St. Paul’s Hospital (Vancouver) attempts to play down stabbings committed by their of their discharged patients

VANCOUVER — St. Paul’s Hospital in Vancouver is defending its record for treating psychiatric cases, even though three recently discharged patients have been arrested for violent crimes in the last year.

The downtown hospital released recommendations Thursday from an internal review that was launched after 35-year-old Nicholas Osuteye of Alberta was charged with three counts of attempted murder for his alleged attacks on women aged 63, 79 and 87 last December. He had seen emergency room doctors at St. Paul’s two days earlier after asking police for help.

The latest review follows a more sweeping, independent report prompted by attempted-murder charges against Mohamed Amer, who allegedly stabbed a 71-year-old man in a café on Feb. 21, 2012. The homeless man, 30 at the time, had been taken to St. Paul’s by police for assessment under the Mental Health Act twice that day, but was released both times.

Then in January of this year, a stabbing spree in a West End apartment building resulted in French national Jerome Bonneric, 33, being charged with 12 counts of assault. Bonneric’s lawyer has said his client suffers from mental health problems and had been to St. Paul’s shortly before the attack.

But Dr. Maria Corral, head of psychiatry at St. Paul’s, said the hospital has far more success stories than tragic ones.

“There are many ways to treat psychiatric illness and mental illness problems,” she said in an interview. “By far the most common and effective is to treat them in the community by outpatient means. We had 4,500 psychiatric patients (through the emergency department last year) … the majority of those patients are managing very well in the community as our neighbours, our friends, our brothers, our mothers.”

She emphasized that hospital staff will hold anyone — even against their will — if they are considered a threat to themselves or others. St. Paul’s has 60 beds in its psychiatric ward and a four-bed secure observation unit in the emergency department.

The hospital serves Vancouver’s Downtown Eastside and a larger than average number of people who have mental health problems, drug addiction, low incomes and inadequate housing.

“I want to assure the public that I’m very confident in our treatment team and in the processes we have in place to deliver safe psychiatric care to all the patients who visit St. Paul’s,” Corral insisted.

But Darrell Burnham, executive director of Coast Mental Health, says that St. Paul’s has been trying to cope with a flood of psychiatric patients for years and there aren’t enough places for discharged patients to go.

“I think it’s safe to say their emergency ward is overwhelmed with the number of mental health crises it sees on a daily basis and this has been going on for many years, at least 12. They’re in the unenviable position of deciding who is the most in need today … Every once in a while, despite their best efforts, they’re going to make that call wrong.”

Coast Mental Health is a not-for-profit charity that runs group homes and supported living apartments for about 800 people in Vancouver. While more spaces are being created for mentally ill people to get help from health and support workers outside of hospitals, there still aren’t enough, said Burnham.

“It’s because Vancouver is the end of the road and it’s also because people’s living situations are less supported. There are a lot of folks coming out of SROs (single-room occupancy hotels) and shelters and literally off the street … If you’re discharging someone to a loving family to care for them that’s far better from a hospital point of view rather than discharging them to a shelter or literally to nowhere.”

All of the accused are in custody awaiting trial and no one was killed in any of the incidents.

At least one of the women beaten in December is still in hospital, as is one of the victims from the Jan. 31 stabbings, according to Vancouver police department spokesman, Const. Brian Montague.

Source: Erin Ellis, “St. Paul’s Hospital defends record after three discharged psychiatric patients arrested for violence,” Vancouver Sun, March 1, 2013.

Man misdiagnosed by psychiatrists as delusional for 20 years sues

A man who spent nearly 20 years locked in a state psychiatric ward in Lincoln is suing doctors for malpractice, saying he was never mentally ill during his time there.

John Maxwell Montin, 52, filed the lawsuit Friday in federal court, naming 21 former or current Lincoln Regional Center doctors, a program manager and two nurses, the Lincoln Journal Star reported (http://bit.ly/1mVKX89 ).

Montin is seeking more than $22 million in damages for incorrectly labeling him mentally ill, unnecessarily holding him and subjecting him to treatments he didn’t need. He’s also seeking $760,000 in lost wages and $10 million in punitive damages.

