Saturday, 21 October 2023 07:07

Cashing in on Troubled Teens

Photos of Katrina Edwards taken on admission to North Star. She spent more than two years at the facility between 2012 and 2017.

How the country’s biggest psychiatric hospital chain is profiting off kids trapped in a broken child welfare system.

The first time Trina Edwards was locked in a psychiatric hospital for children, she was 12 years old. She was sure a foster parent would pick her up the next day. But instead, Trina would end up spending years cycling in and out of North Star Behavioral Health in Anchorage, Alaska.

At times, she was ready to be discharged, but Alaska’s Office of Children’s Services couldn’t find anywhere else to put her – so Trina would stay locked in at North Star, where she would experience violent restraints and periods of seclusion. Then, shortly before her 15th birthday, Trina was sent to another facility 3,000 miles away: Copper Hills Youth Center in Utah.

Both North Star and Copper Hills are owned by Universal Health Services, a publicly traded, Fortune 500 company that is the nation’s largest psychiatric hospital chain. Trina’s experience is emblematic of a larger problem: a symbiotic relationship between failing child welfare agencies, which don’t have enough foster homes for all the kids in custody, and large for-profit companies like Universal Health Services, which have beds to fill.

This hour, Mother Jones reporter Julia Lurie exposes how Universal Health Services is profiting off foster kids who get admitted to its facilities, despite government and media investigations raising alarming allegations about patient care that the company denies.

Dig Deeper

Read: Inside the Psychiatric Hospitals Where Foster Kids Are a ‘Gold Mine’ (Mother Jones)

Read: ‘What the Fuck Just Happened?’ (BuzzFeed News)

Read: How a Giant Psychiatric Hospital Company Tried to Spin Us – And Silence Its Staff (BuzzFeed News)

Credits

mother jones logo

Reporter: Julia Lurie | Producers: Katharine Mieszkowski, Neroli Price, Julia Lurie and Michael Montgomery | Editor: Cynthia Rodriguez | Fact checkers: Katie Herchenroeder and Nikki Frick | Production managers: Steven Rascón and Zulema Cobb | Digital producer: Nikki Frick | Original score and sound design: Jim Briggs and Fernando Arruda | Interim executive producers: Taki Telonidis and Brett Myers | Host: Al Letson | Special thanks to Reveal’s Jonathan Jones and Nadia Hamdan and to Ian Gordon and James West from Mother Jones.

Support for Reveal is provided by the Reva and David Logan Foundation, the John D. and Catherine T. MacArthur Foundation, the Jonathan Logan Family Foundation, the Ford Foundation, the Hellman Foundation, the Robert Wood Johnson Foundation, and the Park Foundation.

Transcript

Reveal transcripts are produced by a third-party transcription service and may contain errors. Please be aware that the official record for Reveal’s radio stories is the audio.

