A series of Boston Globe articles reporting on breakdowns in care at Arbour Health System in Massachusetts, a Universal Health Services subsidiary, reveals the human cost of UHS’s failure to prioritize quality of care and compliance throughout the company.
Mental Health Clinics Cited
June 20, 2013 – Arbour Counseling Services –
Dozens of therapists who were unlicensed or improperly supervised routinely treated mentally ill patients at three clinics owned by a major provider of care to low-income people in Massachusetts, state records show.
At an Arbour Health System clinic in Lawrence, state inspectors determined that all 23 therapists were not qualified to see patients on their own, yet were doing so without regular oversight by a licensed professional. Similar staffing violations were discovered at Arbour clinics in Malden and Fall River.
[Edward] Keohan, the clinic director and a licensed independent clinical social worker, told inspectors that he had been “unaware that supervision was required to be provided on a regular and ongoing basis,” the report said.
Staff Failures Cited in Deaths at Arbour Psychiatric Centers
[T]hree questionable deaths within 18 months in the Arbour Health System that involved staff failures identified by state or federal health regulators. The health care company, which operates Arbour-Fuller, six other inpatient psychiatric facilities, and a chain of mental health clinics in Massachusetts, has been repeatedly cited for violating patient-care standards before and since the three deaths, including citations for staffing too few nurses or relying too much on lesser-trained or temporary workers.
At Arbour-HRI, the only Arbour facility with unionized nurses and mental health workers, employees repeatedly have filed complaints with hospital administrators about mandated overtime and low staffing levels at night or on units housing patients who require individual attention. They also have questioned why the hospital has no security staff despite serving patients who can be violent.
Many who work there are trying “to provide a decent standard of care in the face of a corporate philosophy that seems to relentlessly put profits ahead of patient and employee safety,” union spokesman Jeff Hall said by e-mail.
National Reviews of Centers Rare in Mental Health
November 11, 2013 – Arbour Health System
Pennsylvania health officials in 2011 temporarily stopped a mental health center from admitting children or teens after they found poor conditions, excessive use of physical restraints, and too few people caring for patients, according to state records.
In a psychiatric hospital in Chicago the same year, investigators found that violence was “an everyday occurrence,” fueled by understaffing.
And when regulators in North Carolina last year took steps to revoke the license of a residential treatment center after violence at the facility, they cited, among other things, incompetent clinical staff.
All three facilities were owned by Universal Health Services, the largest operator of freestanding psychiatric centers in the United States. Universal has a history of staffing problems at its hospitals around the country, but this record has rarely factored into reviews by state regulators — including in Massachusetts.
New Curb on Brookline Mental Health Hospital
November 26, 2013 – Arbour-HRI Hospital
State regulators have prohibited a Brookline psychiatric hospital from admitting any patients, citing deteriorating conditions and an immediate risk to patient safety.
Inspectors made a surprise visit to Arbour-HRI in October, after receiving a report about a female patient being forcibly searched, an incident that state Mental Health Commissioner Marcia Fowler described in an interview Monday as “a very serious human rights violation.” The inspectors identified a range of problems, including dirty conditions and untrained or inexperienced staff, she said.
Fowler was pointed in her criticism of Arbour-HRI officials. The problems inspectors found indicate a “lack of leadership and oversight of that facility,” she said. The first improvement plan was so poor, she said, that it appeared hospital administrators “really seemed to miss the point.”
The union that represents nurses and mental health workers at the hospital expressed support Monday for the state’s move to freeze admissions.
Jeff Hall, spokesman for Local 1199 of the Service Employees International Union, said members have been telling hospital administrators for years that the facility was understaffed, needed security guards, and lacked the necessary doctors and other medical resources to meet patient needs.
“The appeals by health care workers for improved conditions and staffing at Arbour-HRI have been repeatedly and chronically disregarded by Arbour and its parent company Universal Health Services,” he said in an e-mail.
Brookline Psychiatric Hospital Resumes Taking Patients
December 11, 2013 – Arbour-HRI Hospital
A Brookline psychiatric hospital is again accepting patients, but on a limited basis, after the state gave preliminary approval to the hospital’s plan for correcting serious safety and human rights violations found by inspectors, including the forcible strip-search of a patient.
The state received several anonymous calls from employees who said they felt “coerced by leadership to be silent about the incident or their jobs would be in jeopardy,” which hospital officials denied, said one inspection report.
The hospital did not always meet minimum staffing requirements, a situation that made it difficult for nursing staff to respond during patient emergencies, one inspection report said.
Regulators Find Brookline Psychiatric Hospital Deficient Again
May 29, 2014 – Arbour-HRI Hospital
Three months after state regulators allowed a Brookline psychiatric hospital to start accepting new patients again, federal investigators found deficiencies with psychiatric evaluations and treatment plans, problems they said may have hindered patients’ recovery.
Frank Barnes, a longtime mental health worker at the hospital and a union representative for 1199SEIU, said the problems at Arbour HRI reflect the culture of the administration.
“The emphasis wasn’t on the quality of care,” he said. “It was on increasing income.’’
Staff members have filed numerous complaints with hospital leaders and regulators about a lack of security personnel; inadequate staff; and patients not having enough towels, blankets, and food at night, he said.