Montin was released nearly a year ago after a regional center doctor acknowledged Montin had been misdiagnosed from the beginning. Doctors at the center had based his diagnosis of delusional disorder on police reports of a 1993 incident in which he was accused of walking up to rural house, declaring it had belonged to his ancestors and that he was taking it back.

But at his 1993 trial, witnesses refuted much of what Montin was accused of doing.

A Hayes County jury found him not responsible by reason of insanity of two charges: false imprisonment and use of a weapon. He was acquitted of more serious charges of attempted murder and another weapons charge.

He was sent to the Lincoln Regional Center that year. For the next 20 years, regional center doctors and others involved in Montin’s treatment relied on information from initial police reports that said Montin was delusional, rather than court records that showed otherwise.

But last year, a regional center psychiatrist found that it was medicine Montin had taken for his injured back that had led to a medication-induced psychosis. When Montin stopped taking the medication, which was long before he was committed to the regional center, the psychosis was gone. Doctors at the center simply didn’t believe him — for 20 years — when he insisted he was not delusional.

“It was an injustice, and he was right from the beginning,” said Jon Braaten, Montin’s attorney.

Braaten said Montin has returned to Florida, where he has a business cleaning the bottom of boats. The lawsuit says Montin missed the opportunity to marry and have a family, as well as his mother’s funeral, because of the Lincoln Regional Center’s malpractice.

Leah Bucco-White, a spokeswoman for the Nebraska Department of Health and Human Services that runs the center, declined to comment to the newspaper Friday.

Source: “Man misdiagnosed as delusion for 20 years sues, Associated Press, July 12, 2014.

Parkland psych ER is again scene of patient abuse

The psychiatric patient spat at Parkland Memorial Hospital staff as they strapped her into a chair. Then a nurse shoved a toilet paper roll into her mouth, while a co-worker put a sheet over her head.

“Blood stains can be seen on the toilet tissue” after its removal, says a police report that describes security camera footage. A follow-up report says a third employee warned the caregivers that their actions were “illegal.”

Texas health authorities are investigating the March incident — the first abuse in Parkland’s psychiatric emergency room to become public since the hospital hired a new chief executive. One nurse involved in the gagging was also involved in the 2011 restraint of a psych ER patient whose death triggered a federal investigation and virtual takeover of Parkland.

State health regulations prohibit restraint that obstructs a psychiatric patient’s airway or ability to communicate. A prior state enforcement action against Parkland requires hospital managers to report patient abuse within two days of becoming aware of it.

Parkland reported the gagging incident more than three weeks after it occurred. The hospital said managers didn’t know about it initially but acted promptly once they did.

“Employees on site did not elevate this incident appropriately,” Parkland spokeswoman April Foran said. The hospital fired two of five employees who were present during the restraint, she said. Two others resigned, and a fifth “received corrective action.”

Parkland, which collects hundreds of millions of dollars a year from Dallas County taxpayers, would not name the employees. But The Dallas Morning News confirmed the identities of two: Charles Enyinna-Okeigbo, the nurse who forced the toilet paper roll into the patient’s mouth, and Sherwin De Guzman, a supervising nurse.

Authorities have previously investigated both nurses: Enyinna-Okeigbo for domestic violence, and De Guzman in connection with the 2011 death of psych ER patient George Cornell. State and federal regulators found that Cornell was illegally restrained shortly before dying. They cited De Guzman for failing to supervise the technicians who subdued Cornell.

Parkland’s in-house police department investigated the March incident and asked the Dallas County district attorney’s office whether assault charges should be filed. A prosecutor said that the use of force was “unfortunate” but not criminal.

Both nurses declined to comment to The News. Enyinna-Okeigbo told police that he was merely trying to stop the spitting and was not angry with the patient, according to Parkland records.

UT Southwestern Medical Center, whose physicians supervise care at the public hospital, identified the psychiatrist in charge as Dr. Uros Zrnic. He “was not informed or aware of the incident until the videotape was reviewed” in April, UTSW said.

Terrified patient

Experts criticized Parkland after reading police reports on the latest incident at The News’ request.

