You’re trapped.

They’re cashing in.

How one Florida psychiatric hospital makes millions off patients who have no choice

Editor’s note: This story contains descriptions of self-harm. If you or someone you know is contemplating suicide, call the 24-hour National Suicide Prevention Lifeline at (800) 273–8255 or the Crisis Center of Tampa Bay by dialing 2-1-1.

WESLEY CHAPEL — More than two thousand people arrive each year at North Tampa Behavioral Health in extreme crisis.

They are checked in under a state law that lets mental health centers keep people who might hurt themselves or others for up to 72 hours.

But when that time is over, some patients find themselves held captive by the place that is supposed to protect them.

Priya Sarran-Persad had a psychologist threaten to commit her a second time if she didn’t volunteer to stay longer. Michael Jenkins hired a lawyer to help him get out but couldn’t for a week because the hospital never sent his paperwork to a judge. Robert Allen was held an extra three days for not participating in group therapy. His family was stunned. Allen is deaf and wasn’t given his hearing aids.

Each night they stayed, more money flowed into the psychiatric hospital.

A Tampa Bay Times investigation has found that North Tampa Behavioral makes huge profits by exploiting patients held under Florida’s mental health law, known as the Baker Act.

The hospital illegally cuts patients off from their families. Then it uses loopholes in the statute to hold them longer than allowed, running up their bills while they are powerless to fight back.

Powerless

The problems with Florida’s Baker Act In the coming months, the Times will explore the unintended consequences of Florida’s mental health law. This is the first in an occasional series.

Some patients describe getting virtually no psychiatric treatment. Meanwhile, people at risk of suicide have been allowed to hurt themselves, and helpless patients have been attacked on the ward.

For this, the hospital charges up to $1,500 per night.

The Times analyzed thousands of hospital admission records and reviewed hundreds of police reports, state inspections, court records and financial filings.

The documents — and interviews with 15 patients and their families or advocates — show the hospital uses a variety of tactics to keep patients beyond 72 hours. Some are tricked into thinking they’ve waived their right to leave. Others are forced to wait for court hearings that never happen.

The patients’ stays are typically stretched just a few extra days. But keeping all of the hospital’s Baker Act patients even one additional night would add about $1.4 million in annual revenue, according to figures provided by the hospital.

Support investigative journalism Times reporter Neil Bedi spent months on this investigation. He tracked down patients and families from across the region, wrote computer code to analyze the hospital’s billing data and unearthed thousands of pages of documents that showed what was really happening inside North Tampa Behavioral Health. Work like this is only possible thanks to the support of readers like you. Click here to subscribe today. Subscribe

North Tampa Behavioral hasn’t escaped the notice of state regulators. Since 2014, it has been cited 72 times for unsafe conditions and code violations, more than all but one other psychiatric hospital in Florida. Inspectors have zeroed in on unqualified and undertrained staff members who have put patients in danger or denied them basic rights.

Even still, the Wesley Chapel hospital has grown and thrived. It made $17 million last year in net annual revenue, mostly from taxpayer-funded insurance programs like Medicare. In recent years, it has had one of the highest operating profit margins of any free-standing psychiatric hospital in the state. Of the 26 facilities in Florida, half couldn’t break even.

Hospital leaders declined multiple interview requests. In a statement, CEO Bryon Coleman Jr. called the Times’ findings a “highly distorted and sensationalized portrayal that absolutely does not reflect NTBH’s overall record” across thousands of patients.

The hospital “strongly rejects any claim that it deliberately or willfully holds patients against their will absent a legitimate, clinically based determination,” he wrote, adding that decisions to extend stays are never “driven by financial motivations and/or any type of nefarious intent.”

Coleman said the hospital’s average operating margin since 2014 was “well below” the average for all psychiatric hospitals in Florida. But he calculated North Tampa Behavioral’s figure using 2014 data, which brought it down because the hospital was new and operating at a loss.

In 2015 and 2016, North Tampa Behavioral was one of the state’s eight most profitable psychiatric hospitals. It was in the top four in 2017, the most recent year for which statewide data is available, although its margin dropped in 2018.

Experts say North Tampa Behavioral isn’t the only place in Florida that has violated the Baker Act, which has provided life-saving support to people with mental illness for decades. But the psychiatric hospital stands out both for its success making money from Baker Act cases and the frequent problems with its care.

Profits and problems In recent years, North Tampa Behavioral has been one of the most profitable psychiatric hospitals in Florida. It’s also been cited by state regulators for unsafe conditions and code violations more often than almost any other facility. North Tampa Behavioral Other Florida psychiatric hospitals Operating profit margin in 2017 -10 0 10 20 30% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Citations since 2014 0 24 48 72 96 120 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 NEIL BEDI | Times

Source: Times analysis of Florida Agency for Health Care Administration records

Martha Lenderman, an expert on Florida’s mental health law and a former director of the state’s Baker Act program, described the way the hospital routinely extends patients’ stays as a “red flag.” Some of the hospital’s tactics she called “shocking.”

