Former psych hospital staff allege they were told to falsify records

Former psych hospital staff allege they were told to falsify records

This article was co-published with WRAL-TV. 

By Taylor Knopf 

Days after her 21st birthday in March 2023, Mo Hatcher found herself short of breath and dizzy, feeling helpless at what she described as minor inconveniences to most people, but major events for her. Hatcher had a history of anxiety, but her panic attacks had become more frequent and intense, at times feeling like a heart attack, she said. Hatcher asked her parents to take her to Brynn Marr Hospital, a psychiatric facility near her home in Jacksonville, so she could gain better control of her anxiety. 

But the reasons for admission written in Hatcher’s discharge summary from Brynn Marr reads, in medical shorthand: “Suicidal ideation with a plan, history of substance abuse via overdose on pills and substance abuse.”

“That’s the part that makes me unsettled with all of it,” Hatcher said after reading the document aloud. “(An intake worker at the hospital) had asked about feeling suicidal, and I told her ‘no.’ Obviously, knowing where I was going into, I made it a point to say ‘No, that definitely is not how I feel right now or anything along those lines.’”

As for the drug overdose, Hatcher said she told the hospital worker that it happened five years ago.

“For my diagnosis, they literally just put a ‘major depressive disorder’ and the suicidal ideation,” Hatcher said of her hospital discharge papers, which she shared with North Carolina Health News. “The biggest reason I was there was because of my anxiety and my panic attacks. So I thought it was kind of crazy that that wasn’t even written down.”

Hatcher’s experience isn’t that surprising to some former Brynn Marr employees, including several who told NC Health News that they quit in part due to what they perceived and described as unethical practices at the hospital. One of those practices, they alleged, included documenting more severe diagnoses for patients to make them appear sicker than they were, so that the hospital could bill more to insurers.

A former hospital employee who reviewed patient records at Brynn Marr from 2017 to 2019 alleged that management told nurses to avoid documenting a patient’s denial of suicidal or homicidal thoughts or hallucinations. If it was in the record, the former employee said, then it would have to be reported to the insurance company. Once reported, the insurance company would stop paying, they said. 

NC Health News interviewed 13 former Brynn Marr Hospital employees who made allegations about what goes on behind the locked doors of the facility, including claims of unchecked violence and lack of mental health treatment. 

Most of the former employees who were interviewed alleged that the hospital engaged in records falsification.

The majority of former staff, 12 out of the 13 interviewed, say they were instructed by management to falsify or exaggerate information in patient records or claim to have seen evidence of falsification in records they worked with.

Most former employees interviewed for this story spoke to NC Health News on the condition of anonymity due to fear of retaliation or negative impact on their careers. NC Health News verified employment by reviewing personal tax documents, pay stubs and identification badges.

Many former employees said they left the hospital’s employment disturbed by what they said were explicit efforts to cherry pick patients with the best insurance and use questionable tactics to keep patients longer. 

The better the insurance, the longer some patients would stay, one former unit coordinator said. Tricare, the military-sponsored insurance which is common near Marine Corps Base Camp Lejeune in Jacksonville, was considered particularly valuable. 

These former employees claim that what they saw and experienced at Brynn Marr mirrors a continued pattern of alleged issues that have gotten Brynn Marr’s parent company, Universal Health Services, into trouble before.

In a statement made to NC Health News, hospital executives denied any records falsification and denied instructing employees to falsify records. 

Multiple lawsuits

The accounts of Brynn Marr staff who worked at the hospital between 2017 and 2023 echo those made in 2016 by scores of former employees of other hospitals owned by Universal Health Services, a publicly traded company headquartered in Pennsylvania. 

Universal Health Services agreed in 2020 to pay $117 million to resolve multiple allegations against several of its hospitals for knowingly filing false claims for payment for behavioral health services that were not necessary or were not appropriately provided, according to the U.S. Department of Justice. UHS entered the settlement agreement without admitting guilt. Records falsification was one of the allegations in the lawsuit.

In a case against a UHS-owned facility in Virginia, former patients made claims of sexual and physical abuse, as well as allegations of medical record falsification. In Illinois, a UHS-affiliated facility was ordered to pay $535 million in a negligence lawsuit following allegations of the sexual assault of a 13-year-old patient by another patient. The company’s lawyer called the verdict excessive and said the hospital plans to challenge it.  

