Tracy Valdez frantically called Indianapolis Neuropsychiatric Hospital for four days to find out if her grown son, who is deaf and suffers from bipolar disorder and schizophrenia, had been admitted. He was transferred to the hospital more than 250 miles from their home in Lansing, Michigan, despite her objections.
“I was heartbroken, I cried every day, every night, thinking: What is my son going through? she said.
A week later, Valdez found out he had been given medication even though he couldn’t understand what was happening without a sign language interpreter. Valdez says her son’s seven-day stay at the northwest Indianapolis hospital traumatized him so much that he has refused to get much-needed care, for fear of being transferred again.
Indianapolis Neuropsychiatric Hospital has been the target of complaints from families and workers in recent years as the company expands its footprint in Indiana and other states. The privately owned hospital chain, which has seven locations and another under construction, has been financed by a private equity firm since 2020. Its expansion, some fear, has come at the expense of employees and patients.
Psychiatric facilities like the Indianapolis NeuroPsychiatric Hospital receive some of the region’s most vulnerable patients—patients who often have to travel a distance because psychiatric hospital beds in their areas are not available. Some may be in mental crisis, some may become violent, and some may need specialized individual attention.
Prompt communication with the family and enough staff trained to defuse conflict should be the standard, said Don Parker, president of the National Behavioral Health Association.
And if these best practices are not followed, patients and their families may be at risk.
JoAnne Glick, an Elkhart resident, said she also had trouble getting information about her husband when he was admitted because he was a danger to himself. After two weeks, she went to pick him up, awaiting a discharge discussion on how to care for him. That never happened, she said.
He has been at another hospital in Elkhart since leaving the Indianapolis facility, she said. And the contrast was stark.
“I can talk to the nurses. I can call there. He can call me. I’ve talked to his psychiatrist a few times,” she said.
The patient attacked the staff
Patients and their families are not the only ones concerned about practices at the Neuropsychiatric Hospital. Staff members say low staff-to-patient ratios can often lead to problems. “We are woefully understaffed,” said Peter Moore, a registered nurse. “It really is a disaster waiting to happen in many ways.”
He said he witnessed a nurse in charge of caring for 20 patients. Moore said the challenge increases when patients demand one-on-one attention, further thinning staff.
On March 8, police and other emergency responders were called to the Neuropsychiatric Hospital because a patient assaulted several health workers. Multiple employees and patients sought medical attention, according to a 911 call log. That month, police were called to the hospital 10 times, and fire and EMS were called 10 more times, according to the Metropolitan Emergency Services Agency. In April, police were called to the facility once and fire and EMS were called 22 times. EMS is usually called for medical issues while police are called to assist with disturbances, disputes or suspected crimes.
Moore and another employee told IndyStar they haven’t seen security guards at the hospital in the past year, further putting employees at risk.
The second employee, who did not share her name for fear of retaliation from the company, said she would like the hospital to stop accepting high-needs and violent patients if it doesn’t have enough resources to care for them. them.
“The problem is just the severity of the patients they’re getting. If you don’t have the support or the staff for those kinds of violent patients, don’t get them,” she said.
The hospital chain declined to comment for this story.
Violent outbursts
The March 8 incident was not the first time police responded to calls from the 50-bed hospital. Police were called to the location 10 times in March to investigate crimes, disturbances or assist EMS, according to the Marion County Metropolitan Emergency Services Agency.
Parker, who ran a psychiatric hospital in New Jersey before taking on an advocacy role earlier this year, declined to comment on specifics at the Neuropsychiatric Hospital. However, he said his facility rarely called the police. The staff at that facility, which is being reviewed by New Jersey officials, required a ratio of one employee to two to three patients.
“We just don’t call the police to handle those things,” Parker said. “We know how to manage them and manage them effectively.”
Private equity concerns
While providing quality mental health care has long presented a challenge, a new player in the industry may be putting additional pressure on facilities like the Neuropsychiatric Hospital. Across the country, patient advocates have raised alarms about the growing influence of private equity in health care, because the aggressive, profit-seeking business model can result in poor quality of care and cost reductions. About 8% of all private hospitals, including chain neuropsychiatric hospitals, are privately owned, and nearly a quarter of privately owned hospitals are psychiatric hospitals, according to the Private Equity Stakeholder Project, a nonprofit that tracks equity investments. private in health care. .
Morgan Shields, a researcher at Washington University in St. Louis.
Since private equity firm Enhanced Healthcare Partners invested in NeuroPsychiatric Hospital in 2020, the chain has grown from four locations in Indiana to a total of seven hospitals, including locations in Texas and Arizona. The chain plans to open another Michigan site soon, according to its website.
In 2021, NeuroPsychiatric Hospital and Enhanced Healthcare Partners received a $15 million loan from another investment company, Capital Southwest Corp.
Enhanced Healthcare Partners did not respond to a request for comment.
Indiana lawmakers are also concerned about increasing private equity in health care. In March, lawmakers passed a law requiring health care organizations and private equity firms to report mergers and deals like the one between Enhanced Healthcare and NeuroPsychiatric Hospital to the Indiana Attorney General’s Office.
While the results of private equity investments in health care can vary by company, the typical trajectory is that investee companies increase cash flow through taking out loans, cutting staff or hiring at lower wages, Eileen O’Grady said. , a research and campaign. director for the Private Equity Stakeholder Project.
Parker, a spokesman for the industry, isn’t worried. It’s not about nonprofit, for-profit or private equity ownership, he said, but rather about oversight and regulations that hold psychiatric care to quality and safety standards.
Matters of the past
Indiana’s hospital watchdog, through its inspections, has thrown up more red flags.
The state has investigated eight complaints about the Indianapolis hospital in the past five years. Failure to follow health care law and maintain records are problems that plague the psychiatric health care industry as a whole. And complaints to regulatory bodies about health care facilities, especially psychiatric hospitals, are common.
The facility has had no complaints during the past year. But a complaint-related inspection on March 8, 2023 revealed problems. The hospital failed to ensure nurses provided wound care, including dressing changes, to one patient on four occasions, according to a records review. The inspector also found that staff did not keep records of lab work in patient files.
In 2020, an inspector found management failed to tell staff which patients were at risk of assaulting others, failed to prevent abuse of patients on a unit and failed to show one-to-one care was provided to a patient that he needed. The inspection came about two months before the private equity investment was announced and as the company expanded into Arizona.
Employees demand higher staffing standards
Nurses and behavioral health workers began a union drive earlier this year, a move Moore hoped would fix some of the problems. They were unsuccessful in the April midterm elections, but Moore said they are challenging the results.
Leslie Moore, who is married to Peter Moore, left the hospital after three months because her role as a behavioral health aide at the psychiatric hospital became so overwhelming.
“Sometimes you don’t have the right backup when you need it the most,” she said.
Peter Moore said many members of staff, including middle management, are doing their best with limited resources.
“The director of nursing who oversees us is a wonderful person,” he said. “It’s just limited by a system that condemns us to failure.”
Binghui Huang can be reached at 317-385-1595 or [email protected].
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