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Rick Santorum-Linked Hospital Chain Saw Suicide Attempts, Abuse, And Loss Of Parents' Rights

Jason Cherkis

Posted: 02/21/12 10:23 AM ET  |  Updated: 02/23/12 03:14 PM ET

WASHINGTON -- Three weeks ago, former Sen. Rick Santorum (R-Pa.) canceled campaign events in Florida on the eve of the state's primary to be with his ailing daughter in a Virginia hospital. His three-year-old, Bella, has a genetic condition that can be fatal and had contracted pneumonia. On the phone from his daughter's hospital room, the presidential candidate told reporters, "It's been a very hectic 36 hours."

Bella recovered, but Santorum rejoined the campaign with his daughter's health still on his mind. Stumping in Minnesota, he insisted that children like his daughter who are on the "margins of life" would not get adequate medical attention under President Barack Obama's health care reform law. He went so far as to invoke former Alaska Gov. Sarah Palin's infamous charge that the federal law would create bureaucratic "death panels."

"In top-down, government run systems, patients become commodities, and their value is based on their usefulness to society," Santorum elaborated to The Huffington Post. "Often times, those with special needs are not viewed as 'useful' by society's standards -- and far too many like our little girl have been forced to receive inadequate care and in many instances no care at all."

"We need a health care system that provides consumers the best choices for the best care available. These choices should not be left in the hands of bureaucrats to judge an individual's value. Instead we should place that choice in the hands of the consumer -- the children and the parents -- who can make the best choices for their individual circumstance."

"Put simply, a patient should be the decision-maker in their care -- not a government or bureaucrat."

Despite his advocacy for patients' rights and his stake in providing care for severely vulnerable children, Santorum has avoided discussing another personal experience with the health care industry. From 2007 through the first half of 2011, Santorum served on the board of directors of Universal Health Services, Inc. (UHS), one of the country's largest hospital chains.

According to the company's Securities and Exchange Commission filings, as of Feb. 28, 2011, UHS owned 25 acute care hospitals and 206 behavioral health centers located in 37 states, Washington, D.C., Puerto Rico and the U.S. Virgin Islands. Many of those facilities include or are classified as residential treatment centers (RTCs) -- secure facilities charged with the difficult task of treating children with severe mental-health or behavioral issues, many of whom are living very much on the margins of society.

The RTCs make up a significant part of UHS' business portfolio. The UHS board on which Santorum served is partially responsible for general management of the company's operations. Santorum declined to comment on his work at UHS or the company's RTCs.

RTCs are often last chances for kids who haven't adjusted to foster care or who come from the juvenile justice system and are at risk of possible mental health problems. Although the process varies from state to state, children are generally sent to residential treatment centers by child-welfare agencies or juvenile-justice authorities. Parents sometimes turn to these facilities on their own as well if there are no other options that their insurance will cover. The centers tend not to produce a lot of happy moments -- those that a presidential campaign could highlight in a stump speech or a cheery video.

The Department of Justice is close to settling with UHS over allegations that it committed medicaid fraud in one of its RTCs. The DOJ settled a case with the company in 2009 for $27.5 million over allegations that it bribed doctors to get them to refer patients to hospitals in Texas. Various state authorities have penalized UHS facilities with serious sanctions, suspending their licenses and barring them from receiving Medicaid reimbursements. In several incidents, staff and patients have been implicated in criminal activity ranging from rape to homicide.

The Huffington Post has documented these incidents in a series of stories on Santorum and the hospital chain.

Placing children in an RTC, away from home and in the care of strangers, can be hard on parents even when things go well. In a majority of cases, the RTC is the last option offered by their insurance and only after less severe options have been tried. It doesn't mean they give up their rights as parents, however, just as with other hospitals. They get to make decisions about things like medications, and can generally remove their children at any time.

But in interviews with HuffPost, two families of former UHS patients treated at the company's RTCs voiced a common complaint -- a feeling that their parental rights stopped at the facilities' front doors. They recall RTC staff limiting communication with their children, flouting parental consent, and brushing off their attempts to monitor their loved ones' care. They all say that their troubles started soon after their children were admitted.

ON NEEDLES AND PINS

In the fall of 2008, Candace Touchstone, 38, brought her 11-year-old daughter (who asked that her real name not be used to protect her privacy), to UHS' Timberlawn facility in Dallas, Texas.

Touchstone says her ex-husband had been physically abusive to her and their child when their daughter was five. Her daughter had struggled with the memories, becoming more and more withdrawn. She began running away from home that September. Her attempts became more daring -- one time she was found at a major intersection in central Dallas a mile and a half away. She had a suitcase full of canned goods and some clothing. On the fourth and final attempt, she jumped out of her mother's car and hid in a bathroom stall in her therapist's office building. It took Touchstone nearly two hours to find her.

After seeking help from private therapists, Touchstone says the doctors recommended Timberlawn, thinking it could stabilize her daughter. She says doctors told her they had never been there and admitted they did not know what it would be like. Timberlawn was just 10 miles from their home, however, whereas the only other facility that Touchstone's insurance would pay for was 60 miles away.

