EDITOR’S NOTE: Due to stigma attached to mental illness and sexual assault, this article assigns the pseudonym Marie to a child committed to a psychiatric hospital. Her parents are identified by their first names only. And a caution: This article mentions self-harm, suicide and sexual assault. If you need mental health support, call or text 988 or consult this resources page.
By Taylor Knopf
When Dan and Megan reflect on their decision to take their 11-year-old daughter to the emergency room for psychiatric help, they say they wouldn’t do it again.
Their daughter, Marie, had struggled with anxiety and depression for a few years, in part because of a chronic pain condition that causes her to be easily injured. And after a close relative died by suicide in the summer of 2021, her mental health worsened. She started talking about harming herself during therapy sessions.
By Labor Day, Marie told her psychiatrist that she was thinking about ending her own life. She named specific ways she would do so.
The psychiatrist told Marie’s parents that in order to keep their daughter safe, they should take her to the emergency room so that she could be admitted to a higher level of psychiatric care. So they did.
But her parents say that the system that was supposed to help Marie only hurt her further.
The 11-year-old from Durham spent a week last September locked inside Brynn Marr Hospital, a privately owned psychiatric facility on the coast of North Carolina, far away from her family with few opportunities to talk over the phone.
Marie described being in a co-ed unit with kids several years older than her. She says she witnessed fights break out, followed by blaring alarms and “lockdowns” in their rooms. She also says she was harassed and called vulgar names by other patients.
Then on the day before she was released, Marie alleges she was sexually assaulted by an older patient.
“Our worst fears came true,” Dan said.
Not the first incident
After her hospital stay, Marie was diagnosed with post-traumatic stress disorder, according to the child’s medical records, which North Carolina Health News reviewed with her parents’ permission.
Marie now needs advanced warning of loud noises, like fire alarms at school. For months after her hospitalization, she struggled to fall asleep due to recurring nightmares of being sexually assaulted.
Reports of sexual assaults at Brynn Marr are not rare. Local police records show that Jacksonville police received 117 calls with reports of sexual assault or rape at the hospital over the last three and a half years. Police records show an uptick in sexual assault reports after the pandemic began.
Brynn Marr Hospital CEO Cynthia Waun said the hospital “complies with all state and local requirements for contacting law enforcement if an allegation of abuse is made by a patient or a family member. It is the facility’s legal obligation to do so in order for an investigation to occur.”
“It is the role of law enforcement to assist with the investigation to determine its validity. These calls are made in order to ensure that patient safety is maintained,” she wrote in an email response to NC Health News.
Marie and her family said they are sharing their story because they don’t want anyone to go through similar trauma. Families need to be warned, they said, that North Carolina courts, psychiatric hospitals and state regulators don’t always shield vulnerable kids from harm.
And when they are hurt by the mental health system, they and their families often have little recourse.
“In our pain and our suffering, we’re trying to help other people avoid it,” Dan said.
Dan is an attorney and Megan is a research psychologist. Despite their knowledge and connections, they struggled to navigate the mental health crisis system for their child.
For one, early on they had no idea many complaints were filed against Brynn Marr Hospital and its parent company.
Under involuntary commitment
Two sheriff’s deputies drove Marie three hours from the emergency department at Duke University Hospital to Brynn Marr Hospital in Jacksonville.
Because she was under a court ordered involuntary commitment, she was transported from Durham to Onslow County by law enforcement officers. Her parents were not allowed to ride in the vehicle with her and were asked to not directly follow the officers.
Involuntary commitment is a legal process that is supposed to be a last resort when a person is determined to be an immediate danger to themselves or others. Involuntary commitment petitions have increased at least 97% — from 53,779 to 106,175 — in North Carolina over the last decade as hospital emergency departments regularly use the legal tool to handle the droves of patients in need of psychiatric care, as NC Health News previously reported.
An involuntary commitment allows hospital staff to make decisions for patients and provides secure transportation between hospitals. Some North Carolina physicians have said that commitment paperwork is necessary to secure beds at certain facilities.
Committed patients temporarily lose the right to make their own decisions while treated for psychiatric problems or substance use. The process usurps the rights of a parent or guardian to make health decisions for a child too — a reality that can surprise parents, including Dan and Megan.
They had read negative reviews about Brynn Marr online and didn’t want their daughter sent there. But because space in North Carolina’s psychiatric hospitals is limited and in high demand — especially during the pandemic — patients are often sent to the first available bed.