“When a patient spits, it’s the last resort of a terrified human being, and being restrained like this is terrifying,” said Dr. Peter Breggin, a New York psychiatrist and former consultant for the National Institute of Mental Health.

“Trained mental health workers in this day and age know that spitting is a cause for staff to back off,” he said, adding that forcing objects into patients’ mouths can escalate violence. “There’s no excuse for this abuse.”

Dennis Borel, executive director of the Coalition of Texans with Disabilities, said some Parkland psych workers “still don’t get it.”

“This is pretty outrageous when it was just a few years ago that these kinds of actions were supposed to trigger training and other safe approaches at Parkland,” Borel said. “Everything in the patient’s behavior indicates she was desperately trying to protect herself, and they were making it worse. They failed the patient miserably.”

The state health department hit Parkland in 2012 with a $1 million fine because of Cornell’s death and several other “egregious deficiencies.” It was by far the largest hospital fine in Texas history.

Under a settlement, the hospital paid $750,000. It can avoid paying the rest if, by later this summer, it demonstrates compliance with safety requirements.

Because of the gagging incident, regulators are investigating whether there have been more “significant, egregious deficiencies and a failure to correct them or an attempt to hide them,” said health department spokeswoman Carrie Williams. “It’s an open investigation, and there have been no findings in this case so far.”

Parkland also remains under a 2013 corporate integrity agreement with the U.S. Department of Health & Human Services. It requires periodic reports on patient safety, among other steps.

Compliance with that agreement is a top stated priority of Dr. Fred Cerise, Parkland’s new chief executive. He started work about a week after the March gagging incident.

Cerise and other hospital officials declined to be interviewed for this report. In written responses to questions, Parkland said “the event was discovered” on April 8 during a routine review of security video from March 16. Parkland notified the Texas health department within a day, they said, in compliance with state regulations.

Parkland also said that in addition to taking personnel actions, it now requires video reviews of restraints within 24 hours. But it would not say whether it previously had a schedule for reviewing the security videos, or why it took more than three weeks to detect the gagging incident.

Quick investigation

The criminal investigation lasted less than 48 hours before the case was closed as “unfounded,” police reports show. A News investigation last year found that Parkland police have a history of quickly closing cases in which hospital employees are accused of abuse.

The hospital released nine pages of reports on the investigation, blacking out the names of employees and the patient. It released no information about why the patient was in the psych ER or whether she was injured in the restraint incident. There is no indication in the records that police tried to interview the woman.

When asked, the hospital spokeswoman told The News that “Parkland made multiple attempts to locate the patient” but failed.

The reports contain conflicting versions of what led to strapping the patient to the chair.

Enyinna-Okeigbo told police the woman became “extremely agitated” while in a common area of the psych ER. He said he gave her medication to calm down, but it didn’t work. When staff then directed her toward seclusion rooms, she began to “spit, swing, and kick at the staff,” police wrote, summarizing Enyinna-Okeigbo’s account.

A fellow caregiver who was interviewed “does not recall seeing the patient strike or attempt to strike any staff members,” a police report says. This caregiver also said he didn’t recall seeing the toilet paper roll put into the patient’s mouth or any bleeding. He denied covering the patient’s face with the sheet. The police report noted that “video of the incident contradicts this.”

The reports quote another staffer as saying he saw the bleeding and thought the patient had been “struck by a nurse.” He described the scene as “very chaotic” and said employees lacked training for such situations.

The police description of video footage begins as the patient resists efforts to strap her into a restraint chair: “She appeared to be acting aggressively toward to the medical staff, including spitting on multiple occasions in the direction of the staff.”

Five staffers approached the woman, including one who “immediately placed the roll of toilet tissue over the patient’s mouth,” a report says. “The patient began to resist,” leading Enyinna-Okeigbo to “shove the end of the roll into the patient’s mouth, at one point even appearing to force the patient’s jaw open to completely insert the roll.”

Then another employee secured the sheet around the patient’s head, and the bloody toilet paper was removed from her mouth. Next, a surgical mask was put on the patient. It, too, later showed blood stains.

