Fairview's new mental health partner is under investigation for holding patients against their will

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

The company operates psychiatric hospitals in 19 states. Minnesota isn't among them yet, but Acadia is working 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 is calling a mental health bed capacity crisis. Given these plans, we wanted to know more about the investigation. So we called New York Times reporter Jessica Silver-Greenberg and she's on the phone. Jessica, thank you. I know you're busy. Thank you for taking 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 compels a reporter to get involved in a story. What was the core of this reporting project for you?

JESSICA SILVER-GREENBERG: Well, my reporting partner Katie Thomas and I have been writing about health care, focusing on a variety of health screenings. And last year, when we were reporting on a completely separate project, we heard whispers, something like, “You should look at this company, Acadia Healthcare.” And at the time it didn't mean all that much to us.

And then, earlier this year, we started digging in, and this is – just for people who don't know Acadia Healthcare, it's the largest for-profit company focused solely on behavioral health, and it has inpatient as well psychiatric hospitals across the country. As you said in your introduction, the company doesn't exist in Minnesota yet, but there is already a joint venture with another hospital system to open an inpatient psychiatric hospital. So the company has a very large presence.

And we started requesting information, such as complaints, health inspections, complaints to federal and state regulators like attorneys general, and state and federal health inspections. Just to get a sense of what the company's business practices were like, as we were a bit uninitiated at this point. And what we found ultimately led to the investigation that was published last month.

CATHY WURZER: Hmm. OK. What have you heard from patients about their experiences at some of these hospitals?

JESSICA SILVER-GREENBERG: We heard from patients who, regardless of their condition, 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 seeking medication adjustment because they had their mental illness under control but needed help with medication adjustment.

And sometimes they went to the emergency room of a non-Acadia hospital just to get treatment for a mental health incident, only to be sent against their will to an Acadia facility, admitted and held there – we heard all kinds of things different stories, but some people were held for a week, others longer. And they couldn't get out, even though they had neither the desire to be there nor the medical need to be there.

CATHY WURZER: That's illegal.

JESSICA SILVER-GREENBERG: That's it. Yes, the practices we have found are that this company, Acadia, is exploiting involuntary commitment laws. So these laws state that someone can be involuntarily held against their will if they pose an imminent threat to themselves or others.

And what we found in our investigation, which was based on extensive internal and external records as well as interviews with more than 50 current and former employees of this company, found that while these laws were intended for people who posed an imminent threat to themselves or others, that Acadia detained patients who appeared not to meet this legal standard. So yes, there were people being held who shouldn't have stayed there much longer than is allowed under those state laws.

CATHY WURZER: Was there an economic reason for this?

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

So the company used a variety of strategies to get insurance companies to cover these longer stays, including exaggerating patients' symptoms, adjusting the dosage of their medications, and then claiming to insurance companies that the patients needed to stay longer It is argued that patients are not well enough to walk because they have not eaten a single meal. These strategies were widespread in 12 of the 19 states where Acadia operates inpatient psychiatric hospitals.

And patients experiencing a mental health crisis often do not know their rights and therefore do not know how long they can legally be held there. And we found that they were stuck there without their families or without the ability to hire lawyers, which is a huge hurdle for so many people. They were stuck inside, which, as you can imagine, is a nightmarish scenario for someone who had no intention and was just trying to get outpatient help.

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

JESSICA SILVER-GREENBERG: In response to our findings, as with any article, we sent the company a full list of our findings and asked for comment. And they declined to comment on the individual patient examples we highlighted throughout the article, citing patient privacy laws. However, they said the examples were not representative of patients, many of whom they said had positive experiences with the company.

But they said that any incident – I think I'm reading from their comment – “any incident that does not meet our strict standards is unacceptable and that action will be taken to address it.” However, now we know and have reported, that federal authorities are launching a new round of investigations into the practices we uncovered in our last article.

CATHY WURZER: And what will you pay attention to in this investigation?

JESSICA SILVER-GREENBERG: We will be watching to see how this investigation turns out and whether other states decide to investigate. Because as far as we know, and 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. Finally, we were told that Acadia had told its investors to expect similar inquiries from the Securities and Exchange Commission.

So that's three new investigations, and we'll wait and see what the outcome is. And also, as I mentioned, whether other states decide to investigate the Acadia hospitals in their backyards, so to speak.

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

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 comment and they said, and I quote now: “We take our role in the Capitol Park Mental Health Hospital joint venture seriously and are committed to delivering the high quality care that that offers.” Our community expects and deserves.”

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