The Profitable Business of Holding Patients Against Their Will

from The New York Times I'm Katherine. benold and this is the. [Music]. daily a times investigation into a. leading chain of psychiatric hospitals. in the US reveals a world where profits. Trump medical needs and patients are. detained against their will today my. colleague Jessica silver Greenberg on. the story of one woman trapped.

[Music]. inside it's Thursday September. [Music]. 26th so Jessica earlier this year you. started looking into abuses in the. mental health care sector what made you. dick into this one major chain of. psychiatric. hospitals well I'm an investigative. reporter on the business desk and I look. at how big businesses collide with.

ordinary Americans and basically how. those companies affect their lives so. last year my reporting partner Katie. Thomas and I while working on another. series of stories about Healthcare got a. tip it was more of a whisper it was. something like you guys should take a. look at a company called aadia. Healthcare at the time that honestly. didn't mean that much to us we had no. idea what AO was it's certainly not a. household name.

but when we started digging in we got. actually really interested because it. turns out that aadia is one of America's. largest chains of psychiatric hospitals. I mean I have never heard of Acadia so. what's the story of this company so the. story of Acadia is really a broader. story of how Americans today receive. mental health care so AIA gets its start. in. 2005 and it's entering this new Niche.

because Mental Health Care used to be. provided by essentially two big groups. nonprofit Hospital systems or the. government but you know over the past. decade or so as costs have risen and. demand has increased those players are. stepping back and they're closing psych. wards and Acadia is one of the. for-profit players that's stepping into. that Golf and aadia grew slowly at first. but in 2011 the company goes public and.

the timing couldn't have been. better at the time Obamacare is being. rolled out and ObamaCare requires. insurers to cover mental health and that. coverage brings in billions of dollars. into the market and Acadia gets a boost. from all of that money they are now so. big and they've had so much growth. including through the pandemic that. today they're valued at $7 billion and.

they are. everywhere you know they are in 19. States and chances are if you as a. patient need mental health care you. might very well encounter an aadia. Hospital Jessica so far all of this. sounds kind of like a win-win honestly. more money to cover mental health and a. corporate success story so what did you. actually learn when you started to look. into those Whispers you mentioned that.

something was going on at Acadia well. even though Acadia is this enormous. publicly traded company it wasn't that. easy at first to get a window into its. operations so what we started doing was. we started putting in Freedom of. Information requests we requested all. manner of things Health inspections. complaints to the Attorneys General in. every state where Acadia does business. every state where they have inpatient. psychiatric hospitals. [Music].

and once those documents started coming. back we started to hear similar stories. again and again that started to give us. a window into how this really profitable. company was making decisions around how. to provide care to this very vulnerable. group people who are really in. [Music]. crisis and maybe the best way to. understand this Dynamic is to look at. the case of one woman yes I am Kathy.

McKenzie I'm 51 years old named Kathy. McKenzie and I live in Wesley Chapel. Florida she's a school social worker. from a very young age it just made me. happy to help other people and see them. accomplish their goals and throughout. her life since her 20s she has struggled. with bipolar disorder and her first. episode was when she was in her 20s and. at the time she was playing volleyball.

pretty intensely the pressure of a it. was a new team for me became. overwhelming her commitment her. excitement about volleyball morphed into. a kind of mania for her she started. having these Notions of grandeur I was. saying to my mom over the phone I'm I'm. jumping higher than the other kids I'm. I'm hitting harder I'm thinking that I'm. far surpassing my other teammates when. that that wasn't true at all and when.

the reality of her situation kind of. began to intrude when she started to. Grapple with how she had these very. grandiose elevated thoughts but those. weren't really consistent with reality. she. crashed and my mind is like so dark and. I I remember my father picking me up. from Richmond to get me up to DC to a. hospital and and I even said I just want.