During the intake process, Touchstone says she explained to Timberlawn's doctors and staff that her daughter had an extreme phobia of needles, and she forbade doctors and nurses from using them on her daughter. John Touchstone, who married and later divorced Candace after she left her ex-husband, says he made a similar request.

"One thing we told them was don't give her needles," he explains. "She's afraid of needles."

The Touchstones say the admissions nurse promised they would not inject their daughter, but then promptly did so -- restraining her and injecting her three times with tranquilizers.

The next morning, their daughter tried to kill herself.

In a largely barren room, she took off her pants and tied them around her neck so tightly that the staff had to cut them off. The Touchstones say their daughter had never spoken of or attempted suicide before.

The Touchstones' daughter, now 14, recalls her mother repeatedly telling her that she wouldn't get shots, and the devastation she felt when the doctors injected her.

"I remember thinking everyone was lying to me," she says. "I couldn't stay in a place like that. I couldn't. I just. I didn't know. I remember looking -- they put me in a room with a window. I remember thinking ... I would never be able to leave. And that was the only way to leave."

Candace and John Touchstone say a doctor called and apologized and promised they would not inject her daughter again but that during the following shift a nurse did so anyway.

After that, the Touchstones say, their daughter tried to kill herself by wrapping her shirt around her neck. Timberlawn did not return a request for comment.

John Touchstone says he felt helpless once his step-daughter entered the RTC. "I'm a man," he says. "I fix everything, right? And this is something I can't fix. You're stonewalled. You got a child who won't talk to you. And you have a hospital that won't listen. There's not any support."

He says it felt like he was putting his step-daughter into Gitmo. "You might as well waterboard her," he says. "That's what it felt like. That was kind of the overtone of everything. It seemed like that was the level of care we got at that hospital."

That dynamic proved frustrating for Candace Touchstone, who says she constantly called the RTC to inquire about her daughter's care. "They felt like I was fighting against them," she says. "I was fighting for her. They didn't see that."

HORSE-AND-BUGGY OPERATIONS

Rooted in the early 20th-century juvenile-justice reform movement, which favored work farms and bucolic reformatories over hard time, residential treatment centers tend to play up their idyllic, often rural settings when marketing themselves, according to experts and written accounts about the industry.

Timberlawn, founded in 1917, advertises itself as just "a half day's buggy ride from the bustling city of Dallas."

In the last decade or so, in fact, health care experts have dismissed these facilities as about as old fashioned as the horse and buggy. The U.S. Surgeon General condemned the RTC model in a widely-circulated report in the late '90s. "In the past, admission to an RTC has been justified on the basis of community protection, child protection, and benefits of residential treatment," the nation's top health official wrote. "However, none of these justifications have stood up to research scrutiny."

The RTC's isolation can be an incubator of pathology as well as a hindrance to family-supported therapies, analysts say. "Families are often not regularly involved in decisions made about their children when moved to a RTC, and this isolates them from continuing engagement with their child and limits success," wrote Bruce Kamradt, director and founder of Wraparound Milwaukee, a consortium of social service agencies and providers who work on preventing RTC placements, in an email to HuffPost.

A year before the Touchstones' daughter entered Timberlawn, the Washington, D.C.-based University Legal Services published a study on RTCs and highlighted the barriers between parents and children in these settings. The report noted that the isolation "severely impedes youths' clinical treatment and quality of life. The isolation that comes from being in an institution cannot be overstated."

Candace Touchstone, who is a nurse at a state-run mental hospital, thought there was no way the staff at Timberlawn could inject her daughter, because she had not given consent. But Jennifer Lav, ULS' managing attorney and the author of the study, says that facilities often don't take families and guardians into consideration.

"We've had quite a few [cases] where parents say 'I want to know why my child is taking medication, if this is the correct one, I didn't authorize this medication,'" says Lav.

In December 2010, Karen Dunning, 50, flew her 14-year-old schizophrenic daughter, Alysha, from Arvada, Colo., a suburb of Denver, to the San Marcos Treatment Center in San Marcos, Texas. At the time, she was desperate to get her daughter help.

"Our local mental health center found it," she says. "When they found there was a bed, they gave us 24 hours to get her there. I didn't get a chance to look at it. She had been in and out of the children's hospital psych ward four or five times in the previous six months. She had been in acute care for two months."

Dunning says staff at San Marcos promised her that Alysha would be under constant supervision for the first 48 hours. On Alysha's first day, however, Dunning says, another patient slammed her head against a concrete wall, punched her in the face, and gave her a bloody nose. That night, a staff member left Dunning a message downplaying the incident, according to a voicemail provided to HuffPost.

"Another little girl I guess got mad at her about something," the staffer stated, "She hit her in the nose. ... She's OK."

The next day, Dunning says, Alysha passed out and had no pulse and no blood pressure. San Marcos did not call 911, however, and Dunning says the facility didn't notify her for hours. When they did, they told her they had laid Alysha down, and she started breathing again on her own. They only had a psychiatrist check her out. "I was beyond panic mode," Dunning says. "That was day two."

Dunning says her daughter complained that her face was black and blue. Personnel told her it was just the bloody nose. "I wanted to Skype to see her," Dunning says. San Marcos rejected her request, citing privacy laws. "I said I can waive that because she's my child. Nope, they wouldn't do it."