A Parkland officer met with Assistant District Attorney Craig McNeil on April 10 to discuss potential criminal charges against Enyinna-Okeigbo. “McNeil stated that he felt the culpable mental state exhibited was negligence, and the mental state that has to be met for assault is reckless,” a police report says. “Therefore, McNeil stated that he did not feel that [Enyinna-Okeigbo] met the culpable state to be charged with a crime.”

McNeil told The News he did not know why the hospital didn’t consider charges against the staff member who put the sheet around the patient’s head. Foran, the Parkland spokeswoman, said hospital police gave the DA’s office “complete details” of the incident and noted that prosecutors have “full discretion” about how to proceed.

No assault

The News became aware of the incident on May 28 and asked Parkland for all related police reports. That same day, a Parkland detective asked McNeil for a written explanation of his reasoning, which the hospital gave The News.

“The use of force against a patient in an altered mental state is always unfortunate and should be avoided,” McNeil wrote. But it “does not appear to have been done with the intent to harm the patient.”

In an interview with The News, McNeil identified Enyinna-Okeigbo as the nurse who stuffed the toilet paper roll into the patient’s mouth.

The prosecutor said that spitting could be considered assault because of the potential for disease transmission. In using that term, he said, he did not mean to suggest that the patient should be charged with assault but added: “You have the right to defend yourself.”

McNeil said he could not tell from the video why the patient had blood in her mouth. He said he saw no footage of the patient being struck.

McNeil handled a 2011 case in which security video showed Parkland psychiatric technician Johnny Roberts choking a patient into unconsciousness. The hospital fired Roberts, but grand jurors declined to indict him.

“I was not happy about that,” McNeil said. “I still don’t know why they did that.”

Troubled pasts

The News’ reporting of George Cornell’s death ultimately led to a regulatory crackdown and two years of round-the-clock federal monitoring of Parkland.

The hospital installed security cameras — the same ones that captured the recent gagging incident. It also promised to fire problem employees and retrain others, especially on patient restraints.

Parkland would not say whether Enyinna-Okeigbo or De Guzman received this training.

De Guzman left his job at Parkland at some point after Cornell’s death in February 2011. He returned to work later the same year, according to hospital employment data. Parkland would not explain his departure or return.

Cornell’s death also led to a federal civil rights lawsuit that’s still pending against the hospital, UTSW, De Guzman and other caregivers. In court records, Cornell’s family has noted ways that regulators found fault with De Guzman.

Enyinna-Okeigbo, who was hired at Parkland in 2005, was charged with misdemeanor assault of his wife in 2008.

Dallas County prosecutors initially proposed a deal under which he could plead guilty and serve probation, court records show. Instead, for reasons the records don’t explain, they dismissed the charge in exchange for his completion of an anger management class. He never entered a plea and has no conviction record.

Parkland would not say whether it was aware of the allegations against Enyinna-Okeigbo. The hospital said that before 2011 it conducted criminal background checks only on prospective employees. It said it now checks existing employees, too.

In 2013, Parkland hired privately owned Green Oaks Hospital to manage its psychiatric services. Green Oaks, which receives $1.1 million a year under the deal, declined to comment for this report. Parkland would not discuss the company’s performance.

Source: Miles Moffeit and Brooks Egerton, “Parkland psych ER is again scene of patient abuse,” Dallas Morning News, June 14, 2014.

Czech psychiatric hospitals violate human rights laws

During a panel discussion held in Prague on June 30, psychiatric experts, lawyers and human rights activists all agreed that psychiatry in the Czech Republic is in an appalling state and violates international human rights laws. It is necessary to invest more money in psychiatric facilities and make them compliant with human rights standards. We appeal to the Ministry of Health and the government, headed by Prime Minister Bohuslav Sobotka, to enforce systemic changes to psychiatric hospitals and prevent the cruel treatment of patients.

Extreme understaffing, lack of control and lack of care within large institutions lead to massive violations of the dignity and rights of psychiatric patients. “Hospitals are like factories for patients,” said Lenka Ritter, a member of the Kolumbus Association and a former psychiatric patient.

In their critical report on the situation, the Mental Disability Advocacy Center and the League of Human Rights appealed to the Czech government to immediately prohibit the current inhumane practices rife within the country’s psychiatric facilities. The document shows that locking people in cages, tying them to their beds, closing them in solitary confinement and excessively medicating them with sedatives are still common practices. By ignoring this situation, the state is committing serious violations of international law.