to go to heaven I just want to be with. my grandfather just let me go let me go. Daddy I just literally collapsed at the. doors of the hospital and I remember him. screaming and yelling and asking for. help and at that time she's briefly. medicated she realizes this is something. that she's going to live with I really. want to study it I wanted to understand. it so she harnesses it uh and I think. that really also drove me towards social. work even more.

being sympathetic to something that you. personally struggle and ultimately try. to. overcome and so rather than be a. hindrance it's actually something that. fuels her conviction and her commitment. to her passion which is her career as a. social worker and things are going well. I I have a really good plan of action to. to take my medication I don't miss. anything I don't get confused by it if I. feel that I need somebody to talk to I.

have a group of girlfriends um in a. support group then fast forward to 2020. I had so much excitement surrounding. this job this was she gets this great. job and she moves to Florida to be. closer to her mom good I have a very. tight connection with her the two are. very very bonded always have and I. always felt. calmer yeah that that felt great and I. knew.

I but like we all know moving is. stressful it's one of the biggest. stresses in a lot of people's lives and. this move is particularly tough she. moves she doesn't immediately have a. doctor so her care is a little bit. fragmented and her mom notices that. she's sleeping less I had a slight. elevation in mood she's talking really.

quickly they were picking up on a little. bit of Rapid speech which is typically a. red flag for her family a little bit of. excitement you know maybe a little bit. above the normal and her mom and her. sister decide that she should probably. go see a doctor I didn't want to go I. didn't feel a need to go but again you. do what your family feels as best. sometimes and what they want is they.

want a physician to assess her bipolar. medications and see if they need to be. tweaked or adjusted given her new. situation I mean I actually drove myself. to the hospital my mom went with me you. know it's the middle of the pandemic so. we're firmly in 2020 it's the summer. August of 2020 and no one is allowed to. go in with her to that emergency room so. I you know I went in with my water. bottle my phone and my medicines and the. little note from my mother and just kind.

of like okay I expected to be in and out. of there quickly so at this point no one. has any reason to believe anything has. gone ay but when Kathy ultimately sees. the doctor in the emergency room that. doctor wants to send her to another. hospital to have her get a psychiatric. evaluation and is that normal. increasingly it is since the pandemic. emergency departments like the one that. Kathy went to have been overrun with. people. who are seeking some kind of mental.

health care they can be in crisis they. could be seeking like Kathy was to get. you know medication evaluations and so. those emergency departments because it's. not really their area of expertise are. Outsourcing that care to hospitals like. aadia and then a couple young um. gentlemen showed up with a gurnie and. then they said that you have to do this. to get transported to have the. evaluation so she sent to another. hospital for a psychiatric evaluation.

and so I wasn't strapped in or anything. like that they just asked me to get on. and I did the hospital she's sent to is. North Tampa Behavioral Health I I. believe I arrived about 1:00 a.m. it was. dark and just totally uninviting. and very um. scary. and you know they let me just walk in I. had my purse I had my phone they take. her to a small room and the intake.

person there starts asking her very. standard questions as part of this. psychiatric evaluation are you feeling. having like thoughts of um harming. yourself so she's asked whether she has. any suicidal thoughts and plans to harm. herself and to which she answers no and. that's reflected in her medical records. do you take. medications uh do you do you have a. medical diagnosis and she's Al asked.

whether or not she is homicidal whether. or not she you know has any imminent. plans to harm others to which she also. answerers no but it was a fairly brief. interview I felt that I I answered. questions very. appropriately and the young lady said. that I did they're trying to evaluate. whether a patient is a danger to. themselves or is a imminent danger to. others if patients meet either of those.

they can be held against their will. under what are called involuntary. commitment laws for up to 72 hours as a. social worker Cathy is pretty familiar. with this. process and she thinks she answers the. intake questions pretty well but still. there's something about the whole. episode she's there in the early hours. of the morning and something in her some. spidey sense kicks in at that point I.