Al Letson: From the Center for Investigative Reporting and PRX, this is Reveal. I’m Al Letson. When Trina Edwards was 12 years old, she had a really active imagination.
Trina Edwards: I’m a Pisces, so I’m already in my head as it is.
Al Letson: Her window in Anchorage, Alaska looked out at a parking lot of a bank. Nothing special, just your average bank parking lot, but for Trina, that ordinary asphalt was like a stage.
Trina Edwards: Every person that pulled in or drove away, I would look and I would make a story, just a random ass story about that person’s life. No fact at all whatsoever, but that was their life in my head.
Al Letson: The mailman, the bank tellers, the customers, regular people going about their business, they became Trina’s characters.
Trina Edwards: I swear on everything I love, I was reading one of my journals and I was like, who the hell is Bill Frank and why is he always in my journals?
Al Letson: She’d assigned them names and backstories.
Trina Edwards: That man got paid every Thursday and would be at the bank, cashing his check right after work. And he has a stressful life because he has seven kids and two baby moms.
Al Letson: These stories helped Trina pass the time because she wasn’t able to do the things many other 12 year old girls do, like hang out with friends, or be dragged by a parent on a boring errand to the bank. Trina was locked in a psychiatric facility for children owned by a company called Universal Health Services. She had no idea when she’d get out. Trina was a foster kid and what she didn’t know until much later was that she was caught in the middle of a dysfunctional relationship between an overstressed child welfare system and a Fortune 500 company. One had too few foster homes for all the kids they’d taken in, and the other was looking to fill beds.
Over the past few years, universal Health Services has been the subject of several lawsuits and a Department of Justice investigation that raised alarming allegations. The company denies they’ve done anything wrong. And Mother Jones reporter Julia Lurie has found that despite all the scrutiny, child welfare agencies keep sending foster kids to UHS facilities often for months at a time. We should note this hour deals with child abuse, sexual assault, and suicide, and may not be appropriate for all listeners. Julia begins her story in Alaska.
Julia Lurie: Hi.
Speaker 4: Hello.
Julia Lurie: Hello. Hi, I’m Julia.
Speaker 5: Yeah.
Julia Lurie: It’s nice to meet you.
Speaker 4: You must be Trina.
Trina Edwards: Yes.
Speaker 5: Yeah. Hello. Aiy, ya, ya.
Trina Edwards: [inaudible 00:03:01]. You’re good.
Julia Lurie: I first met Trina this spring in Anchorage, Alaska in the parking lot of her apartment building. She lives there with her two toddlers.
Speaker 5: What is that?
Trina Edwards: It’s a microphone.
Speaker 5: A microphone?
Trina Edwards: Yeah.
Speaker 4: Do you want to say hi?
Julia Lurie: Trina’s wearing jeans and a gray hoodie. She’s 23 now.
Trina Edwards: Say hi.
Speaker 6: [inaudible 00:03:19].
Speaker 5: Well, I love you.
Trina Edwards: I love you.
Speaker 5: I love you.
Trina Edwards: Okay, here.
Julia Lurie: We end up spending most of the day together and Trina has this unfiltered way of operating, that’s disarmingly charming.
Trina Edwards: The way you drive is frustrating.
Julia Lurie: We drive, apparently, too slowly, according to Trina, to a pizza place for lunch. [inaudible 00:03:43]. Trina’s kids play nearby while she shows me photos from her time at the psychiatric facility. It’s a place called North Star Behavioral Health. There’s Trina at Thanksgiving, holding a Turkey made out of Oreos and Candy corn. And one of her on Halloween with lime green wings on her back.
Trina Edwards: Yeah, I wanted it to be a slutty Tinkerbell. I couldn’t be a slutty Tinkerbell.
Speaker 4: This is not slutty. You have many, many layers on. This is going beyond your knees.
Julia Lurie: Trina didn’t get the costume she wanted. The reality is she didn’t have a say about much in her life. Everything was controlled by the facility, when you slept, what you ate, what you wore, who you talked to on the phone, what medications you took. And when one kid got in trouble, they often all suffered the consequences. Trina remembers having her Harry Potter book taken away when one girl acted out and her unit was put on lockdown.
Trina Edwards: I was halfway in and got my fucking book taken away, bro. I wanted to know if they kissed or not.
Julia Lurie: So how did Trina end up at North Star? Well, first she went into foster care in 2012 after she reported being sexually abused by her mother’s boyfriend. She was just 12 and she was having flashbacks and trouble sleeping. Then she mentioned to her foster mom that she was having suicidal thoughts, so Alaska’s Office of Children’s Services sent Trina to North Star. When she was admitted, Trina told the hospital psychiatrist that she never had a plan or intention of killing herself. These details are in court documents and medical records. Trina never believed she needed to be in a locked psychiatric facility, but she says it was often overwhelming to live with people who did need that high level of care like her former roommate who used to hallucinate and talk to someone named Sally.
Trina Edwards: She’s like, “You’re so funny. Sally’s a real person. She’s standing right next to you.” And I said, “Tell Sally to back the fuck up. Don’t play with me bro.” These girls had mental issues and it sucks that I’m laughing about it, but I had nothing wrong with me. I was just a troubled child who didn’t listen to rules.
Julia Lurie: When Trina arrived at North Star, she assumed a foster family would pick her up the next day. She couldn’t have been more wrong. Instead, she would be put on multiple psychiatric medications, experience isolation, and violence, and cycle in and out of North Star for more than five years. Instead of parents, she had staffers.
Trina Edwards: I have a love-hate relationship with the staff people.
Julia Lurie: Because as hard as they made North Star for her, they were also there for milestones. When Trina got her first period, it was a staff member who taught her how to use a tampon.
Trina Edwards: It’s intimate, and so for them to know all of my first times, my first crushes, my first everything, it’s a lot. And I just wanted a family. I just wanted a mom and a dad to teach me all of my firsts.
