Pt. 1: Driving People Crazy at Taxpayer Expense

[Guest guest]

This is an article written by me that appeared in CHANGE: THE JOURNAL

OF

THE SYNERGETIC SOCIETY, number 233, September 1993. I retain the

copyright. The editor is N. Arthur (Art) Coulter, M.D., 1825 North

Lake

Shore Drive, Chapel Hill, NC 27514, USA. The phone numbers are

919/942-9365 (am) and 919/942-2994 (pm).

 

Driving People Crazy at Taxpayer Expense

Scandal in American Health Care

Part I: The Techniques of Abuse ©

 

By Judy Fitzgerald

 

In November 1990, I was asked by the founder of the Ramsey Survivors

Support Group to volunteer my time and writing skills interviewing

survivors (patients, family groups, and former staff) of the Ramsey

Canyon Hospital, a privately owned for-profit psychiatric hospital

near

Sierra Vista, AZ. I was also asked to help them get their complaints

on

paper, so they could be sent to the appropriate agencies. Joyce Simo

had

just founded this self-help group in response to her own abuse at this

hospital (which is not connected with the Ramsey Hospital chain).

 

I believed the first people I interviewed, but figured their accounts

were aberrations, exceptions to a rule of fine care. I soon realized

that I was mistaken.

 

What emerged was a shocking picture of sick people made sicker and

well

people made sick, of individuals targeted because of generous

insurance

and government benefits, of diagnoses tailored and manufactured

according

to what insurance companies and the government were willing to pay

for,

and of a for-profit psychiatric hospital out of control and

answerable to

no one.

 

In time it was learned that this was not just a local problem.

Testimony

before the House Select Committee on Children, Youth and Families

revealed a nationwide problem. Abuse and fraud are the rule; good

care

is the exception.

 

In the early 1980s the U.S saw a mushrooming of for-profit psychiatric

hospitals. Most of these were clustered around military

installations,

because of the generous CHAMPUS* (*CHAMPUS - Civilian Health and

Medical

Program of the Uniformed Services.) benefits to military active duty

personnel, retirees, and dependents, and the generous insurance

benefits

of federal employees. Taxpayers pay between 75% and 100% of the bill

for

CHAMPUS coverage. CHAMPUS makes direct payment to private health care

providers, supposedly to fill the gap when military health care is not

available. Examples include military retirees and their dependents

who

do not live close to a military hospital, and active duty personnel,

retirees, and dependents who live next to an installation too small to

have a needed specialist such as an endocrinologist, orthopedic

surgeon,

etc., or too small to have a psychiatric wing in the military

hospital.(1) The federal taxpayer also pays part of the bill for the

premiums of federal employees as part of their employment package.

 

Three other developments contributed to this mushrooming of for-profit

psychiatric hospitals, especially around military installations.

Chief

among these was the abolition of proof of need tests, at the urging of

corporate hospital chains. Hospitals and treatment facilities no

longer

had to prove that a community needed a new facility, or the expansion

of

an existing facility. Capital and the thirst for profits became the

sole

criteria for building new facilities and expanding existing ones.

(See

the book MARKETPLACE MEDICINE by Dave Lindorff for more details.)

 

A second impetus for growth was the Reaganomics doctrine that private

business can provide services at a fraction of the cost of government

agencies. This led to a downsizing of military medicine. Patients

were

turned away from military hospitals and told to " use CHAMPUS " (2) -

even

though a military hospital can provide services at a fraction of the

cost

of civilian providers!

 

The third factor fueling the explosive growth of for-profit

psychiatric

hospitals was the role of OCHAMPUS - the agency in Aurora, Colorado

which

oversees the CHAMPUS program. OCHAMPUS regulations actually encourage

hospitalization over cheaper and often more effective treatment.(3)

More

serious, no one at OCHAMPUS seemed to care about how the money was

being

spent! There was no attempt to insure that the government was

receiving

value for the money it disbursed. Private businesses may be able to

provide services more cheaply than government agencies if the money is

coming out of the pockets of individuals. The reverse is true when

there

is no oversight or quality control on how that money is being spent,

and

the businesses which receive the money are allowed to determine who

needs

its services. Naturally, everyone with generous benefits needs its

services! There are no exceptions.