Touchstone estimates that she called UHS' corporate headquarters between 10 and 15 times complaining that her daughter had been mistreated. She says she never got a call back.

Isa Diaz, vice president of UHS public affairs, declined to comment on individual cases, citing UHS policy and patient confidentiality laws. "All UHS facilities place quality of care and patient satisfaction as our most important priority," she wrote in an email to HuffPost. "UHS provides extensive training to its staff on all patient care matters including but not limited to medication administration, restraint usage and protecting the safety and well being of our patients."

Dunning says that San Marcos only allowed phone calls in 15-minute slots and near a staff desk, so patients had no privacy. Often the background noise was a girl screaming at Alysha to get off the phone, Dunning says. Every time Dunning reached her daughter by phone, Alysha would tell her that the facility scared her.

"She's crying every time I talk to her," Dunning explains.

Making matters worse, Alysha was assigned a blind therapist, despite the fact that Dunning told staff that her daughter communicates visually better than she does verbally.

Alysha says the scariest part was simply getting beat up and that the staff was rarely around to protect her. "They weren't doing anything," she says.

During a conference call concerning her daughter's 10-day review, according to a tape recording Dunning provided to HuffPost, the San Marcos psychiatrist charged with Alysha's care made it clear they did not appreciate Dunning's level of oversight. "You try to micromanage everything," he complained to her.

"She's my child, I'm going to," Dunning replied. "She doesn't belong to you."

The doctor urged Dunning to trust them. He said that Dunning's calls put the staff on edge and interfered with therapy. "The trust needs to be earned," Dunning said. "This is not micromanagement. This is the concern of a parent."

The doctor then blamed Alysha's mental-health struggles on her mother. "I think that some of her problems are caused by your over involvement," he said.

By then, Dunning also discovered that San Marcos wasn't properly monitoring Alysha's diabetes and filed a complaint with Texas social services. The state investigated the diabetes incident and confirmed that the staff at San Marcos had failed to provide appropriate care, according to a Texas Department of Family and Protective Services report. San Marcos did not return a request for comment.

Alysha continued to be assaulted as well -- at least six times during her month there, Dunning calculated, before she finally decided to remove her from San Marcos.

Dunning says the UHS facility was her only option because there were no places in Colorado that would fit her daughter's needs. The local mental health provider couldn't offer the level of intensive in-home services Alysha required, Dunning explains.

Several states, including Wisconsin, Virginia and Tennessee, realizing the limits and costs of institutional care, have worked to develop alternatives to sending kids far from home.

The city of Hampton, Va., stopped sending children to RTCs in April 2007, finding more success by keeping kids in family settings. Instead of secure facilities, therapists make house calls. Mental health, social services and the courts all collaborate and meet on individual cases. The city also sees extended family members as resources for taking care of kin.

Others have pursued similar reforms. In Wisconsin, Kamradt began transforming social services in the mid '90s with his Wraparound Milwaukee initiative. His model emphasizes keeping at-risk kids out of RTCs by giving families leadership roles and support from coordinated government agencies, a pool of private providers, and emergency services for moments of crisis.

The wraparound model works, Kamradt says, because it emphasizes families over RTCs, small case loads and intensive services. "It's around strengths and needs of kids," he explains. "Better we plan this together. We'll look at family needs too. If the youth problem is he's in a gang and the mother really needs to get out of this neighborhood, we may find alternative housing. If she needs a job, we'll try to find a job for her. We're going to focus not only on the kid's need but the family's need."

If the Touchstones' daughter had run away in Milwaukee instead of Dallas, a team could have been put in place to help her immediately and link Touchstone with community-based assistance. She would not have to have had an expensive hospital stay. Recent figures show RTCs can cost hundreds of dollars per day, per child. In comparison, family-based models cost a fraction of that amount.

"It's a great paradox in child welfare: the worse the option, the greater the cost," Richard Wexler, executive director of the National Coalition for Child Protection Reform, explains. "Once the child is admitted and the door is closed behind him, the RTC is effectively in charge."

CORRECTION: This article originally reported that Santorum's daughter, Bella, had been taken to a Philadelphia hospital. That was the information initially provided by the Santorum campaign, but, unbeknownst even to Santorum's staff at the time, she was being cared for in Virginia. The campaign later apologized for the confusion. We regret the error.

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Rick Santorum And Universal Health Services: Presidential Hopeful Serves On Board of Hospital Chain Being Sued By DOJ
Santorum

by Jason Cherkis

First Posted: 06/07/11 09:33 PM ET Updated: 08/07/11 06:12 AM ET

WASHINGTON -- Former Pennsylvania Sen. Rick Santorum, who announced his bid for president Monday, has spent the past four years serving on the board of Universal Health Services Inc. (UHS), one of the country's largest and most troubled hospital chains.

It turns out Santorum may have had a more personal stake in railing against President Barack Obama's signature health care legislation and beating the drum for less government intrusion in our health care system. Both federal and state officials have routinely cited UHS for a seemingly endless number of violations, ranging from Medicaid fraud to patient neglect and abuse. Investigations have uncovered everything from riots to rape to homicide at UHS facilities.