Universal Health Services, which operates hundreds of inpatient behavioral health facilities across the country, also owns and operates two other psychiatric hospitals in North Carolina: Holly Hill in Raleigh and Old Vineyard in Winston-Salem.

UHS is also under scrutiny from U.S. senators over allegations of “exploitation, mistreatment and maltreatment, abuse and neglect and fatalities” at residential psychiatric facilities for young people, according to a statement from Sens. Patty Murray, D-WA, and Ron Wyden, D-OR.

When NC Health News sought comment from UHS and Brynn Marr Hospital, Bryn Marr’s CEO Cynthia Waun responded.   

NC Health News emailed UHS and Waun a list of allegations made by former hospital employees interviewed for this story. Waun provided a five-page response denying allegations of record falsification and most other claims made by the former employees.

“(Brynn Marr Hospital) categorically denies the accusations that any instruction was given to falsely document a patient’s condition or fail to chart improving conditions solely to extend a patient’s length of stay,” she wrote. “Those allegations are false. Efforts have been made to instruct staff and clinicians to chart more specifically and with greater detail in order to better reflect the patient’s condition and to assist with charting reviews.” 

Waun added: “When there are isolated situations discovered where staff are not following required documentation practices, appropriate corrective action is taken.”

UHS reported $13.4 billion in revenue last year and net income of close to $657 million. 

Former Brynn Marr employees told NC Health News that they took issue with what they perceived as the hospital’s sole priority — patients’ insurance money.

“I get it. They are for profit. But there’s also ethics within the profession,” said Aaron McDonald, a former Brynn Marr mental health technician. “So you have to be able to make a profit and be ethical at the same time.” 

He added: “Brynn Marr cares more about your money than helping your loved one.”

‘Everything looks pretty on paper’

A dozen former employees interviewed for this article alleged that it was common practice at Brynn Marr for some staff to falsify information on patients’ charts, stretch the truth about patients’ conditions or backdate vital signs, visual checks and signatures on reports. 

One former Brynn Marr social worker said that staff members were often asked to backdate information in charts — even if they hadn’t been the employees involved in parts of the treatment. She described being “yelled at” for refusing to sign documents she thought were produced unethically.  

The social worker said she ultimately left Brynn Marr for fear these practices would jeopardize her professional license.

Several former employees alleged that it was important to hospital management to fill in and backdate missing information to pass inspections by the Joint Commission, a regulatory agency, or in the event state regulators investigated a patient complaint. Because Brynn Marr used paper documentation instead of an electronic system, former staff members say that this wasn’t difficult to do.

State lawmakers have pushed the state’s psychiatric hospitals to adopt electronic records, but the facilities have pushed back, scoring delay after delay to required implementation.

A former technician who worked at Brynn Marr from 2018 to 2022 — who had risen to a position as high as unit coordinator — said it was often her responsibility to go through charts before state regulators visited to make sure everything was filled in correctly. 

While chart reviews are common in health care settings, they are not intended to be used to obfuscate or falsify events which is what several former employees say was happening. The former technician says incomplete paperwork was often flagged and later signed and backdated so that “everything looks pretty on paper” for state regulators.  

Missing information that she claimed would be flagged included nurses’ signatures on medication distribution, including the amount of medication given, what time it was given and how long the patient had been on the medication. She said staff would fill in missing patient metrics, such as weight and blood pressure. Medication can affect these measurements, so if they were missing, the former employee alleged that staff would average the last documented vitals and make sure it was in the appropriate range. 

The goal was to write something that wouldn’t cause concern, she added. She said many employees would comply with requests to backdate or fill in information because they needed to keep their jobs. 

A former nurse who worked at Brynn Marr between 2018 and 2022 said she found the hospital’s documentation of patient seclusion — putting someone alone in a designated safe room to calm down — questionable. When she first started at the hospital, she said, it was more common to use seclusion to manage patient behavior. But later on hospital management wanted to move away from using it as much, she said. She explained that thorough documentation and reporting to outside monitors is required every time staff put a patient in seclusion.

But sometimes, the former nurse alleged, Brynn Marr staff would use alternative methods of secluding younger patients that didn’t involve the room dedicated for seclusion purposes. This way, they would not need to fill out any special paperwork or make a report, she said. 

