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Earlier this year, young patients at North Star Behavioral Health System — a locked, for-profit psychiatric hospital for children and teenagers in Anchorage — staged a small mutiny.
In June, a patient hit the fire alarm, unlocking doors. Four patients fled the hospital. The group roamed Anchorage for hours. By the time they were tracked down and returned by police, one patient was so drunk they had to be taken to a different hospital.
The next day, a staff member described the events to a visiting federal investigator with the Centers for Medicare and Medicaid Services as a “riot.” A physician later described the days as “the (worst) weekend the facility has had in years.”
During two hospital inspections in April and June, federal investigators documented more than a dozen “deficiencies” at North Star Behavioral Health System’s Anchorage campuses, the only hospital in Alaska to be cited during that timeframe. Investigators found some problems at North Star to be so serious, like assaults, they were deemed “immediate jeopardy” situations at the time, meaning the health and safety of patients was at risk.
North Star CEO Anne Marie Lynch said she couldn’t say anything about the events documented by the federal investigators, citing patient privacy laws, when contacted this week by the Anchorage Daily News.
The same federal investigators visited in September and found “no deficiencies or recommendations,” she said. The hospital isn’t under any plan of correction with their powerful federal regulators, according to North Star.
“We continue to monitor our compliance with standards as well as the quality of our programs,” Lynch wrote. “When issues are identified we investigate thoroughly and create action plans to improve.“
The more than 150 pages of reports by federal investigators offer an official view of dysfunction that former patients and families of patients have long described at the East Anchorage hospital.
Among the findings:
• Patients assaulted other patients, including an instance where two children were locked in a “quiet room” together accidentally. One attacked the other, leaving a child’s nose bloodied. The hospital didn’t investigate how the incident happened.
• One patient was punched, slapped in the eye and kicked by peers but their parent wasn’t told, according to the investigation. “Mother stated she is really upset for not being notified when her child was attacked by another patient,” the child’s case notes read. She tried to discharge her child immediately, but ended up waiting overnight at the suggestion of staff.
• A young patient at North Star psychiatric hospital in Anchorage spent 40 days in the locked facility without receiving a single therapy session.
The investigation’s findings are no surprise to Angel Gonzales, the board president of Facing Foster Care in Alaska, a nonprofit advocacy organization. Gonzales was in and out of foster care from ages 7 to 16 and now works at Covenant House as a permanency navigator. She’s been hearing stories about escapes, seclusion and assaults from kids sent to North Star for years now. She remembers almost being sent there herself because the Alaska Office of Children’s Services didn’t have another placement, she said. She said she was terrified by the prospect.
“All of the things this investigation is going to highlight have been happening for years and years,” said Gonzales. “Nothing is new.”
North Star operates three campuses in Anchorage and one in Palmer: a hospital at 2530 DeBarr Road, a residential treatment facility at 1500 DeBarr Circle and the Chris Kyle Patriots Hospital, for adults, on Bragaw Road. North Star also operates a home in Palmer, for children. The report is mostly focused on the DeBarr Road locations but found that the Chris Kyle Patriots Hospital lacked a process for reporting allegations of abuse against vulnerable adults by staff or volunteers.
The Centers for Medicare and Medicaid Services, the federal regulator, is charged with ensuring hospitals are meeting standards for patient safety and care. Hospitals that fail CMS inspections and don’t fix serious problems can be decertified, which means they would no longer be allowed to accept Medicaid or Medicare payments. That’s usually a death sentence for hospitals that rely on the ability to bill federal programs.
It was that threat of CMS decertification that led officials, in 2019, to bring in an Outside consultant to help run the Alaska Psychiatric Institute after it repeatedly failed inspections, coming perilously close to losing its CMS certification.
Complaints about North Star pour into the Disability Law Center of Alaska, a nonprofit legal organization with a federal mandate to investigate whether Alaskans with disabilities are treated fairly.
