Residential treatment centers prioritize profits over care, Senate says

Children housed in residential treatment centers run by some of the nation’s largest behavioral health companies are at risk of sexual abuse, dangerous physical restraints and overmedication, problems made worse by weak oversight and a system that “optimizes profit over the well-being and safety of children,” a Senate committee reported Wednesday.

Companies investigating per diems paid by Medicaid and other government sources to care for youth in their care, many of whom are developmentally disabled or in foster care, but companies often fill facilities to capacity and “regularly fail” to hire a sufficient number of qualified employees,” the report said. These flaws are “endemic to the operating model” of companies, which “treat children as payments,” the report says.

The Senate Finance Committee released its landmark report Wednesday ahead of a hearing on its findings, the result of a two-year investigation examining four major operators of children’s residential treatment facilities: Universal Health Services, Acadia Healthcare and Vivant Behavioral Healthcare, which are for-profit businesses, and Devereux Advanced Behavioral Health, a non-profit organization.

The report notes “widespread civil rights violations,” including excessive use of seclusion and “chemical restraints,” injections intended to keep children calm, even when they were already relaxed or cooperative.

The bulk of the 130-page report documents mistreatment and violations at the facilities. The majority of them stem from incidents at facilities run by Universal Health Services and Acadia, which are publicly traded companies, and include explicit allegations of sexual assault by staff members against children. The report states that there are “numerous” accounts of residential treatment staff “dragging or throwing” children in their care and pushing them against fences, walls and furniture”, based on business records.

Sen. Ron Wyden, chairman of the Senate Finance Committee, helped lead the investigation.Francis Chung/E&E News/POLITICO via AP Images

In an incident described by the Senate committee, which was also detailed in a state investigative report obtained by NBC News, a female staff member at a universal health facility in Oklahoma admitted to molesting a girl in 2021 and said she planned to have “a more intimate relationship.” relationship” when the child left and turned 18. The facility moved the staff member to another unit after patients reported the misconduct, but she continued to stand in front of her victim’s window each night, according to the report. Universal Health told the committee the staff member was later fired.

At one facility in Acadia, Arkansas, the report said, company records showed staff members simultaneously placing children in an isolation room and chemically immobilizing them — which is prohibited by federal regulations — 110 times in 30 days. Acadia executives told the Senate committee that employees at the facility did not follow company policy or government rules.

“The patient stories highlighted in the Committee’s report are heartbreaking,” Acadia said in a statement. “Our industry can and must do better,” he said, adding that it is committed to ensuring that “all patients treated at Acadia receive the support and compassionate treatment they deserve.”

Leah Yaw, Devereux’s senior vice president, said the company categorically denies that children in its programs are placed in abusive or unsanitary conditions. She said the use of the drugs was “extraordinarily cautious” and that she was funding college aid programs to help address industry-wide staffing issues.

Universal Health Services said in a statement that it vehemently disputes the report’s characterization of its facilities as understaffed and unsafe.

“Incidents where employees fail to follow our training, policies, procedures and protocols are an extreme exception and not the norm,” the company said.

Marc Miller, the company’s CEO, declined a committee invitation to testify at Wednesday’s hearing in a letter from a multinational law firm to Senate Finance Committee Chairman Ron Wyden, D-Ore. . In the letter obtained by NBC News, the company said it had already provided more than 12,000 pages of documents and spent hundreds of hours answering questions from Senate staff and was concerned the investigation would presents an “incomplete picture of care and treatment” at the company’s facilities.

Devereux and Vivant said their executives were not invited to testify. Acadia did not specify whether its executives had been invited.

The investigation began in 2022 as child welfare advocates called for increased oversight of youth treatment centers following high-profile incidents of abuse and deaths at facilities across the country.

In one 2020 example cited in the report, Cornelius Frederick, 16, died after being restrained by several staff members at a Michigan facility run by Sequel Youth and Family Services for throwing a sandwich. NBC News investigations found that states often cite Sequel facilities for improper use of restraints and for their unsanitary conditions.

The Senate Finance Committee said the problems stemmed from inadequate employee training and understaffing, pointing to a talk Sequel founder Jay Ripley gave at a university in 2015. “You Can Win “money in this business if you control the staff,” Ripley said in a video previously obtained by NBC News, adding that he was focused on taking in children whose grades would be covered by government agencies in order to ensure greater financial stability for the company.

Ripley founded Vivant in 2021 as states cut contracts with Sequel and some of its facilities closed. Vivant then purchased the majority of Sequel’s operations. Several of Vivant’s top employees were executives at Sequel until 2021, according to their LinkedIn profiles, according to the Senate report.

In a statement, Vivant said controlling staffing levels is a normal business concept of having an appropriate number of employees and is not synonymous with being understaffed. Vivant said it provided the committee with records showing it is not understaffed at its facilities and requires its employees to be trained in patient safety.

The Senate report urged businesses to conduct comprehensive reviews of their staff, install more security cameras and ensure they are following existing federal regulations regarding restrictions. State and federal oversight agencies must ensure enterprise-wide improvements, rather than site-specific fixes, when violations are discovered at a facility, the committee said.

“As long as providers are allowed to continue business as usual,” the report says, “children will continue to suffer.”

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