Julia Lurie: I first talked to Trina over a year ago when I started investigating the placement of foster kids at places like North Star. Since then, we’ve kept in touch over the phone and had long conversations where she would be parenting in the background.
Speaker 5: Mommy, I go poopy.
Trina Edwards: You go poopy?
Speaker 5: Yeah.
Julia Lurie: As I asked her questions about her life at North Star.
Trina Edwards: Okay, give mommy a minute.
Julia Lurie: How are you spending your days at North Star? What did a typical day look like?
Speaker 5: [inaudible 00:07:23].
Julia Lurie: Every morning at North Star, Trina said she was required to write in a journal.
Trina Edwards: They would ask, on a scale from 1 to 10, how are we feeling? I’m locked in a damn building. How do you think I’m feeling?
Julia Lurie: And after this writing exercise, they would go to breakfast. Trina, like lots of kids at North Star was heavily medicated. She was put on an anti-psychotic that made her groggy.
Trina Edwards: You can’t go to breakfast and pick out what you want to eat for breakfast if you don’t take your medication in the morning.
Julia Lurie: Trina had a caseworker at Alaska’s office of Children’s Services. They were supposed to check in on her once a month, but Trina says she rarely heard from them. At times, she didn’t even know who her caseworker was. Trina tried doing North Star every which way. She got in fights and got kicked out of group therapy more times than she can count.
Trina Edwards: I’m not going to sugarcoat it, I was not a star player.
Julia Lurie: When she realized that wasn’t working, she decided to follow the rules to a T, but that didn’t work either.
Trina Edwards: I’m doing everything you’re telling me to do. I’m following the program. I’m being good. I haven’t gotten in trouble. I’m taking the medication that’s making me feel like shit, and I still end up with the same result. Nobody. I’m alone. They’re like, “Well, you just got to keep doing it.”
Julia Lurie: The forces keeping Trina in North Star were much bigger than whether she behaved or not. The Office of Children’s Services in Alaska has been in shambles for years. More than half of caseworkers leave every year. There are three times as many foster kids as there are licensed foster homes. Alaska puts kids in foster care at a rate that’s among the highest in the country. And two thirds of foster kids in Alaska are indigenous. Trina is part Yupik.
Trina Edwards: The staff people are like, “You really don’t need to be here. You just don’t have a foster home.”
Julia Lurie: Her medical records back this up. During one particularly long stay, Trina’s discharge was pushed back twice because there wasn’t a foster home for her to go to. She stayed there for another six months. No one from Alaska’s Child Welfare Agency would do an interview on the record, but in an emailed statement, they said that “Foster children are placed at North Star based on medical diagnosis and with the approval of a judge.” But the agency said that finding placements for kids with behavioral health needs is a nationwide challenge, and they admitted that some kids do experience delays while they wait for a lower level of care. Universal Health Services is the publicly traded company that owns North Star, it’s the largest psychiatric hospital chain in the United States that you’ve probably never heard of. They keep their branding off their facilities, but UHS operates one in six inpatient psychiatric beds across the country.
Speaker 7: Integrity, the word that I think about to describe UHS is doing the right thing.
Julia Lurie: When the company brought in $13.4 billion last year. Haley Morrissey didn’t know much about UHS back in 2013. She was a recent college grad, she studied fine art and psychology and she was looking for a job.
Haley Morrissey: And then a friend of mine told me that, “Oh, there’s this place called North Star in Anchorage and it’s always hiring.”
Julia Lurie: Haley worked at North Star when Trina was there, and as a recreational therapist, she felt like she was putting her training to good use. By 2018, she was on an outreach team marketing the facility in the community, that included reaching out to Alaska’s office of Children’s Services.
Haley Morrissey: We would send out care packages just being like, “Hey, we’re thinking about you guys. Thank you for all you do.” It’s a little nod, it shows that North Star is still there.
Julia Lurie: The gifts reminded the agency workers to practice self-care. There were North Star branded coffee mugs, and lip balm, and stress balls. Over time though, Haley began to have second thoughts. She watched foster kids come back to North Star again and again, and she says The facility was chronically understaffed.
Haley Morrissey: Yeah, you’d have people that were in director positions kind of being like, “Okay, well this person quit and this person quit, so okay, we only have one therapist now.”
Julia Lurie: One of those therapists was Jason Fidel. He started at North Star in 2016, so he overlapped with Trina and Haley and he saw new tasks constantly being added to his roster.
Jason Fedeli: As those responsibilities were added, the amount of time spent with the patient decreased significantly to where maybe you’d be able just to do a check-in with a patient, “Hey, how are you doing? You feeling good? Are you suicidal? What’s going on?” Some kids would get maybe 5, 10 minutes at the most.
Julia Lurie: Those minimal check-ins were so common they had a name.
Jason Fedeli: They used to call it a touch and go or a fly by. It’s like, “Just check in, do a fly by, how’s everyone doing?” It’s not real therapy.
Julia Lurie: Foster kids who spent time at North Star told me similar stories. They talked about not getting much therapy, feeling abandoned there, being overmedicated, and consistently they talked about violence, including Trina.
Trina Edwards: They had pinned me down to the floor. I remember one of the staff members’ knee on my back.
Julia Lurie: Medical records show that staffers thought she was part of a plot to run away.
Trina Edwards: And I could feel the weight of his body on top of me. I don’t know why you need to hold me down so much.
Julia Lurie: She was 12 and about to experience what the kids call booty juice and what the industry calls a chemical restraint. It’s an injection that’s only supposed to be used to sedate kids when they’re at risk of harming themselves or others.