When officers dropped Marie at Brynn Marr, she was alone. When her father arrived with clothes and books — only some of which she was allowed to keep with her — Dan said he was told that family couldn’t visit her due to COVID restrictions.
But inside patients were not allowed to wear masks to protect themselves against the virus because of the ear loop strings, Marie said. That was problematic for Marie who struggles from a weakened immune system due to several health conditions.
Dan said he left the hospital shaken and in tears.
Inside, Marie said she was taken for a strip search by a male hospital worker who looked for and documented marks on her body, which she said made her incredibly uncomfortable.
Larger problems loom
Brynn Marr Hospital is one of hundreds of health facilities owned by a large for-profit company called Universal Health Services, which has faced scrutiny. Because the hospitals receive taxpayer funded payments from Medicare and Medicaid, state and federal officials regulate them.
Following multiple reports of abuse and neglect, the chairs of two U.S. Senate committees on health and finance sent stern letters to the leaders of four companies that operate youth mental health treatment facilities, including Universal Health Services.
“We are concerned by numerous stories of exploitation, mistreatment and maltreatment, abuse and neglect, and fatalities in these facilities,” Sen. Patty Murray (D-WA) and Sen. Ron Wyden (D-OR) said in a press release earlier this year.
The senators are requiring the company executives to “provide information about any instances of abuse or neglect; any complaints, inspections, and investigations; funding sources; and details about their policies and use of restraint and seclusion,” according to the press release.
In 2020, Universal Health Services agreed to pay $117 million to resolve allegations made in more than a dozen cases across multiple states. The company was accused of knowingly filing false claims for payment for behavioral health services that were not necessary or were not appropriately provided, according to a U.S. Department of Justice statement.
The company resolved the case without admitting guilt and continued to deny the allegations after the government announced the settlement agreement.
In addition, Universal Health Services entered a five-year agreement with the U.S. Department of Health and Human Services’ Office of the Inspector General that requires an independent monitor to conduct annual reviews of the company’s behavioral health claims to federal health programs.
“The government further alleged that UHS’s facilities billed for services not rendered, billed for improper and excessive lengths of stay, failed to provide adequate staffing, training, and/or supervision of staff, and improperly used physical and chemical restraints and seclusion,” reads the DOJ’s statement announcing the settlement.
The DOJ alleged that the company’s mental health facilities didn’t properly develop and update patient treatment and discharge plans and that they didn’t provide required individual and group therapy services.
This state’s Department of Health and Human Services has investigated several complaints at Brynn Marr Hospital in recent years, citing the facility’s residential treatment unit, located in the same hospital where Marie was admitted, for more than a dozen deficiencies. Some include failing to properly train staff on alternatives to using restraints and failing to report serious incidents to the proper agencies — which is required by law — including when patients are placed in restraints or seclusion and if patients attempt suicide.
The state cited Brynn Marr multiple times for failure to maintain proper staff to patient ratios. One incident resulted in two patients attacking a staff member, stealing her keys and escaping the facility last year, a state document describes. In another incident, one staff member was left to supervise 14 patients during which time a fight broke out and a patient ended up in the emergency department, the state reported.
Marie’s parents knew none of this when their daughter arrived at Bynn Marr struggling with depression and talking about suicide.
Inside Brynn Marr
Dan and Megan were shocked when Marie told them over the phone that she was in a co-ed hospital unit with kids up to 15 years old. The majority were boys who often got into physical fights, triggering alarms and scaring younger patients, she said.
When Marie was involuntarily committed, her parents say they recall being told by the attending psychiatrist at Duke’s emergency department that she had been accepted to a unit for girls 12 and under.
Most of the day at the hospital was spent in a lounge-like area where kids played cards or colored, Marie claims. A schedule on the wall indicated there should be daily group sessions, but she said they didn’t always happen. The only sessions Marie remembers were a story time where they read a short children’s book and a class about human anatomy.
“As someone who’s done a lot of group therapy or therapy, there was nothing that I would define as therapy,” Marie said during an interview.
Marie alleges she had a total of two 15-minute conversations with a psychiatrist during the week she was there. But her medical records indicate that a psychiatrist billed her insurance for daily visits. Meanwhile, Marie’s parents say the psychiatrist assigned to care for Marie did not make herself available to answer her parents’ questions.