During Santorum's tenure on the UHS board, state documents and court records show, patients at UHS health care facilities have endured systemic failures that have cost millions in court settlements. In several instances, the company and its subsidiaries have been threatened with losing the ability to take in federally-subsidized patients. At various times, states have stopped sending children to UHS facilities. And in the last few years, the King of Prussia, Pa.-based mega-company has been the subject of two Department of Justice lawsuits accusing the chain of fraud.

According to UHS' website, Santorum currently sits on the board's compensation committee and the nominating/corporate governance committee. Santorum's committees appear to play no direct role in overseeing the actual operations of the hospitals. But the board -- like any corporate board -- is responsible for maintaining oversight and making sure facilities are safe and do not violate the law.

He was appointed to the board in April 2007. UHS CEO and chairman of the board, Alan B. Miller, said in a press release at the time, "Rick Santorum has a long record of accomplishment and leadership and will provide valuable advice to the board."

Through his campaign, Santorum refused to comment about his ties to UHS nor the allegations concerning the hospital chain. "I would encourage you to contact UHS about these allegations," replied spokesperson Virginia Davis via email. "If I have any additional contact from Sen. Santorum I will let you know."

In response to The Huffington Post's inquiries, UHS refused to elaborate on Santorum's role as a board member. "UHS has always made quality and patient safety its highest priorities at all of our facilities," the company said in a statement released to The Huffington Post. "UHS has been one of the leading providers of mental healthcare services for over 25 years because of our commitment to quality and patient-focused programs. All of our facilities are licensed by their states, nationally accredited and/or certified and in good-standing. As a company, we strive to always provide the best possible treatment in a safe environment."

According to the company's SEC filings, as of Feb. 28, 2011, UHS owned 25 acute care hospitals and 206 behavioral health centers located in 37 states, Washington, D.C., Puerto Rico and the U.S. Virgin Islands. The company also owns or manages seven surgical hospitals and surgery and oncology centers. The filings state that the company and/or its affiliates currently face at least seven lawsuits addressing allegations ranging from patient care to wage disputes among employees.

On Oct. 30, 2009, a McAllen, Texas, hospital group owned by UHS agreed to pay the U.S. government $27.5 million to settle allegations of what amounted to medical payola, or providing kickbacks or "illegal compensation" to doctors in an effort to pressure them to funnel patients to its hospitals, according to a DOJ press release. The payments were disguised via "shame contracts" including medical directorships and lease agreements.

Department of Justice attorneys, along with their counterparts in Virginia, filed suit in March 2010 against a UHS facility based in Southwest Virginia charging that operators had committed Medicaid fraud. The facility billed itself as an inpatient psychiatric facility for youth but did not provide such services. The DOJ case, along with a whistleblower lawsuit, also accused the facility of orchestrating a cover-up.

Timothy J. Heaphy, the United States Attorney for the Western District of Virginia, stated in a DOJ press release:

    "We intend to prove that these defendants billed Medicaid for providing troubled children with much needed psychiatric medical care when, in fact, they provided no such service. We will not sit idly by and allow healthcare providers to take advantage of troubled children in order to feed their own desire for wealth. The Medicaid system was designed to help the most vulnerable among us, not to line the pockets of fraudsters."

In its statement, UHS claimed that all patients at the Virginia facility were treated appropriately.

But DOJ's conclusions wouldn't surprise current and former UHS employees, who said the hospital and treatment settings have been "depressing" and comparable to prisons or worse.

Leah Mercer, a former employee with the Pines, a residential treatment center located in the Tidewater region of Virginia, described one unit as a "dog pen."

"It's a money making business," Mercer said. She worked not only at the Pines but also at an adult treatment facility in Tennessee. "That's all it is ... Working with adults and the kids in two different states and two different facilities, there was no therapy. It was all about money."

Mercer, who used to work as a prison corrections officer before working with emotionally disturbed children at the Pines, says she was surprised by how little experience was needed to work at the facility. "I know they pull a lot from security people ... You could start out making $10, $11 an hour and not know jack. You didn't have to know anything. In fact, I had a 19-year-old stripper and this was her part-time job -- she was part-time."

HuffPost readers: If you've ever worked for UHS or have been a resident or patient at a UHS facility, we want to hear from you. Tell us your stories by emailing jason.cherkis@huffingtonpost.com. Please include your phone number if you're willing to do an interview.

Santorum joined the UHS board in April 2007. Here is just a sampling of incidents that have taken place at the company's facilities during his tenure:

- In June 2007, Omega Leach, 17, died after being strangled by staff at UHS' Chad Youth Enhancement Center, located outside of Nashville, Tenn. Leach's death was ruled a homicide. Two years earlier, a 14-year-old Long Island girl died at the same facility.

According to the autopsy on Leach, news accounts at the time stated that the youth had "multiple superficial blunt force injuries" to his body as well as injuries to his neck muscles. He also sustained scrapes and bruises to both shoulders as well as a bruise under his left eye.

Omega Leach's family subsequently sued UHS. In 2010, UHS settled with the family for $10.5 million.