Trina Edwards: And they had pulled my pants down, like forcefully ripped my pants down and gave it to me in the butt. And I feel like that’s something that you shouldn’t be doing to a child inside a facility like that.
Julia Lurie: Trina passed out, when she woke up …
Trina Edwards: I’m in this secluded room by myself and I can’t even open the door. I can’t get out of the room that’s feeling like it’s closing in on me. And I’m trying to tell them I can’t breathe, I’m really going to go through a panic attack if you don’t open this door.
Julia Lurie: Trina says staffers wouldn’t listen to her and kept her in isolation until eventually she fell asleep. I interviewed more than 50 people for this story, including former patients, former staffers, and other experts. I reviewed dozens of lawsuits, also a justice department investigation where I found similar allegations that UHS facilities were understaffed, held patients too long, and improperly used restraints and seclusion. No one from Universal Health Services would talk to me for this story, but the company did respond to written questions and they denied all these allegations. They said they have policies in place to ensure that staffing levels are appropriate, and restrictive practices are, “Used as a last resort to ensure safety for patients and staff.” They also claim that they are, “Striving to eliminate the use of restraints and seclusion.” The violence, the understaffing, the influx of foster kids, these are not new issues at psychiatric facilities. Ronald Davidson is a psychologist and the former director of the Mental health Policy Program at the University of Illinois at Chicago, and as part of a federal consent decree, he spent two decades monitoring facilities where Illinois Foster kids were sent.
Ronald Davidson: My staff and I, essentially flew around the country looking at these facilities and were horrified at what we found.
Julia Lurie: They found that understaffing was often at the root of violent and punitive disciplinary tactics. When there aren’t enough staffers, the staffers who are there more quickly resort to restraint and seclusion. We asked him about Trina’s experiences.
Ronald Davidson: You don’t put hands on a child who’s been physically or sexually abused, pull their pants down, and shoot a syringe in their butt and think that that’s going to be a therapeutic response to a child in crisis. It’s not just wrong, it’s insane.
Julia Lurie: Ron says a psychiatric hospital with enough trained staffers can almost always deescalate tense situations. The problem is staffers are expensive.
Ronald Davidson: When that is not part of your business model, then you immediately jump to the use of restraints and quiet rooms where you can simply lock the door on your problems and walk away with money in your pocket.
Julia Lurie: Understaffing wasn’t the only chronic problem Ron observed. He said many of the children he saw could have been treated in an outpatient setting and didn’t need to be institutionalized. We asked him about suicidal ideation, the reason Trina was sent to North Star to begin with. It’s an issue with a lot of nuance. It requires a meaningful evaluation to determine how serious the threat of suicide is.
Ronald Davidson: Is she really suicidal or just an angry outburst? Is she asking for help? And is the child truly at risk?
Julia Lurie: The decision to send Trina straight to North Star, it had ramifications way beyond that first day, because there’s a pattern that plays out for kids who are sent to facilities like North Star.
Ronald Davidson: Unfortunately, in many hospitals, the door only swings one way. You become a patient and you stay a patient, and whether you’re there for a week or a month, more often than not, you’re going to be readmitted even more angry and more upset and maybe stay longer because of the mistreatment or the failed treatment that you received.
Julia Lurie: Ron saw these problems play out at more than 400 facilities across the country, including ones owned by Universal Health Services.
Ronald Davidson: As far as UHS goes, they’re the biggest elephant in the room, obviously, but they dominate the marketplace.
Julia Lurie: We know that UHS dominates the marketplace when it comes to Alaska’s foster kids. Two thirds of the foster kids sent to psychiatric facilities go to places owned by the company and its expensive care, at North Star, more than $900 per night. Medicaid usually foots the bill. But I wanted to see just how often child welfare agencies across the country send foster kids to UHS facilities, so I submitted records requests to every state. 38 responded, and the data showed that over the past six years, foster kids were admitted to UHS facilities more than 36,000 times. In the handful of photos of Trina at North Star, she’s usually smiling, even in a photo taken on admission like a mugshot, Trina smiles against the gray backdrop. But her writing at North Star, that tells a different story. She brought her essays and journal entries to one of our visits.
I don’t want you to feel like you need to share everything if you don’t want to.
Trina Edwards: No. This is my authentic self. This was me at North Star.
Julia Lurie: She starts reading one of her essays.
Trina Edwards: Closed doors. Growing up it’s hush, hush, never say what happens in the home. You listen because they put fear in your heart. They say this like, “Do you want to be taken away from us?”
Julia Lurie: Trina takes long pauses, big deep breaths, then keeps going.
Trina Edwards: Teachers ask, “Are you okay? Can we help you with anything? Are things good at home?” There are days I wish I had never told them what happened behind those closed doors.
Julia Lurie: It’s a painful last thought. Trina had spoken up about being sexually abused at home. She had spoken up about her suicidal thoughts, but now North Star felt like a punishment for all this speaking up. Sometimes she wished she just stayed silent.
Al Letson: Trina had spent a total of two years at North Star when just before her 15th birthday, she got some news. She was being moved to another facility owned by Universal Health Services in Utah. That’s next on Reveal.