 

IN an atmosphere of little or no oversight, where psychiatrists

traditionally have all the power and the patients little or none,

anything goes. Profits were maximized. Patients interviewed

described

treatment as " one size fits all " , " cattle drive " , and " I felt like the

staff's attitude was 'Here's another whacko. Let's get her through

the

program' " .(4) There were few or no real attempts to arrive at correct

diagnoses because that would mean the possibility of a cure and the

object was not to cure but to keep patients for as long as the

insurance

or the government was willing to pay. More than one " miraculous cure "

took place the day the insurance ran out.

 

AT the hospital where I interviewed survivors, there were only three

diagnoses: Borderline Personality Disorder, Alcoholism, and Sexual

Addiction. All patients - when they were told their diagnosis

(frequently they were not) - were diagnosed as having one of these

three.

One woman found she was being treated for alcoholism. She

threatened to

leave the hospital. She was then told she suffered from Borderline

Personality Disorder. Later, when her husband was stationed in

another

state, she was found to be manic-depressive; she is now doing fine on

Lithium. But there were months of suffering that she need not have

endured had she received the correct diagnosis and treatment to begin

with. There were also tens of thousands of dollars of bills to

CHAMPUS

for what amounted to warehousing this woman until the CHAMPUS benefits

ran out.

 

This neglect of real problems while warehousing patients for as long

as

the insurance or the government will pay is bad enough. But it pales

compared to the practice of creating problems where none existed

before,

in order to make multiple diagnoses and extend hospital stays. Many

hospitals use what are called Behavior Control Rooms (BCRs). These

are

not legitimate Time-Out Rooms which patients enter voluntarily. Nor

are

they used for the legitimate purpose of confining a violent patient

when

all else fails, until the violence passes. These are rooms which are

used to intimidate, break down, abuse and brainwash. Patients (and

former staff) reported that patients sometimes are forcibly stripped

naked (one young man had his briefs cut off with a buck knife; others

report having clothes torn off), and " four pointed " with leather

restraints to a cot under a TV camera while staff stand nearby making

fun

of their naked bodies. Patients are told this is for their own

good! An

adult woman said that for a long time after leaving the hospital she

was

" afraid to disagree with anyone about anything no matter how trivial "

because people who disagreed in the hospital were punished. She gave

as

an example her husband offering her another piece of toast at

breakfast.

She automatically was afraid to refuse because of what had been done

to

her in the hospital and what she had witnessed done to others.

 

The BCRs are kept cold. Physical discomfort is a time-proven

brainwashing technique. Patients in the BCRs were clearly visible to

other patients via the monitors at the nurse's station, windows in the

doors to the BCRs, and the BCR doors often being left open. This is a

time-proven technique with POWs: it is only necessary to make an

example

of a few, in order to keep them all in line. Other patients could not

only see those in the BCRs, they could hear their screams and cries,

and

smell the odors coming from those rooms. Patients were not always let

out to use the bathroom or to shower; more than one BCR patient told

of

finding urine and feces left by the previous occupant. The BCRs are

the

size of a walk-in closet, bare except for a cot bolted to the floor

and a

TV camera in the ceiling. Children and adolescents as well as adults

are

confined in the BCRs.

 

So called Isolation Rooms are also used, with children and

adolescents.

These are the size of regular closets, bare except for carpeting.

There

are no windows. The light switch for the room is located outside the

room. Children and adolescents are put into these rooms in the dark.

The use of total darkness is another time-proven brainwashing

technique.

