How a leading chain of psychiatric hospitals traps patients
nytimes.com
nytimes.com
I know someone who was threatened with having their children taken away, and prison if they tried to leave the hospital, or stopped taking medication that was making them feel worse.
But since it was just the doctor's word against theirs, they were told there was very little chance of winning in court.
If this happening as frequently as the article suggests, and if Arcadia operates over 50 hospitals, you’d think there would be at least 1 law firm dedicated solely to prosecuting this specific hospital.
Skip the class action BS, and run those “mesothelioma” type commercials. Then have a boilerplate structure for a lawsuit that you can repeat successfully, hire your own doctors as expert witnesses to refute the hospital, etc.
If they are imprisoning people illegally, I imagine the settlements would be quite high per patient.
> But since it was just the doctor's word against theirs
When something is widespread and perpetrated by the same people, you have to establish a pattern of behavior to discredit the witness.
The narrative could be pretty straight forward: the doctor was lying to the insurance company, and they’re lying to the jury, too.
Seems they already settled a couple suits, which could potentially be used to discredit the hospital as well.
But again, you really need a specialized firm willing to take them down by taking on a bunch of similar cases to make it worthwhile to do all of the background/evidence/research to make a case.
This is also the type of case that could get heavy PR / public support which the right law firms can leverage in their favor.
…or we embrace better regulation and trust the government to fix this. But the government also has a terrible track record when it comes to caring for the mentally ill.
That depends on whether or not anyone cares about the patient.
Many, many psych patients have basically been disowned by their families, they have no friends, and don't have the ability to live on their own in society. Maybe the lawyers would care enough about them, if they could win a suit, but I'd not bet on that.
I'd suspect that a huge number of homeless folks were ones that would have been "lifers" in mental hospitals. The enormous homeless problem in the US is actually relatively new. I remember when it was much, much less of a problem (We have always had them, but nowhere near the scale we have them, now).
We live in a nation, where it is easier for mentally ill people to get weapons, than help[0].
That said, in MD, where I lived for a while, we had The Patuxent Institution[1]. It may still be around. Charming place. It inspired this movie[2].
[0] https://www.npr.org/sections/shots-health-news/2024/08/24/nx...
What after winning the suit? I mean, if they dont have the ability to live on their own, what happens with them?
They'll probably get cheated out of whatever winnings they get, and end up back on the street.
Thank god for Ken Kasey and thank god for desinsitutionalization and the anti-psychiatry movement.
The effects of medications will encourage patients to act out, decompensate, commit acts of self-harm and violence upon others. The strategy is to get them jailed or cause serious bodily harm/death, because... Well let's just say that the incentives are perverse.
Whereas lunatics of old wore visible chains and straitjackets, and were mercifully housed, fed, and clothed, now they are largely on their own, sink or swim; hope some other human family member cares enough to pick up the pieces.
Of course, you can point to some centrist flyover states, but in anywhere worth living, it’s either extreme blue team or extreme red team policies.
These types of abuses happen with all the "institutional" civil laws - involuntary commitment, civil asset forfeiture, guardianship, red flag, and especially protection from abuse orders (weaponized in divorces fairly commonly). It will continue to increase as we, as a society, continue to favor quick and easy "fixes" to overcome the protections found on the criminal side.
They helped more than 1 friend of mine when they when they needed the help.
The real issue is the 100k+ bill they got at the end, but politics so I digress.
This kind of thing used to scare me - once you're booked into the system, they can literally stab you with an injection to make you behave in whatever way they want to portray you in court. And that's just if they're outright malicious.
Worse, they might instead be entirely earnest in their belief that you need to take that particular pill, that makes your misdiagnosed condition worse.
then its not patient vs doctor, it's doctor vs doctor
The affordable care act mandated that insurance companies cover mental health. Psychiatric hospitals can charge insurers $2,200/day for holding patients who "pose an imminent threat to themselves or others".
So now you get this:
> Once Acadia gets patients in the door, it often tries to hold them until their insurance runs out.
> Acadia goes to great lengths to convince insurers that the patients should stay as long as possible, often around five days.
> 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.
