Psych hospital failed to provide ‘safe and therapeutic’ environment

Psych hospital failed to provide 'safe and therapeutic' environment

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. A caution: This article mentions suicide and sexual assault. If you need mental health support, call or text 988 or consult our resources page

By Taylor Knopf

Federal regulators have threatened to terminate Medicare funding to a psychiatric hospital in eastern North Carolina after a series of visits to the facility, which started with a complaint alleging mistreatment and sexual assault of an 11-year-old patient. 

State regulators made a surprise visit to Brynn Marr Hospital, a privately owned facility in Jacksonville, after news reports late last year detailing the alleged mistreatment and assault of the child. Among other violations, state regulators substantiated the claims that the hospital “staff failed to supervise to provide a safe and therapeutic environment for behavioral health patients” and “failed to ensure daily visits from a psychiatrist.”

State and federal regulators conducted on-site investigations at Brynn Marr in December, January, February and March. In February, regulators put the hospital under “immediate jeopardy” after they determined that an adolescent patient had escaped the facility.

Click here to view the Brynn Marr plan of correction document.

Immediate jeopardy is the most severe citation a hospital can receive from the federal regulatory agency, the Centers for Medicare & Medicaid Services (CMS). It means the hospital has failed to meet one or more federal health, safety or quality regulations, according to CMS. The citation indicates that serious injury, harm, impairment or death has occurred or is likely to occur to one or more patients, and immediate action is necessary.

The adolescent patient at the center of the initial complaint that sent state regulators to Brynn Marr was hospitalized at the facility against her parents wishes in the fall of 2021, reporting published in North Carolina Health News, The News & Observer and The Charlotte Observer detailed. Then 11-year-old Marie was at risk of suicide and, at the suggestion of her psychiatrist, her parents took her to the emergency room at Duke University Hospital in Durham. 

Even though her parents consented to treatment, Marie was placed under an involuntary commitment order by a judge at the request of hospital staff. Involuntary commitments are supposed to be used when a patient is a danger to themselves or others, and it forces the patient to undergo psychiatric treatment.

The parents objected to their daughter being sent to Brynn Marr based on its poor reviews online, but since Marie had been placed under an involuntary commitment order, their parental rights were limited. Their wishes were overruled by the hospital staff and, under that commitment order, sheriff’s deputies drove Marie three hours away to Brynn Marr.

Her parents’ worst fears came true, they said. 

In June 2022, the parents filed a complaint with the state health department alleging that their daughter was called vulgar names by other patients and sexually assaulted by a teenage patient. These allegations are not uncommon at Brynn Marr. Local police received 117 calls with reports of sexual assault or rape at the hospital between April 2019 and September 2022, NC Health News previously reported.

Out of compliance, but accepting patients

In March, CMS removed Brynn Marr’s immediate jeopardy status. However, the hospital remained in noncompliance with every one of the main categories of the Medicare Conditions of Participation for hospitals. These are minimum health and safety standards that hospitals must meet to receive funding from Medicare and to maintain their hospital’s accreditation with the Joint Commission, the nation’s largest hospital accreditation organization. 

On March 27, CMS sent a letter to the hospital, saying if Brynn Marr did not fix its issues and submit an acceptable plan detailing how the facility would correct the problems, the hospital’s agreement with CMS would be terminated on June 2. That termination would result in the institution losing federal payer reimbursements, something that could cause the hospital to close. The hospital has now submitted a plan of correction that details the steps hospital staff is taking to fix the issues. Brynn Marr is waiting for another inspection, which will determine if the hospital will be deemed back in compliance with federal regulations. 

“We are confident that we will demonstrate substantial compliance upon resurvey prior to June 2, 2023,” Brynn Marr CEO Cynthia Waun wrote on May 3 in an emailed statement. “Brynn Marr Hospital is committed to providing the highest standards of psychiatric care to adults, adolescents and children.”

Immediate jeopardy is a rare occurrence. One study which looked at 30,808 deficiencies cited by CMS in the nation’s health facilities over a recent 10-year period found that only 730 — or 2.4 percent — were cases of immediate jeopardy. The study also found that institutions where a patient death occurred were more likely to receive such a citation. 

Although the hospital has been out of compliance for several months, patients continued to be involuntarily committed and sent to Brynn Marr. 

On March 29, Michelle Vanstory took her teenage son to UNC Medical Center in Chapel Hill for psychiatric help. When hospital staff said they would be sending her son to Brynn Marr under an involuntary commitment order, she and her son’s father expressed “vehement disagreement,” according to the teenage patient’s medical records reviewed with his mother’s permission. The parents brought their son to the hospital voluntarily, consenting to treatment. They objected to the involuntary commitment order and the placement at Brynn Marr. 

Vanstory said she had read Marie’s story in NC Health News, and she pointed out to emergency department staff the number of sexual assault complaints at the hospital over the past three years.