“The whole Czech psychiatry is in a net bed,” commented Dr. Ján Praško, psychiatrist at the University Hospital Olomouc, speaking figuratively about the inability to improve the lives of patients without systemic solutions.

“In a cage you feel like a monkey, but worst of all is being chained to the bed. Your muscles stiffen, you can’t move and the staff will not give you a drink even for 12 hours. You have your tongue cracked and in your diapers are accumulating excrements and nobody is changing them. Even these days, I sometimes wake up with nightmares about being chained to the bed,” says Lenka Ritter, describing her experience in one of the country’s psychiatric hospital.

According to Zuzana Durajová of the League of Human Rights, “The state must undertake immediate actions to stop the inhumane treatment of patients to prevent further tragedies. Prohibition of the use of degrading restraints is just one of them. It must be accompanied by a revision of the entire mental health care system.”

Monday’s panel discussion introduced the petition End Cage Beds, which is addressed to Czech Prime Minister Bohuslav Sobotka. The petition can be found here.

Source: The League of Human Rights, “Czech Psychiatric Hospitals Violate Human Rights Laws,” European Liberties Platform, July 3, 2014.

Psych hospital spied on patients via closed-circuit TV without consent

Psychiatric patients in a major Dublin hospital were being spied on in their bedrooms without their consent, according to the inspector of Mental Health Services.

The Irish Patients’ Association has demanded an immediate investigation after it emerged that CCTV was placed in bedrooms without the patients’ knowledge.

Patients in a high-dependency unit (HDU) in Connolly Hospital, Blanchardstown, were being watched through CCTV cameras, although they had not been told about it.

The inspector described the practice as “unacceptable” and an “infringement of their right to privacy and dignity”.
He said the CCTV cameras had been installed “without adequate risk assessment and care planning for the residents”.

After the inspection by Mental Health Services, it was reported that “the CCTV in bedrooms had been disconnected”.

In a statement the HSE said CCTV was installed when the hospital was built.

“The CCTV was installed in the HDU to assist in ensuring the safety of patients,” said a spokesperson.

It noted that all CCTV is now disconnected except in seclusion rooms. “CCTV is only ever used in the seclusion room of the HDU and never in the bedrooms. Whenever a patient is in seclusion, the patient is told the CCTV is in use.

“The nursing staff in the HDU have access to the CCTV cameras and the information is not stored.

“The decision to install CCTV was made by the Mental Health Service Management at that time and the management team also made the decision only to use CCTV in the seclusion room in the HDU,” the HSE said.

Stephen McMahon of the Patients’ Association said: “It’s a serious issue. CCTV should never be installed in the absence of a full ethical framework.

“If it is something that is being done for patient safety or staff safety, it should adhere strictly to ethical guidelines laid down by data protection and the ombudsman.

“Without such guidelines you can have ‘function creep’ where cameras are installed in the car-park, then in the corridors and before you know it in patients’ bedrooms and the toilet.”

The whole issue, he added, should be investigated by both the Data Protection Commissioner and the Information Ombudsman.

APPROVED
The report, which revealed the CCTV was one of the third batch of 2013 inspection reports that are being released at intervals throughout the year.

This particular batch looked at six approved centres – Connolly Hospital, University College Hospital Galway, the Central Mental Hospital, St James’s Hospital in Dublin, Kerry General Hospital and Carraig Mor Centre in Cork.

While the issue of CCTV surveillance only arose at Connolly Hospital, it was also found that the centre overall “had made significant progress in introducing an excellent individual care plan template” since the last inspection.

It did, however, require urgent maintenance and painting and “adequate seating areas and chairs still had not been provided” despite a previous recommendation.

At St James’s “medicine was not prescribed in accordance with Medical Council guidelines”.

The Central Mental Hospital had vacant psychology and occupational therapy posts.

In the Cork unit “there was no provision for privacy in the bathrooms or lavatories in the male areas of the ward”.

In Galway, the night inspection had no difficulties.

