Latest BuzzFeed News exposé on UHS for-profit UK behavioral facilities

By CCHR International
The Mental Health Industry Watchdog
December 19, 2017

BuzzFeed News has found the troubled Universal Health Services (UHS) psychiatric hospital chain in the U.S. is now under scrutiny in the United Kingdom over allegations similar to those leveled at its behavioral facilities in the U.S. In the U.S., UHS has been plagued by federal and state investigations into potential billing fraud and patient abuse, including sexual abuse and suicides, and has been the subject of thousands of complaints filed by Citizens Commission on Human Rights (CCHR), including to UK authorities in 2015 and 2017. CCHR has questioned how UHS was able to purchase psychiatric hospitals in the UK while under U.S. Department of Justice civil and criminal investigation for possible fraud.

On December 15, 2017, BuzzFeed News reporters said the UHS-owned Cygnet Health Care, one of the UK’s biggest chains of private psychiatric hospitals, has been “accused of failing to properly care for vulnerable young patients by their families.” These complaints follow a series of official inspection reports that rated the safety of patients at one of the hospitals as ‘requires improvement,’ and another as ‘inadequate.’”[1] This included one hospital “not taking sufficient precautions to ensure patients’ safety.” These are allegations that CCHR raised with UK authorities during the past two years as potential risks based on what has occurred in the U.S. In light of the recent allegations, CCHR suggests that UK inspections should be extended to also look for potential fraudulent billing.

The allegations are almost identical against UHS behavioral facilities in the U.S. that prompted Charles Grassley, head of the U.S. Senate Judiciary Committee, to write the U.S. Department of Health and Human Services in December 2016 about UHS’s behavioral facilities painting “a picture of greed and raises serious questions about patient safety.”[2] In April 2017, he wrote again calling for a federal probe into UHS behavioral facilities.[3] He said reports “portray a pattern of conduct that is extremely concerning and cast a dark cloud over UHS’s ability to properly care for its patients and whether it is properly billing federal programs.”[4] On December 18, 2017, it was reported that Senator Grassley again called for a federal probe into UHS’s chain of psychiatric hospitals. “The continued reporting on UHS facilities shows a disturbing trend of behavior,” Grassley wrote in a letter to the inspector general of the Department of Health and Human Services. Responding to allegations against UHS’s Hill Crest behavioral health in Alabama, where surveillance cameras showed staff assaulting patients, Senator Grassley wrote: ”The most recent allegations cause significant concern about whether UHS has the ability to adequately manage the facilities under its control.”[5]

In the UK, BuzzFeed News reported it spoke to the relatives of four young people who are or have been detained under the Mental Health Act at hospitals run by Cygnet, which received more than £100 million (U.S. $134 million) from the country’s National Health Service (NHS) in the 12 months to June 2017.[6]

UHS acquired Cygnet Health Care Limited, a psychiatric hospital chain, in 2014 and then in December 2016, acquired Cambian Group for a total of 102 facilities in the U.K.[7] CCHR wrote the Competition and Markets Authority (CMA), the NHS and the Care Quality Commission (CQC) warning about the allegations against UHS’s psychiatric operations in the U.S. On 29 January 2016, David Behan, Chief Executive of CQC wrote CCHR saying they took the allegations “seriously” and “We were very concerned to read about the issues that have been identified in UHS in America and we note your concerns about these in relation to the services provided by Cygnet Healthcare since they were acquired by UHS.”[8]

The BuzzFeed News UK investigation established that:

• Several families allege their relatives sustained serious injury through self-harm while under Cygnet care.

• On one occasion a 16-year-old patient placed as many as five metal items in his arm but was not taken to the local hospital for emergency care, his family claim.

• A doctor with knowledge of Cygnet hospitals has described an environment that is unsafe.

• Two young patients at one hospital told Care Quality Commission inspectors that some staffs were “unsympathetic and vindictive towards them.” The report rated the hospital “inadequate in terms of safety and effectiveness.”

Behavioral Hospitals Create Suicide Risks

A doctor with experience of working in the Cygnet chain of hospitals, who spoke to BuzzFeed News on the condition of anonymity, said that “patients were really suicidal and really unsafe and some of them were tying ligatures in their room and staff was outside the room because they were told that they couldn’t intervene.”