 

There are other techniques used to make well people sick and sick

people

sicker, which extend hospital time. Among these are overmedication,

inappropriate medication, and withholding needed medication such as

asthmatic inhalers.(5) Patients with families, and family members

themselves, reported attempts to turn family members against each

other,

creating suspicion and isolating the patient. This makes the patient

more vulnerable to control. Patients in Arizona as well as most other

states have the right to make telephone calls. This right is

frequently

denied at abusive facilities, demonstrating to the patient that she

or he

is totally at the mercy of the facility.

 

Patients who voluntarily admit themselves also have the right to leave

the hospital anytime they choose, for any reason, unless the patient

is

thought to be a danger to himself or herself, or to others. At

abusive

facilities, when a patient elects to leave, the hospital charts the

patient as " a danger to self or others " and starts involuntary

commitment

proceedings. Patients are then covertly drugged to make sure they

appear

as basket cases when the prepetitioning agent shows up.(6)

 

Abusive facilities cultivate people who are in positions to help them

(see ABC PrimeTime report " Morgan Medical " ). This is done by paying

bounties to social workers, school nurses, emergency room nurses, and

even ministers - anyone who is in a position to funnel patients to the

for-profit hospital. Some doctors may needlessly refer patients to

and

from each other for financial gain, a practice called " ping-ponging " .

Patients at for-profit psychiatric hospitals are often sent to other

hospitals and clinics for medical tests costing thousands of dollars,

tests that have nothing to do with psychiatric disorders. The woman

who

was manic-depressive but misdiagnosed first as suffering from

alcoholism

and then from Borderline Personality Disorder was one of three

patients

who were in the hospital at the same time. All three were sent to

various clinics for expensive medical tests. All three were told they

have fatty tissue in the liver and told to stop drinking. One of the

women is almost a teetotaler; another only a sometime social drinker.

CHAMPUS was billed for two EEGs on the woman who was practically a

teetotaler, when only one was performed.

 

It should be noted that the doctor who ordered all these tests sits on

the Board of Advisors of this for-profit hospital. He referred these

women and other patients to his own practice downtown, to colleagues

in

the health alliance he belongs to, and to the community hospital

where he

is a trustee. He is very highly recommended by local doctors and

referral services.(7)

 

Notes and references

 

1. CHAMPUS HANDBOOK, CHAMPUS, aurora, CO 89945-6900

 

2. Interviews with soldiers, retirees, and dependents at Ft. Huachuca.

Conversation with Carolyn Tucker, Patient Advocate, at Raymond W.

Bliss

Army Hospital, Ft. Huachuca.

 

3. " Regulations encourage hospitalizations " , AIR FORCE TIMES, 17

August

1992, Soraya Nelson, p 14.

 

4. From various complaints on file with Ramsey Survivors and with

state,

federal, and private agencies.

 

5. Ibid.

 

6. Joyce Simo Complaint. The Arizona Department of Health Services

investigator who investigated Joyce's complaints said it was obvious

her

records had been falsified. The first third of the intake notes -

which

describe Joyce as " neat " and " calm " - was in direct contrast to the

last

two-thirds which described her as " suicidal " . Also, the charting on

Joyce did not match the hospital's Incidence Report. A former psych

tech

attendant also came forward to substantiate her claims. The Joyce

Simo

complaint is only one of many that describe covert drugging and

attempts

to involuntarily commit voluntary patients who try to exercise their

legal rights to leave the hospital.

 

7. Calls to Cochise County medical referral services asking for a

doctor

qualified to treat a variety of complaints. If the referral services

are

to be believed, this doctor is the best qualified to treat an amazing

variety of illnesses ranging form anorexia to yeast infections.

 

Editor's Note: When I first read this article, and the one to

follow, I

was skeptical. So I asked Ms Fitzgerald for documentation. She sent

me

plenty! She also called my attention to an ABC DAY ONE piece on

another

for-profit psychiatric hospital, Truckee Meadows, exposing similar

fraudulent practices. I also showed her articles to a colleague, who

is

a psychiatrist. While pointing out that they were written from the

perspective of the patient, he acknowledged that such practices did

occur.

 

The second article of this series will discuss the techniques of

influence buying.