From the Center for Investigative Reporting and PRX, this is Reveal. I’m Al Letson. We’ve been talking about Trina Edwards, as a teenager she spent years cycling in and out of North Star, a locked psychiatric hospital in Anchorage and Trina was getting worse. Her medical records say she was depressed, oppositional, and bullying other kids. So in 2015, Trina learned she was being transferred to a different locked facility, owned, once again by Universal Health Services. This one was 3,000 miles away in Utah. Trina was nervous. She was nearly 15 and she’d never left Alaska before. On the plane she had on scrubs, two security escorts were by her side, and Trina says she was placed in handcuffs. It was humiliating.
Trina Edwards: I’m in society now. I’m not hidden behind closed doors. Other human beings can see me in handcuffs. I looked like a fucking criminal.
Al Letson: She was headed to Copper Hills, a sprawling campus on the outskirts of Salt Lake City. Once again, Trina felt stuck and she considered her options.
Trina Edwards: If I run away from this place, I don’t have money for a plane ticket. I’m thousands of miles away.
Al Letson: From the outside, Copper Hills actually looks nice. If you look at their website, there’s equine therapy, river rafting, and yoga, but inside the facility was spiraling out of control. Mother Jones reporter Julia Lurie interviewed multiple former staffers and picks up the story from here.
Julia Lurie: Five months before Trina arrived at Copper Hills, Utah’s Department of Human Services sent a letter to the facilities CEO. It said that Copper Hills was understaffed and improperly using seclusion rooms. The facility could face sanctions if things didn’t change.
Brian Blohm: They were very unhealthy financially and culturally.
Julia Lurie: Around this time, Brian Blohm became the facility’s new CFO. He was brought in around the same time that Trina got there in 2015. He was there to help make Copper Hills more efficient.
Brian Blohm: We made some changes. We cut a lot of costs.
Julia Lurie: But Brian had his limits. Take the details of his bonus plan.
Brian Blohm: Part of my bonus plan was based on EPOB, employees per occupied bed.
Julia Lurie: This is industry jargon for the ratio of staffers to patients. The goal was to minimize the cost of staffers. He tried to crunch the numbers.
Brian Blohm: I’m being paid a financial bonus for running staffing at lower than the state requirements. And so I thought that was weird to incentivize a leader to not meet the state regs financially.
Julia Lurie: So he took the problem to his higher up.
Brian Blohm: I said, “Hey, this EPOB is too low, it needs to be higher.” You know, and then it’s, “You can do it. You can just do it. Just do it.” Finally, I had said, “It’s literally under the state regs. We can’t run at this, look.” I showed them the books and then they kind of had to cave.
Julia Lurie: Brian was the CFO for four years. When I asked UHS about his comments, the company said they would never encourage unsafe staffing levels and they added that Brian was fired. Which is true, he was fired for retaliation. He said he was the victim of discrimination and he filed a complaint with Utah’s Labor Division. But Brian says the problem at Copper Hills wasn’t just staffing levels, there was also a push to fill beds. Copper Hills had a marketing team that pitched the facility across the country from school districts to child welfare agencies to native reservations.
Brian Blohm: They go to these referral sources and they say, “We redid this. Our food’s really good now. We have five open spots on girls and two on boys. Like you got anybody? You got anybody.”
Julia Lurie: Kids flew into Copper Hills from all over Nevada, New Mexico, Idaho. Brian says he felt pressure to make sure the facility was taking in kids, even kids who weren’t a good fit.
Brian Blohm: He said, “Yeah, we got five referrals yesterday, but they were all very violent and it’s not going to be safe.” They’ll probably get laughed at and say, “We’ll make it safe.” You got to have the doors open.
Julia Lurie: Other staffers have corroborated a lot of what Brian said. One told me that the pressure to fill beds meant making fast decisions on the referrals that would come in each morning.
Anna: Because if you don’t hurry and make a decision, they might decide to go somewhere else.
Julia Lurie: Anna was the clinical director at Copper Hills. That’s not her real name. She didn’t want to be identified because she still works in the field and didn’t want to face professional repercussions. Anna’s job was to oversee patient care. She and Brian were high up at Copper Hills while Trina was there. And around 2016, both say they were informed of a new goal, increase the length of patient stay from about seven months to about a year. They say they were instructed to hold patients until their insurance ran out rather than discharging them when they were ready.
Brian Blohm: Maybe they’re ready to go home today and maybe it’s their birthday tomorrow, but we have two weeks approved, we’ll just plan to travel for two weeks and maxing those out.
Anna: Even though we might have a resident who, after six months is good to go and ready to step down, we were encouraged to keep them longer because they would help to create stability on the unit.
Julia Lurie: Keeping the kids longer, foster kids fit well into this vision because often there were no family members clamoring to get them out. And Anna says the caseworkers on the outside, they were often relieved to have a place to put the kids. She says there was an upside for the unit too.
Anna: We have a really stable kid on the unit who’s not creating behavior problems and assaulting people, and then the clinical team’s been told, “Research shows that they’re really going to benefit the most if they’ve been here a year, so let’s do our best to keep them here a year at all costs.”
Julia Lurie: She never saw that research and Brian, he remembers being told the same thing.
Brian Blohm: If we have the ability to keep them off the street, or out of their abusive home, or away from their bad influence friends or whatever, then every day that they’re here, safe with us, is better for their life.
Julia Lurie: This lingering at Copper Hills is in effect what happened to Trina. She became a stabilizing member of the unit. Her resistance turned into something like acceptance. She remembers the exact moment it happened when a staffer took her on a walk and talked to her.
Trina Edwards: Her name was Callie. She’s pretty cool.
Julia Lurie: What was it about her doing that, that made you change your mind?
Trina Edwards: I don’t know, everyone else was talking to me like I was stupid and she just talked to me like I was an adult. And so I started acting like one for her.
