On a cool October evening in 2012, Samantha Trimble walked into the lobby of Millwood Hospital, a low-slung brick building on the side of a road in Arlington, Texas, seeking a free mental health assessment.A few weeks earlier in the AP world history class Trimble taught, after a kid started acting childish, she put a diaper on his head — something she admits was a bad idea. When administrators heard about it, she was escorted off the property. Worried for her job and her ability as a single mother to support her daughter, she visited her doctor’s office in tears. A physician assistant asked if she wanted to talk to someone at Millwood.
Just after 8 p.m. that evening, a counselor at Millwood asked Trimble if she was having suicidal thoughts. With her pastor beside her for moral support, she replied, “Well, who hasn’t had suicidal thoughts?” She said she had no intention to kill herself but joked, “It’s Texas, it isn’t that hard to get a gun.” They all laughed, she recalled. She said she had no idea that the counselor characterized the line as a plan to commit suicide.
Nor did she know, she later testified in a deposition, that the dozen or so forms he gave her were anything other than standard doctor’s-office paperwork. She signed them and waited for her counseling session.
Samantha Trimble Rosalind Adams / BuzzFeed News
It was nearly 11 p.m. by the time a staff member walked her down a long hallway. She recalled being startled to see rooms that were filled not with desks but with beds.
A technician rifled through Trimble’s purse for sharp objects and then a nurse told her to strip down to her underwear. It was then, she said, that she realized the doors to the psychiatric ward had locked behind her.
Trimble, who has recently reached a settlement regarding her hospitalization, recalled shaking with fear and “deep, shameful humiliation” as the nurse examined her body, noting the location of any identifying marks. “All you can do,” Trimble said, “is stand there and let it happen.”
The nurse handed her a small cup of pills, and soon she was asleep.
When she woke up early the next morning, she recalled thinking, What the fuck just happened?
Millwood Hospital is part of America’s largest psychiatric hospital chain, Universal Health Services, or UHS. Its more than 200 psychiatric facilities across the country admitted nearly 450,000 patients last year. The result was almost $7.5 billion in revenues from inpatient care last year and profit margins of around 30%. More than a third of the company’s overall revenue — from both medical hospitals and psychiatric facilities — comes from taxpayers through Medicare and Medicaid.
A yearlong BuzzFeed News investigation — based on interviews with 175 current and former UHS staff, including 18 executives who ran UHS hospitals; more than 120 additional interviews with patients, government investigators, and other experts; and a cache of internal documents — raises grave questions about the extent to which those profits were achieved at the expense of patients.
Scores of employees from at least a dozen hospitals said those facilities tried to keep beds filled even at the expense of the safety of their staff or the rights of the patients they were locking up.
Current and former employees from at least 10 UHS hospitals in nine states 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.
A state-funded 2011 report on one Chicago hospital found “woefully inadequate” staffing levels, a “repeated and willful failure by UHS officials to ensure that their staff were properly trained,” and a pattern of admitting more patients than it had room for “in an effort to maximize financial profit.” Investigators also flagged broader concerns, citing “troubling reports suggesting a pattern of quality of care issues, harm to patients, or major healthcare fraud charges involving UHS-operating facilities in a dozen other states.”
UHS is under federal investigation into whether the company committed Medicare fraud. The probe involves more than 1 in 10 UHS psychiatric hospitals. Three are being investigated criminally — including one facing allegations that it routinely misused Florida’s involuntary commitment law to lock in patients who did not need hospitalization.
In March last year, the federal criminal investigation expanded to include UHS as a corporate entity, the company told investors.
The company has said it strongly disputes the allegations of civil or criminal fraud and is cooperating with the investigation. It has not been charged with any wrongdoing.
UHS also disputed BuzzFeed News’ investigation, whose conclusions, it said, “are contrary to the factual record and UHS policies and practices” and which “appears to focus on anecdotal accounts” and “personal perspectives.” It added, “Most of our patients are unable to make the same judgements regarding clinical care and appropriateness of admission and discharge that they might if undergoing other non-psychiatric medical treatment.” (Read the company’s statement here.)
The company “absolutely rejects” any claim that it held patients solely for financial gain. It disputed “the alleged findings and conclusions” in the Chicago report and said UHS hospitals have provided compassionate and high-quality care to millions of patients. Citing the approval of independent regulatory agencies, it said, “Every patient care decision is made with the goal of furthering the best interests of our patients.”
UHS “absolutely rejects” any claim that it held patients solely for financial gain.
After BuzzFeed News began reporting on UHS, the company purchased the domain name uhsthefacts.com. A person with direct knowledge of the matter said the site was intended to showcase stories of positive patient care to counter BuzzFeed News’ investigation.
Many current and former staff spoke to BuzzFeed News on condition of anonymity, often because they didn’t want to jeopardize future job options.
About 20 employees said UHS operates ethically and provides high-quality care. “I can honestly say in my hospital I never felt like people were being held long after they were due to be discharged,” said Bill Niles, who ran Roxbury Hospital in Pennsylvania for eight years.
“They wanted you to perform with the highest standards,” said Shari Baker, who ran Palmetto Behavioral Lowcountry Hospital in South Carolina until earlier this year. She called UHS “a very ethical organization.”
But scores of employees from at least a dozen UHS hospitals said those facilities tried to keep beds filled even at the expense of the safety of their staff or the rights of the patients they were locking up.
“YOUR JOB IS TO GET PATIENTS”