Despite multiple ongoing U.S. Federal and state investigations into alleged billing fraud or patient abuse, the largest psychiatric hospital chain in America has been approved to expand its behavioural health business in the United Kingdom.
The mental health watchdog, Citizens Commission on Human Rights International (CCHR), warns that this could put UK patients at risk and needs investigating. Universal Health Services (UHS) completed its acquisition of Cambian Group, PLC’s Adult Services Division in December 2016, which added 81 behavioural facilities to the Cygnet psychiatric hospital chain UHS bought in 2014. It now owns 102 facilities in the UK.[1. “Universal Health Services, Inc. Completes the Acquisition of Cambian Group PLC’s Adult Services Division,” PR Newswire, 28 Dec. 2016, http://www.prnewswire.com/news-releases/universal-health-services-inc-completes-the-acquisition-of-cambian-group-plcs-adult-services-division-300383892.html ]
The acquisition was approved and finalised despite it being reported in December 2016 that “current and former employees” in UHS’s behavioural facilities said they “were under pressure to fill beds by almost any method — which sometimes meant exaggerating people’s symptoms or twisting their words to make them seem suicidal — and to hold them until their insurance payments ran out.”[2. Rosalind Adams, “Intake,” BuzzFeed News, 7 Dec 2016, https://www.buzzfeed.com/rosalindadams/intake?utm_term=.fgZ69127n#.amO6aY3PL]
Within six hours of this allegation being reported, U.S. stocks in UHS plummeted 12 percent, or £1.2 billion ($1.5 bn), and continued to fall over the next two weeks.[3. Matthew Zeitlin, “UHS Loses $1.5 Billion in Value After Investigation Into Its Hospitals,” BuzzFeed News, 8 Dec 2016, https://www.buzzfeed.com/matthewzeitlin/uhs-loses-1-5-billion-in-value?utm_term=.creK3xe9p#.yhnnM4wXA Rosalind Adams, “Intake,” BuzzFeed News, 7 Dec 2016, https://www.buzzfeed.com/rosalindadams/intake?utm_term=.fgZ69127n#.amO6aY3PL] Several U.S. Congressmen, including Senator Charles Grassley, head of the U.S. Senate Judiciary Committee, called for a resolution of ongoing investigations into reports of “greed” and “serious questions about patient safety” at the UHS behavioural hospitals.[4. Rosalind Adams, “Federal Investigation into UHS Must Stay Secret, Says Inspector General,” BuzzFeedNews, 22 Dec. 2016, https://www.buzzfeed.com/rosalindadams/federal-investigation-into-uhs-must-stay-secret-says-inspect?utm_term=.ondaX9YQzL#.xwp9kVARPj; “Senator seeks details on UHS investigation from HHS,” Becker’s Hospital Review, 12 Dec. 2016] About 20 law firms have announced they have begun investigating UHS for a class action lawsuit on behalf of investors, with an initial Class Action lawsuit filed on December 23.[5. “EQUITY ALERT: Rosen Law Firm Files Securities Class Action Lawsuit Against Universal Health Services, Inc. – UHS,” Yahoo! Finance, 23 Dec. 2016, http://finance.yahoo.com/news/equity-alert-rosen-law-firm-170000428.html; “INVESTOR LOSS ALERT: Rosen Law Firm Announces Investigation of Securities Claims Against Universal Health Services, Inc. – UHS,” 7 Dec. 2016,http://www.businesswire.com/news/home/20161207006402/en/; “SHAREHOLDER ALERT: Bronstein, Gewirtz & Grossman, LLC Announces Investigation of Universal Health Services, Inc. (UHS),” PRNewswire, 8 Dec 2016, http://www.prnewswire.com/news-releases/shareholder-alert-bronstein-gewirtz–grossman-llc-announces-investigation-of-universal-health-services-inc-uhs-300375281.html; “SHAREHOLDER ALERT: Goldberg Law PC Announces an Investigation of Universal Health Services, Inc. and