Julia Lurie: Would it be fair to say that that shocked you and made you want to act like one?
Trina Edwards: No. It was a mix of that and just realizing that I’m not leaving.
Julia Lurie: Trina felt a sense of resignation, but at the same time things did start to go better. She started earning fake money based on good behavior called copper cash and buying snacks at the campus store. She participated in more activities for well-behaved kids like car washes and a cheerleading routine. For Trina, the tiniest bits of freedom that were offered at Copper Hills were a big deal.
Trina Edwards: There was a lot of downtime where the door was just open. You could freely just go outside.
Julia Lurie: After more than a year, Trina finally left Copper Hills. She was discharged to a less restrictive place, a group home in Anchorage, and this time when she flew back to Alaska, she wore normal clothes, her own shoes, no handcuffs. But the following months were hard for Trina. She testified in the trial of her mother’s partner whose sexual abuse led her to foster care to begin with. He was convicted and sentenced to 39 years in prison. Soon after, things started going downhill at the group home. This period is a blur to Trina now, but medical records show it was a dark time. She was sent to North Star twice in quick succession, both after serious suicide threats or attempts.
I think that probably a lot of people would hear something like that and say, well, it sounds like this person needed help.
Trina Edwards: I don’t think that the help that North Star was giving me was the help that I needed. I think I needed someone to sit down and not judge me. I think I just needed someone to say, “Yes, it’s okay to have a thought to want to die.” And, “Yes, it’s okay to feel this way because of the stuff that you went through at such a young age.”
Julia Lurie: By late 2016, it looked like Trina’s North Star stay was going like her other North Star stays. She was unhappy. She was resistant to treatment. Her psychiatrist expected her to stay a full year. When she was admitted, she was asked to list three things she wished for. They were to get out, to go to school, and to find a foster family. Then just before she turned 17, it all happened. A foster family came through and it was actually someone Trina already knew, a former North Star staffer. Trina told her psychiatrist she was very excited and happy about this. She was discharged early. By that point, she’d spent a total of three and a half of the past five years at UHS facilities, that included 891 nights at North Star. After Trina got out, her experiences being institutionalized for so long stuck with her. Her questions were endless.
Trina Edwards: When is an appropriate time to shower? Does my foster mom think I’m weird if I eat a snack right now and then I’m hungry again in five minutes?
Julia Lurie: She found herself waiting for a staffer with a key card to go from room to room.
Trina Edwards: I’d walk up to my room door and I’d wait a couple seconds and then I would be like, oh, I could just open my door. I don’t have to wait for my mom to open my door.
Julia Lurie: While Trina was navigating her new life outside of treatment centers, UHS found itself in a PR crisis. First, the media outlet, Buzzfeed, spent two years investigating the company and found that staffers were under pressure to fill beds “by almost any method.” But what really caught the attention of the local media were surveillance videos the reporter uncovered. They showed violence, abuse, and chaos, including at UHS facilities in Alabama and Oklahoma.
New Station: New at five o’clock, a former Shadow Mountain employee speaks out after a scathing internet article accuses the Tulsa facility of child abuse and misconduct.
WVTM 13: WVTM 13’s Chip Scarborough has the video that we caution some viewers may find hard to watch.
Julia Lurie: UHS strongly disputed Buzzfeed’s findings. But Buzzfeed wasn’t the only one scrutinizing UHS by that point, the Department of Justice was on the case too. They were talking to whistleblowers from UHS facilities across the country and the DOJ was in the process of investigating not just individual facilities but UHS as a corporate entity. The crisis was escalating.
Newport East 91…: Newport East 911 where is your emergency?
Foster kid: At Newport News Behavioral Health Center.
Newport East 91…: What’s going on?
Foster kid: We have a resident that is coded blue.
Julia Lurie: This call came in 2018 from a resident of a UHS facility for kids in Virginia. She was a teenager concerned about another patient.
Foster kid: The nurses are trying to help her, but I just had to call because I don’t trust it. They have been telling her she’s doing this to herself and she’s faking it. And I’m just really worried because I’m not sure they’re doing what they need to do to take care of her medically.
Newport East 91…: Okay.
Julia Lurie: Raven Nicole Keffer died that night of an allegedly preventable adrenal deficiency. She was a foster child, 17 years old. The state investigated and found that the center had violated more than a dozen regulations. Raven’s sister sued and settled with the facility last year for an undisclosed amount. I tried to talk to UHS about all of this Raven’s death, the DOJ investigation, kids being held even when it wasn’t medically necessary. In their written response, they said, “Leadership offered its deepest condolences about Raven’s death.” And said, “This was the only death of a patient while in the care of the facility.” They also addressed the DOJ investigation and said a portion of those allegations occurred under a different owner. They were adamant the company did nothing wrong. And when it comes to foster children, UHS said, “None of them get admitted unless they need to be, based on a doctor’s order.” They added that the kids haven’t been successful in other settings, they’ve disrupted many foster homes due to their “extreme behavioral issues.”
Many of the former foster kids I talked to agreed, they were difficult kids, and they did need mental health services, but they said facilities like North Star made them worse rather than better. They talked about this cycle. You’re put in a locked building separated from society, surrounded by violence with no idea when you’ll get out and you become more traumatized. You start acting out more, giving them reasons to keep you there, and this all has long-term consequences.
