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Mental Anguish at Texas West Oaks Hospital

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Even if the state has fined them and said they aren't taking care of patients correctly, that they have unsanitary conditions? "I really can't comment on that," Morris said.

Mary got a better response from the state of Texas. In a letter dated April 15, 2007, Ronda Tewell of the Health Facility Compliance Division of the Texas Department of State Health Services wrote her that their investigation of West Oaks's treatment of her sister showed that "the facility had violated one or more of the applicable regulatory requirements." Violations were identified and deficiencies cited. As to what the state specifically found wrong, it won't say.

Lucinda DeBruce, CEO of West Oaks, did not return calls from the Press for comment on this story. Janet Codamo, West Oaks's director of performance improvement, also did not return calls.
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Schoolteacher Annetta Hudson worked for West Oaks from 2004 until 2007, one year full-time, the other two part-time. "I don't know about that hospital. They have a lot of things that aren't right," she says.

"We're supposed to have certain classes...and they don't do it, but when the state gets ready to come in, they want you to sign all these papers that make it look like you have gone to all these classes."

Hudson said she went outside West Oaks to keep up her training, such as keeping herself current in CPR classes.

Staffing was always a problem, she says. During the day there would be three techs, one medications nurse and one RN who would do all the charting for 20 patients on a unit. In the evening this would drop to two techs, and the overnight shift, she says, would often drop to one tech. In the juvenile units, she says, the chart nurse would be responsible for three units.

Often, she says, counselors might make it to one group patient session, but for the most part the techs were running these meetings.

Whereas Hudson had previously worked as a nurse's aide and holds a pharmacist technician's license, she says many of the techs hired had no background in psychiatry. "Mostly they hire big guys. They don't do too many females, but they did a lot of big guys. Some of those guys have been in prison or jail."

She says she left because West Oaks wasn't giving raises, and she and others were stuck at $11 an hour. She says she saw several changes in management while there, but no real changes in operation. They did renovate three units before she left.

The Reverend Perry Boutte worked as a tech for West Oaks for one month in 2005 before he injured himself on another job and was unable to return to work. He complained to West Oaks and the state of Texas, saying he saw adult patients fraternizing with adolescent patients and staffers making no attempt to stop this.

Boutte says he had gone to West Oaks to work on his license for chemical dependency counseling, but was instead sent to psych. He says he has numerous years of experience working in psychiatric hospitals, but most of his co-workers did not. "There was a one-week orientation, and then people were just thrown out on the floor."

There wasn't sufficient staff to do the job with, Boutte says. Added to that, he says, "it just seemed like the people they had working there didn't know what they were doing. It was just a constant chaotic situation; everything was always up in the air."

In 2001, West Oaks was acquired by Psychiatric Solutions, Inc., which also owns Cypress Creek Hospital in Houston and Kingwood Pines in Kingwood in the Houston area. The company, headquartered in Franklin, Tennessee, owns other facilities in Texas, and its 2007 10-K filing to the U. S. Securities and Exchange Commission says it operates 90 owned or leased in-patient facilities, with more than 10,000 licensed beds in 31 states, Puerto Rico and the U.S. Virgin Islands. In a recent press release, it said it ranked 49th on Fortune magazine's 100 Fastest Growing Companies in America list.

The 10-K report of PSI (PSYS on the New York stock exchange) declares its operating strategy: "We intend to focus on improving our profitability by optimizing staffing ratios, controlling contract labor costs and reducing supply costs through group purchasing."

In its 10-K, Psychiatric Solutions disclosed that it was spending 54.6 percent of its total revenue on salaries, wages and benefits. This was a slight decrease from 2006, when it spent 55.2 percent of its total revenue on the so-called SWB package.

The Centers for Medicare and Medicaid Services, part of the U.S. Department of Health and Human Services, puts out an annual report used to develop its Medicare psychiatric payment system. Its 2007 survey of all psychiatric care facilities shows that about 65.8 percent of all revenue is spent on staffing at the average psychiatric hospital.

So Psychiatric Solutions and its hospitals are spending more than 11 percentage points less on staffing than the average psychiatric hospital. It also appears to be practicing economics by hiring a significant number of part-time employees. "As of December 31, 2007, we employed approximately 21,800 employees, of whom approximately 14,800 are full-time." This means that 7,000 employees were part-time, roughly 32 percent of its workforce.

Psychiatric Solutions responded to inquiries from the Houston Press by e-mail. The company's statement ignored questions about its own corporate operations and hiring policy and instead just couched its answers in terms of West Oaks. In total, it read:

"Our doctors, nurses, and therapy staff are sincerely committed to providing the best possible treatment to our patients in a manner which is caring, respectful, and focused principally on the safety and well-being of the patient.

"We work closely with the state of Texas, the Joint Commission, CMS and other regulatory agencies in order to ensure full compliance with all applicable ­requirements.

"West Oaks, like most health care providers, employs some part-time staff to allow for flexibility as patient populations shift.

"All staff are required to complete an orientation and extensive clinical training led by certified instructors before they go into clinical areas. Many programs are facilitated by the facility medical staff and all are approved by applicable oversight groups.

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