increase the price.
The Chronicle found that about 65 percent of the nearly 100 contracts with private hospitals paid more than the Medicaid per day rates for inpatient psychiatric beds — sometimes hundreds of dollars more per day — in fiscal year 2019.
Hill Country Mental Health and Developmental Disabilities Centers, a community center in Kerrville, paid Laurel Ridge Treatment Center $675 per day, while Camino Real Community Services in Lytle paid $700 per day.
The Medicaid rate for this hospital is $511.80 per day. The state says it will not pay more than $700 a day.
Ross C. Robinson, executive director of Hill Country, said it’s not unusual to pay higher rates to private hospitals than what Medicaid authorizes, especially in a market that is so competitive.
Local mental health authorities are required to ensure the facilities chosen are accredited by the Joint Commission, a nonprofit that accredits more than 20,000 health care organizations nationwide, or other accrediting entity recognized by the CMS. They also have to make sure that the facilities are licensed by the state.
Some centers told the Chronicle they do patient interviews and quality audits to ensure a safe environment, but many said they don’t research if they have state or federal violations, or how often police are called.
Shena Ureste is the director of behavioral health care services at the Texana Center in Rosenberg, one of the state’s local health authorities, which contracts with eight private hospitals, including Westpark Springs, for beds.
“There’s no way we can go in and monitor in the way we monitor our business here,” she said.
Center officials were not aware that police were so frequently called to Westpark Springs, she said, but they don’t send patients there who are in severe crisis because the hospital doesn’t have a psychiatric intensive care unit.
Alex Blanchard first noticed her son was different in 2012, when he was about 6 months old.
He was constantly rubbing his head to keep himself awake. He was always fidgeting his fingers and toes. Even in his sleep, he could never stay still.
She felt sure he had ADHD, but she was hesitant to medicate him. She watched him grow into a fearless kindergartner who never met a person he didn’t like.
But in January 2017, he started having tantrums at school, she said. He ran into the hallway when he wasn’t allowed. He threw books and pencils across the room. He ripped posters off the wall.
Doctors put him on Abilify and then Ritalin. The side effects were heartbreaking. He was like a zombie. Alex took him off the medications.
Eight months later, on Aug. 22, 2017, Alex — who owned a housecleaning business — was at work when her son’s school called.
He’s out of control, they told her: He’s aggressive and irritable. You need to take him to the emergency room for an evaluation.
Alex arrived at the hospital in the afternoon, she said, and sat there waiting with him for hours.
She had repeatedly explained what was wrong: Her son had ADHD. He wasn’t allowed to return to kindergarten until he was medicated and under control.
The first doctor was perplexed: He’s only 5, the doctor said. There isn’t much we can do.
Alex understood. But she had to work. Her son had to be in school.
The second doctor felt differently.
Psychiatric commitment was necessary, he said. They found him a bed at Austin Oaks Hospital for a week. The doctors there would put him on the right medication and get him on track, she was told.
The sun had set by the time Alex walked her son to their car.
She started sobbing and couldn’t stop. She hadn’t been away from her son for more than six hours since he was born.
Trust the doctors, she thought. They know what they’re doing.
She had no idea that the hospital she was driving her son toward had repeatedly been in trouble with both federal and state authorities since 2014.
Hospital staff did not monitor patients for side effects after administering medication, according to hospitalinspections.org. Parents weren’t involved in treatment meetings for their children. The hospital admitted to investigators that it didn’t have enough staff members overseeing the adolescent wing.
Police had been called to the 80-bed hospital about 400 times between 2014 and the August 2017 day Alex’s son was admitted. Ten percent of the calls were assault-related, police records show.
But Alex hadn’t had a moment to research the hospital the doctor recommended.
She strapped her son into his booster seat and started the 16mile drive to Austin Oaks.
He was scared and couldn’t stop crying.
“Where are we going, Mommy?” he asked. “Why can’t you stay with me?”
She comforted him as best she could.
Take a deep breath, she thought. The doctors know what they’re doing.
The next day, Alex was cleaning a home when her phone rang.
The number that flashed across the screen was unfamiliar — could her son be calling already?
But the voice on the other end of the line wasn’t her son. It was a nurse.
“There’s been an accident,” the nurse said. “We’re taking your son to the hospital out of an abundance of caution.”
Alex dropped her broom and raced out of the house, speeding down the highway.
She arrived before the paramedics and vowed to never let her son out of her sight again.