Trina Edwards: When I first went in there, I was really outgoing, happy. I came out with more problems than I entered.
Former Foster k…: I got used to the world being cold. I don’t expect anything more.
Trina Edwards: I have really bad anxiety now. I can’t go into public really.
Former Foster k…: I’ve never been able to connect with anybody.
Trina Edwards: I feel like I have to watch what I say because what I say can lead to me getting booty juice.
Julia Lurie: These former foster kids are adults now, they’re out in the world and they’re still feeling the impact of a childhood locked up.
Al Letson: In 2020, Universal Health Services settled with the federal government to resolve claims that will now sound familiar. The UHS admitted patients who didn’t need to be there to begin with that had flouted staffing requirements, didn’t provide adequate treatment and use restraints and isolation improperly. The settlement was for $117 million, just 1% of UHS’s revenue that year. UHS said it wasn’t an admission of liability and it settled to avoid distractions and the high cost of litigation. In a moment, how UHS’s strategy to settle and move on has paid off. You’re listening to Reveal.
From the Center for Investigative Reporting and PRX, this is Reveal. I’m Al Letson. Soon after Universal Health Services agreed to the settlement with the Department of Justice the company was facing a new kind of pressure. This one was coming from an unlikely but powerful advocate.
Barbara Walters: Paris Hilton, there’s a new breed of celebrity, famous for being famous.
Paris Hilton: That’s hot. That’s hot. That’s hot.
Al Letson: That’s all from the documentary This is Paris. In the 2000s, she was entertaining millions as a fixture of reality TV and the tabloids, but all the glitz covered up a painful past. When Paris was 16, her parents believed she was too rebellious and sent her to a psychiatric facility in Utah called Provo Canyon School.
Paris Hilton: I tell my story, not so that anyone feels bad for me, but to shine a light on the reality of what happened then and is still happening now.
Al Letson: Paris was testifying before Utah Senate Judiciary Committee in 2021. She was 39 and had recently gone public with physical and sexual abuse she endured as a teenager.
Paris Hilton: Although Provo Canyon School marketed itself as a premier treatment center, it was as if it was hell itself on earth. I cried myself to sleep every single night, praying I would wake up from this nightmare.
Al Letson: Paris stayed there for 11 months. Universal Health Services didn’t own Provo Canyon when Paris was there, but they bought it three years later and since then, the damning allegations of abuse have continued.
Paris Hilton: Provo Canyon School excuses their abusive behavior by saying they are now owned by a new company, Universal Health Services. UHS, you can’t silence me. The practices used and the staff employed remained and remained today the same.
Al Letson: Despite mounting outrage, legal settlements, and a celebrity speaking out, UHS is thriving and child welfare agencies keep sending foster kids to facilities with troubling track records. In the final chapter of today’s show, Mother Jones reporter Julia Lurie investigates how UHS has become part of what some call the child welfare industrial complex.
Julia Lurie: To understand Universal Health Services, you have to go back to the man who founded it, Alan Miller. Alan grew up in a working class neighborhood in Brooklyn in the 1940s. He played basketball in college, did a stint in the army and got his MBA from the Wharton School.
Alan Miller: Always was competitive and once I got into something, I wanted to be the best at it.
Julia Lurie: This is Alan in 2010 when he won the Horatio Alger Award. The award is given to people who are supposed to personify the American dream. People who went from humble beginnings to wealth and sometimes fame justice. Clarence Thomas, Oprah Winfrey and Billy Graham have all won the award and Alan fits the mold, he’s built an empire of medical and psychiatric hospitals. He’s a billionaire today, the kind who gets invited to talk on the Fox Business Channel.
Fox Business Ne…: Welcome back. Earnings alert, Universal Health Services reporting after the bill last night, profit and revenue up from a year ago. The company-
Julia Lurie: It was 2018 and Alan was there to talk about the company’s financial growth and about growth in the mental health industry.
Alan Miller: The demand is so great that the business is just a very sound business, and we’re and have been from the outset, a pioneer in mental health.
Julia Lurie: Alan started Universal Health Services in 1979 and his timing was perfect. State psychiatric hospitals were shutting down all over the country and private facilities stepped in to fill the gap. In the 1980s, the for-profit psychiatric hospital industry exploded. At the same time, more and more kids were being placed in foster care, largely because of new mandatory reporting laws. People like teachers, doctors, and social workers were now required to report suspected cases of child abuse or neglect. Reported cases skyrocketed from 60,000 in 1974 to about 3 million in 2000 ,and all those kids, they needed places to go.
Ronald Davidson: Well, along comes large corporations with beds to fill and they parachute into these different states and counties with a solution, a ready-made solution. You got kids, we got beds.
Julia Lurie: That’s Ron Davidson, the psychologist we heard from earlier. He and his team spent years evaluating psychiatric facilities, writing reams of reports for the state of Illinois. He later served as a confidential informant for the DOJ investigation into UHS.
Ronald Davidson: Of those 400 reports that we did, you’ll find countless reports where we not only slammed the hospitals for the problems that we found, we mercilessly slammed the Department of Children and Family Services.
Julia Lurie: For Ron, there were two groups to blame, failing child welfare agencies and for-profit companies like UHS that made money off of those failing agencies. This created what he calls the child welfare industrial complex.
Ronald Davidson: Foster care kids are a highly profitable cash cow for corporations, who essentially are not run, by the way, by medical or psychiatric professionals, they’re run by business people.
