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New York Times
Aug 8, 1997 By BARRY MEIER
A decade has passed since Kelly Stafford walked through the doors of the Brookhaven Psychiatric Pavillion here. But for her, the nightmarish days that followed are fixed forever.
She had agreed as a 17-year-old to enter the hospital, expecting a brief respite from troubled family relationships. But once the doors closed, Ms. Stafford said, she remained inside for 309 days, many of them behind blackened windows in cruel darkness.
At Brookhaven and other psychiatric hospitals operated by National Medical Enterprises, patients like Ms. Stafford said they had their arms or legs strapped down for months at a time. Others said they were forced to sit motionless and silent for 12-hour stretches. And a medieval-looking device called a ''body net'' was used to completely restrain some.
All this and more became widely known in 1993, when a task force of 600 Federal agents swooped down on 20 National Medical facilities. A year later, the company's psychiatric subsidiary pleaded guilty to Federal charges that it paid kickbacks and bribes to doctors and others for patient referrals; the company paid $362.7 million in fines and penalties to settle various Federal and state charges of health care fraud.
National Medical, which was required as part of its guilty plea to sell its mental health care operations, has since risen from the ashes of that debacle, installing new management and changing its name to the Tenet Healthcare Corporation. But it is only in recent weeks that Tenet, now the nation's second-largest chain of for-profit hospitals, has confronted the scope of the episode's human toll, paying out $100 million to settle some 700 claims filed in two Texas courts by former psychiatric patients.
''I had to eat Thanksgiving and Christmas dinner in restraints,'' said Ms. Stafford, who now works as a model. ''There's not a day that goes by that you don't think about it.''
Those who entered places like Brookhaven, often as teen-agers, faced problems ranging from depression to drug and alcohol abuse to suicidal impulses. In lawsuits, they charged that they had been effectively imprisoned -- rather than treated and quickly released -- as part of a scheme to exhaust their lucrative insurance policies.
For many mental health care professionals, National Medical came to symbolize the excesses of an era when the corporate thirst for insurance dollars overrode patients' needs. Now, as managed care companies move into the area of mental health, many psychiatrists fear that patients' needs are again being overlooked -- but this time to scrimp on insurance costs. Today, seriously ill patients are often discharged from mental health units after just a few days, trapping them in a cycle of hospitalization, relapse and hospitalization, doctors say.
''National Medical was treating the insurance contract and not the patient,'' said Dr. Fred Goodwin, director of the Center on Neuroscience, Medical Progress and Society at George Washington University Medical Center. ''Now, in reaction, doctors are being forced to react to the needs of managers, not patients.''
Managed health companies defend their practices as reining in undisciplined and wasteful spending on mental health care, where it is often hard to measure the extent of a patient's progress. And likewise, both Tenet and the doctors who admitted patients to Brookhaven and other National Medical hospitals have consistently denied any mistreatment of patients. Along with the payments from Tenet, some doctors once affiliated with the company's psychiatric unit also recently agreed to pay $20 million in compensation to their former patients.
Those involved in the settled cases are barred from speaking about them. But in lengthy interviews before the settlement was reached, Ms. Stafford and two other former Brookhaven patients spoke of their lives at the hospital and of the years since. What emerged were stories not only of individual suffering -- and of its long-lasting effects -- but also a cautionary tale with lessons for the health care industry today.
With National Medical aggressively seeking patients, a teen-ager could land in one of its hospitals for months as a consequence of behaviors that many psychologists say could have been treated with short-term therapy.
In 1987, for example, Jeanne Ford was a 14-year-old living in Dallas with her mother. When her mother refused to take her out one evening, Ms. Ford said she raided the medicine chest, washing down the pills she found with alcohol. After her stomach was pumped in an emergency room, she was admitted to Brookhaven.
''The doctor asked me if I was trying to kill myself, but I just wanted my mom to pay more attention to me,'' said Ms. Ford, who ultimately spent 225 days at Brookhaven.