had pretty much kind of figured this out. and she thinks this evaluation is. strange and maybe it isn't going as well. as she'd thought my. suspicion went off and I thought oh my. gosh that they really are going to hold. me so Kathy decides that she's going to. kind of. test how they treat her I wanted to test. the waters so I asked to go to the. restroom the staff at North Tampa. Behavioral agree to let her use the.

bathroom but when she leaves the. interview room she ends up in another. room with 10 other people this is not a. bathroom this is not a bathroom there. was a woman with a blanket and there was. like one window and there was literally. only like one or two chairs and there. had to been 10 of us maybe I think the. moment that is especially chilling for. Kathy is when that door closes they lock. the door behind her could you hear the.

door lock yes and I screamed and I. yelled and I said I want to see my. paperwork I want to see my paperwork. this this isn't you've got this totally. wrong so Kathy is basically. institutionalized against her will in. North Tampa Behavioral that's right. she's been held against her will she is. trapped it's the worst claustrophobic. feeling and lack of control on.

steroids it makes you instantaneously. think your life. is a turn towards something that you. never ever thought I've never been. arrested I've never had any level of. involvement in any negative way with. with law enforcement I thought oh my. gosh my career is. [Music]. done so what happens to her so she's.

first placed in a room with another. woman and that other patient was on. suicide watch and that's her first night. there yeah they took everything from me. they gave me one sheet where I quickly. jot down phone. numbers that I wanted and. um you know I wanted to call them and. tell them that I was physically okay at. that point but I that I was not allowed. to do that and I um just had to sit.

there for the whole night so over the. next couple of days she falls into a. kind of routine there would be breakfast. lunch dinner you would have to walk. military style to the dining hall I was. constantly going to the nurse's desk and. said I I want my rights like I want my. my records I want to talk to my family I. want to make a phone call and and then. they'd say stuff like oh you're a hot. one or you're a wired one or you're.

going to cause some trouble so they on. the television there are television. screens and for whatever reason Kathy. remembers that the movie Jumanji was on. the screen the whole time on a kind of. Groundhog Day Loop oh. God I don't know um they looped that. movie over and over um can you ever. watch Jumanji again no I don't want to. ever see that movie. again and then there was some. significant amount of time where you.

just sat for hours waiting for the next. activity so I would just walk down to. the nurses station and look at the. clock and there was just a very slow. passing of time it all felt it felt like. a movie it felt so surreal. [Music].

and does she get any treatment for this. supposed episode that they're keeping. her in for her medical records indicate. that she's not getting what any of us. would consider care she's not getting. one-on-one. therapy she's basically in a holding. pattern I was able to get phone calls in. with my sister I never she does. eventually call her sister who's both a. lawyer and her medical proxy I did talk. to her she would just say hi honey you. have to stay calm you have to they're.

trying their hardest to come up with a. plan to get her out which involves a. couple of things one is Kathy you know. has to be a model citizen she can't show. any kind of emotion that would give the. facility any other reason to hold her. and I think having that communication. when I was able to made all the. difference and so she develops these. coping mechanisms like saying the. serenity prayer over and over again. there was a like sort of seats where I.

could pull my knees up to my chest to. give myself a little bit of. comfort just trying to sort of say. prayers that would help me hold it. together mentally and. emotionally and it took two days at. least to get a pen and a journal I. begged for that I needed something to. write where I could write my prayers I. could write my thoughts and they another. thing she does that really helped her. and gave her a sense however feeble of. control in this situation is she gets.

her hands on a journal and she starts. taking notes I would shower with it I'd. go to the bathroom with it like I was so. scared of them taking anything and. everything from me and she shared a copy. of her journal with me and I was just. blown away by it she wrote at one point. God please connect me back to my mom. ASAP and she also said and the grammar. on this is a little off and I find it. actually more moving She Wrote wrote. every time the locked door open and slam.