Kendra Parris, an Orlando attorney who specializes in mental health patients’ rights, has represented five North Tampa Behavioral patients in the past year alone. The most recent was held at the hospital for five days in April.

Parris said the reason was simple: “She has great insurance.”

Explosive growth

North Tampa Behavioral sits on a desolate stretch of State Road 56 near the southern border of Pasco County. Stout palm trees line its well-manicured yard. Tall white columns give the entrance a stately feel.

Need help? If you are in crisis or concerned about a loved one, click here for resources that can help.

The hospital opened in October 2013 as part of a chain called Acadia Healthcare. Five months later, it was approved to treat Baker Act patients.

The Baker Act lets judges, police officers, and mental health practitioners commit people with mental illness if they threaten to seriously hurt themselves or somebody else. The mental health center has 72 hours to do an evaluation.

Over the next two years, Baker Act patients became an essential part of North Tampa Behavioral’s business model, accounting for more than two-thirds of its admissions. Revenue soared.

A recipe for growth Beginning in 2014, North Tampa Behavioral quickly increased the number of Baker Act patients it admitted. The hospital’s revenues grew at the same time. Baker Act patients 900 1,350 1,800 2,250 2,700 2014 2015 2016 2017 2018 Net revenue 6 8 10 12 14 16 18 $20 million 2014 2015 2016 2017 2018 NEIL BEDI | Times

Source: Florida Agency for Health Care Administration

Because of negotiations with insurance companies, hospitals rarely collect the entire amount they bill. But on average, North Tampa Behavioral still receives $670 for every night a patient stays, the hospital said.

In 2017, the hospital posted a 13.9 percent operating profit margin. Only three psychiatric hospitals in Florida performed as well or better. None generated as much business from Baker Act patients.

Amid the success, North Tampa Behavioral broke ground on a new wing. By the end of 2017, it had 126 patient beds — almost as many as the two other Pasco County hospitals that take Baker Act cases combined.

But there was turmoil behind the scenes. The hospital cycled through four CEOs in as many years. Last year it hired Coleman to be the fifth.

In a video interview with the Hernando Post, an online publication that focuses on “positive” business news, Coleman conceded the frequent leadership changes had left the hospital “broken.” He described the workforce as “unstable” and “unsure” and said employees had not been held accountable by the upper ranks.

“I knew I’d be inheriting a leadership group that would have a lot of questions,” he said. “Who is this person? What does he have that I don’t have?”

In his statement to the Times, Coleman said he had experience in logistics, financial forecasting and customer service, as well as “valuable, transferable skills and attributes including team leadership, situational analysis and sound decision-making.”

Coleman, 31, had been a quarterback on the Green Bay Packers practice squad and played a few snaps in the 2012 and 2013 preseasons. After that, he signed with an indoor professional football team, was the vice president of sales for a Tennessee-based trucking company, played for a Canadian football team and managed employee benefits for BB&T Insurance Holdings.

He had no background in healthcare.

Longer stays, higher charges

When Coleman arrived at North Tampa Behavioral, the hospital had already managed to boost an important metric. From 2014 to 2017, the average length of stay climbed from 6.5 days to 8.8 days, an analysis of state data shows.

Its two competitors in Pasco kept patients an average of 5.2 days.

To forcibly hold a Baker Act patient for more than three days, a mental health center must file a petition in court. Under the law, a judge has five work days to rule on the case.

North Tampa Behavioral filed 592 such petitions last year. But it dropped 86 percent of them before the hearing, records show. Hundreds of patients were stuck waiting to see a judge, but never saw one. Meanwhile, their bills grew.

The other two Pasco hospitals that accept Baker Act patients each filed half as many petitions as North Tampa Behavioral, even though both admitted a similar number of people under the law. One dropped just two petitions; the other dropped none. The only other facility in Pasco County that admits Baker Act patients, a small mental health crisis center, withdrew about half of its 242 petitions.

Held without a hearing North Tampa Behavioral asked judges for permission to hold Baker Act patients longer than 72 hours more often than any other Pasco County hospital. But most of the petitions were dropped before the patient ever had a hearing. 0 150 300 450 600 North Tampa Behavioral BayCare Behavioral Health ISU Medical Center of Trinity Morton Plant North Bay Petitions filed Dropped before the hearing NEIL BEDI | Times

Source: Pasco County Clerk

Robert Allen was a patient at North Tampa Behavioral this year. He thought about hurting himself after Christmas and knew he needed help. An emergency room doctor sent him to North Tampa Behavioral.