After a few days, Marie became sick with a stomach virus and was kept away from other patients due to her symptoms, she said. She remembers soiling her sheets and clothes in her sleep and waiting for hours for staff to come help. During that time, she said she was served a hot dog, coleslaw and cake to eat on a sensitive stomach.
“I’m in a situation that I can’t control, where I’m locked in my room for hours, and I feel like I’m dying, like vomiting,” Marie said. “And like, just, everything’s awful.”
She said a teenaged female patient who was also sick was later placed in the room with her. Marie said she’d seen this patient meltdown in front of others, throwing things and hitting people.
“So we were alone in this room together all day. We weren’t allowed to leave,” she said.
It was there, Marie said, that the older patient sexually assaulted her.
“I didn’t tell anyone because, one, I was scared of her,” Marie said. “And second, she had told me herself that someone had done the same thing, like another kid, to her. And no one did anything when she told [staff], a couple days before it, so I didn’t want to cause any problems.”
“At the time, I didn’t know when I would leave,” Marie said. “So I kind of couldn’t make waves.”
Jacksonville police and the Onslow County District Attorney’s Office didn’t respond to requests for interviews about the reports of sexual assault or rape at the hospital. The police department released the log of calls from Brynn Marr and select transcripts of 911 calls with nearly all specific information redacted.
‘15 days’
At home in Durham, Dan and Megan said they spent hours trying to reach Marie or hospital staff on the phone for updates and were horrified at the details they learned from their daughter.
“It was clear that this was not a safe place for her to heal,” Dan said.
They said when they spoke to hospital staff, most of their questions were met with: “I don’t have a lot of time” or “We’re short staffed” or “I don’t know, I’m new.”
After one week, in keeping with the involuntary commitment process, a Brynn Marr representative, an attorney appointed to represent Marie and her parents met virtually before a judge who would decide whether Marie would be released or stay up to 15 more days.
Dan and Megan told an Onslow County District Court judge about how scared their daughter was inside the hospital, they said. And they explained they had lined up an extensive outpatient treatment plan for her away from Brynn Marr, with an intake appointment scheduled for the upcoming week.
When the judge asked for the hospital’s recommendation, Dan claims that the Brynn Marr representative, a physician who had not treated Marie, uttered only two words: “15 days.”
The Brynn Marr representative offered no explanation for why Marie should stay at the hospital, Dan said. And the attorney representing her wasn’t given an opportunity for cross-examination, a right that cannot be denied under state law, he said.
“It was such a short circuiting of the statutory process,” Dan said. “It disturbed me.”
The judge was ready to grant the hospital’s request, but being an attorney, Dan was comfortable pushing back, he said. He told the judge that the family’s treatment plan for Marie would fall apart if she stayed at Brynn Marr, he said, and the judge reconsidered and ordered Marie’s release.
At the time, Dan said he considered filing a lawsuit against Brynn Marr but there was a moratorium on medical malpractice lawsuits related to Gov. Roy Cooper’s state of emergency order during the COVID-19 pandemic.
So Dan and Megan did what they could. They contacted their local state representative, spoke to a reporter and filed a complaint with state regulators.
Complaint filed
In the complaint Marie’s parents submitted to the state Department of Health and Human Services in June they say Brynn Marr “did not comply with the [involuntary commitment] process in good faith and in the best interest of our daughter’s well-being.”
They allege, among other things, that Brynn Marr had poor or no communication with them or Marie regarding patient expectations. “Our daughter was not provided with rules and later disciplined for breaking a rule she wasn’t aware of,” the parents wrote in their complaint.
They claim Marie’s belongings were confiscated after she asked a question about one of the hospital’s safety protocols.
Dan and Megan claim that Marie was placed on a violent co-ed unit with patients several years older and received poor treatment while sick. They recount that Marie saw a psychiatrist only twice, but claim that they were billed for daily visits by the psychiatrist.
The parents described in their complaint the allegations that their 11-year-old was sexually harassed and later sexually assaulted by another patient.
Brynn Marr CEO Cynthia Waun said she could not comment on specific patients, but pushed back on several allegations. “The assertion that Brynn Marr misrepresented that a bed was available for a specific 11-year-old patient is completely inaccurate,” she wrote in an email to NC Health News.
Waun said that Brynn Marr doesn’t have a dedicated unit for females aged 12 and younger. Brynn Marr does have inpatient programs for patients aged 5 to 12 and another for patients 13 to 17, according to the hospital’s website.
