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How a leading chain of psychiatric hospitals traps patients
- Traubenfuchs 2y agohttps://archive.is/n7NKM https://archive.is/n7NKM
- kingkawn 2y ago[flagged]
- staplers 2y agoOnly citizens get prison, citizens acting behind a corporation get fines.
- spencerchubb 2y agoBernie Madoff, Jordan Belfort, Elizabeth Holmes, Sam Bankman Fried, just to name some infamous cases
- deleted 2y ago[deleted]
- usrusr 2y agoTiny tip of the iceberg. And all of those only got to prison for crimes against their investors, not for crimes done on behalf of their investors. Your examples actually support grandparent's point.
- gruez 2y ago>Tiny tip of the iceberg. And all of those only got to prison for crimes against their investors, not for crimes done on behalf of their investors False. SBF was specifically convicted of committing wire fraud on FTX customers, not just investors/lenders. https://en.wikipedia.org/wiki/United_States_v._Bankman-Fried https://en.wikipedia.org/wiki/United_States_v._Bankman-Fried
- staplers 2y agonot just investors/lenders Still waiting on the non-billionaire investors example.
- i_am_jl 2y agoI'm not sure those are instances of executives being held to account for harm to the public as much as they're instances of people being punished for stealing money from the wealthy.
- bawolff 2y agoWeren't some of madoff's victims pension funds? I'd call that harm to public.
- i_am_jl 2y agoI think they all harmed the public. My point is that it seems that the only circumstances that lead to corporate decision makers being held to account for wrongdoing is if someone can link their wrongdoing to a financial fraud.
- gruez 2y ago>much as they're instances of people being punished for stealing money from the wealthy. Don't most instances of corporate malfeasance result in "stealing money from the wealthy"? If you do a bad, try to cover it up, and then try to raise money from investors, that's basically stealing money from them.
- i_am_jl 2y agoPlenty of corporate malfeasance ends after the "do a bad" or the "cover it up" steps.
- malfist 2y agoYeah but their victims were other wealthy people. Who went to jail for the BP oil spill? The wells Fargo auto signing? Will anyone go to jail for the price fixing for rentals?
- jprete 2y agoIf I remember correctly, both Bernie Madoff and SBF had a vast number of victims of all economic classes. I think this is more related to the ability to build a criminal case.
- ericjmorey 2y agoAlthough I agree that the driving factor is the ease of building a case, you entirely missed the argument being made by the prior comment.
- SpicyLemonZest 2y agoThe Wells Fargo scandal is a good illustration of the problem with this kind of thing. The people who actually opened the fake accounts were low level sales staff and their direct managers, who public opinion saw as victims of unrealistic expectations. So prosecuting any of the actual perpetrators wasn't politically feasible. The only other person they could find to prosecute was an executive who didn't support the fake accounts, and routinely had her team fire people who opened them, but knew about them and didn't disclose them when she should have. Which is a crime, don't get me wrong, but it's not a very serious one.
- deleted 2y ago[deleted]
- thayne 2y agoA big problem is that people receiving psychiatric care often can't get justice in court. Who is the jury, or judge, more likely to believe, someone who needed psychiatric care, or a credentialed doctor? I know someone who was threatened with having their children taken away, and prison if they tried to leave the hospital, or stopped taking medication that was making them feel worse. But since it was just the doctor's word against theirs, they were told there was very little chance of winning in court.
- awinter-py 2y agocould create a system for getting an easy second opinion from a doctor outside the facility then its not patient vs doctor, it's doctor vs doctor
- cj 2y agoAgreed, to an extent. If this happening as frequently as the article suggests, and if Arcadia operates over 50 hospitals, you’d think there would be at least 1 law firm dedicated solely to prosecuting this specific hospital. Skip the class action BS, and run those “mesothelioma” type commercials. Then have a boilerplate structure for a lawsuit that you can repeat successfully, hire your own doctors as expert witnesses to refute the hospital, etc. If they are imprisoning people illegally, I imagine the settlements would be quite high per patient. > But since it was just the doctor's word against theirs When something is widespread and perpetrated by the same people, you have to establish a pattern of behavior to discredit the witness. The narrative could be pretty straight forward: the doctor was lying to the insurance company, and they’re lying to the jury, too. Seems they already settled a couple suits, which could potentially be used to discredit the hospital as well. But again, you really need a specialized firm willing to take them down by taking on a bunch of similar cases to make it worthwhile to do all of the background/evidence/research to make a case. This is also the type of case that could get heavy PR / public support which the right law firms can leverage in their favor. …or we embrace better regulation and trust the government to fix this. But the government also has a terrible track record when it comes to caring for the mentally ill.