The 89-year-old said he didn’t get the clothes his family brought him and had only a hospital gown. No one told him showers were available. Employees didn’t give him his hearing aids.

Allen asked to leave repeatedly, but staff members insisted he stay beyond the three days, his family said. The hospital’s chief concern: He wasn’t participating in group therapy.

“That blew our minds,” said Allen’s son-in-law, Wayne Dowdy. “He can’t hear.”

The hospital petitioned to keep Allen longer. Six days into his stay, a nurse told Allen’s daughter, Jennifer Dowdy, that his case would be heard by a judge.

Jennifer Dowdy took off from work to attend. On her drive over, she called to find out where the hearing would be held but was told there was no record of her father’s case. Hearings weren’t even scheduled for that day. She pulled over in tears. As she sat in her car, North Tampa Behavioral called to say her father was being discharged and would be waiting for her in the reception area.

Allen was charged $9,000 for the six nights. His insurance paid much of the cost. In July, he received a bill for the remainder: $1,465.

Jennifer Dowdy and Robert Allen pose for a family photo. Courtesy of Jennifer Dowdy Robert Allen is still traumatized by his stay at North Tampa Behavioral. LUIS SANTANA | Times

Other patients were held with a simpler method. Eight told the Times that they felt tricked or pressured into signing voluntary commitment forms. Four of them said they were told the documents would expedite their release. In reality, the forms let the hospital hold them longer than 72 hours without a judge’s consent.

Priya Sarran-Persad was sent from a hospital emergency room to North Tampa Behavioral after attempting suicide in 2015. When the 72 hours were up, Sarran-Persad was woken in the middle of the night by a nurse and escorted to a doctor’s office.

His first question: “What insurance do you have?”

After Sarran-Persad named her private insurance company, the doctor said she had a “flavor of bipolar disorder” and needed to stay at North Tampa Behavioral longer, she recalled. He insisted she sign a voluntary commitment form — and threatened to “re-Baker Act” her if she didn’t.

The law does not allow doctors to re-commit someone without a petition unless they’re experiencing a new crisis.

Sarran-Persad refused to sign, but the hospital still took two additional days to discharge her. She said a psychiatrist who treated her after the incident determined she had depression, not bipolar disorder.

In the hospital’s statement, Coleman said the average length of stay at North Tampa Behavioral is lower than the average for Florida mental hospitals. But the figure he used included hospitals that mostly provide lengthier treatments to patients who aren’t admitted under the Baker Act.

He also pointed out that in 2018, the hospital’s figure fell to 7.4 days. The state hasn’t yet published comparable data for other hospitals.

Coleman said “confrontations and disagreements” sometimes happen because psychiatric patients can’t always make rational decisions about their care.

But in one extreme instance, North Tampa Behavioral was accused of kidnapping. In that case, first reported in the Miami Herald in 2015, the hospital refused to discharge an intellectually disabled woman for three weeks. Throughout, the woman’s longtime patient advocate argued that an extended stay could make her condition worse.

“They basically held her hostage,” the advocate, Nikki Drake, told the Times.

The woman, Cindy Mertz, was eventually returned to her group home, Drake said. But she was traumatized by the incident and later committed to a state mental hospital. She’s been there ever since.

“They just did her in,” Drake said.

Cut off with little care

To help prevent these types of problems, the Baker Act guarantees family members “immediate access” to patients. But the families of 10 former patients told the Times that they weren’t allowed to see their relatives, which experts say is illegal.

Four families said their calls went unanswered or straight to voicemail as they attempted to check on loved ones. When they called from a different line, some said, their calls went through.

The law allows hospitals to deny access only if a doctor determines the visit would harm the patient. But that’s not what happened to any of the families. Instead, the hospital insisted they come during one of the two hour-long windows reserved each week for visitors.

The law doesn’t specify how often a hospital should hold visiting hours. But Lenderman, the Baker Act expert, called the schedule “totally inappropriate” and “overly restrictive.”

In other cases, state inspectors found that North Tampa Behavioral didn’t tell patients’ representatives the details of their care, even for patients who couldn’t speak or make independent medical decisions.

Many of the North Tampa Behavioral Baker Act patients who spoke to the Times said they rarely saw medical professionals and the therapies they received were unsophisticated or nonsensical. One patient remembered being told to smell an orange to ease her anxiety and depression. Another recalled having to watch an educational video on electricity.

In the statement, Coleman said the hospital’s visiting hours are scheduled around the treatment day and employees work “in good faith” to accommodate visits. He disputed that patients don’t see doctors often enough and said the hospital’s therapies use “evidence-based techniques.”

That wasn’t Michael Jenkins’ experience. Jenkins, 37, was committed last July after attempting suicide. His parents and his wife tried to see him but were told they would have to return during visiting hours.