I feel a quick feeling of fear I I was. trying to get as much down about the. place like I felt like I was this little. detective I'm like I'm inside this. nightmare for her it was all way to keep. her mind. focused and the days are ticking by I'm. going to get as much information out of. it cuz God willing I'm going to get out. someday. [Music].

we'll be right back. [Music]. so Jessica Kathy's story is really a.

kind of nightmare scenario for anyone. seeking mental health care to be kept. against your will in a closed. institution and you said her story was. just one of many you found in your. reporting but what was acadia's motive. here we found again and again that aadia. was making decisions in the interest of. maximizing its profits even if that. meant sacrificing patient care and to. really understand what was happening. we called hundreds of people and we.

ultimately got 55 current and former. employees and that's a mix of Staff. Executives of the various hospitals all. across the country to talk to us and. they outlined this pretty elaborate. system at aadia to get as many patients. in the door and then keep those patients. especially the ones with insurance in a. Cadia facilities for as long as possible. I mean that's really dark explain the.

system to me how do they actually do. this well it starts with the way aadia. finds and recruits patients so they. first mark it directly to potential. customers they run advertisements that. tell people skip the ER come to us the. company also cultivates relationships. with people who are more likely to. encounter patients in the throws of some. kind of mental crisis so police officers. emergency responders and the hope there.

is that those individuals will bring. patients to Acadia and I imagine that's. a pretty attractive offer given how. overrun emergency rooms are these days. right and we found that aadia actually. directly markets to those ERS Business. Development teams show up at ERS bearing. donuts and coffee and they say look we. have the expertise we have the skills to. quickly evaluate and stabilize these. patients and we can treat them that's.

really appealing it means that aadia is. willing to take some of the most. difficult patients off the hands of. these emergency departments and it's all. about filling beds because every patient. they get into a bed especially if that. person comes with private insurance is. money in the door for aadia and some of. acadia's strategies to attract patients. I would say take the normal kind of.

sales relationship a little bit further. so in some states Acadia has actually. dispatched teams to these overwhelmed. ERS to help those emergency rooms. determine whether patients need to be. hospitalized these employees are known. as assessors and they're supposed to be. providing an objective evaluation as to. whether someone at an emergency room. needs a further psychiatric evaluation. and whether that patient needs to be. hospitalized but they're paid bar arade. to do this in ERS exactly so that's.

where it gets a little muddy several. aadia assessors who we spoke to said. that when they didn't send patients to. Acadia when they opted to send them home. because they determined that they didn't. need that level of care they didn't need. to be hospitalized or when they sent. them to other facilities they would be. scolded by their superiors one assessor. that we spoke to a woman named gwenneth. Shanks said felt deeply unethical to her.

because she thought all of the pressure. actually clouded the judgments of. assessors okay so that's how they get. the patients into the door but what. happens once these patients are on the. premises well they typically keep them. there for as long as they can and we. found that in case after case they do. this by exploiting a fundamental. information IM balance as we've talked. about patients can only be held against. their will for a relatively short amount.

of time but patients don't always know. that and aadia is kind of capitalizing. on that confusion to keep patients there. as long as possible and Acadia deploys a. lot of different strategies that we. identified in our reporting to convince. insurers to pay for those extra days so. sometimes staff exaggerate patients. symptoms they write patients up and call. them out. branding them as uncooperative if they.

don't finish a meal they argue that. they're not well enough to leave in one. case in Reading Pennsylvania we found. that actually inspectors called an aadia. Hospital out for this because in. 2022 State Health Inspectors found that. workers had been instructed to avoid. adjectives like calm and compliant in a. patient's chart h and remember how I. said we filed just like these voluminous.

records requests those started yielding. similar things in other states so that. same year in 2022 we found in records. that Acadia employees in hospitals in. Ohio and Michigan complained to their. state Regulators that doctors had. written false statements in patients. medical charts to justify their. continued stays and these strategies. ultimately led to patients spending more.