In Kerry, one resident was not given enough dignity in relation to clothing while in seclusion and was at risk of injury from the furnishings in the room.

Source: Clodagh Sheehy, “Hospital’s psychiatric patients ‘spied on’ with CCTV in their rooms,” Herald.ie, August 6, 2013.

Scottish psych nurse loses license for locking patient in room

A nurse at a Tayside psychiatric hospital has been suspended from practising for three months after locking a patient in a room and walking away.

Susan Sutherland trapped the man in a room at Murray Royal Hospital in Perth to “see what he would do”.

Ms Sutherland, who was sacked after the incident in December 2010, has always denied the charge against her.

A Nursing and Midwifery panel ruled that Ms Sutherland remains a risk and could put patients at unwarranted harm.

The panel heard from healthcare assistant Gary Boyle, who said he had managed to persuade Patient A into a bathroom in an attempt to bathe him, only for the patient to run out of the room naked.

The patient ran into and lay on the floor of a smoking room on the ward, before Ms Sutherland and Mr Boyle managed to convince the man to return to his room.

But when the patient returned to his room, an irate Ms Sutherland shut the door, locked it and told Mr Boyle she “was locking his door for five minutes to see what he would do before she “stormed off down the corridor away from Patient A’s room”.

The incident was reported to Margaret Cullen, the nurse in charge at Glenelg Ward and Ms Sutherland was suspended two days later.

Source: “Psychiatric nurse suspended after locking naked patient in room,” STV, January 13, 2013.

Worker at child psych center, 24, arrested for sex with patient, 13

Jackson police arrested a Madison Oaks Academy staff member early Thursday morning after another worker at the facility reported that the man was caught having sex with an underage female resident there.

Madison Oaks Academy, located at 49 Old Hickory Blvd, is a 73-bed residential psychiatric treatment facility for children between the ages of 10 and 18 “with emotional and behavioral disorders,” according to the facility’s website.

Officers received a call from the facility around 1 a.m Thursday. An employee at the academy reported to police that staff member Larry McIntosh, 24, had just been caught having sex with a 13-year-old resident, according to a news release from the Jackson Police Department.

The release said investigators concluded that a staff member was making early-morning rounds when the worker saw McIntosh engaged in the act.

“The staff member, who witnessed the incident, immediately alerted his superiors, who then notified police,” the release said. “McIntosh, 24, was arrested at the facility and booked into the Madison County Jail at 2:40 a.m.”

The Department of Children’s Services is assisting in the investigation, police said.

Police reported that Madison Oaks Academy suspended McIntosh pending the outcome of the investigation.

When The Jackson Sun contacted the facility Thursday afternoon to inquire about McIntosh’s position and employment history at the facility, a worker who answered the phone said Madison Oaks Academy has declined to speak on the matter at this time.

The academy’s website said the facility is “specifically designed for children and adolescents.”

“Our staff specializes in the treatment of children and adolescents with disorders such as ADHD, PTSD, depression, anxiety disorders, oppositional defiant disorder and other behavioral and mood disorders,” the facility’s homepage said Thursday. “A highly structured behavioral management program, with a level system, is implemented to assist residents in gauging their progress. It also assists residents in learning to accept responsibility for their own behaviors, both positive and negative.”

The facility is part of the Woodridge Behavioral Care centers also located in Arkansas and Missouri.

McIntosh is scheduled to be arraigned at 8 a.m. today in Jackson City Court on charges of aggravated statutory rape and statutory rape by an authority figure.

Source: Jordan Buie, “Madison Oaks Academy staffer faces sex charges; Employee reported seeing co-worker with 13-year-old,” Jackson Sun, January 10, 2013.

Owner of chain of mental health centers pleads guilty to fraud

WASHINGTON – The owner of a string of community mental health centers pleaded guilty today in connection with a health care fraud and money laundering scheme involving defunct health care provider Health Care Solutions Network Inc. (HCSN), announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Michael B. Steinbach, Acting Special Agent in Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami office.

Armando Gonzalez, 50, of Hendersonville, N.C., pleaded guilty before U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida to one count of conspiracy to commit health care fraud and one count of conspiracy to commit money laundering.  Under the terms of his plea agreement, Gonzalez will also forfeit his interest in property valued at several million dollars, including $987,910 in currency seized in July 2012 as well as several vehicles and properties located in Hendersonville.