- In April 2010, North Carolina government records reported that the Old Vineyard Youth Services facility had been the scene of a sexual assault between two male teenagers. One resident reportedly tried to force his roommate "to have oral sex and intercourse holding roommate by neck to force him to have oral sex and dragged him on the floor trying to have intercourse." The residents, 17 and 15 years old, were found to not be adequately monitored by staff. The Winston-Salem Journal had previously reported that the facility had been sited for a "long list of deficiencies that included nurses' training and responses to incidents" in October 2009.

- In September 2010, the Chicago Tribune reported that in the previous two years, two rape allegations were levied at UHS' Hartgrove Hospital. "Police were called to Hartgrove Hospital on the city's West End when a juvenile patient alleged he was punched and forced to perform oral sex on a male patient, then raped when he tried to resist," the reporters noted. "The alleged victim was hospitalized with abrasions consistent with rape, a police report said."

The Tribune went on to detail another incident involving a 13-year-old male who performed oral sex on a 15-year-old in a crowded day room "with roughly 14 other youths and only one hospital employee to monitor them."

- In April 2011, Two Rivers Psychiatric Hospital in Kansas City was barred from taking Medicaid after feds discovered that hospital workers had failed to monitor a suicidal woman who killed herself at the facility. Authorities also ruled that workers had erred in their attempts to revive the woman. The hospital has appealed the decision and challenged the decision in court.

The Kansas City Star also reported that the facility has a history of neglect issues:

    "Federal records show that Two Rivers has had a history of patient-care problems dating to 2008, when an Army soldier committed suicide at the hospital by using bed linens to hang himself in a closet.

    That year, inspectors also found that a hospital employee had poured water over a patient’s head and that a nurse had put a towel over an elderly patient’s mouth to stop the patient from screaming.

    Inspectors who examined medical records in 2009 found little evidence that Two Rivers patients were receiving psychotherapy or medical treatment other than medications. In September 2010, the hospital refused the emergency admission of a teenager who had threatened to kill someone, records show."

- On April 18, 2011, North Carolina authorities announced that it would be removing all of its wards from The Pines residential treatment center after a youth made an allegation of sex abuse at the facility. The incident triggered a larger investigation. North Carolina officials found multiple instances of ill-trained staff, inadequate staff-to-patient ratios, and "multiple safety risk incidents," according to an email from N.C. authorities to Virginia officials concerning The Pines.

Virginia has since slapped The Pines with a provisional license and halted sending state wards to the facility. The D.C. government has also begun to pull its youths from The Pines.

Susan Lawrence, a parent and child advocate in Virginia, runs a Facebook page dedicated to cataloging abuses within the mental health system with a particular focus on UHS facilities. In an interview, she called on Santorum to investigate the company. "He talks about being brave, about standing up to the establishment," she said. "That's a joke. He should be asking hard questions of UHS ... If he wants to lead the country, he should be able to lead a business."

"He's all concerned about unborn children," Lawrence continued. "He's a lot less concerned about children that are already here."

Santorum's relationship with UHS extends beyond the boardroom. While he served on the board, the company donated $5,000 to his political action committee, America's Foundation, in 2010. UHS CEO Miller, as well as the company's employees, have donated thousands more in previous campaigns.

This is the first in a series of stories on UHS facilities during Santorum's tenure on the hospital chain's board.

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Inside Rick Santorum-Linked Universal Health Services Facility: Herpes, Porn and Drug Dealing

by Jason Cherkis jason.cherkis@huffingtonpost.com. Please include your phone number if you're willing to do an interview.]

---PAGE 2---

Barely a teen, T. had already known how it felt to fill his stomach with pills and to receive a jolt from a police officer's Taser. Other things left deeper scars. T. had grown up in Hamlet, N.C., abandoned from birth by his biological mother. He'd had to hear stories about her and her new family living in faraway Oregon; she didn't visit. He never knew his father.

T. was adopted by Honeycutt, his own mother's former foster mother, who provided a stable and loving home. But he fell into violent rages, and when they became too much to handle, the child-welfare system sometimes had to find alternatives.

By the time T. was 8 years old, group home staff and hospital nurses had become something of an extended family. In at least one instance, however, they proved anything but safe. At one group home, Pinon said, her brother claimed he'd been raped by a staffer.

Not long after, T. wore out his welcome at every group home and therapeutic foster care placement in the state. He stabbed one foster parent with a fork. He ended up on probation after pelting a foster dad's truck with rocks. He could be equally destructive with his own body, using his thighs and arms as a canvas for his not-so-secret cuttings.

Officials had to look beyond the state's borders to Virginia to find T.'s next placement, a next chance at normal. T. had gone to The Pines fresh from a psych ward. It turned out to be a huge step backward.

On June 3 of this year, T. was forced out of The Pines, this time not as a punishment but out of concern for his own well being. Honeycutt and Pinon were there to pick him up. There was no teary sendoff. A Pines worker greeted them at the entrance with a taunt, according to Pinon. "We are so ready to get rid of him," she recalled the worker saying.

Another employee shepherded T. to their car. Both Pinon and Honeycutt recalled that she had one final message for T. before leaving his side. If he gave his family a hard time, the employee told him, "I'll beat your ass like a man."

A Pines staffer had already done that, according to T.