“We were very clear,” she said. “We wanted to get an injunction to stop the transfer and to find another place for him to go that wasn’t horrifying.”

According to Vanstory, emergency department staff at UNC Medical Center overruled the parents, and her son spent four days at Brynn Marr. She said she was present in Brynn Marr’s lobby each day and saw patients continue to arrive by police car to the hospital for admission. 

A patient under an involuntary commitment order arrives by sheriff at Brynn Marr Hospital in Jacksonville on April 3. Credit: Michelle Vanstory

The NC Department of Health and Human Services’ Division of Health Service Regulation is responsible for licensing inpatient psychiatric hospitals, including Brynn Marr. In June of last year, NC Health News requested several years worth of complaints against Brynn Marr and the follow-up investigative reports by the division, which are all public record. As of May 9, 2023, those reports have not been received. 

When NCDHHS surveyors act on behalf of CMS, a federal agency, to investigate complaints made against hospitals, there can be additional steps in fulfilling records requests that can lengthen the time it takes to deliver records, a department spokesperson explained. The spokesperson said the department is working to fulfill NC Health News’ records request and sent an emailed statement and the latest letter from CMS to Brynn Marr. 

“No child should ever experience trauma or harm while in the care of a health care facility, and NCDHHS takes all allegations of harm very seriously,” a department spokesperson said in an emailed statement in April. “The Brynn Marr investigation represents a broader child behavioral health crisis our state and country are experiencing — increasing numbers of children who have complex behavioral health needs and fewer places for them to receive treatment.” 

“Treatments and supports must be delivered locally, in the communities where children reside, to provide the least restrictive environment for help. The reimbursement rates paid to providers across the behavioral healthcare continuum must be sufficient to recruit and retain experienced staff and to provide quality care and services,” wrote the department’s spokesperson, adding that these are some of the solutions proposed in Gov. Roy Cooper’s $1 billion mental health investment plan

Complaint sparks investigation

In addition to alleging sexual assault, Marie’s parents named several other issues in their official complaint to the state health department. 

Her parents, Dan and Megan, alleged that their 11-year-old was placed on a violent co-ed unit with patients several years older who regularly got in fights, triggering blaring alarms followed by patients being locked down in their rooms. As a result of these experiences, Marie was diagnosed with PTSD, according to medical records reviewed by NC Health News with her parents’ permission.

The parents’ complaint alleged that during their daughter’s weeklong stay, she only saw a psychiatrist twice for a couple of minutes, but claimed that they were billed for daily visits by the psychiatrist. 

The parents wrote in their complaint that their daughter received poor treatment while physically ill and was left to sit for hours in soiled clothes. After Marie contracted a stomach virus during her hospital stay, the parents claimed she was served an inappropriate diet, including a meal that consisted of a hot dog, coleslaw and cake. 

Lastly, the parents alleged that Brynn Marr staff had poor or no communication with them or Marie regarding patient expectations and facility rules. They claimed Marie’s belongings were confiscated by staff after she asked a question about one of the hospital’s safety protocols. 

Initially, Dan and Megan’s complaint to the state health department was dismissed. But after a state lawmaker got involved, the department said it would reopen the case. Nonetheless, no one from the department visited the facility.

“A legislator did intervene, and they still didn’t go out there,” Dan said. “It’s mind-blowing to me.”

It wasn’t until after NC Health News copublished Marie’s story with News & Observer and the Charlotte Observer that Dan received a call from a state health department representative informing him that regulators were on site to investigate his complaint.

Dan said he doesn’t think the state would have investigated without the story being published, which he said made him angry for all the other children who go through the mental health system who are “silenced or ignored.”

Impacted lives

In January, Marie’s parents received a letter from the state health department that said regulators had substantiated four out of the eight allegations in their complaint against Brynn Marr. The letter said “facility staff failed to supervise to provide a safe and therapeutic environment for behavioral health patients.”

The state’s investigation also found that “staff failed to provide an appropriate diet for a patient with nausea and vomiting, failed to communicate the unit and facility rules and failed to ensure daily visits from a psychiatrist.” 

Records show that Marie’s health insurance was billed for daily psychiatric visits while she was at Brynn Marr. The hospital’s parent company, Universal Health Services, has been accused in the past of billing for psychiatric services not rendered. 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

State regulators were unable to substantiate the allegation of sexual assault, but added that this doesn’t mean that allegation and the others do not have “some validity.”

“It means we were unable to verify them based on the information available to us. At times, it is extremely difficult for us to substantiate some allegations unless we are witnesses to what has been charged or there is corresponding documentation in the records,” the letter reads.

Megan said she has “mixed feelings” about the letter, since they only found evidence for half of their claims, but said she felt “vindicated that they found support for some of the things.”

Dan said he hopes pushing for this investigation and sharing his family’s story will improve care for future patients and their families.

“We feel like this impacted our life for a reason,” he said, “and we have a role to play in making things better for everybody.”

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