“Brynn Marr has a long hallway that can be separated by two doors,” the former nurse said. “So there have been instances where I know a kid has acted up and those doors have been shut. So that child is now on the hallway by themselves to scream and holler and kick, pound on doors, in order to keep other kids away from him because he’s acting up.”

Other former staffers told NC Health News that they witnessed similar scenarios.  

Brynn Marr’s CEO said these allegations are unfounded.

Missed therapy sessions

Multiple former mental health technicians — who supervised patients, led group sessions and took them from outdoor time, to meals and to showers — told NC Health News they were asked to write that 30-minute or hour-long group therapy sessions happened even when they didn’t. 

The former technicians said they were supposed to lead several group therapy sessions a day that included topics such as addiction or healthy coping skills. However, former staff members reported that fighting and other disruptive incidents would occur so frequently that there wasn’t always time for the group sessions. 

One former technician said some group sessions were conducted in a fraction of the allotted time — for example, one question per attendee — to illustrate that meetings did happen.

Another former technician who worked the night shift said she was responsible for leading the last group of the day — a 30-minute check-in with patients on whether they achieved their previously-stated goal for the day. It was rarely 30 minutes, she said. But she was told the charts needed to reflect that a 30-minute session had been conducted, she said. 

According to state health department records, a doctor at Brynn Marr — anonymized by the state as “MD #7” in the report — told state regulators that patients should attend programming as part of their treatment; however, “no real group therapy” happens at Brynn Marr.

Another former night shift technician told NC Health News that technicians are supposed to do 15-minute visual checks — which includes checking for breathing — on all patients throughout the night. These mandatory checks are documented for each patient. Sometimes these checks were missed or delayed if something came up, she said. If they were missing from the charts, the technician alleged, management would give the charts back and tell them to write them in. 

While some would do it, she said, others refused to knowingly document false information. 

Industry experts interviewed for this article said that treatment notes in a patient’s record should be frequent and thorough. 

While some signatures are missed in real time within medical facilities, the time at which the signature is rendered shouldn’t be falsified, said Nora Dennis, a psychiatrist and former head of behavioral health at insurer Blue Cross and Blue Shield of North Carolina. 

For example, Dennis explained, sometimes in the case of restraint or seclusion, a physician will be verbally notified and give the order, but they are not physically able to sign the patient’s chart at the moment. But the notes in the patient’s record should reflect the verbal order and the later signature should have the time it was signed. 

She said there are times when psychiatric patients minimize their symptoms because they want to leave. “But if somebody saw the patient responding to internal stimuli, they could document, ‘They deny this. However, staff has observed them responding to internal stimuli and we maintain concern that they are still experiencing hallucinations,’” Dennis said.

“It’s not like you can’t document what they’re experiencing and document your concerns in the same notes,” she said. “It requires thoughtfulness and effort.”

Additionally, making patients appear worse to continue payment is insurance fraud, Dennis said. 

‘Struggling at all times’

A former Brynn Marr nurse alleged that she and her colleagues were encouraged to make it appear on paper as if the patients “were struggling at all times.” They were encouraged to focus on negative symptoms, to gloss over any progress — to write “not completely false information, but to make it appear a little worse than it was.” She said she refused to do it, and that she felt like it was a strategy to keep patients hospitalized for longer.

Many patients are admitted to psychiatric hospitals under involuntary commitment orders, where a judge orders treatment for a certain length of time because the patient is considered to be a danger to themselves or to others. These legal orders are reviewed at mandatory court hearings and a patient can be ordered to more inpatient treatment if they still meet the criteria for involuntary commitment. 

A former Brynn Marr employee who reviewed patient records in the business department also alleged that management would tell the nursing staff not to write down if a patient was no longer experiencing suicidal ideation, homicidal ideation or hallucinations. These are symptoms that would meet the criteria — danger to self or others — for holding someone under involuntary commitment. 

The hospital would keep patients as long as possible, one former business department employee alleged. If a patient was under a commitment order, that was further justification to the insurance companies that the patient needed to be hospitalized, the former employee explained. And if a patient’s insurance stopped paying, she said, Brynn Marr would send them home, regardless of whether they had a safe discharge plan. 

Brynn Marr’s CEO denied that staff are instructed to falsify a patient’s condition to extend their length of stay at the hospital.