T. had two black eyes. One came from a staff member who T. said punched him after he complained about the staffer flirting with a coworker.

One bruise was still a deep black, while the other had started to fade. But both could still be seen through T.'s foundation and rouge, and his pink-and-purple eye shadow.

While T. was at The Pines, Honeycutt, 63, tried to follow up on her adopted son's treatment as best she could. She kept in regular contact with T. and participated in weekly therapy sessions by phone. When she needed gas money to make the drive up to see him, she said she resorted to hosting yard sales where she sold off her clothes and appliances. The real valuables she carted off to Ned's Pawn Shop.

"My mom sold collectibles, porcelain dolls," Pinon, 28, recalled. "All of her gold, she pretty much pawned it or melted it down so she could afford gas or clothes for him. I took her to the pawnshop one time -- she pulled out family heirlooms. The people in the pawnshop were telling her not to do it. She sold it anyway."

When T. complained that he went to bed cold, Honeycutt bought him a blanket. When he needed clothes, she mailed him pants and shirts from his favorite store, Hot Topic.

Honeycutt alleged that Pines officials had promised to assist her with travel expenses but never came through. "They lied," she said. "They were supposed to meet me part of the way, and they didn't."

Initially, documents show, The Pines saw T. as a serious case. The reasons for his admission to the facility were manifold. Pines officials wrote in an assessment that T. "represents an actual and potential danger to himself and others as evidenced by his frequent episodes of self injurious behavior including cutting himself in the chest, arms, legs, frequent episodes of physical aggression, threatening to kill his mother including biting his adoptive father, hitting the walls, running away from home ... [and] bringing deadly weapons to school."

The facility's management promised they could improve T.'s behavior and even get him well enough that he wouldn't need to spend more time in another residential setting. But under the center's care, Honeycutt and Pinon said, they only saw T. continue his destructive ways. The facility, they said, failed to accurately report problems to them.

Honeycutt and Pinon said they were often left to navigate written reports that were either missing critical information or contained contradictory assessments. In one example, the reports failed to mention that Pines staff had left T. unsupervised long enough for him to pierce his own nose with the broken tooth of a comb. Nor had they witnessed him stabbing a hole through his tongue.

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---PAGE 3---

While the family heard from T. about how the staff had physically restrained him on multiple occasions, Pines officials failed to report most of the incidents. In one month, Pinon recalled, T. had been physically restrained more than 10 times. She also said her brother reported being chemically restrained. During one restraint, his family said, a Pines employee broke T.'s glasses. The facility never replaced them. T. later said to Pinon: "I've had knees in my back. Knees on my head."

"None of the paperwork documented the amount of restraints that he had," Pinon said.

Physical restraints were the staff's go-to method of control, according to T. Even when he was held down, T. said, staff took cheap shots -- jabbing him, pinching him and punching him. In one incident, he said, he was slammed against a wall.

"They bend your arm in all different directions and stuff," he said, adding that the staff called him "faggot."

"One time, I was in a restraint and a man punched me in my nose and my nose started bleeding," he said.

The center's low-I.Q. inhabitants were particularly targeted, he said: "They would always hit in the special residents."

Although The Pines was required to provide schooling for T., confidential records show that he often didn't make it to class. T. said that he was often held back over minor infractions like talking back to staff. Sometimes, he'd beg to go to class and was still denied.

According to his last report card, T. failed five out of seven subjects. His Pines teachers cited his absences as the main reason for his dismal grades. And yet, in its last report to the family, Pines officials wrote that T. was "doing well in school. He has grades from A's to C's."

Honeycutt seized on what she considers the most painful document of all. It's another Pines assessment of T., this one dated to this past February. A Pines clinician wrote: "It is clear the family will not support T." because of his sexual orientation.

The Pines was charging Honeycutt's health insurance and Medicaid a combined nearly $20,000 per month for taking care of T.
* * * * *

Honeycutt's account of her experiences with The Pines rang true for Kimberly Imanian, who told The Huffington Post that the facility has also consistently whitewashed reports of her adoptive 13-year-old daughter's behavior. Her daughter, she said, has been involved in six violent episodes, but only three were actually reported. In one incident, the facility did not report that her daughter had threatened to kill her roommate. The roommate remained in place for months.

Imanian said her daughter has not shown improvements since being admitted. "She does not want to be at a place anymore," Imanian said. "She wants to get well. More often, she asks, ‘Why am I not getting any better?'"

A UHS vice president, Car Evans, wrote in an email that The Pines complied with all state reporting policies. "The Pines reports all requisite incident or restraint matters to the appropriate agencies or individuals in compliance with all legal and regulatory requirements of the various states or municipalities with whom we work with," he wrote.

But misinformation and an unsettling lack of care appeared to be the norm at a facility even staffers described as overwhelmingly depressing and disorganized. Documents show a campus low on management oversight and staffed with unqualified employees. "When I first got there, I was like, 'Oh my God, I would never want to live here,'" recalled one current Pines worker, who requested anonymity to speak openly about the facility's conditions.

Leah Mercer, a former Pines frontline worker, told The Huffington Post she often did not know the case histories of the children in her care. Mid-level managers simply failed to give her each child's diagnosis, she said, and her supervisor spent most of his time concentrating on his fledgling career as an R&B singer.

