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Veterans Day is a time to honor the sacrifice and commitment of those who serve and have served this country. It also presents an opportunity to reevaluate the programs and services in place to support these courageous men and women throughout their service and after. Members of the military and their families have chosen a life of sacrifice, many facing long deployments and intense combat conditions, and the pace and stress of this life can take its toll. In the largest study of mental health risk ever conducted among the U.S. military, many service members were found to be battling some form of mental illness. The study found that the rate of major depression is five times as high among soldiers as civilians and post-traumatic stress disorder is nearly fifteen times as high.[1] For military children with a deployed parent, one in four experience depressive symptoms and one-third are at high-risk for psychosocial issues.[2] For a population with unprecedented mental health challenges, guaranteeing access to quality health care services is absolutely paramount to ensuring a healthy, quality life. It is imperative that large behavioral health providers like Universal Health Services (“UHS”) have the highest standards in place to serve the growing mental health needs of service members, veterans, and their families.

TRICARE’s private providers skirt by with little oversight and accountability.

There is a growing debate about whether the private sector should be seen as a solution to this growing crisis in mental health care for service members and veterans. In fact, service members and their families are much more likely to receive care in a private, civilian facility through TRICARE than a military treatment facility.[3] However, even with a growing presence in TRICARE,[4] private providers are able to fly under the radar with a shocking lack of scrutiny compared to military treatment facilities, which could have serious consequences on patient care. A review of the Military Health System conducted by the Department of Defense found a substantial gap in identifying quality and safety issues for TRICARE beneficiaries—only military treatment facilities have mandatory reporting requirements for clinical quality data and potential patient safety events.[5] Even with the limited data available on TRICARE’s private providers, the review revealed a significant need for improvement in the quality of behavioral health care services. For the only two mental health metrics measured (follow-up after hospitalization for mental illness within 30 days of discharge and within 7 days of discharge) the quality records of TRICARE’s private providers were below the 25th percentile and worse than the military’s own facilities.[6] Private providers in TRICARE have been shielded from accountability through the voluntary reporting process currently in place. This is especially troubling because UHS is the leading provider of behavioral health services through TRICARE.[7] This for-profit conglomerate operates nearly 140 TRICARE-certified facilities[8] including 35 of the 60 TRICARE residential treatment centers (RTCs)[9] —the facilities that provide live-in care for the children of military families. UHS positions itself to be the provider of choice to the military, TRICARE, and VA[10] and claims that many of their facilities are especially equipped to treat service members and their families.[11] Revealing their key intention for focusing on services to the military, UHS has said that the rising need for mental health services among the military is a significant growth opportunity[12] and is one of their most profitable behavioral health business lines.[13]

As UHS seeks to profit from military members and families, the company fails to provide the high quality care that this population needs and deserves.

To ensure a profit, UHS keeps its beds full and the staffing low, which can be dangerous for both patients and workers. At the TRICARE-certified Vines Hospital in Florida, a psychotic patient was left unsupervised for two hours and murdered his roommate. When interviewed, an employee said, “Sometimes there are not enough staff to care for the residents and residents do not receive the care they should.”[14] At TRICARE-certified Timberlawn Mental Health System in Texas, two patients were not adequately monitored allowing for the rape of a female patient. During the timeframe of this incident, the facility was also in the practice of routinely exceeding capacity, leaving patients to sleep on couches and chairs. In addition, UHS’s TRICARE-certified facilities have been cited by regulators for serious issues related to patient safety and quality of care, including patient deaths and suicides, and numerous allegations of sexual abuse and assault. TRICARE has an additional set of standards for RTCs in order to protect vulnerable children of military families. However, UHS has frequently been in violation of two of these conditions – maintaining a safe place where patients are protected from harm and reporting instances of suspected abuse to the proper authorities – creating terrifying environments for military children.[15] In one instance, Kempsville Center for Behavioral Health in Virginia was cited for secluding and restraining an apparent TRICARE beneficiary “as a ‘punishment’ for the convenience of staff.” The facility was found to have “failed to protect and monitor [the patient] from abuse, neglect and exploitation” and also failed to report the incident as required by law to the Office of Licensing and the Office of Human Rights—two regulators who could crack down on this kind of behavior.[16]

NOW is the time to hold private providers like UHS accountable.

To ensure access to quality mental health services for military members and their families, we need to hold UHS and other private providers in TRICARE to the same standards as military treatment facilities. The Defense Health Agency, which oversees TRICARE, is currently evaluating bids for the new TRICARE 2017 managed care contracts. In this time of transition, the Defense Health Agency has the pivotal opportunity to put the mechanisms in place to hold providers accountable and ensure quality, safe, cost-effective mental health care for our military families. In light of Veterans Day 2015, and the opportunity to honor those who serve and have served, we wanted to share this information and step out as an advocate for access to quality mental health care for military members and families. SEIU is strongly encouraging the Defense Health Agency to hold UHS and other TRICARE providers accountable, now and in the upcoming TRICARE contracts. Take a look below to see how you can get involved.

Join us in advocating for quality care in TRICARE and improving standards at UHS’s TRICARE facilities.

  1. Report TRICARE fraud or abuse. The Program Integrity Office at the Defense Health Agency (DHA) is the central coordinating agency for allegations of fraud and abuse within the TRICARE program. According to the DHA, “abuse is when providers supply services or products that are medically unnecessary or that do not meet professional standards.”[17] If you have experienced firsthand fraud or abuse at TRICARE-certified UHS facilities, contact the Program Integrity Office immediately at http://www.health.mil/fraud.
  2. Tell us your story. We have met and spoken with several patients and families, as well as community advocates who share our mission to improve the care provided to military service members and their families in the mental health system, especially at UHS facilities. We are working to gather firsthand accounts, stories and experiences of care individuals and families have received from UHS facilities nationwide to raise awareness at the grassroots level and to hold UHS accountable for how their corporate practices are affecting patients all across the country. Please contact us to share your story at susana@uhsbehindcloseddoors.org
  3. Fill out our survey. Help us better understand how for-profit health systems are affecting the military community by completing this survey about your experiences and sharing it with your organization’s constituents, as well as your friends, family, and other networks. If you are a Healthcare Service Provider in addition to a consumer of care please consider also filling out, and sharing, our similar survey geared towards providers: http://goo.gl/forms/IGonL6jmzW.

