Oh, let's just privatize everything

The hospital closings, bankruptcy filing, and reeking greed and venality of its private-jet-flying/yacht-sailing/Fifth-Amendment-taking CEO - oh, and I forgot to mention the patient deaths attributed to repossessed life-saving equipment for failure to pay bills while the CEO was swanning around on his jets and yachts - of the private, profit-driven (no surprise!) Steward Health Care have been much in the news these days, thanks to a brilliant Boston Globe Spotlight series. 

But Steward is not, of course, alone. There are plenty of other examples of privatized hospitals providing a shoddy version of what should be a public good. Because profits.

And one of those is Acadia Healthcare, a chain of private psychiatric hospitals. Given the lack of and demand for mental health services, Acadia has been just humming along churning out the profits.

But a New York Times investigation found that some of that success was built on a disturbing practice: Acadia has lured patients into its facilities and held them against their will, even when detaining them was not medically necessary. (Source: NY Times)

What's been happening is that folks in need of routine care show up in the ER, or are brought in by a police officer, or come in on their own based on a recommendation "only to find themselves sent to Acadia facilities and locked in."

A social worker spent six days inside an Acadia hospital in Florida after she tried to get her bipolar medications adjusted. A woman who works at a children’s hospital was held for seven days after she showed up at an Acadia facility in Indiana looking for therapy. And after police officers raided an Acadia hospital in Georgia, 16 patients told investigators that they had been kept there “with no excuses or valid reason,” according to a police report.

Acadia held all of them under laws meant for people who pose an imminent threat to themselves or others. But none of the patients appeared to have met that legal standard, according to records and interviews.

You'll get no argument from me that there are times when a person experiencing a mental health crisis should be held whether they like it or not. A fellow in Boston was recently sent to a state psychiatric facility after he was arrested for chasing folks around downtown streets, flailing around with a machete. When the name of the fellow sent to Bridgewater was published, I wasn't surprised. I knew him from the homeless shelter where I'm a long time volunteer, and where this guy radiated mental health issues, including hostility and disconnection, that were apparent even to us lay people. I'm glad he's off the streets and hope he gets straightened out. And I hope that Bridgewater State holds him long enough to get him straightened out. Or at least stable enough that he won't be chasing folks around with a machete.

But at Acadia, they're holding patients longer than they need to be held, and in many cases the reasoning behind the hold is financial rather than medical. 

Acadia, which charges $2,200 a day for some patients, at times deploys an array of strategies to persuade insurers to cover longer stays, employees said. Acadia has exaggerated patients’ symptoms. It has tweaked medication dosages, then claimed patients needed to stay longer because of the adjustment. And it has argued that patients are not well enough to leave because they did not finish a meal.

Without a legal intervention, patients are kept under lock and key in an Acadia hospital "until their insurance runs out."

Doctors, nurses, hospital management, patients, their families - all have reported bad behavior on the part of Acadia. 

There's no doubt that plenty of the old time state-run or other public psychiatric facilities were snakepits, where nobody got much by way of care. I remember driving by Worcester State Hospital - idealized view above - and thinking about what a scary fortress it was. And there's no doubt that there are more and more people in need of mental health care. Still, as we've seen time and again when public services and non-profit entities are replaced with privatized, profit-making concerns, the focus quickly veers from the supposed market efficiencies the private sector brings to a laser focus on profit making at the cost of providing services. 

Insurance companies are not, of course, in the business of reimbursing providers for services the insurance cos. don't deem necessary. So Acadia had to make sure they were making a compelling case for keeping patients. 

To do that, Acadia needs to show that patients are unstable and require ongoing intensive care. Former Acadia executives and staff in 10 states said employees were coached to use certain buzzwords, like “combative,” in patients’ charts to make that case.

In 2022, for example, state inspectors criticized an Acadia hospital in Reading, Pa., for having instructed workers to avoid adjectives like “calm” and “compliant” in a patient’s chart. That same year, employees at Acadia hospitals in Ohio and Michigan complained to their state regulators that doctors had written false statements in patients’ medical charts to justify continuing their stays.

At an Acadia hospital in Missouri, three former nurses said, executives pressured them to label patients whose insurance was about to run out as uncooperative. Acadia employees then would argue to insurance companies that the patients weren’t ready to leave. Sometimes, the nurses said, they wrote patients up for not finishing a meal or skipping group therapy.

Once Acadia won more insurance days for patients, it often would not release them before their insurance ran out, according to dozens of former Acadia executives, psychiatrists and other staff members.

Capitalism has much to commend it - the potential for prosperity, opportunity, creativity, high quality products - but, man, does it come with a downside. And one of those downsides shows up big time when it comes to healthcare (and education and prisons and, and, and). God help you if you're in need of mental health care and end up in an Acadia profit-making hospital. Not finishing a lousy hospital meal - no doubt prepared using the cheapest means possible; gotta squeeze costs out, don't you know - can be enough to keep you in the stir? 

Sure, let's just privatize everything.