Julia Lurie: For things to change, Ron says you need more social services for struggling families so that fewer kids enter the foster care system to begin with, and more community-based mental health programs so that kids can stay home rather than being institutionalized. Last year, the Department of Justice said something similar about Alaska, Trina’s home state.
Speaker 22: The Department of Justice released findings in mid-December about an investigation into allegations that the state of Alaska violated the Americans with Disabilities Act when it comes to children.
Julia Lurie: The DOJ accused the state of segregating kids with mental health issues in institutions instead of providing them treatment in their homes just like Ron said. It was another damning report, but rather than calling out UHS, this time the DOJs focus was on Alaska for allowing kids to languish at places like North Star. I keep thinking about this deposition I read, it came from the case of a former foster kid named Nathan Presley. He was sent to North Star again and again starting when he was just five years old. And as an adult he sued Alaska’s office of Children’s Services for negligence. There’s no recording of this deposition, so I asked some folks here at Reveal to read it. Nathan’s lawyer is questioning an official from OCS.
Speaker 23: So Nathan didn’t really belong at North Star anymore because he didn’t meet that level of care and he was already stabilized, at least as far as North Star goes, but there wasn’t any place else with the right level of care to put him.
Speaker 24: Correct.
Speaker 23: So he just stayed locked up in a psychiatric facility?
Speaker 24: Yes.
Speaker 23: For months?
Speaker 24: Yes.
Julia Lurie: Foster kids have long suspected that they were being warehoused. And here’s Alaska’s child Welfare Agency confirming that in this one case that’s exactly what happened, but instead of taking responsibility, they shifted the blame. The Office of Children’s Services turned around and sued North Star. Both ultimately settled with Nathan last year for an undisclosed sum. Now, there’s another former foster kid suing.
Trina Edwards: Sometimes when I think about it, I’m like, I’m actually going to change something, maybe make somebody else’s life a little easier.
Julia Lurie: Trina is suing North Star and UHS for battery and false imprisonment. Her lawsuit is still pending, but North Star, they’ve turned around and sued Alaska’s Office of Children’s Services. The finger pointing continues.
Speaker 5: Hey.
Trina Edwards: It’s going to be around that light.
Julia Lurie: Okay. On a windy day this past spring, I pick up Trina and her kids from her apartment on the outskirts of Anchorage. We drive to North Star.
Trina Edwards: There’s North Star. This is intense.
Julia Lurie: When’s the last time you were here?
Trina Edwards: This is the very first time I ever came to North Star.
Julia Lurie: Wow. So I’m just going to put us in park.
Speaker 5: Why you stop?
Julia Lurie: We stopped because we’re just going to talk for a second.
Speaker 5: For a second.
Julia Lurie: Talk for a second.
Speaker 5: Oh.
Julia Lurie: Walk me through where we are right now.
Trina Edwards: In like how I’m feeling?
Julia Lurie: Mm-hmm.
Trina Edwards: I don’t know, anxiety mostly.
Julia Lurie: About being here specifically?
Trina Edwards: Yeah. I didn’t realize how traumatic growing up in the treatment facility was until just now. This is my childhood in one building. It’s a lot. It’s a lot to take in.
Julia Lurie: Trina and I get out of the car. It’s a surreal moment. Behind us on the other side of the car windows, her kids are in the backseat watching The Lorax. In front of us are the big reflective windows of North Star, the windows she spent countless hours looking out of when she was a child. What do you think of the kids who might be looking out the window right now?
Trina Edwards: They’re probably thinking the same thing I thought, a way to escape. Probably just staring out the window, bored, waiting for the next therapy session to happen, or class, or lunch. They had you on a strict schedule. I feel so unorganized because growing up that’s how I lived, on a strict schedule. I waked up at a certain time. I eat at a certain time. I poop at a certain time. I breathe at a certain time, to going to being able to do that whenever, I don’t know what to do with myself. I think if you were to look up institutionalized in a book, you’d see a picture of me. It’s actually the definition of institutionalized.
Julia Lurie: Trina takes it all in. She points out the fenced in play area outside where there was always a deflated basketball. The door she tried to escape from once. The bank with customers she used to make up stories about, but her eyes keep coming back to the windows like she’s searching for something.
Trina Edwards: You know, the first time I came here, I didn’t know that the windows were like mirror windows. You can see yourself, so when people would walk up, I’d bang on the window thinking they could see me, cry for help. They can’t see me at all, they just heard banging. That’s about it.
Al Letson: That story was reported by Julia Lurie from Mother Jones, you’ll find a link to her written story on our website. Our lead producers for this week’s show was Neroli Price and Katharine Mieszkowski. Unfortunately, this is the last show we’ll be doing with Katharine as she’s moving on to another job. I have to tell you that Katharine is an amazing producer, but also an amazing human being, and she’s my friend and I will miss her dearly. They had help from Julia Lurie. Cynthia Rodriguez edited the show. Special thanks to Michael Montgomery as well as to our partners at Mother Jones, Ian Gordon, James West, and Katie Hirshenrotter. Nikki Frick is our digital producer. Victoria Baranetsky is our general counsel. Our production managers are Steven Rascon and Zulema Cobb. Score and Sound Design by the dynamic duo, Jay Brezy, Mr. Jim Briggs, and Fernando, my man, yo, Arruda. Our CEO is Robert Rosenthal.
Our COO is Maria Feldman. Our interim executive producers are Taki Telonidis and Brett Myers. Our theme music is by Comarado, Lightning. Support for Reveals provided by the Reva and David Logan Foundation, the Ford Foundation, the John D. And Catherine T. MacArthur Foundation, the Jonathan Logan Family Foundation, the Robert Wood Johnson Foundation, the Park Foundation, and the Hellman Foundation. Reveal is a co-production of the Center for Investigative Reporting and PRX. I’m Al Letson, and remember there is always more to the story.