Patients at the psychiatric hospital -- a two-story building with small windows that has since been demolished -- witnessed scenes they found hard to fathom. When Sherry Sylvester entered the hospital in 1987 as a 16-year-old, she noticed that a large number of patients spent their days in wheelchairs. It took her several days to realize, she said, that the patients were not paralyzed, but instead were tied down.
Ms. Sylvester, who was referred to Brookhaven for treatment of a possible chemical imbalance, expected to be in the hospital for two weeks. But her stay stretched on for 422 days.
A constant refrain of life at Brookhaven, she said, were the calls for ''Dr. Rush, Dr. Rush'' over the hospital's loudspeaker. The pages, it turned out, were not a call for a particular doctor, but an alert for hospital personnel to converge and restrain a patient. As she wrote in an account of her experiences prepared for her lawsuit, she first heard it after she refused a nurse's order to leave a room so a group therapy session could be held.
''Five minutes later, I'm hearing 'Dr. Rush, Dr. Rush' over the intercom,'' Ms. Sylvester wrote. ''All these loonies are freaking out and I'm thinking 'God, what the hell is going on, I've got to get out of here.' I was still sitting on the bed when six big guys run in and tackle me.''
She said she was given an injection of thorazine and her hands and legs were tied to her bed with leather restraints. ''They stole my innocence that day,'' wrote Ms. Sylvester, who is now married with two children and runs an aviation-related business with her husband. ''If I'd been raped, I could attempt the healing process. But my attackers were to remain my jailers for the next 14 months.''
Along with stolen time and fractured relationships with the parents who agreed to their hospitalization, others believe they lost the opportunity to get the treatment they needed. Kay Banner, one of 300 former patients whose suits against Tenet are still active, said that the therapy she received during an 18-month stay at Brookhaven for treatment of depression was of little help. She said that therapists expected her to silently sit in a chair for 12 hours at a time, a task she found impossible.
''I was in there for a year and half, and I expected to be helped in some way,'' said Ms. Banner, who is 25 and lives in Allen, Tex. ''For the past eight years, I have felt like a failure because it didn't do that.''
Former patients at Brookhaven say that money alone will not help them close this chapter of their life. They want apologies, and with rare exceptions, neither officials of Tenet nor the treating physicians have yet to offer any, they say.
''None of the doctors have approached me to apologize to me, to redirect to a different kind of therapy or to say 'here's what we feel,' '' Ms. Banner said.
In a statement, officials of Tenet, which is based in Santa Monica, Calif., said that the individuals interviewed for this article were among many patients at the company's hospitals who had been diagnosed with serious and, in some cases, life-threatening disorders.
''Confronted with these and other serious symptoms, physicians administered what, in their professional judgment, was the most appropriate course of treatment to help their patients,'' the company said.
Lance Ignon, a Tenet spokesman, confirmed that the claims of Ms. Ford, Ms. Stafford and Ms. Sylvester were among those that had been settled. The company is approaching lawsuits by other former patients, like Ms. Banner, on a case-by-case basis, he added.
''We will continue to settle those that are appropriate and continue to defend those that we feel are not appropriate for settlement,'' Mr. Ignon said.
William A. Smith, a lawyer in Dallas who represents doctors who once practiced at Brookhaven, said that his clients acted in their patients' best interests and provided them with excellent medical care.
''We would like to see the former patients allow their medical records to be released to the public so that we could discuss their individual cases and why they needed the care,'' he said.
While the approaches taken by National Medical and some managed care companies represent two extremes, many mental health care experts say that ultimately it is the responsibility of psychiatrists and other health care professionals to put their patients' interests ahead of corporate profits. Indeed, most states hold doctors, not health care companies, accountable for patient care.
But some who were patients at Brookhaven say there may be a more direct way than filing lawsuits or conducting investigations to make health care providers understand the profound impact of their actions.
''I would like to take the staff members and tie them down for a few months,'' Ms. Stafford said. ''Make them sit down until we could tell them to move. I would like to make them do everything we'd have to do. I want these people to feel what I feel. I want them to know with their own two eyes what they put us through.''