“We get complaints from parents, foster parents, other folks that are concerned about the quality of care,” said Patrick Stocks, an attorney with the Disability Law Center.
At the same time, Alaska has so few options for hospital-level or outpatient psychiatric care, especially for kids, that North Star represents one of the only places available to families and agencies, Stocks said. Often, it’s the only in-state option available.
“We also get the calls ... from families who are desperately looking for a place to comply with the level of care they need, and they’re just not finding anything and it’s a pretty terrible situation,” he said.
North Star is owned by Universal Health Services, a Pennsylvania-based corporation listed on the Fortune 500. It owns and operates hundreds of health facilities, including many behavioral health hospitals, around the country. Annual revenues exceed $11 billion, according to the company.
In 2020, Universal Health Services Inc. agreed to pay $122 million to settle allegations that it billed for medically unnecessary behavioral health services and failed to provide adequate care, among other allegations, the U.S. Department of Justice said at the time.
Many of the kids who spent time in North Star were in state Office of Children’s Services custody.
Alaska child welfare authorities have been criticized for sending children to North Star because other placement couldn’t be found, not because their problems are severe enough to warrant a stay in a locked facility. A 2022 class action lawsuit filed on behalf of children in Alaska’s foster care system describes the Office of Children’s Services placing a child at North Star simply because they couldn’t find anywhere else. In 2021, the U.S. Department of Justice’s civil rights division opened an investigation into whether the state of Alaska “unnecessarily institutionalizes” children with behavioral problems. That investigation remains open.
Mateo Jaime was 16 and in OCS custody when he was sent to North Star for about two months back in 2018. He says there was no reason for him to go other than lack of another foster home placement. The problems described by the federal inspectors were familiar.
”That was the whole experience,” he said. “You have not gone to North Star unless you’ve seen a fight. Unless you’ve seen people escape. Unless you’ve been locked into a quiet room.”
Jaime said he became “like a zombie” to get through the days at North Star. When he was released, a sense of fear that he could be sent back at any time lingered. He’s now a student at the University of Alaska Anchorage pursuing dual music and legal studies degrees. He ages out of foster care in a month.
He’s also become an activist for change in the foster care system, in part because of his experience at North Star.
”It needs to be addressed,” he said. “A for-profit organization should not have the most control over youth mental health in Alaska.”
North Star remains a licensed facility, and OCS continues to send children to the hospital, said Brian Studstill, communications director for the Alaska Department of Family and Community Services. As of Monday, there were “less than 10″ children in North Star who were in state custody, he said.
“North Star is one of only two facilities in Alaska that can accept children and youth experiencing mental health crises and need acute care treatment,” Studstill wrote. “The lack of in-state acute care treatment for children continues to pose challenges for both parents in our communities and OCS.”
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In North Star’s inspections from this year, many of the investigators’ critiques revolved around the hospital’s use of locked seclusion rooms for children and teens acting out. The investigators found instances in which children were left in the rooms without any documentation in their records, or were not properly monitored. In one case, a child slept in the room overnight. A patient under the age of 9 spent more than an hour locked in seclusion, against policy, investigators found.
Managers told the inspectors that short staffing was a major problem at North Star, the reports say.
That’s not an issue confined to North Star, Stocks said. Elsewhere in Alaska and around the country, psychiatric hospitals have struggled to find enough workers, a longstanding problem made worse by the coronavirus pandemic and a generally tight labor market. North Star has a “robust recruitment program” and has been hiring staff, said Lynch, the CEO.
“Our institutions up here are really struggling to staff,” Stocks said. “One thing that happens is when a psychiatric facility doesn’t have enough staffing is they’re going to take shortcuts at the expense of their patients.”
Gonzales, who spent time in OCS custody, said the experience of a stint inside North Star is a common one among kids in the foster care system. That’s even clearer now that she works at Covenant House, helping young people who are homeless or living in shelters find permanent housing.
“A lot of them know each other from North Star,” she said.