- giantg2 2y ago
- spencerchubb 2y agoRare instance of good journalism. More people need to know about this company that commits heinous crimes
- antisthenes 2y agoIf we're talking about US healthcare, you can just point a finger to any one of those companies at random. Hospital chains, big pharma, insurance companies, retirement care. Think Sackler-family stuff. It's all designed to extract the maximum possible amount of money from the patient, while providing as little as possible.
- hn_version_0023 2y agoI’m beginning to think of the US healthcare system as a cruel and unusual punishment. I guess we’re being punished for having the temerity to exist?
- falcolas 2y agoNo, we're left to suffer so we can keep coming back and handing them more profit. At least I can't think of a better reason for so many of the decisions our health "care" system makes.
- AStonesThrow 2y agoYes; if a patient didn't [couldn't] take good care of their body to begin with, then they're punished for complaining and/or being sick. The more they lean on the PCP or psychiatrist, the more opportunities to find "treatable" disorders. It's a test of obedience and willingness to cooperate. You dutifully believe the screening tests, you fill the scrips, you take the pills, and now you're on a treadmill that is profitable for all parties except you, and you may notice that you're not healing but actually becoming sicker.
- DangitBobby 2y agoApparently Acadia faced civil liabilities only, which is wild for kidnapping.
- ctxc 2y agoHighly recommended movie watch: Unsane.
- ctxc 2y agoForgot to add the link - https://en.m.wikipedia.org/wiki/Unsane https://en.m.wikipedia.org/wiki/Unsane
- bookofjoe 2y agoSee also: 'One Flew Over The Cuckoo's Nest' (1975) https://www.youtube.com/watch?v=aTSz56rs_WE https://www.youtube.com/watch?v=aTSz56rs_WE
- tomxor 2y agoOne Flew Over the Cuckoo's Nest
- jprete 2y agoI've read that this movie is, at best, wildly out of date. I can't say for sure since I have no direct experience of the subject.
- Der_Einzige 2y agoThe idea that we don’t do things which are at least as bad as lobotomies in 2024 is asinine. Male genitalia mutilation AKA circumcising is something that most doctors in America think is okay but will get you jailed in many European countries. A societies understanding of what qualifies as being mentally unwell is extremely subjective and often leads to extreme cruelty. Americans declaw their cats, dock their dogs tails, crop their ears, and lock them in crates for inhumane amounts of time. Americans love to beat their children, and many schools in the south legally can paddle children (and this happens to usually black kids) That movie is spot on the mark and is not a day out of date.
- hypercube33 2y ago
- derbOac 2y agoPrisons and psychiatric care provide compelling examples of the boundaries of for-profit models and why they might not always be the best solutions in an area. You can always argue — reasonably I think — that these cases represent anomalous bad apples but I think as long as that incentive structure is there it will pull for this kind of thing at some level, even it's not quite as extreme as this example. I think that profit incentives and lack of competition tend to distort healthcare across all sorts of specialties in much more subtle ways than what was going on at this hospital chain. When threats to personal autonomy start to become the consequence it seems to clarify some of the problems involved, but the same processes are at work in all sorts of areas.
- deleted 2y ago[deleted]
- LadyCailin 2y agoWell, yeah. Nobody actually wants a true free market system, no matter how much libertarians and anarchocapitalists may scream that that’s exactly what they want. If they got their way, the whole planet would become a dystopian nightmare, with no safety for anyone but the top handful richest people, and every single tragedy of the commons possible occurring, polluting the earth to the point of unusability. The only reason they claim to want it, is because of either greed, complete lack of empathy, or willful ignorance. The only possible way to have a society is to have regulations.
- left-struck 2y agoCan confirm, as a libertarian I don’t want a free market, it’s more like I think the rights of people should be above the rights of companies, corporations and so on. Governments exist to protect the rights of the people and in this age, in developed countries, there is no greater infringement on those rights than by large businesses.
- briandear 2y agoFree market healthcare means it gets cheaper. Go pay cash at a doctor or a surgeon — it’s dramatically less expensive. The idea of comprehensive health insurance has ruined healthcare. Insurance should be to protect against financial risk from an unforeseen loss — a car crash should be insured, changing the oil should not. If car insurance covered tires and oil changes, car insurance would cost dramatically more.
- delichon 2y agoMost doctors agree that people in the throes of a psychological crisis must sometimes be detained against their will to stabilize them and prevent harm. These can be tough calls, balancing patients’ safety with their civil rights. IMHO it's acceptable sometimes to balance others' safety with a patients' civil rights. But it's not acceptable to trump someone's civil rights with concerns about their own safety. That balance can certainly result in tragedy when people make horrible choices. But it preserves the concept of civil rights against the incompatible alternative of overruling them in the name of safety. We can't get the benefits of freedom by only allowing "good" choices, because those benefits flow largely from learning from the bad ones. We are very capable of collectively making bad choices (from slavery to lobotomies) and defining them as good. Civil rights are a way to counterbalance those.