According to court documents, HCSN operated community mental health centers (CMHC) at three locations in Miami-Dade County, Fla., and one location in Hendersonville.  HCSN purported to provide partial hospitalization program (PHP) services to individuals suffering from mental illness.  A PHP is a form of intensive treatment for severe mental illness.

According to Gonzales’s plea agreement, HCSN obtained Medicare beneficiaries to attend HCSN for purported PHP treatment that was unnecessary and, in many instances, not even provided.  HCSN obtained beneficiaries in Miami by paying kickbacks to owners and operators of assisted living facilities (ALF).  According to court documents, HCSN routinely admitted patients in Miami who were ineligible for PHP treatment because they suffered from medical conditions – including mental retardation, dementia and Alzheimer’s disease – that could not be effectively treated by PHP services HCSN was purporting to provide.

According to Gonzalez’s plea agreement, his employees routinely fabricated patient census data and patient medical records that were then utilized to support false and fraudulent billing to government sponsored health care benefit programs, including Medicare and the Florida Medicaid program.

Gonzalez pleaded guilty to directing his employees in North Carolina to routinely submit fraudulent PHP claims for Medicare patients who were not even present at the CMHC or on days when the CMHC was closed due to snow.  Similar to HCSN’s Florida operations, patients who were suffering from conditions such as mental retardation were improperly and routinely admitted to HCSN for purported treatment.  To increase its patient base, HCSN Hendersonville employed “marketers” in North Carolina who recruited ineligible patients from surrounding counties.  HCSN would then transport the patients daily and reward them for their attendance by giving them cigarettes.

In furtherance of the North Carolina fraud scheme, HCSN employees and licensed therapists routinely fabricated patient progress notes purportedly documenting intensive mental health therapy.  In reality, patients were crowded into dysfunctional groups that often exceeded more than 20 people. HCSN therapists would then produce bogus therapy notes for sessions that had little therapeutic value and, in many cases, never even occurred.

According to Gonzales’s plea agreement, he was the president of Miami-based Psychiatric Consulting Network Inc., which he used as a shell corporation to launder HCSN health care fraud proceeds.

According to court documents, from 2004 through 2011, HCSN billed Medicare and the Florida Medicaid program approximately $63 million for purported mental health services. The false and fraudulent billing resulted in more than $28 million in payments from Medicare and Florida’s Medicaid programs.

In addition to Gonzalez, former HCSN employees John Thoen, Alexandra Haynes, Serena Joslin and Sarah Da Silva Keller have pleaded guilty to health care fraud and related charges.  ALF owners Daniel Martinez, Raymond Rivero, Ivon Perez and Alba Serrano have pleaded guilty to health care fraud and related charges for their roles in the scheme.  Alleged co-conspirators Paul Layman and Wondera Eason are scheduled for trial on Jan. 14, 2013, before judge Altonaga in the Southern District of Florida.

The cases are being prosecuted by Special Trial Attorney William J. Parente and Trial Attorneys Allan J. Medina and Steven Kim of the Criminal Division’s Fraud Section.  The case is being investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion.  In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

Source: “Leader of $63 Million Mental Health Fraud Scheme Pleads Guilty in Miami,” Department of Justice Office of Public Affairs press release, December 17, 2012.

Mental health clinic director sentenced to 100 months prison for fraud

WASHINGTON – A former clinical director for Biscayne Milieu, a Miami-based mental-health clinic, was sentenced today to 100 months in prison for his participation in a Medicare fraud scheme involving the submission of more than $50 million in fraudulent billings to Medicare, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Michael B. Steinbach, Acting Special Agent in Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami Office.

Rafael Alalu, 47, of Miami, was sentenced today by U.S. District Judge Robert N. Scola Jr. in the Southern District of Florida.  Alalu was convicted on Aug. 24, 2012, of one count of conspiracy to commit health care fraud and two substantive counts of health care fraud, following a two-month jury trial.  The evidence at trial showed that Alalu participated in treating ineligible patients, concealing that fact by falsifying patient files and writing fraudulent group therapy notes, and instructing others to do the same.  In addition to the prison term, Alalu was ordered to pay more than $5.6 million in restitution, jointly and severally with his co-defendants.