days there than medically necessary. sometimes it was between 3 and 5 days. sometimes it was longer we found that. aadia often holds patients until that. insurance money runs out and how much. money are we talking about here we don't. know in every case but for Kathy for. example we saw that for every day she. was held aadia was charging her. insurance. $2,200 that's a lot of money especially. if you're held in there for a long time. but as you said there are legal limits.

to keeping people in hospital against. their will so how does Acadia get around. these. rules so the mechanics of this are. pretty interesting in Florida as we've. talked about the limit for holding. patients like Kathy McKenzie against. their will is 72 hours right and in. order to extend that time hospitals like. North Tampa Behavioral where Kathy was. have to go to to court to get.

approval and the way they do that is. they file a petition that says this. patient needs to be held longer than. that 72-hour period now here's where. things get really interesting simply. filing that petition whatever the. prospect of it succeeding in the end. allows the hospital to legally hold the. patients and more importantly Bild their. insurance until the court date which can. be several days after the petition is.

filed so they've effectively identified. this loophole Yeah in our reporting we. found that North Tampa filed thousands. of petitions to extend patients. involuntary stays between 2019 and. 2023 of those and this is when my jaw. really hit the floor when we got this. data back judges granted only. 54 of more than 4,500. of North Tampa Behavioral petitions so.

that's about 1% of the total that's. crazy so 99% of these patients had their. confinement prolonged by several days. with petitions that were never really. expected to be granted they were simply. a delaying tactic it seems a tactic to. maximize the daily Insurance payouts. that's absolutely right and that's. according to current and former. employees that we interviewed and judges. in in this case agreed wow but Jessica.

how did the company actually implement. the strategy sort of on the ground was. there an internal policy like were there. written guidelines to keep patients in. for as long as possible I mean how do. you get a whole Hospital staff to fall. into line with this strategy so it's a. really good question and it's one that I. tried to use to guide my reporting as. well is like how is this put into. practice and what we found is that there.

was nothing in writing there were no. instructions like here is how you. convince insurance companies to hold. patients as long as possible but when we. spoke to those 55 current and former. employees and that group included. psychiatrists who worked at these. facilities they said it was subtle. pressure from their. bosses and the pressure manifested in. different ways sometimes it was don't. you think this patient could you know.

benefit from a couple of more days. inside you know don't you think that. know they said they weren't suicidal but. maybe they're behaving a little. erratically could we describe them as. combative and so these people at least. said that was a real problem for them. and that it all comes back to a company. that was run more by the business side. than by the the clinical side I mean one.

thing that consistently came up is that. every Patient First was identified by. how many Insurance days they had left. not their constellation of symptoms I. mean that pretty much says it all. identifying patients by the potential. profit gains they bring basically how. valuable they are to the company's. bottom line so is this ultimately just. what happens when for profit companies. move into a space that used to be.

occupied by governments and not for. profits mean we definitely found that in. our reporting and it's been something of. a consistent theme that as Healthcare. becomes more monetized and more. for-profit companies move into this. space it's the patients who really. suffer and in this story about aadia I. think both Katie and I found it. particularly Stark because these. patients are particularly vulnerable.

they are in the midst of some kind of. Mental Health crisis and so sometimes. they're not believed they're easy to. dismiss to not listen to so it makes. what's happening all the. more upsetting and harmful because as. these patients are being commoditized. they are also being ignored and kind of. brushed aside and have you confronted. Acadia with all of these findings you. know these different layers of abuse.

they're accused of yes absolutely so the. Acadia spokesman wouldn't comment on. individual patients and he said the. reason was patient privacy laws which is. pretty. standard and the spokesman also said and. he really emphasized this that quality. care and medical necessity does Drive. every patient related decision at. aadia he said that the patient examples. we cited people like Kathy McKenzie were.

not representative of the many patients. who did have positive experiences at. aadia but what has really struck me is. actually what has happened since the. story published so Katie and I have just. been overwhelmed with reader emails with. reader comments on the story and what. people are saying is that they have. experienced very similar things to what. Kathy experienced in the story and some.