Rather than providing rehabilitation or care, Mercer said, the facility deepens old wounds and even creates some new ones among the young residents. She said one boy with no history of sexual abuse has started acting out sexually. Another boy had been left alone long enough to dig into his arm with a plastic spoon. AWOLs were commonplace. She recalled one incident in which an employee threatened to kill a child; another called a kid a "piece of shit."

"There are staff that continue to be there that should not be in this line of work," Mercer said. "There are staff that I feel are too rough, that don't have an understanding of child disabilities. They don't understand that each one has individualized treatment. You can't treat all children the same, especially ones with disabilities."

Another current employee said she believed that not all of her colleagues thoroughly reported deserving incidents. "I don't feel that everybody that works at all three campuses are there ethically to provide therapeutic care," the employee said. "Some people are there just to get the paycheck. ... I don't feel some of the people are educated to deal with the issues we have -- I don't feel the people even care."

---PAGE 4---

Mercer said she quit over what she described as unsafe staff-to-patient ratios, meaning that the kids often didn't receive basic necessities. She said she knew of a child who waited eight months to get a pair of glasses, another who endured a toothache for five months before seeing a dentist and still another kid who went without underwear.

"I've seen staff buy soap, socks, underwear, shoes," Mercer said. "I mean, the kids don't have any soap."

In one case, Mercer recalled, she had to move some residents to a new unit, but found that it had not been cleaned. There were urine-stained floors, semen stains on a desk and a pair of mattresses, a bloody mixture left on a bulletin board. She described a different unit as a "dog pen."

Therapy could be just as haphazard. A current employee agreed with Mercer's assessment that the staff-to-patient ratios weren't safe. The other current employee described the sessions as mere drive-bys, lasting 20 minutes at a time.

"Do you think you are ever going to get anything accomplished in 20 minutes?" the employee asked.

"It's a moneymaking business," Mercer said. "That's all it is."

The current employee said there are staff issues. "They're lazy. They come in late. The communication is bad," she said. "There's a lot of money but I don't see it. It's going to the wrong people."

Those at the top were well paid. Santorum received roughly half a million dollars in cash and stock options for his services on the UHS board. In 2007, he received $50,412; in 2008, he received $77,958; in 2009, he picked up $45,000. In 2010, Santorum took home a substantial windfall: $168,069. And on Jan. 19, 2011, he received stock options valued at $174,126, Securities and Exchange Commission records show. The company and its CEO have also contributed thousands to Santorum's political action committee and his campaigns over the years.

When Santorum resigned from the UHS board in early June, company officials had kind words for the former senator.

"We appreciate Senator Santorum's service on our Board of Directors and he has been a valuable asset to our Company," Alan B. Miller, the UHS chairman and CEO, said in a press release. "We certainly understood that should Senator Santorum formally announce and initiate his campaign for President, it would result in his departure from the Board given the substantial focus and effort required to achieve that goal. However, Rick's guidance and stewardship will be sorely missed."
* * * * *

In February, a Pines staff member was caught punching a child in the face and torso after being bitten during a restraint, records show. The incident was not immediately reported to authorities. The staffer admitted, according to a licensing investigation, that she had no experience in working with residential treatment center kids. That same month, licensing found that "staff currently providing therapy is not licensed or licensed eligible. ... THIS IS A REPEAT VIOLATION."

The following month, two boys at the Brighton campus, ages 8 and 9, confessed to engaging in oral and anal sex, Virginia records show.

At the same campus a short time later, according to records and interviews with Mercer, who saw a video recording of the incident, and another staffer, a Pines worker grabbed a 9-year-old boy and dragged him across a table during a therapeutic group session. Another worker then took the boy into a room and was captured on video repeatedly bashing his head against a wall.

The staff member was suspended for a week before being fired. She wrote about how she was spending her time away from the facility on her Facebook wall:

"Backyard tanning was a success, including nips ;P Ugh! Dread having not having AC in a hawt ass house! Time to take a cold shower."

By then, North Carolina had concluded it could not continue to send children to The Pines. The state had launched an investigation after parents came forward with an allegation that their son had been sexually abused at the facility.

According to a subsequent report by Virginia authorities, The Pines concluded that on at least one occasion the abuse had indeed taken place. But the facility had failed to immediately notify the parents. The Pines had described one incident of inappropriate touching as "horse playing."

In mid-April, North Carolina paid the facility an unannounced visit. Patrick Piggott, chief of the state's Behavioral Health Review Section, reported his findings to Virginia licensing officials. In an April 28 email obtained by The Huffington Post, he said the state was making a formal complaint against The Pines -- that the facility had failed in nearly all aspects of its responsibilities. Piggott's group found:

    The Pines had inadequate staffing for the entire month of January and two weeks in February for all campuses.

    Employees lacked training on utilizing non-restrictive interventions.

    No evidence of supervision in any personnel records.

    No evidence of sex offender training.

    No evidence of training on how to write a treatment plan.

    No evidence of supervision plans for unlicensed staff.

    Some therapists working in the facility had masters degrees but were not licensed.