Various owners, doctors, managers, therapists, patient brokers and other employees of Biscayne Milieu have also been charged with various health care fraud, kickback, money laundering and other offenses in two indictments unsealed in September 2011 and May 2012.  Biscayne Milieu, its owners, and more than 25 of the individual defendants charged in these cases have pleaded guilty or have been convicted at trial.  Antonio and Jorge Macli and Sandra Huarte – the owners and operators of Biscayne Milieu – and Dr. Gary Kushner – its medical director – were each convicted at trial of various offenses and are scheduled for sentencing in March 2013.

According to the evidence at trial, the defendants and their co-conspirators caused the submission of over $50 million dollars in false and fraudulent claims to Medicare through Biscayne Milieu, which purportedly operated a partial hospitalization program (PHP) – a form of intensive treatment for severe mental illness.  Instead, the defendants devised a scheme in which they paid patient recruiters to refer ineligible Medicare beneficiaries to Biscayne Milieu for services that were never provided.  Many of the patients admitted to Biscayne Milieu were not eligible for PHP because they were chronic substance abusers, suffered from severe dementia and would not benefit from group therapy, or had no mental health diagnosis but were seeking exemptions for their U.S. citizenship applications.  The evidence at trial showed that once these ineligible patients were admitted to Biscayne Milieu, Alalu and others concealed the fraud by falsifying patients’ group therapy notes to reflect legitimate PHP treatment that was never provided, and directed others to do so.

The case is being prosecuted by Assistant U.S. Attorneys Michael Davis and Marlene Rodriguez of the U.S. Attorney’s Office for the Southern District of Florida, and by Trial Attorney James V. Hayes of the Fraud Section of the Justice Department’s Criminal Division.  The case was investigated by the FBI with the assistance of HHS-OIG, and was brought by the U.S. Attorney’s Office for the Southern District of Florida in coordination with the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

Source: “Clinical Director for Miami-based Health Care Clinic Sentenced to Prison for Role in $50 Million Medicare Fraud Scheme,” Department of Justice Office of Public Affairs press release, December 20, 2012.

Australian mental hospital identified wrong man as escaped patient; involuntarily detains, drugs

A mental health advocate says the case of a man who was arrested and drugged after being mistaken for a patient from a Perth psychiatric hospital is not a one-off.

Police arrested the man while on lookout for an involuntary patient who left Graylands Hospital without permission.

The man was wrongly identified as the missing patient and then given an antipsychotic drug.

He had a bad reaction and was taken to hospital, where the mistake was discovered.

Western Australia’s Mental Health Minister Helen Morton says she was shocked to hear about incident.

“The policies and procedures are stringent about identifying people when they are made involuntary and when they are about to receive a Schedule 4 drug, and it would appear those policies and procedures weren’t carried out,” she said.

Mental Health Law Centre principal solicitor Sandra Boulter says there were probably several errors.

“There are a series of people, there were the police, there were the admitting staff, there’s presumably the treating psychiatrist, and the Aboriginal Health Service, all of whom could possibly have identified the error,” she told AM.

“It is always the case when there is a mistake, as even an airline pilot will tell you, it is never one mistake, it is a series of errors that accumulate leading up to the big error.

“I think it is a critically important that an independent person such as an official visitor is appointed or contacted so there is independent oversight of any admission.”

Ms Boulter says this is not the first time an incident like this has occurred.

“I am certainly aware of one patient, one client of ours, who was admitted mistakenly and another two clients who were admitted on a false report where [it] was subsequently established that they did not have a psychiatric illness,” she said.

She says she it is not sure if authorities are aware of the second incident.

“I’m not sure about that,” she said.

“Our clients were unwilling to complain about what happened to them because they were fearful of being further traumatised by taking an action against the state.”

Ms Boulter says she wants to confirm that authorities are in contact with the wrongfully detained man.

Source: David Weber, “Experts concerned over arrest, drugging of wrong man,” ABC News, December 27, 2012.