He knew something was wrong as soon as he saw his 13-year-old daughter.

Even as she struggled with depression at Kingwood Pines psychiatric hospital, she always gave him a hug when he visited.

But that October day in 2015, she sat quietly, withdrawn, and fled to her room only minutes after he arrived.

He flagged down a nurse. What was wrong? Had they changed her medications?

The nurse pulled him aside and lowered her voice: His daughter said she'd been raped by two other patients the night before.

"I wanted the boys and I wanted my daughter out of there," he said, recalling his fury. "That's not a day you want to relive."

The girl was one of two teens assaulted at the hospital that night by two other patients, according to a lawsuit filed recently in Harris County court.

But the allegations were not the only concerns raised in recent years about patient safety at the 116-bed psychiatric hospital in Kingwood and its parent company, the for-profit nationwide chain, Universal Health Services Inc.

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A Houston Chronicle review of medical records, court filings, hospital accreditation reports and records from state and federal regulators, and interviews with parents, portray an understaffed facility that has failed to watch over patients, leaving the most vulnerable among them open to further victimization.

The parents of the two girls agreed to talk to the Chronicle on the condition they be identified by first names only, to protect the privacy of their daughters. The Chronicle does not typically identify the victims of alleged sexual assault.

Hospital Chief Executive Officer Shanti Carter said Kingwood Pines denies the allegations and will fight the case.

"Due to the pendency of litigation and patient confidentiality requirements, we cannot comment further at this time but look forward to defending this case in court," Carter said in an statement emailed to the Chronicle.

"Over the course of many years, Kingwood's dedicated and compassionate clinicians have successfully provided care to tens of thousands of patients, enabling them to live happier, healthier and more productive lives," she wrote. "Our most sacred responsibility is and always will be the wellbeing of our patients. We are committed to our mission of providing high quality treatment programs and services to patients with serious and complex mental health needs who often come to Kingwood during some of the most difficult periods of their lives."

She said Kingwood cooperated fully with state and federal regulators and independent accreditors to comply with all requirements. UHS did not respond to multiple requests for comment.

The lawsuit, filed Jan. 8, argues that hospital administrators acted negligently, "failing to provide a safe and secure environment" for the two patients. It seeks up to $1 million in damages.

"I don't want them operating," said Joe Mathew, the attorney who filed the lawsuit on behalf of the two families. "These are kids."

Scrutiny from regulators

The federal Centers for Medicare and Medicaid Services has cited the facility for nine separate violations of state rules governing patient care since 2011, including a 2016 incident in which three high-risk adolescent patients escaped from the facility. Investigators concluded the hospital did not have enough staff that weekend to adequately monitor the 23 adolescent patients in its care.

In a separate 2015 incident, the hospital was cited for placing two adolescent patients in the same room, even though one had a documented history of perpetrating sexual abuse and the other had previously been a victim of sexual violence. After an evening alone in their room, the boy who had previously been a victim reported to hospital staff that he and the other boy had engaged in sexual activity.

The hospital failed to impose any disciplinary action against a nurse who falsely claimed hospital staff had been monitoring the boys that evening as required, according to the reports.

Three years earlier, in 2012, the hospital was cited for failing to accurately log how often patients were being observed after two adults were found having sex in a patient room.

Information from The Joint Commission, which accredits and certifies health care organizations and programs in the United States, shows performance issues at Kingwood Pines surfaced during hospitalwide inspections in 2011 and 2014. The hospital corrected the deficiencies and has been in compliance ever since, said Elizabeth Zhani, a Joint Commission spokeswoman.

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The Joint Commission's Office of Quality and Patient Safety assesses reports of public safety and quality. The commission was not aware of the alleged assault on Oct. 26, 2015, Zhani wrote in an email response to the Chronicle.

The lawsuit is the latest allegation of unsafe conditions in recent years at facilities owned by UHS. Congressional leaders first called for an investigation into UHS in 2015, after reports of unsafe facilities in Massachusetts and Illinois.

Federal regulators have repeatedly faulted UHS hospitals for patient safety lapses and other issues, according to government records. The company operates more than two dozen hospitals in Texas, including four in the Houston area.

Officials from the Centers for Medicare and Medicaid Services (CMS) in September 2015 wrote they had found 50 serious deficiencies in quality of care or safety since 2012 and eight findings of "immediate jeopardy" non-compliance in 44 UHS hospitals certified to accept Medicare, according to a letter sent to U.S. Rep. Joe Kennedy III of Massachusetts.

Thirty-seven of the 44 facilities subsequently took "appropriate, remedial" action to come into "substantial compliance" with federal requirements, the letter noted.

In October, a 13-year-old girl at Timberlawn Hospital in Dallas reported being raped by another patient, the Dallas Morning News reported. A federal CMS "statement of deficiencies" report concluded the hospital "failed to ensure a safe setting" for the patient, had inadequate training for staff and did not follow national standards for nursing supervision.