Advises Investors with Losses to Contact the Firm,” Business Wire, 7 Dec 2016, http://www.businesswire.com/news/home/20161207006425/en/SHAREHOLDER-ALERT-Goldberg-Law-PC-Announces-Investigation; “IMPORTANT SHAREHOLDER ALERT: Lundin Law PC Announces an Investigation of Universal Health Services, Inc. and Advises Investors with Losses to Contact the Firm,” Business Wire, 8 Dec 2016, http://www.businesswire.com/news/home/20161208005958/en/IMPORTANT-SHAREHOLDER-ALERT-Lundin-Law-PC-Announces; “Salpeter Gitkin LLP Announces Investigation of Fraud Claims on Behalf of Investors in Universal Health Services, Inc.,” Nasdaq Global Newswire, 8 Dec 2016, https://globenewswire.com/news-release/2016/12/08/896258/0/en/Salpeter-Gitkin-LLP-Announces-Investigation-of-Fraud-Claims-on-Behalf-of-Investors-in-Universal-Health-Services-Inc.html; “Wolf Popper LLP Announces Investigation of Fraud Claims on Behalf of Investors in Universal Health Services, Inc.,” PRNewswire, 7 Dec 2016, http://www.prnewswire.com/news-releases/wolf-popper-llp-announces-investigation-of-fraud-claims-on-behalf-of-investors-in-universal-health-services-inc-300374887.html; “INVESTOR ALERT: Law Offices of Howard G. Smith Commences Investigation on Behalf of Universal Health Services, Inc. Investors,” Business Wire, 8 Dec 2016, http://www.businesswire.com/news/home/20161208006233/en/INVESTOR-ALERT-Law-Offices-Howard-G.-Smith; “SHAREHOLDER ALERT: Levi & Korsinsky, LLP Announces an Investigation Concerning Possible Violations of Federal Securities Laws by Certain Officers and Directors of Universal Health Services, Inc.,” Digital Journal, 8 Dec 2016, http://www.digitaljournal.com/pr/3169980#ixzz4SHeNcghB; “UHS NOTIFICATION: Faruqi & Faruqi, LLP Encourages Investors Who Suffered Losses In Excess Of $100,000 Investing In Universal Health Services, Inc. To Contact The Firm,” PRNewswire, 8 Dec 2016, http://www.prnewswire.com/news-releases/uhs-notification-faruqi–faruqi-llp-encourages-investors-who-suffered-losses-in-excess-of-100000-investing-in-universal-health-services-inc-to-contact-the-firm-300375697.html; “IMPORTANT INVESTOR ALERT: Khang & Khang LLP Announces an Investigation of Universal Health Services, Inc.,” Business Wire, 8 Dec 2016, http://www.businesswire.com/news/home/20161208006322/en/IMPORTANT-INVESTOR-ALERT-Khang-Khang-LLP-Announces]
CCHR, which has been investigating allegations against UHS’s psychiatric hospitals since 2008, said the acquisitions and expansion of UHS’s for-profit psychiatric business into the UK should have awaited the outcome of U.S. investigations.
In November 2015, CCHR’s UK Chapter wrote to the Competition and Markets Authority (CMA), the National Health Service (NHS) and the Care Quality Commission (CQC) warning about the allegations against UHS’s psychiatric operations in the U.S. On 29 January 2016, David Behan, Chief Executive of CQC wrote to CCHR saying the allegations were “serious” and “We are very concerned to read about the issues that have been identified in UHS in America and we note your concerns about these in relation to the services provided by Cygnet Healthcare since they were acquired by UHS.”[6. David Behan, Chief Executive of UK Care Quality Commission, letter to Mr. Brian Daniels, Citizens Commission on Human Rights, UK, 29 Jan. 2016]
The warning to UK authorities included:
• “Patient suicides, restraint deaths, falsification of records, body-slamming patients into walls and sexual assault are just some of the abuses reported in UHS behavioral facilities that U.S. state authorities or the U.S. Centers for Medicare and Medicaid Services (CMS) have investigated.”