Patients are not punished for asking about the hospital’s safety protocols, Waun said. “We categorically deny any such unfounded accusation,” she wrote, adding that patients and guardians receive a handbook during admission that explains the hospital rules and expectations.
Marie and her parents say they never received a handbook.
Waun wrote that hospital protocol is that patients are “seen daily including on weekends by a provider which may include telehealth consultations.” She added that the “standard operating procedure is that the on-call physician is responsible for participating in county court proceedings, not necessarily the attending physician.”
She noted that those physicians are briefed before court hearings and have access to patients’ medical records, including records of exams relevant to involuntary commitments.
Complaint dismissed
Dan and Megan said they were “beyond disappointed” when they received a letter in July from the state Division of Health Service Regulation saying it would not be investigating their complaint.
“We regret that the care provided by this hospital has not been satisfactory,” the letter stated. After reviewing the complaint, “we do not believe an investigation is warranted at this time.”
Because Brynn Marr is accredited by a national agency called The Joint Commission, an investigation of hospitals with this accreditation are only conducted if “the complaint alleges deficiencies of such severity as to place the facility in noncompliance with applicable program requirements,” the letter concluded.
That response did not sit well with Rep. Graig Meyer (D-Durham) who emailed a copy of the complaint to state Health and Human Services Sec. Kody Kinsley in late July asking that his department investigate or give a “full explanation as to why alleged sexual assault of a child put in the care of a hospital for treatment does not rise to the level of severity that warrants investigation.”
A week after Meyer got involved, the state followed up with an email to Dan and Megan saying that the health department would reopen the issue and schedule an investigation.
But the parents have not received any communication about it since then, they say.
Waun told NC Health News in November that Brynn Marr has not been told of an official complaint investigation regarding its acute psychiatric services from the state since April.
“I think this case stands out because of the number of issues that it brought together,” Meyer said in a interview, “and the failure in the system in one particular family’s case and the severity of what happened seems to me like it obviously deserves attention from state leadership, including both the Department of Health and Human Services and the General Assembly.”
“If DHHS was not going to look into it, then at the very least, I want to know why,” he said.
Distrust of a ‘broken’ system
Dan and Megan acknowledge that their daughter needed intensive care when they brought her to Duke’s emergency department. Her mental health issues weren’t new and had escalated over the pandemic.
Around Christmas of 2020, Marie wouldn’t come out of her bedroom. After recovering from a bad tonsil infection, she just wasn’t the same, her parents said. She stopped texting and calling friends. Megan said she had to coax her daughter out of her room to join family dinners.
By the spring, Marie started seeing a psychiatrist who diagnosed her with clinical anxiety. With some medications and regular therapy appointments, her symptoms improved. That summer she again enjoyed activities like swim practice, even with the limitations from a pain condition.
Marie’s parents were encouraged. She seemed excited to start middle school and was making friends, her mother said.
But when a close relative died by suicide that summer, things took a turn for the worse. Marie started talking about being a burden to her family in therapy sessions. Losing a loved one to suicide can be a significant risk factor for someone already struggling with their mental health, her parents later learned.
Then Marie’s psychiatrist warned that she was disclosing she was thinking about hurting herself and suicide and needed to go to the hospital.
But Marie left the psychiatric hospital worse than she was when she went in, she and her parents say. She’s spent the past year working through new traumas and symptoms of post-traumatic stress disorder, her medical records show, with dialectical behavior therapy, a treatment that’s new to Marie and has really helped.
“I’m doing my best every day to recover and it gets easier the more you try,” Marie said, who is now 12.
The hospital stay scarred her in more ways than one, she said. She has a lot less trust in the mental health system.
“I know there are good places, but from what I’ve seen, I really can’t trust in that,” Marie said. “I’m still sometimes nervous to be honest with my therapist, because I’m scared that I’m gonna get sent to a place like that again.”
She said she hopes explaining all that happened to her might raise awareness about the problems so no one else gets hurt.
“I just want a safer environment for different kids that come from different walks of life to get the support they need without facing anything like what I went through,” she said.
When asked what they would do if their daughter faces another mental health emergency, the parents said “we don’t exactly know what we would do because we realize the system’s broken.”
While the family has many concerns about the treatment of children at Brynn Marr, they don’t necessarily want a hospital with needed youth psychiatric beds to close. They want mental health care for kids like Marie to improve.
“What would be better is for them to do things the right way and actually help kids,” Dan said.
This article was supported by a grant from the Fund for Investigative Journalism and co-published with McClatchy North Carolina.
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