A UK inspection report into Cygnet’s Sheffield hospital released in August 2017 also showed that the poor state of the building meant patients had “access to screws in fixtures and fittings, which had led to repeated incidents of self-harm.”[9] Again, there’s the parallel to the U.S.

Recently, The Dallas Morning News told of similar concerns at UHS’s Timberlawn psychiatric hospital in Dallas, Texas. Two years ago, the facility was under threat of being shut down over severe safety problems that investigators said put patients in jeopardy.[10] It had failed to ensure doorknobs could not pose a potential “ligature risk,” meaning they could not be used by patients to hang themselves. In failing to act, a 37-year-old then hanged herself from a closet doorknob with a torn bed sheet.[11] The family settled a malpractice suit.[12]

Earlier this year two former U.S. Congressmen—Rep. Ronnie Shows (MS) and Rep. Bart Stupak (MI)—wrote about healthcare fraud and the need to eliminate wasteful spending, particularly noting UHS and another for-profit behavioral hospital chain owned by Acadia Healthcare, which also has acquisitions in the UK. Rep Shows pointed out that “when it comes to healthcare fraud, mental health and drug treatment programs are some of the worst actors.”[13] Rep. Stupak encouraged the Centers for Medicare and Medicaid Services to review the Medicare and Medicaid charges made by UHS and Acadia.[14]

CCHR says it was pleased BuzzFeed News reported that a UK Member of Parliament, Louise Haigh, a representative for Sheffield Heeley and a shadow minister, commented: “The NHS should not be placing patients in Cygnet hospitals if CQC inspectors were to judge that they have ‘inadequate’ safety.” After Haigh met with NHS and CQC officials in October, she wrote to both bodies to say she was “deeply worried about the ability of Cygnet to provide adequate and safe health care to patients who are clearly some of the most vulnerable individuals in our society.”

Psychiatry Creates Profits for Industry

That worry should extend to whether profit is being put before patients. BuzzFeed News also reported that “the attraction of the UK’s psychiatric hospital market for foreign investors is clear: As in the US, this is a big-money opportunity.” Reporters examined 12 months of financial records and found that over the last year NHS England paid Cygnet £101 million ($135 million) for young people’s acute psychiatric services. This money, plus payments from local NHS bodies for adult mental health services, makes up the bulk of Cygnet’s £131 million ($175.4 million) turnover. Cygnet made a healthy £6.3 million ($8.4 million) annual profit, according to its latest accounts. In the firm’s latest annual, UHS reports that Cygnet had been expanding because it views “the U.K. market as increasingly attractive.”

Similar comments have fueled concerns in the U.S. UHS officials told investors that by reducing staffing costs and keeping occupancy rates high in its behavioral health division, this helped generate robust profits.[15] In December 2016, another BuzzFeed News investigation found internal financial reports where a UHS behavioral facility projected a more than 50 percent profit and while it increased its revenues, it cut its number of staff.[16]

In its complaint to UK health authorities earlier this year, CCHR pointed out that UHS told investors in April 2015 and again in May 2016 that the UK was a lucrative investment, because there had been a one percent decrease in NHS beds between December 2013 and March 14, 2014 and NHS bed closures were “expected to continue.” It was predicted that this would lead to a “continuing trend towards more outsourcing to independent sector provision” (i.e., UHS) and “partnerships with the NHS and new models of contracting opportunities.”[17]

CCHR says the underlying problem is the lack of results from psychiatry in general. It has no medical tests to verify any of its diagnoses, it admits it has no cures and, as such, patients are often heavily drugged once admitted to a psychiatric facility and deteriorate from there. Long-term “care” becomes the answer to a mental health system that has failed its users while companies profit from what has essentially been a blank check handed to them.

References:

[1] “A Chain Of Private Psychiatric Hospitals Has Been Accused Of Failing Vulnerable Young Patients,” BuzzFeedNews, 15 Dec. 2017, https://www.buzzfeed.com/patricksmith/cygnet-health-care?utm_term=.opeoeXgq2#.bgQMRXKzO.