The report came after the hospital had faced previous scrutiny – and possible closure – over unsafe conditions in 2015.

Timberlawn recently notified the Centers for Medicare and Medicaid Services that it plans to voluntarily shut down.

"James Miller, the CEO of Timberlawn, has informed CMS that it intends to close on Feb. 1 or as soon after that as possible," said Bob Moos, spokesman for the CMS Dallas office. "The facility will be expected to safely relocate patients before that occurs."

State regulators, meanwhile, have investigated 50 complaints related to patient care against Kingwood Pines Hospital from 2010 to last fall, substantiating 12 of them, according to Texas health officials.

At UHS's three other Houston-area psychiatric hospitals, regulators have investigated over 100 complaints, substantiating more than 30, the spokesman said. The agency is barred by state law from providing additional information about complaints and investigations against Texas hospitals.

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'A devastating impact'

Clint, the father of the 13-year-old, said his daughter was admitted to Kingwood Pines in northeast Harris County in October. She was briefly discharged then readmitted when she continued expressing suicidal thoughts.

Tina, the mother of a 16-year-old who also reported being assaulted that night, said her daughter arrived at the hospital after escalating drug use.

She was assigned to a room with the 13-year-old on a co-ed floor, she said.

"I'm thinking, 'If you have adolescents, with hormones ... why would they even have a co-ed floor?" she asked.

The girls were assaulted on the night of Oct. 26, 2015, according to the lawsuit. Medical records provided to the Chronicle by Mathew show the 13-year-old was taken to Texas Children's Hospital and given a rape kit.

No criminal charges were filed, according to the parents and their lawyer.

The suit accuses the hospital of medical negligence in failing to: provide a safe environment for minors with sufficient staff and supervision; separate male and female patients; and hire, train and supervise competent and experienced employees and contractors.

The hospital owed the teenagers "a duty of care to provide a safe and secure environment where they were protected from others causing harm or threat of harm to them," the suit said.

In 2010, the mother of a 13-year-old patient who said she'd been assaulted in 2008 by her roommate sued Kingwood Pines, when the hospital was owned by Psychiatric Solutions Inc. UHS bought the chain, including Kingwood Pines, in 2010.

According to the lawsuit, the patient, who was at the hospital to receive a psychiatric evaluation, had been a victim of past sexual assault and abuse.

Her mother warned staff to keep her isolated from other patients, but hospital employees placed her in a room with a patient who later sexually assaulted her, according to the suit.

An expert witness for the patient's family said the hospital had failed to ensure the teen's safety and well-being and that the hospital had failed to properly staff or supervise the facility.

"There is no indication that adequate or competent staffing was provided by Kingwood Pines at the time the sexual molestation occurred," wrote Mark Blotcky, a Dallas psychiatrist in a sworn statement filed among the court documents. "Had there been appropriate and competent staffing, there would have been a staff member observing the halls or in the hall, and these girls would not have been allowed together unsupervised, and they certainly would not have been assigned to the same room. ... Certainly the monitoring provided was inadequate because [she] was allowed to be sexually assaulted by a known sexual predator."

Court filings show Kingwood Pines disputed the claim that the hospital or its employees acted negligently.

"All of Defendants and their agents, representatives and employees['] treatment were appropriate and rendered within the applicable standards of care," the hospital lawyers wrote in court documents.

Kingwood Pines ultimately settled the suit, said Norman Straub, the family's attorney. The terms of the settlement prevent him from divulging more details, he said.

"It had a devastating impact on a young girl's life," Straub said. "She continues to suffer from issues related to that incident."

Psychiatric experts said a sexual assault at a psychiatric hospital — or any sexual contact between patients — raises questions about staff supervision.

"A parent has reasonable expectation a hospital supposedly full of trained staff ... knows what they're doing, and knows what they're watching for, and makes diligent efforts to keep everybody safe," said George Santos, a clinical psychiatrist who has managed psychiatric inpatient hospitals in Harris County. "That's extremely egregious ... It suggests a potential failure of the hospital monitoring systems."

Questions remain

Mathew said the girls' stay at Kingwood Pines affected them and their families long after their stay ended.

"Something like this should never have happened," he said. "Unfortunately, nothing will ever ease the pain and the suffering these young girls and their families have endured."

Clint said his daughter is making progress and seems less withdrawn than she did after her parents pulled her out of the hospital.

Tina said her daughter continued to struggle and later moved to Austin, to her father's house.

"It seemed like she just kept spiraling out of control," she said.

A year after she left Kingwood Pines, the girl died in a late-night car crash in the Austin area. She was a passenger in a vehicle driven by a man police charged with intoxication manslaughter.

"I feel like I let my daughter down," Tina said, tearfully. "Being at a place where I thought she was going to get help."

Mike Hixenbaugh contributed to this report.

St. John Barned-Smith covers public safety and major breaking news for the Houston Chronicle. Follow him on Twitter and Facebook. Send tips to st.john.smith@chron.com.