    Staff did not watch children closely -- sexual activity among children had taken place.

    Allegations of abuse or sexual misconduct did not result in clear consequences or changes in treatment.

Piggott went on to note that basic records of children often contained missing documents and contradictory assessments. He also reported that "the child prompting this investigation was at risk and there is evidence of harm yet the facility did not appear to take adequate steps to [protect] him."

---Page 5---

North Carolina would not wait for The Pines to correct itself. It had already announced that it would be pulling its children from the facility.

Meghan McGuire, communications director for Virginia's Department of Behavioral Health and Developmental Services, which oversees inspections of facilities like The Pines, released a statement after North Carolina went public with its decision: "Over the past several years, we have encountered significant problems at the Pines' facilities that have required tremendous monitoring time by DBHDS licensing and human rights staff. Since concerns continue to arise despite staff's continual efforts, it may again be time to reevaluate the status of their license."

Ten days after North Carolina completed its investigation, Virginia authorities inspected The Pines' Brighton campus.

Not only did Virgina's inspectors corroborate North Carolina's findings, they uncovered 17 pages worth of violations. They found scores of untrained staff as well as staff working without proper documentation or licenses or criminal background checks. The facility even failed to prove that its van operator had a valid driver's license.

Supervision of residents was also a problem. Inspectors found rampant use of cellphones in the units. One resident, who had been placed on special precautions requiring 15-minute checks, was not properly watched. "A review of the videotape revealed that Staff did not perform the 15 minutes room check," the inspector noted in its report. "The documentation of the 15 minute rounds were fabricated."

In some cases, Pines workers may have crossed the line into criminal behavior, as in the case of another resident who reported being sexually assaulted while also on "close watch."

The Virginia inspection turned up a January incident in which staff showed the young residents pictures of naked women and a February incident in which residents and staff watched a pornographic DVD together.

That same month, investigators found out that a resident admitted using and selling drugs within the past six months. A source stated that the resident "also admitted to buying drugs from a staff who no longer works at the Pines. Resident admitted that he did the drugs in November and December."

On the day the inspection was made, Virginia announced that it would be suspending admissions to The Pines and issued the facility a provisional license. According to McGuire, the provisional license means The Pines had failed in caring for its children.

"A provisional license means that a provider has demonstrated an inability to maintain compliance with the regulations, has violations of licensing regulations that pose a threat to the health and safety of residents served, or has two or more systemic deficiencies," McGuire wrote via email. "It is a sign to referral sources and payers that a provider is having serious problems."
* * * * *

Universal Health Services, in its emailed statement to The Huffington Post, expressed optimism that its oversight had corrected any problems at The Pines:

"We are pleased to report that as a result of our efforts, in May of this year, two external independent surveys by regulatory agencies were conducted at The Pines and found the program in compliance," the statement reads. "Further, North Carolina has expressed a willingness to work with our facilities and The Pines is currently treating children from North Carolina."

UHS' statement appears to have been overly optimistic. McGuire says Virginia's position on The Pines is unchanged -- there continues to be a ban on new admissions. She added that she did not know of any surveys by regulatory agencies and that her office had two new, open investigations against the facility.

Brad Deen, a spokesman with the North Carolina Department of Health and Human Services, said his agency "has informed the Pines that without rapid corrective action to correct the seemingly systemic safety and quality-of-care issues, the Pines will be terminated as a N.C. Medicaid provider." He added that his agency has relocated nearly all of its children and is not approving any new admissions to the facility. Plans are moving forward to have all of the state's kids removed from The Pines.

Whatever happens with The Pines, Heather Pinon said she thinks the damage the facility has done to her brother might be permanent. His depressive bent seems even more ingrained, she said.

"Now he talks about dying before he's 20," Pinon said. "He says he knows he's going to be dead by the time he's 20. He said, 'Nobody loves me. Nobody cares whether I live or die.' I don't know where that comes from. The person that came out of The Pines is a very lost, very confused boy."

"I'm not sure it's reversible," she added. "It's just -- they screwed him up."

After picking T. up from The Pines in early June, the family members arrived home in Hamlet after 8 p.m. Pinon and her brother stayed up late talking. The next morning, Pinon fixed T. a huge breakfast of eggs, sausage, bacon and biscuits. They shopped for clothes. They stopped at a Krispy Kreme. He had only one blowup. The next day, he started to beg for more time at home.

"It was everything," T. said.

But after 48 hours, North Carolina authorities had T. transferred to a residential treatment facility in Orlando, Fla.

"I really liked being home and I miss it," T. said in a recent phone interview. "I'm actually on suicide precautions because I've been missing my house. I cut myself the other day on my arm." T. said he had busted a hole in a wall, ripped out a screw and used it on himself.

"People were picking on me," he said by way of explanation. "It's better than The Pines, this place. They don't pick on me that much."

In the final memo from T.'s last month at The Pines, officials had concluded that he had "met maximum benefit at this facility."

Shahien Nasiripour contributed to this report.

This is the second in a series of stories on UHS facilities during Santorum's tenure on the hospital chain's board. Read Part 1: "Rick Santorum And Universal Health Services: Presidential Hopeful Serves On Board of Hospital Chain Being Sued By DOJ."

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