If Acadia is engaged in insurance fraud, the insurance companies have every incentive to stop that.
Clearly falls into mandatory coverage (if claims are accurate), so all companies are going to have to pay it. Raises costs. Insurance gets to have overhead (profit) based on claims paid.
There's more incentive to deny marginal claims, because some insurance companies won't and then you may attract more customers with a lower price and maybe you get more money that way.
Patients are unlikely to complain to insurance to tell them the treatment/confinement was unjustified... because the patient will then need to pay the bill.
Honestly, you buried the lede here. This is the horrifying and broken part. Under no circumstances should someone have to be afraid of paying for their involuntary commitment.
Like is Acadia really going to sue so they can have the insurance company and the patient testify under oath that Acadia management is guilty of kidnapping at scale, and in this particular case?
This is one of the prime examples of the utter failure of the US for-profit healthcare model.
If they actually kidnapped you (as is apparently common practice there), I doubt they’d be dumb enough to sue you.
If they were, you can countersue in California, and the civil damages they owe you for kidnapping you will be deducted from whatever court judgement they win (probably making it negative).
> Acadia was founded in 2005 by Reeve B. Waud, a financier, and grew slowly at first. But in 2011, the company went public and embarked on a major expansion.
> The timing was ideal. Over the next several years, Acadia got a lift from Obamacare, which required insurers to cover mental health. Today Acadia has 54 inpatient psychiatric hospitals with a total of 5,900 beds.
I'm not trying to imply that the ACA is bad here - just that the incentive provided by the requirement for insurance companies to cover this form of treatment inadvertently incentivized the kind of fraud described in the article.
This is why legislation needs to be iterated on - to correct for unexpected consequences like this. Ideally the abuse described in this article would be prevented by further legislation - though there's always a chance that could open up further loopholes.
Hospital chains, big pharma, insurance companies, retirement care.
Think Sackler-family stuff. It's all designed to extract the maximum possible amount of money from the patient, while providing as little as possible.
I guess we’re being punished for having the temerity to exist?
The more they lean on the PCP or psychiatrist, the more opportunities to find "treatable" disorders.
It's a test of obedience and willingness to cooperate. You dutifully believe the screening tests, you fill the scrips, you take the pills, and now you're on a treadmill that is profitable for all parties except you, and you may notice that you're not healing but actually becoming sicker.
When stable, they signed over the right to commit them to me, their doctor, their spouse and their parents.
We all attempted to get care for the person during a psychotic break (including talking about plans to shoot up a religious gathering - the police wouldn’t do anything even after that).
As a result, they lost their job, marriage, apartment, possessions, life savings, and ended up $100K in debt.
The insurance company didn’t pay a dime when they finally got help, since coverage had already lapsed.
I can’t believe how broken healthcare is in the US.
More practically, I doubt they get unsupervised phone calls.
And these aren't one of occurrences, these are systematic abuses in the same communities that would come up over and over again - which is presumably why police raided their facility in Georgia.
> More practically, I doubt they get unsupervised phone calls.
Most facilities have communal phones that are available throughout the day for short periods of time.
Unless you are not making them money, then they get you out of there asap and make calls on your behalf all day to other places to shuffle you around to.
Most doctors agree that people in the throes of a psychological crisis must sometimes be detained against their will to stabilize them and prevent harm. These can be tough calls, balancing patients’ safety with their civil rights.
We have all those for alcohol and yet alcoholism still causes massive problems.
Still, I can't be against violating people's rights by stopping them from suicide, and keeping them locked up for a while afterward. A close friend is alive because this.
The thing is, someone may not be rational enough to make that choice. I’ve been suicidal in the past. Reasoning goes out the window and you can easily make a decision you never wanted to make. You simply can’t choose to stay alive any longer.
I’ve lost a friend because they couldn’t hold out long enough for things to get better. They killed themselves because of a temporary situation they could have easily recovered from.
I’ve saved a friend by preventing him from going down that route. It took over a year for him to be healthy. He doesn’t want to die now.
I’m always going to side with stopping people from suicide until they’ve had a chance to be mentally sound enough to make an informed decision.