• In April 2015, UHS’s Rock River Academy (for juveniles) in Illinois closed after the state Department of Children and Family Services refused to send juvenile wards there because of, among other things, use of restraint procedures. The rate of physical restraints was nearly eight times the median for all Illinois facilities.[7. “Center for troubled girls will close, cites decision by DCFS,” Chicago Tribune, 28 Jan. 2015, http://www.chicagotribune.com/news/watchdog/rtc/chi-youth-treatment-rock-river-20150128-story.html] On September 9, 2015, a lawsuit was filed against Rock River on behalf of five adolescent females, who alleged sexual abuse and rape by staff.[8. Lorraine Bailey, “Severe Abuse Alleged at Illinois Home for Girls,” Courthouse News Service, 10 Sept. 2015, courthousenews.com/2015/09/10/severe-abuse-alleged-at-illinois-home-for-girls.htm; (Case No. 2015-L-009253, Cook County Circuit Court, Illinois, Filed 9/9/2015)]
• A Chicago Tribune investigation also reported that staff administered psychotropic drugs, like the antipsychotic chlorpromazine, in dosages that were far higher than doses at similar youth facilities. Residents said they were knocked out for hours at a time from the drugs.[9. “Horrors Behind These Walls: Stories Of Alleged Physical, Emotional, And Sexual Abuse At Rock River,” My Stateline.coe.,2/02/2015, http://www.mystateline.com/fulltext-news/d/story/horrors-behind-these-walls-stories-of-alleged-phys/33880/G4ZGF7fcmUWbrwKb0-N5ZQ]
Like “Switching Seats on the Titanic”
Brian Daniels from CCHR UK, says the level of allegations against UHS’s psychiatric sector should be raising alarm in the UK, which has already seen significant abuse reported in its system and the need for better care.[10. https://www.theguardian.com/commentisfree/2016/feb/17/readers-failed-mental-health-services]
“We see reports of a 21 percent increase in mental health patient deaths in England over a three year period; more than 6,000 instances of physical restraint being used on patients, who are increasingly being hurt as a result of the restraints, and rape or sexual assault of patients in hospitals, significantly in ‘mental health units’ being rife,” Daniels said.[11. “Spike in mental health patient deaths shows NHS ‘struggling to cope’,” The Guardian, 25 Jan. 2016,
https://www.theguardian.com/society/2016/jan/26/rise-mental-health-patient-deaths-nhs-struggling-to-cope; “Mental health patient ‘abuse’ fears,” Wigan Today, 30 Sept. 2016, http://www.wigantoday.net/news/mental-health-patient-abuse-fears-1-8156481; “Sexual violence soars in UK hospitals: Records show 50% rise in reports of sexual attacks, with more than 1,600 in past three years,” The Guardian, 31 Dec. 2014, https://www.theguardian.com/society/2014/dec/31/sexual-violence-soars-uk-hospitals “Jail for mental health worker who took advantage of vulnerable patient,” ITV News, 31 Oct. 2016, http://www.itv.com/news/central/2016-10-31/jail-for-mental-health-worker-who-took-advantage-of-vulnerable-patient/; “Sheffield mental health worker jailed for sex abuse,” BBC News, 10 May 2016, http://www.bbc.com/news/uk-england-south-yorkshire-36259675; “Ex-psychiatric patient speaks of repeated abuse,” BBC News, 13 Jan. 2014, http://www.bbc.com/news/uk-25680659; “Raped SIXTY times in hospital: Mental health patient reveals shocking abuse on wards dubbed ‘playgrounds for predators,’” The Mirror, 31 Jan 2014, http://www.mirror.co.uk/news/uk-news/raped-sixty-times-hospital-mental-3016375] “The solution can’t be to entrust patient care to hospitals now owned by a company whose psychiatric facilities in the U.S. have been accused of similar abuse. It’s like switching seats on the Titanic.”