[2] Rosalind Adams, “Federal Investigation into UHS Must Stay Secret, Says Inspector General,” BuzzFeedNews, 22 Dec. 2016, https://www.buzzfeed.com/rosalindadams/federal-investigation-into-uhs-must-stay-secret-says-inspect?utm_term=.ondaX9YQzL#.xwp9kVARPj; “Senator seeks details on UHS investigation from HHS,” Becker’s Hospital Review, 12 Dec. 2016, http://www.beckershospitalreview.com/legal-regulatory-issues/senator-seeks-details-on-uhs-investigation-from-hhs.html.

[3] “Sen. Grassley Turns Up The Heat On Nation’s Largest Psychiatric Chain,” BuzzFeedNews, 17 Apr., 2017, https://www.buzzfeed.com/rosalindadams/sen-grassley-calls-for-federal-probe-into-troubled-youth?utm_term=.qeyB6OYenv#.rhWj86yGOY.

[4] “Grassley Continues Inquiries into Psychiatric Services Company Amid Reported Problems,” Press Release, 18 Apr. 2017.

[5] “Sen. Chuck Grassley Calls For New Probe Into UHS,” BuzzFeed News, 18 Dec. 2017, https://www.buzzfeed.com/rosalindadams/sen-grassley-calls-for-new-probe-into-uhs?utm_term=.moZ1jQgLRR#.bdkRjVGqll.

[6] “A Chain Of Private Psychiatric Hospitals Has Been Accused Of Failing Vulnerable Young Patients,” BuzzFeedNews, 15 Dec. 2017, https://www.buzzfeed.com/patricksmith/cygnet-health-care?utm_term=.opeoeXgq2#.bgQMRXKzO.

[7] “Universal Health Services, Inc. Completes the Acquisition of Cambian Group PLC’s Adult Services Division,” PR Newswire, 28 Dec. 2016, http://www.prnewswire.com/news-releases/universal-health-services-inc-completes-the-acquisition-of-cambian-group-plcs-adult-services-division-300383892.html.

[8] David Behan, Chief Executive of UK Care Quality Commission, letter to Mr. Brian Daniels, Citizens Commission on Human Rights, UK, 29 Jan. 2016.

[9] “A Chain Of Private Psychiatric Hospitals Has Been Accused Of Failing Vulnerable Young Patients,” BuzzFeedNews, 15 Dec. 2017, https://www.buzzfeed.com/patricksmith/cygnet-health-care?utm_term=.opeoeXgq2#.bgQMRXKzO.

[10] https://www.dallasnews.com/news/investigations/2017/12/10/immediate-jeopardy-safe-kids-timberlawn-psych-hospital-dallas.

[11] https://www.dallasnews.com/news/news/2015/06/05/timberlawn-psych-hospitals-funding-at-risk-after-patient-hangs-herself.

[12] Sue Ambrose, “FATHER OF GIRL, 13, SAYS SHE WAS RAPED AT TIMBERLAWN BY TEEN MALE PATIENT,” Dallas Morning News, 18 Oct. 2017, https://www.dallasnews.com/news/crime/2017/10/13/father-girl-13-says-raped-timberlawn-teenmale-patient.

[13] Ronnie Shows, “Dear GOP: Eliminate Waste And Fraud To Help Pay For Healthcare Bill,” The Daily Caller, 29 June 2017, http://dailycaller.com/2017/06/29/dear-gop-eliminate-waste-and-fraud-to-help-pay-for-healthcare-bill/.

[14] Fmr Congressman Bart Stupak, “Eliminating fraud is key to adequate funding for opioid treatment,” The Hill, 13 July, 2017, http://thehill.com/blogs/pundits-blog/healthcare/341913-eliminating-fraud-is-key-to-adequate-funding-for-opioid.

[15] http://uhsbehindcloseddoors.org/about/, citing UHS at RBC Capital Conference, 3/2/11, UHS at J.P. Morgan Conference, 1/15/14, p. 4.

[16] Op. cit., “Locked On The Psych Ward: Lock them in….” BuzzFeed News, 7 Dec. 2016.

[17] UH Investor Presentation, April 2015.