There have been people I’ve known who did make that decision and did so rationally. All of them had medical conditions they could never recover from without divine intervention. In their case, they wanted to spare themselves and others from a long, painful death. They should be able to make that choice.
The problem is that “mentally sound” is partially defined as not wanting to die. It doesn't matter how stable and coherent you are, as long as you keep saying “on net, I don't feel like my life has been worth living and I would prefer to end it painlessly if I could”, they will not let you out. Getting out is a process of learning the lies you need to tell the doctors and nurses.
On a whole, more people ultimately wish to live afterwards than those who want to die. So any system is going to err on the side of caution.
As I mentioned, there are situations in which a rational decision is easy to understand and verify. Our current system in the US does not allow for these cases.
Unless, of course, you have an illness that happens to be something other than mental illness.
Because pain and suffering can only come from physical ailments /s
Not all depression can be cured or even easily managed. Not all mental illnesses consist of depression.
Why do you think I believe that?
> Not all depression can be cured or even easily managed. Not all mental illnesses consist of depression.
Okay.
source:25y as caregiver of mentally ill spouse. source:7y PTSD support group asst.It's sad that the default freely available information spread around is that the chain of hospitals is a professional institution that's endorsed by the board of medicine. And knowing the truth costs money. Just as bringing these folks to justice costs money.
Unsane.
'One Flew Over The Cuckoo's Nest' (1975)
Male genitalia mutilation AKA circumcising is something that most doctors in America think is okay but will get you jailed in many European countries. A societies understanding of what qualifies as being mentally unwell is extremely subjective and often leads to extreme cruelty. Americans declaw their cats, dock their dogs tails, crop their ears, and lock them in crates for inhumane amounts of time. Americans love to beat their children, and many schools in the south legally can paddle children (and this happens to usually black kids)
That movie is spot on the mark and is not a day out of date.
Apparently, "Medicaid is the single largest payer for mental health services in the United States"[0]
That said, one will likely have to dig through quite a bit of data to determine, on a state-by-state basis, what the reimbursement rates are for inpatient psychiatric services. And they don't make it easy, either.
For example, reimbursement rates for Texas[1], California[2] and New York[3] (chosen because they're large states which, together, make up a significant chunk of the US population) are available, but need to be parsed to figure out which specific code corresponds to daily reimbursement rates for psychiatric care.
[0] https://www.medicaid.gov/medicaid/benefits/behavioral-health...
[1] https://public.tmhp.com/feeschedules/Default.aspx
[2] https://mcweb.apps.prd.cammis.medi-cal.ca.gov/rates?tab=rate...
[3] https://omh.ny.gov/omhweb/medicaid_reimbursement/
Edit: In case my point isn't obvious, I'm wondering aloud whether or not Medicaid (the US medical insurance program for those under 65 who can't afford to pay for insurance) reimbursement rates make it a target for similar shenanigans. While Medicaid is significantly funded by the US Federal government (via block grants[4]), it's administered (in vastly different ways) by each state, which set their own eligibility and reimbursement rates
There’s a wide variety of shenanigans at the provider, managed care and state/county level. A big part of the performative shipping of migrants and poor people to northern states is all about shifting Medicaid expenses.
This happens often to mental patients, who often find themselves released from a police station or hospital, at a bus station with a ticket to NYC.
I don't believe that's true. Do you have any evidence for this?
I have never heard of anyone challenging a Medicare reimbursement for "poor performance." In fact, billing codes often don't make a whole lot of sense, yet are approved without question just because the billing code exists.
What's more, Medicare and Medicaid fraud are often perpetrated[0] by the same folks without and done in exactly the same way.
[0] https://www.cnbc.com/2023/03/09/how-medicare-and-medicaid-fr...
The most common way they do this is with hospital re-admissions. The hospital eats the cost, which is often because of poor hygiene and nursing practices.
I don't remember offhand what the facilities "charge per day" but i imagine it wouldn't be too difficult to ask someone in billing the next time i have a chance.
The only possible way to have a society is to have regulations.
edit: Not defending insurers or our system at all, btw. Quite clear to me as ex-healthtech that a single payer system would solve many of our problems.