‘Heads in beds’

Universal Health Services, Brynn Marr’s parent company, has emphasized to investors the importance of inpatient behavioral health services to its business model. In 2022, the company’s chief financial officer told investors that prioritizing patients with the best insurance and keeping its behavioral health beds filled are vital parts of the company’s earnings strategy. 

“We’ve been going to our lowest payers and either demanding increases from them or canceling those contracts that we view to be inadequate and simply admitting patients whose insurance will pay us more,” Universal Health Services CFO Steve Filton told investors in July. “Again, in an environment where we can only treat a limited number of patients, we can be more selective about who we treat and the fairness of what we think we’re being paid.”

During the company’s third-quarter earnings call in October, Filton highlighted the company’s goal to increase the number of behavioral health patients and the number of days they stay in a UHS inpatient facility.

“Broadly, increasing occupancy is the most significant opportunity we see in our behavioral business,” Filton told investors in October. “We absolutely have the ability to increase occupancy significantly. There’s a handful of important initiatives in behavioral, but all would fall under this umbrella of being able to increase occupancy.”

Part of the increase could come from expanded offerings, such as substance abuse services, he said. He also suggested that telehealth and outpatient services could expand. “We already, I think, offer a pretty broad continuum of care,” he said, according to a transcript of the call. “But broadening that even more and broadening our payer mixes that we reach out to — we have a pretty strong presence in both the active and retired military, but I think have a number of initiatives to increase our penetration there.”

During that call, Filton noted that the lack of behavioral health staff — including nurses, therapists and mental health technicians — remained an issue in some facilities, something that’s an industry-wide problem. Filton said the company would work on recruitment and retention practices. 

He highlighted the company’s 7.6 percent revenue increase due to behavioral health services in the third quarter of 2023 over the same period in 2022. Filton added that the increased number of days patients stay in the company’s acute care behavioral health hospitals was driving up “per day” revenues. The company saw similar profit increases in its fourth quarter.

The prioritization of profits is something many former Brynn Marr staff members told NC Health News was obvious to them during their employment. 

A phrase — “heads in beds” — was used frequently, said a former employee who worked at the front reception desk. 

She said this repeated phrase meant they needed to fill beds with patients with the best insurance. She said the office of staff members answering phone calls and inquiries from hospitals about potential patients was near her’s so she could overhear conversations. She said it was like a “cheering squad” when they were able to admit a patient with good insurance coverage.

“It just seemed like there was no support when it came to the techs, that they were very focused on the influence of income that was coming in for them,” said Jordan Wenzel, a former mental health technician. 

“Tricare was a big one,” Wenzel said of the military-sponsored insurance. “Tricare patients were treated like royalty next to the ones with Medicaid.” Management emphasized that they didn’t want Tricare patients to have any complaints when they talked to family members, she said. 

Another former technician said Brynn Marr needs to stop accepting so many patients, just because they have the beds, particularly when staffing is low. It leads to patient safety issues, she said.

Brynn Marr’s CEO said that the hospital frequently adjusts to the needs of patients and staff, including capping new patient admissions to align with staffing levels.

Meanwhile, the Brynn Marr experience comes at an emotional cost to some patients, according to Mo Hatcher, the patient who went to Brynn Marr for help with anxiety. 

“I was put through more stress inside Brynn Marr than I would’ve dealing with it on my own and with my own psychiatrist and therapist I’ve been with for a couple years,” Hatcher said. “The amount of emotional and mental damage that is done — not only to myself but as I witnessed to other patients as well — is unsettling.”

About the reporting 

NC Health News interviewed 13 former Brynn Marr employees who worked at the hospital for varying lengths of time between 2017 and 2023 in different positions including: mental health technician, nurse, social worker, unit coordinator, receptionist and in the finance department. 

NC Health News initially connected with employees in different ways and conducted one-on-one interviews. Four responded to previous coverage of the hospital. We connected with some former employees on LinkedIn and Facebook. We connected with additional employees through the referrals from employees we connected with via the first two methods. NC Health News verified their employment by reviewing documents including copies of W-2 tax forms, pay stubs and Brynn Marr identification badges. 

NC Health News requested records of inspections completed at Brynn Marr Hospital by the NC Department of Health and Human Services. Over a year later, we received 222 heavily-redacted pages from a survey completed by regulators on Dec. 22, 2022, that examined incidents and complaints from the prior few years. The details and descriptions of incidents from the state records correspond with the experiences shared with NC Health News by the former employees. 

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