of the ones that are particularly kind. of harrowing to me are people who say my. family member my loved one is stuck. inside an aadia hospital right now and. the only thing we can say to them is if. you need help you should contact an. advocate in your state so there are. these groups called protection and. advocacy agencies and they're funded by. the government and they're essentially. watchdogs for these mental health.

institutions but that's really all we. can. do and that I think has been the most. stunning thing to me is just the number. of people who are dealing with parallel. situations to those of Cathy's but in. real time right now and Jess do these. agencies have any real Authority are. there likely to be any real consequences. here. I.

mean. I am skeptical that there will be any. real responses because as we found when. we requested all these public records. people have been raising red flags. raising the alarms for years and so far. very little has. happened it's pretty shocking that. something like this can happen on this. scale without without any real.

consequences and it does make me wonder. you know what does that do to people. like Kathy who have been a victim of the. system so Cathy's mom and sister are. worked together to find and then hire a. lawyer and they do get her. out but for Kathy she doesn't really. know any of this as she's waiting inside. that locked psychiatric hospital and and. she felt so alone it was almost like.

that outside world had really ceased to. exist she was in the upside down I've. never been like in the military or. something but I could only. imagine being almost like in a war. zone where you're just scared for your. life and you have nobody to protect. you and then I walk out into the lobby. and my mother's there. it was surreal it was like something.

that felt like it takeen months and it. was exactly a. week Kathy ends up staying at aadia for. about a week they release her right. before a judge could issue a decision to. have her released so they release her on. the day of her. hearing and so this nightmarish ordeal. that happened to Kathy it's finally over. and what did her life look like after.

she was. released I came. out very quickly diagnosed with PTSD. she was traumatized she was really. traumatized I mean that's the only way I. can think to describe it I had night. tears severe. nightmares they definitely had to do. with um. being locked up again and not um having.

freedoms um had to. re readjust and just start totally fresh. with. medication and kind of just. even going to the grocery store going to. do normal basic things if I would see a. cop car I would get extremely agitated. and and paranoid that they were coming. after me. I was living with my mom again and you.

know there were nights where I would. just Race Across the house and just have. to lay with her just to calm my calm. myself. down when she went into that hospital in. August of 2020 she was in a relatively. good place she had a fair amount of. faith in the mental health care system. and when she left that Acadia facility 6. days later all of that Faith was. gone I have very. clear plan and it will never be to go to.

an emergency room ever. again thank you Jessica thank you for. having me on I really appreciate. [Music]. it we'll be right.

back here's what else you need to know. today late on Wednesday night the times. reported that Eric Adams the mayor of. New York City has been indicted in a. federal corruption investigation the. indictment remained sealed on Wednesday. and it was unclear what charge or. charges Adams will face but the federal. investigation has for focused at least. in part on whether he and his campaign.

conspired with the Turkish government to. receive illegal foreign. donations Adams a retired police captain. who was elected on a pledge to reduce. crime said he was innocent I will fight. these injustices with every ounce of my. strength and my spirit the indictment is. expected to be made public on Thursday. and when it is Adams will become the. first mayor in the city's history to be. indicted while still. office and the United States along with.

its allies in Europe and several Arab. Nations unveiled a joint ceasefire. proposal to end the recent deadly. fighting between Israel and hisbah in a. statement President Biden warned against. the threat of a wider war in the region. unless an agreement is. reached officials said there were. indications that Israel and Lebanon were. supportive of talks that might soon lead. to a ceasefire.

today's episode was produced by Shannon. Lynn and Alex Stern it was edited by. Michael benois contains original music. by Diane Wong Dan Powell and Marin. Lozano and was engineered by Chris Wood. our theme music is by Jim brunberg and. Ben lansor of werly. [Music].

[Music]. that's it for the daily I'm cine benold. see you tomorrow. [Music].