In its presentation to U.S. investors in December 2014, UHS pointed out the profitable venture moving into the UK, where there had been a one percent decrease in NHS beds between December 2013 and March 2014, and that NHS bed closures were “expected to continue.” Therefore, it could be predicted that this could lead to a “continuing trend towards more outsourcing to independent sector provision” (i.e., UHS), “partnerships with the NHS” and “contracting opportunities.”[12. UHS Investor Presentation, Dec. 2014, http://ir.uhsinc.com/phoenix.zhtml?c=105817&p=irol-IRHome]
Other U.S. behavioural healthcare companies also see the UK as a lucrative market. In October 2016, Acadia Healthcare announced the sale of 21 behavioural health facilities in the UK that it hoped would clear antitrust obstacles to its £1.28 billion acquisition of psychiatric hospital Priory Group.[13. Dave Barkholz, “Acadia hopes U.K. sale of 21 facilities greenlights bigger Priory acquisition,” Modern Healthcare, 25 Oct. 2016, http://www.modernhealthcare.com/article/20161025/NEWS/161029965;
“US-owned Acadia Healthcare buys the Priory for £1.28bn.” The Guardian, 4 Jan. 2016, https://www.theguardian.com/business/2016/jan/04/us-owned-arcadia-healthcare-buys-the-priory-for-128bn]
In 2010, UHS bought the U.S.-based Psychiatric Solutions Inc. (PSI), including its then legal liabilities. This included a lawsuit against PSI filed on September 21, 2009 on behalf of shareholders over allegations that “PSI failed to sufficiently staff its facilities, resulting in alarming incidents of abuse, neglect, and even death of its patients, and downplayed the significance of these events when they became public.” The case settled for £53.2 million in 2015.[14. “Shareholders Obtain $65 Million Settlement in Psychiatric Solutions,” Robins Geller, Rudman and Dowd, LLP, 17 Jan. 2015.] All but one of the current corporate officers of Acadia Healthcare is a previous owner and/or officer of PSI.
UHS defends the allegations against it, claiming that the US Joint Commission has designated about 80 of its behavioural facilities as “Top Performers in Key Quality Measures.” The Commission is an accrediting organisation that conducts surveys of healthcare facilities upon which it certifies their performance. However, such surveys are paid for by the health care corporations.[15. https://www.jointcommission.org/facts_about_federal_deemed_status_and_state_recognition/] The Commission also relies upon accurate reporting by the facilities.[16. “Adverse Events in Hospitals: State Reporting Systems,” GAO, 2008, p. ii, https://oig.hhs.gov/oei/reports/oei-06-07-00471.pdf]
In February 2016, The Financial Times reported that Britain’s £16 billion mental health industry was braced for a wave of consolidation as investors sought to take advantage of a rise in NHS outsourcing. The Times reported, “US companies Acadia Healthcare and Universal Health Services entered the UK market for the first time last year, helping to fuel a dealmaking spree in the sector. The number of takeovers of mental healthcare providers rose from 16 in 2014 to 22 in 2015.” Acadia accounts for about a third of the UK’s private behavioural services.[17. “US investors lead dealmaking spree in British mental healthcare Acadia’s purchase of Priory to unleash wave of consolidation,” The Financial Times, 7 Feb 2016]
CCHR says a UK-wide review is needed into not only how a company under US federal investigation and others were allowed to take over the private mental health sector but also into the lack of accountability in the mental health system, both in financial terms and also the poor response rate to the the treatment given individuals. CCHR also urges that anyone whose family member has been abused in a for-profit psychiatric facility or any whistleblower to contact it and report the abuse. [http://www.psychiatric-abuse.org.uk]
About CCHR: CCHR is an international mental health watchdog established by members of the Church of Scientology and Dr. Thomas Szasz, a professor of psychiatry to investigate and expose human rights abuses in the mental health system. In its 46 years, it has helped more than 180 laws to be passed around the world that protect individuals against abuse.