- Gimpei 2y agoI’m guessing you’ve never had to deal with a loved one in the throws of addiction or severe mental illness. We are not perfectly rational beings and sometimes we make very bad choices, especially when we suffer from a mental illness like addiction. If I had the choice between seeing a loved one temporarily institutionalized versus having them die of an overdose, I would take the former. It isn’t ideal, but sometimes you have to choose the least awful thing.
- lazyasciiart 2y agoWhat does “temporary institutionalization” look like in that choice? One of the highest risk periods for overdose is after leaving jail or rehab. Do you support proposals to reduce the risk of overdoses that don’t rely on complete abstinence, such as drug test kits, safe injection rooms or even legal supply?
- bawolff 2y agoWhile there is a place for such things, its hardly a replacement for rehab. We have all those for alcohol and yet alcoholism still causes massive problems.
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- tcj_phx 2y ago[flagged]
- deleted 2y ago[deleted]
- genewitch 2y agoI think i understand why this was flagged, so i will give a small bit of insight that maybe people on HN do not know. There's a growing list of research publications that implicate the gut biome in ... well most disorders. It's hard to see the forest for the trees because of the implications - but there is a growing body of evidence that "metabolics" or in layman's terms your "gut health" is one of the easiest ways to effect psychological changes. Also, everyone who can afford $50 should get their serum vitamin D levels tested, just for fun. The recommendation is 30 ng/ml - but this is to prevent rickets or whatever - not for optimal body and brain function - that number is, well, it's 100ng/ml. There's marginal risk to going over 100ng/ml, but this can be mitigated by additional supplements of vitamin K and Calcium*. As far as i know, vitamin D works either outside of or in tandem with the gut flora and fauna, but does fit in to "metabolic", right? I'm sorry your friend has had such issues. * reputable vitamin manufacturers know this and will produce high-potency vitamin D supplements with all three, or at least D and K as a single pill.
- OutOfHere 2y agoI wouldn't exceed 50 ng/ml because it will risk excessive calcium deposits where they don't belong, such as in the blood vessels. Moreover, 99% of the potential benefits would already have been realized at 50 ng/ml. This is also the level that was found to work for preventing severe Covid.
- genewitch 2y agothe calcium issue only occurs over 100ng/ml (as i said) - i could cite, but apparently this sort of information isn't relevant on this forum. But, regardless of people's feelings on this (and your old data; 50ng/ml isn't enough) - the calcium issues are mitigated completely by, as i said, vitamin K. and, as i said, this is why the higher dosage vitamin D supplements contain K, as well. per your covid reference, there's a reason that 50,000IU or more, dosed 2-4 times (over 2-4 days!) was recommended for certain people with covid.
- gmd63 2y agoIt's sad that this information is behind a paywall. Not as a fault of the New York Times, they deserve money for this work. It's sad that the default freely available information spread around is that the chain of hospitals is a professional institution that's endorsed by the board of medicine. And knowing the truth costs money. Just as bringing these folks to justice costs money.
- gpvos 2y agoIt's a general problem: the good information is behind paywalls, so people only find bad information and start believing nonsense.
- deleted 2y ago[deleted]
- watwut 2y agoTo be fair, the journalism was not historically free service. There was brief period where they tried to live by ads and use free articles to make people buy paper, but it did not worked.
- simonw 2y agoThis story is an incredible illustration of incentives gone wrong. The affordable care act mandated that insurance companies cover mental health. Psychiatric hospitals can charge insurers $2,200/day for holding patients who "pose an imminent threat to themselves or others". So now you get this: > Once Acadia gets patients in the door, it often tries to hold them until their insurance runs out. > Acadia goes to great lengths to convince insurers that the patients should stay as long as possible, often around five days. > To do that, Acadia needs to show that patients are unstable and require ongoing intensive care. Former Acadia executives and staff in 10 states said employees were coached to use certain buzzwords, like “combative,” in patients’ charts to make that case.
- archgoon 2y agoThis doesn't explain why the insurance companies don't have an incentive to fight back. If Acadia is engaged in insurance fraud, the insurance companies have every incentive to stop that.
- deleted 2y ago[deleted]
- nickff 2y agoInsurance company profits are capped as a percentage of expenses, so saving money means they make less money. There are bad incentives all over the place in healthcare regulations.
- gruez 2y agoIf you're referring to the minimum medical loss ratio provisions in the ACA, most insurance companies are above the minimum, which means any marginal fraud reduction is pure profit for them.
- sulandor 2y agounless there's a cut to be had
- 2y ago
- BikeShuester 2y agoTake note that all these victims were either employed or had insurance coverage. It's telling that they're not targeting the local homeless individual for 'care.' Which makes this more disgusting.