Kelly, the Austin Oaks CEO, said in a statement that patient privacy laws prevented him from discussing Alex’s son’s assault. He said, however, that the incident “was fully investigated and reported, per Facility protocols.”
In court documents, the hospital denied the allegations that they were negligent in the treatment and care of Alex’s son.
The Chronicle’s investigation found that stories such as the Blanchards’ are all too common.
Cross Creek Hospital in Austin houses just 90 people, but the private psychiatric facility was investigated by the federal government 12 different times between 2014 and 2019. It racked up 44 separate violations, records show.
A patient was inappropriately restrained, according to hospitalinspections.org. A staff member worked 16 shifts without up-todate training and injured a patient. Several incidents of sexual assault were not investigated, federal investigators found.
In 2017, an adolescent girl banged her head against the wall and threatened to kill herself if she were discharged to her uncle.
Austin police were called. They escorted the patient to her uncle’s car. In the process, she escaped, but federal documents show her uncle didn’t chase after her.
The girl was found the following day at a nearby construction site. She had killed herself by hanging.
Though the young girl’s suicide risk was low just before discharge, federal investigators determined that the registered nurse on duty failed to complete a suicide risk assessment before the patient left the hospital lobby, as required by hospital policy.
In response to the federal government’s finding, the hospital revised several of its policies to allow a discharge to be halted if staff members have concerns about a patient harming themselves or others.
During that same time period, the hospital was fined a total of $115,000 by the state for violations that included failing to monitor patients at the level instructed by a physician and allowing staff members’ crisis training to expire, which resulted in a patient head injury.
The fines were later reduced to $34,000.
Though Cross Creek’s policy does not allow officials to discuss patients’ care, CEO Kay McKennery said the hospital takes all issues and incidents “very seriously.”
“We address them immediately,” she said. “The safety and rights of everyone at Cross Creek — our patients and staff — have been and always will be the hospital’s top priorities.”
Six separate local mental health authorities — including Hill Country in Kerrville — contracted with the hospital for inpatient beds after these incidents occurred. In fiscal year 2019, the hospital treated at least 336 patients and received more than $1.5 million from taxpayers.
Robinson, Hill Country’s executive director, said he had not heard of these incidents. He thanked the Chronicle for bringing it to his attention and said the center would review it immediately.
The Mental Health and Mental Retardation Authority of Brazos Valley in Bryan has a contract with Cross Creek as well. Robert Reed, the center’s director of behavioral health operations, did not know about the incidents.
“It does give me pause as far as future referrals,” Reed told the Chronicle. “However, before making a decision, we would have to review and evaluate the plan of corrections implemented and accepted by the federal or state review team and see how they have been doing since that time.”
The 86-bed Hickory Trail Hospital near Dallas was investigated by the federal government seven separate times between 2014 and 2019, tallying 22 violations.
In 2017, a patient was admitted to Hickory Trail after attempting suicide three separate times in the span of 24 hours. The patient was left alone for 11 minutes, enough time to rip his eye from its socket, federal records show.
Hospital personnel said there was “no need to place the patient in one-to-one (staff ) observation because he was cooperative and never said anything that … (necessitated) one-to-one observation,” federal records state, but investigators found that the hospital failed to take the appropriate preventive steps to make sure the patient was kept safe.
Hospital officials changed their guidelines for which patients needed to have one-on-one observation and revised the highrisk alert form so that they would document specific behaviors showing that the patient might harm themselves or others.
Daniel Martinez-Torres, Hickory Trail’s CEO, said in a statement that the hospital cannot discuss a patient or their treatment because of privacy laws, but that the incident “was fully investigated and reported, per Facility protocols.”
Alex and her son moved to Hot Springs, Ark., where her father had retired, a few years ago.
The woods of Arkansas have become his home, where he can climb a tree and dig for crystals all day long. But it hasn’t been easy.
He used to have no fear. When he was 2 years old, Alex remembers him walking into the house with a rattlesnake. She panicked. He giggled.
Now the 9-year-old is haunted by nightmares and scared of most things — people included. But he’s getting better, slowly, she said. His teacher says he’s doing well. He’s made friends.
On a recent afternoon, Alex’s son sprinted toward his grandfather’s porch, his cheeks red from the chilly air. He needed water — he’d been running around the forest for hours. But he stopped abruptly when he reached his mom and wrapped his arms around her neck.
“I love you, Mom,” he said. “I love you, too,” she replied.