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Psychiatric care's perils and profits

Lapses at a major hospital chain put patients at risk, regulators say, as earnings steadily grow.

November 23, 2008|Christina Jewett and Robin Fields | Christina Jewett and Robin Fields are writers for ProPublica.

Psychiatric Solutions Inc. was on its way to becoming the nation's leading provider of private psychiatric care when it snapped up Sierra Vista Hospital in Sacramento in mid-2005.

The company put its well-honed business formula into action: Staffing fell. Beds filled up. Profits soared.

It was a winning strategy for investors. But for some patients, federal records show, checking into Sierra Vista proved dangerous -- at times deadly.

In December 2005, Ramona Knapp, 51, was left fatally brain damaged after hospital workers restrained her improperly, pinning her to the floor.

In March 2007, an unidentified 29-year-old woman was mistakenly given six times the prescribed dose of a potent antipsychotic drug. Even after 15 hours, she was too weak to swallow.

When Steven Burton, 55, checked in for treatment of alcohol abuse and depression in February, he complained of chest pains. The intake nurse didn't notify a doctor because, as she later told regulators, "he didn't look sick."

Burton was discovered the next morning, facedown on the floor of his room, shaking and sweating. Staffers put him back in bed and paged a psychiatrist, getting no response. Two and a half hours later, a nurse found him blue and not breathing.

Burton, an El Dorado County agriculture official, came to Sierra Vista only at the insistence of his wife, Vickie.

"The last thing I was thinking," she said, "was that I was taking him to the place where he was going to die."

The lapses at Sierra Vista are among a string of cases involving abuse and neglect at PSI facilities nationwide, an investigation by ProPublica has found.

In a challenging field with a troubled history, PSI hospitals often fare worse than comparable private hospitals in meeting government standards for patient care, according to an analysis of state and federal inspection reports.

Since 2005, the 10 hospitals PSI has owned longest have compiled almost twice as many patient-care deficiencies as 10 similar hospitals owned by its closest competitor, Universal Health Services Inc.

The PSI hospitals were cited in three patient deaths and for placing patients in immediate jeopardy four times, the inspection records show. The UHS hospitals received no equivalent citations.

Among private psychiatric hospitals in California, Sierra Vista had the single highest rate of state and federal deficiencies -- about eight times the statewide average.

It has twice been fined $25,000 for endangering patients -- accounting for the only such penalties levied against psychiatric hospitals under a 2006 state law establishing the sanctions.

PSI executives declined to be interviewed for this article and, citing privacy law, would not discuss individual patients.

In written responses, they rejected the analysis showing the company's hospitals compared poorly to others, saying: "Your assumptions, calculations and apparent conclusions are invalid."

A spokesman, John Van Mol, said that PSI arguably has improved psychiatric care in the country overall. He cited the comparatively poor performance of state psychiatric facilities around the country in recent years.

PSI officials apologized for incidents resulting in harm to patients, saying they acted immediately to correct any problems. "Any incident involving patient care is one too many in our view, and everyone involved from the hospital level to the corporate level works very hard to prevent them," they wrote.

Missing the mark

Recent state and federal inspections show the company's efforts have fallen short:

* Poor patient supervision, understaffing and inadequate worker training have led to instances of chaos and brutality.

A 19-year-old alleged he was raped twice within 24 hours by a fellow patient at an Illinois hospital even after he reported the first assault, federal records show.

Staffers at a Texas facility had to barricade themselves in an office and call in a SWAT team to bring unruly residents under control.

In North Carolina, inspectors found, a 12-year-old boy with a history of sexual aggression was put in a room with a 5-year-old and attempted to force the younger boy to perform oral sex.

* Medical neglect and errors have resulted in grave harm. A nurse at another North Carolina facility gave a 7-year-old boy anti-seizure medication prescribed for an older patient, leaving him so drowsy that a doctor wrote in his chart that "he refuses to wake up."

Workers in Virginia waited almost an hour to call an ambulance for a 17-year-old girl who had suffered a seizure and was bleeding profusely, inspection records show. The girl died later that day.

* In several instances, PSI employees have sought to hide their failings from regulators. A hospital in Texas was cited by state inspectors for concealing key facts about a patient abduction and a suicide. Regulators in Virginia uncovered what they called an organized scheme to cover up violence, suicide attempts and medication errors at a Charlottesville facility for juveniles.

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