A lawyer later helped Jenkins file a petition to argue for his release before a judge, records show. But state inspectors discovered that the hospital never sent the petition to the court.

By law, requests must be sent to court the next day.

After a state investigation, the hospital confirmed it broke the law by not submitting the court filing on time and promised to fix its process.

Jenkins spent a total of seven days in the hospital. He said it felt like a prison. He received no psychiatric care and had to beg employees to let him get some air, he said.

“I wouldn’t even wish my worst enemy to go there,” he said.

Left in danger

North Tampa Behavioral promotes itself as one of the safest psychiatric hospitals in the Tampa Bay area. But the hospital has repeatedly failed to protect its patients, police reports and inspections show.

At least six people committed under the Baker Act have been able to escape. Two hopped over the fences during monitored recreation time. One kicked through the security doors and left. Another found an employee key card hanging from a door and showed himself out.

Patients have also been hurt inside the hospital. In July 2014, one smacked a disabled man in the face with a chair while he was sleeping. The victim needed 11 stitches. Later that year, a mental health technician punched an autistic man and kicked him in the head repeatedly. The employee was arrested and fired.

In 2016, two suicidal patients were able to hang themselves, even though North Tampa Behavioral is supposed to provide special monitoring. Both survived.

Two patients reported sexual assaults at the hospital in 2018. When police arrived to investigate one of the cases, hospital leaders couldn’t provide any video footage. The cameras hadn’t worked for weeks.

That June, another patient needed emergency medical care after he found a piece of metal and used it to cut himself. A nurse told police North Tampa Behavioral employees had been conducting the required checks. But the patient, Kevin Roach, told the Times that wasn’t true. He said he sat alone, bleeding, for at least half an hour and lost almost 2 liters of blood.

In the statement, Coleman, the CEO, called the incidents “regrettable but wholly non-representative temporary departures from the overall high level of quality clinical care.”

Coleman touted North Tampa Behavioral’s low frequency of serious incidents like assaults, injuries and runaway patients. But he provided a rate of incidents per patient-day that showed the hospital had experienced roughly 75 serious incidents — on average, one a month since it opened.

Coleman also said that North Tampa Behavioral had not been “subject to any fines or licensure actions” by the government. Later, when the Times pointed out state regulators had fined the hospital 10 times in the past six years, he conceded he was wrong.

Regulators have continued to find safety issues. In December, they cited the hospital for not having a working defibrillator.

During the investigation, the supervising nurse said the hospital didn’t have a team for medical emergencies. The plan, she said, was to call 9-1-1.

A profitable chain

North Tampa Behavioral is one of 595 facilities owned by Acadia, a Tennessee-based chain that specializes in psychiatric care.

The company brought in $3 billion in revenue last year. But serious safety problems, including rapes and patient deaths, have been alleged at Acadia-run facilities across the country.

Just this year, an employee at an Acadia-run rehabilitation center in Chicago was accused of sexually abusing six patients. At least two Acadia facilities were shuttered: one in Montana that used drugs to restrain children and one in New Mexico, where employees were accused of threatening and abusing children and orchestrating fight clubs among patients.

Another Acadia hospital in Florida — Park Royal in Fort Myers — has paid more than $3 million in settlements to eight former patients who said they had been sexually abused by an employee. Park Royal is the only Florida psychiatric hospital with more citations than North Tampa Behavioral. It has been cited by state regulators more than 100 times since 2014.

Acadia declined multiple interview requests. In a statement, the company said serious and grave incidents made up an “infinitesimally small percentage” of patient encounters.

There have also been allegations of fraud. Most recently, investigators said Acadia-run mental health and addiction centers in West Virginia had charged Medicaid millions for lab tests they had actually outsourced at a bargain. The chain settled for $17 million.

In its statement, Acadia said it was “pleased to have reached this resolution” and pointed out that the settlement did not include an admission of liability on the company’s part.

But the scrutiny hasn’t stopped. In its July financial statements, Acadia said nine of its U.S. facilities are under investigation by the Department of Health and Human Services. Another is being investigated by the U.S. Attorney’s Office for the Middle District of Florida. The U.S. Attorney’s Office won’t name the hospital.

In each of the cases, Acadia said in the financial filings, the federal government is probing issues related to patient care, improper admissions and the length of time patients are kept.

In a July call with investors, none of these problems were mentioned.

Instead, Debbie Osteen, Acadia’s new CEO, said she was pleased with the company’s performance. Revenue grew across its facilities. About 300 beds were added in the past six months. The number of billable patient days increased.

Later, a caller asked Osteen if she expected the number of days patients stay to decline in the future. She touted the company’s success keeping the statistic stable, noting that it hadn’t dropped in years.

She said she didn’t expect anything to change.

Neil Bedi Investigative reporter

Read more stories by the Times investigations team