Fairview’s new partner in mental health is facing investigation for holding patients against their will

CATHY WURZER: We're going to turn now to a national investigation that could have implications here in Minnesota. Acadia Healthcare is under scrutiny after New York Times reporters discovered some of its psychiatric hospitals held patients against their will, even when it was not medically necessary. Acadia agreed to pay nearly $20 million in a settlement over its practices last month, and it's now facing a new federal investigation, according to the Times.

The company runs 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 that's under construction right now 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. Given these plans, we wanted to learn more about the investigation. So we've called up New York Times reporter Jessica Silver-Greenberg, and she's on the line. Jessica, thank you. I know you're 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 sparks a reporter to get onto a story. What was the seed of this reporting project for you?

JESSICA SILVER-GREENBERG: Well, my reporting partner, Katie Thomas, and I, we've been writing about health care focusing on a range of health care investigations. And last year in the midst of reporting a totally separate project, we kind of heard a whisper, something like, you should look into this company, Acadia Healthcare. And at the time it didn't mean all that much to us.

And then at the start of this year we started to dig in, and we started to-- just for people who don't know Acadia Healthcare, the company is the largest for-profit company that focuses exclusively on behavioral health, and it has inpatient psychiatric hospitals all over the country. Like you said in your introduction, it is not yet in Minnesota, but it already has a joint venture with another hospital system to open an inpatient psychiatric hospital. So the company has a very large footprint.

And what we started to do is request information, things like complaints, health inspections, complaints filed with federal and state regulators, like state attorneys general, and state and federal health inspections. Just to get a sense, because we were a little uninitiated at that point, of what the company's business practices were like. And what we found ultimately led to the investigation that published last month.

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

JESSICA SILVER-GREENBERG: We heard from patients who, despite what state they were living in, had remarkably similar stories, and the stories went something like this. They went to an Acadia hospital, sometimes to inquire about outpatient psychiatric therapy. Sometimes they were looking for medication adjustments, because they had their mental illnesses under control but they needed help just adjusting their medications.

And sometimes they went to the emergency department of a non-Acadia hospital just seeking treatment for a mental health episode, only to find themselves sent against their will to an Acadia facility, admitted, and then held there for-- we heard all manner of different stories, but some people were held for a week, some longer than that. And they were unable to get out, despite having no desire to be there and no medical need of being there.

CATHY WURZER: That's illegal.

JESSICA SILVER-GREENBERG: It is. Yes, the practices we found that this company, that Acadia is exploiting involuntary commitment laws. So those laws say that someone can be held involuntarily against their will, if they are an immediate threat to themselves or others.

And what we found in our investigation, which was based on voluminous internal and external records, and also interviews with more than 50 current and former employees of this company, we found that even though those laws were meant for people who pose an imminent threat to themselves or others, that Acadia was holding patients who did not appear to meet that legal standard. So yes, it was holding people who should not have been there for much longer than is allowed under these state laws.

CATHY WURZER: Was there some sort of economic reason for that?

JESSICA SILVER-GREENBERG: Yes. We found that actually, that was the entire reason. That it wasn't a medical decision, it was a financial one. So Acadia makes more money from patients' insurance the longer those patients are there, and even one or two days can make a big difference, because Acadia can charge up to $2,200 a day for some patients.

And so the company has deployed a range of strategies to get insurance companies to cover those longer stays, and it has done things like it's exaggerated patients' symptoms, it's tweaked their medication dosages and then claimed to the insurance companies that patients need to stay longer, it's argued that patients aren't well enough to leave because they didn't finish a single meal. These strategies were pervasive in 12 out of the 19 states where Acadia operates inpatient psychiatric hospitals.

And patients who are in the throes of a mental health crisis often don't know their rights, so they're not aware of how long they're allowed to be legally held there. And we found that unless their families, or unless they were able to hire lawyers, which is a huge hurdle for so many people, they were stuck there. They were stuck inside, which you can imagine is a nightmarish scenario for someone who had no intention, who was just trying to get outpatient help.

CATHY WURZER: Exactly. I can't imagine. What have you heard from this company?

JESSICA SILVER-GREENBERG: So the company, in response to our findings-- we sent them, as we do with any article, we sent them a full list of our findings and sought comment on that. And they refused to comment on any of the individual patient examples that we highlighted throughout the article, and they cited patient privacy laws. But they said that the examples were not representative of patients, many of whom they claimed had positive experiences with the company.

But they did say that any incident-- I think, I'm reading from their comment-- "any incident that falls short of our rigorous standards is unacceptable and actions are taken to address it." We now know, though, and we reported that they are under a new round of investigations from federal authorities into the practices that we uncovered in our latest article.

CATHY WURZER: And what will you be watching for with that investigation?

JESSICA SILVER-GREENBERG: We're going to watch to see how those investigations play out, and also whether any other states 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 federal grand jury in Missouri. And lastly, we were told that Acadia told its investors to also expect similar inquiries from the Securities and Exchange Commission.

So those are three new investigations now, and what we'll be looking for is to see how those play out. And also whether other states, as I mentioned, decide to investigate the Acadia hospitals in their backyards, so to speak.

CATHY WURZER: Well, Jessica, my thanks to you and your partner for the reporting, and for your time today. Thank you so 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 take our role in the joint venture for Capitol Park Mental Health Hospital seriously and are committed to delivering the high-quality care that our community expects and deserves."

They also said that Fairview providers will oversee the patient evaluations and treatment, including decisions about whether inpatient care is medically necessary under state regulations, and the hospital's chief medical officer will be employed by Fairview and not Acadia, but chosen by both companies.