UHS’s TRICARE-certified facilities:

Alabama Hill Crest Behavioral Health Services Laurel Oaks Behavioral Health Center Alaska North Star Bragaw North Star DeBarr Residential Treatment Center (RTC) North Star Hospital Arizona Palo Verde Behavioral Health Valley Hospital Arkansas Bridgeway Hospital Pinnacle Pointe Hospital (RTC) Rivendell Behavioral Health Services of Arkansas California BHC Alhambra Hospital BHC Heritage Oaks Hospital BHC Sierra Vista Hospital Canyon Ridge Hospital Del Amo Hospital Colorado Cedar Springs Behavioral Health Services (RTC) Centennial Peaks Hospital Highlands Behavioral Health System Connecticut Stonington Institute Delaware Dover Behavioral Health System Rockford Center Florida Atlantic Shores Hospital Central Florida Behavioral Hospital Emerald Coast Behavioral Hospital Fort Lauderdale Hospital La Amistad Behavioral Health Services (RTC) NDA Behavioral Health System (RTC) Palm Shores Behavioral Health Center (RTC) River Point Behavioral Health University Behavioral Center (RTC) Vines Hospital Wekiva Springs Center Windmoor Healthcare Georgia Anchor Hospital Coastal Behavioral Health Coastal Harbor Treatment Center (RTC) Crescent Pines Hospital Lake Bridge Behavioral Health (RTC) Laurel Heights Hospital (RTC) Peachford Behavioral Health System of Atlanta St. Simons by the Sea SummitRidge Hospital Talbott Recovery Campus Turning Point Hospital Idaho Intermountain Hospital Illinois Hartgrove Hospital Lincoln Prairie Behavioral Health Center Riveredge Hospital Streamwood Behavioral Health The Pavilion Foundation Indiana Bloomington Meadows Hospital Michiana Behavioral Health Center (RTC) Midwest Center for Youth and Families (RTC) Valle Vista Hospital (RTC) Wellstone Regional Hospital Kentucky Cumberland Hall Lincoln Trail Behavioral Health System (RTC) Rivendell Behavioral Health Services of Kentucky The Brook Hospital—Dupont (RTC) The Brook Hospital—KMI (RTC) The Ridge Behavioral Health System Louisiana Brentwood Hospital River Oaks Hospital Massachusetts Arbour Lowell Treatment Center Arbour-Fuller Hospital Arbour-HRI Hospital Pembroke Hospital The Arbour Hospital Michigan Forest View Hospital Havenwyck Hospital Mississippi Alliance Health Center Diamond Grove Center Parkwood Behavioral Health System Missouri Heartland Behavioral Health Services (RTC) Two Rivers Psychiatric Hospital Nevada Spring Mountain Sahara Spring Mountain Treatment Center West Hills Hospital Willow Springs Center (RTC) New Jersey Hampton Hospital Summit Oaks Hospital New Mexico Mesilla Valley Hospital (RTC) North Carolina Brynn Marr Hospital (RTC) Holly Hill Hospital Old Vineyard Behavioral Health North Dakota Prairie St John’s Ohio Arrowhead Behavioral Health Belmont Pines Hospital (RTC) Windsor—Laurelwood Center Oklahoma Cedar Ridge Oregon Cedar Hills Hospital Pennsylvania Brooke Glen Behavioral Hospital Clarion Psychiatric Center Fairmount Behavioral Health System Foundations Behavioral Health Friends Behavioral Health System Roxbury Psychiatric Hospital The Horsham Clinic The Meadows Psychiatric Center Puerto Rico First Hospital Panamericano—San Juan South Carolina Aurora Pavilion Lighthouse Care Center of Conway Palmetto Lowcountry Behavioral Health Palmetto Summerville (RTC) The Carolina Center for Behavioral Health Three Rivers Behavioral Health Three Rivers Residential Treatment-Midlands Campus (RTC) Tennessee Compass Intervention Center (RTC) Lakeside Behavioral Health System Rolling Hills Hospital Texas Austin Lakes Hospital Austin Oaks Hospitals Behavioral Hospital of Bellaire Cypress Creek Hospital El Paso Behavioral Health System Glen Oaks Hospital Hickory Trail Hospital Kingwood Pines Hospital Laurel Ridge Treatment Center (RTC) Mayhill Hospital Meridell Achievement Center (RTC) Millwood Hospital River Crest Hospital San Marcos Treatment Center (RTC) South Texas Behavioral Health Center Texas NeuroRehab Center The Pavilion at Northwest Texas Healthcare System The Recovery Center Timberlawn Mental Health System TMC Behavioral Health Center University Behavioral Health of Denton West Oaks Hospital Utah Center for Change (RTC) Provo Canyon Behavioral Hospital Provo Canyon School (RTC) Salt Lake Behavioral Health Virginia Cumberland Hospital (RTC) Harbor Point (RTC) Kempsville Center for Behavioral Health (RTC) Newport News Behavioral Health Center (RTC) North Spring Behavioral Healthcare (RTC) Poplar Springs Hospital (RTC) Virginia Beach Psychiatric Center Wyoming Wyoming Behavioral Institute