- nobody9999 2y ago>Take note that all these victims were either employed or had insurance coverage. It's telling that they're not targeting the local homeless individual for 'care.' Which makes this more disgusting. Apparently, "Medicaid is the single largest payer for mental health services in the United States"[0] That said, one will likely have to dig through quite a bit of data to determine, on a state-by-state basis, what the reimbursement rates are for inpatient psychiatric services. And they don't make it easy, either. For example, reimbursement rates for Texas[1], California[2] and New York[3] (chosen because they're large states which, together, make up a significant chunk of the US population) are available, but need to be parsed to figure out which specific code corresponds to daily reimbursement rates for psychiatric care. [0] https://www.medicaid.gov/medicaid/benefits/behavioral-health-services/index.html https://www.medicaid.gov/medicaid/benefits/behavioral-health... [1] https://public.tmhp.com/feeschedules/Default.aspx https://public.tmhp.com/feeschedules/Default.aspx [2] https://mcweb.apps.prd.cammis.medi-cal.ca.gov/rates?tab=rates https://mcweb.apps.prd.cammis.medi-cal.ca.gov/rates?tab=rate... [3] https://omh.ny.gov/omhweb/medicaid_reimbursement/ https://omh.ny.gov/omhweb/medicaid_reimbursement/ Edit: In case my point isn't obvious, I'm wondering aloud whether or not Medicaid (the US medical insurance program for those under 65 who can't afford to pay for insurance) reimbursement rates make it a target for similar shenanigans. While Medicaid is significantly funded by the US Federal government (via block grants[4]), it's administered (in vastly different ways) by each state, which set their own eligibility and reimbursement rates [4] https://en.wikipedia.org/wiki/Block_grant https://en.wikipedia.org/wiki/Block_grant
- Spooky23 2y agoUnlike Medicare, which won’t pay for poor performance, Medicaid pays for services rendered, period. If you’re a shitty provider, there’s a calculus for when to bill Medicaid for a lower, guaranteed payment vs Medicare. There’s a wide variety of shenanigans at the provider, managed care and state/county level. A big part of the performative shipping of migrants and poor people to northern states is all about shifting Medicaid expenses. This happens often to mental patients, who often find themselves released from a police station or hospital, at a bus station with a ticket to NYC.
- rKarpinski 2y agoDo the patients ever use the phones from these facilities to call the local police departments about being held against their will without cause? At this scale seems like that should happen.
- jprete 2y agoI'm not a psychiatrist, but it might be hard to tell them from the psychotics who can model the standard view of the world well enough, for long enough, to lie to the police about their condition. More practically, I doubt they get unsupervised phone calls.
- rKarpinski 2y agoThe only thing that should matter is if they are medically claiming the patient "poses an imminent threat to themselves or others", either they did the paperwork or they didn't. And these aren't one of occurrences, these are systematic abuses in the same communities that would come up over and over again - which is presumably why police raided their facility in Georgia. > More practically, I doubt they get unsupervised phone calls. Most facilities have communal phones that are available throughout the day for short periods of time.
- kelsey98765431 2y agoPhone access is typically restricted to a supervised call using the phone on the staff administrator's desk who can simply cut you off and glare at you with silent promises of retaliation if you don't say what they want you to say and what they agreed to let you say before they hand you the phone, all with their finger resting on the disconnect button the whole time. Unless you are not making them money, then they get you out of there asap and make calls on your behalf all day to other places to shuffle you around to.
- hirako2000 2y ago[flagged]
- kelsey98765431 2y agoThis is an industry wide practice for decades across every segment of the healthcare sector.
- geor9e 2y agoI'm not anti-psychiatry per se, but I always keep in mind that every industry has perverse incentives to not lose their customers. Every once in a while, a professor or journalist checks themselves into a psychiatric hospital with some temporary fake symptoms, then behaves perfectly healthy, but are unable to escape without a lot of outside intervention. E.g. https://en.wikipedia.org/wiki/Ten_Days_in_a_Mad-House https://en.wikipedia.org/wiki/Ten_Days_in_a_Mad-House (1887), https://en.wikipedia.org/wiki/Rosenhan_experiment https://en.wikipedia.org/wiki/Rosenhan_experiment (1973) .
- deleted 2y ago[deleted]
- hedora 2y agoA friend of mine was on screwed in the other direction here in California. When stable, they signed over the right to commit them to me, their doctor, their spouse and their parents. We all attempted to get care for the person during a psychotic break (including talking about plans to shoot up a religious gathering - the police wouldn’t do anything even after that). As a result, they lost their job, marriage, apartment, possessions, life savings, and ended up $100K in debt. The insurance company didn’t pay a dime when they finally got help, since coverage had already lapsed. I can’t believe how broken healthcare is in the US.