Correct Care Solutions, a Tennessee-based company that is the sole bidder for a contract to operate Osawatomie State Hospital, has a history of safety problems at the state psychiatric facilities it runs in Florida.
Officials with the Kansas Department for Aging and Disability Services (KDADS) declined to provide details this week on Correct Care’s bid to operate Osawatomie State Hospital, one of two state facilities for people deemed a danger to themselves or others.
The department is evaluating the proposal and hasn’t given a timeline for whether or when it would bring it before the Legislature. Under a law they approved last year, lawmakers must approve the contract before KDADS can move forward.
KDADS Secretary Tim Keck pitched privatization as a way to improve care at the hospital about a year ago after federal officials cut payments to the hospital because of safety concerns. Keck has said the hospital has made substantial improvements to its staffing, training and procedures since then, however.
KDADS issued the request for proposals to operate Osawatomie State Hospital in November and said in January that it received a single bid.
Staffing, Care Issues
In Florida, Correct Care runs South Florida State Hospital, two correctional mental health programs — at South Florida Evaluation and Treatment Center and Treasure Coast Forensic Treatment Center — and a program for sexual predators at Florida Civil Commitment Center.
It also operates two correctional health facilities in Texas and one in South Carolina.
Privatization hasn’t improved care in Florida, mental health advocates there say.
David Boyer, director of investigations at Disability Rights Florida, said poor care and staffing issues are the norm at both privatized and state-managed psychiatric facilities.
“We get a fair amount of abuse calls every year,” he said. “Unfortunately, I think that the folks that we work with are used to a low bar.”
An investigation by the Tampa Bay Times and Sarasota Herald-Tribune found multiple deaths associated with poor care at privatized and publicly run mental health facilities in Florida. That included six potentially avoidable deaths from 2011 to 2015 at facilities run by Correct Care:
- A 42-year-old man died of undetermined causes after being left in a scalding bath that damaged his skin at South Florida State Hospital
- A 53-year-old male patient at South Florida State Hospital jumped to his death from a parking garage when staff failed to take precautions to keep him from escaping
- A 46-year-old woman died after falling and hitting her head in a shower at South Florida State Hospital
- A 62-year-old man suffered injuries that contributed to his death when he hit his head on a concrete floor while left alone at South Florida State Hospital
- A 27-year-old man was found to have unusually high levels of a medication that can cause heart problems after he died of cardiac arrest at Treasure Coast Forensic Treatment Center
- A 33-year-old woman hanged herself in her room when she was left unsupervised at South Florida Evaluation and Treatment Center
Inspectors also reported other safety risks and incidents that could have ended in death. Two patients attempted suicide while unsupervised at South Florida Evaluation and Treatment Center in 2015 and 2016. There was a delay in reviving one of the patients who attempted suicide because an automated external defibrillator wasn’t working, according to a report from the Centers for Medicare and Medicaid Services.
From 2010 to 2014, South Florida State Hospital and South Florida Evaluation and Treatment Center were cited multiple times for violations that increased the risk of deaths in a fire. Some violations included failing to maintain sprinklers or check that smoke detectors worked.
Other reports found more problems at other facilities run by Correct Care:
- Patients at Florida Civil Commitment Center, the sexual predator treatment center, had access to pornography and illegal drugs
- A 40-year-old man died at Treasure Coast Forensic Treatment Center after another patient punched him in the head
- A mental health technician at Treasure Coast Forensic Treatment Center was arrested and charged with abuse of a disabled person after allegedly punching a patient
- A Correct Care employee at Columbia Regional Care Center in South Carolina was arrested for allegedly striking a patient with his fist multiple times
Jim Cheney, a spokesman for Correct Care, said its psychiatric facilities undergo frequent inspections and three of the Florida facilities are accredited by the Joint Commission.
Correct Care is proud of its work with Florida, which started in 1998 at South Florida State Hospital, he said.
“We have some of the best professionals in the industry providing care in these facilities,” Cheney said.
He declined comment on the company’s bid to operate Osawatomie State Hospital.
No ‘Best Practices’
If Kansas decides to privatize Osawatomie State Hospital, it will be starting down a path with relatively little guidance from other states.
Florida has gone furthest with privatization, and state officials there generally have been satisfied with the results, said Ted Lutterman, senior director of government and commercial research at the National Research Institute affiliated with the National Association of State Mental Health Program Directors.
“It’s still so rare that I don’t know that anybody has looked at best practices for privatization,” he said.
Most states haven’t privatized entire psychiatric facilities but have contracts for specific patient populations, said Brian Hepburn, executive director of the National Association of State Mental Health Program Directors. For example, some states use private hospitals to care for voluntary patients, because private psychiatric hospitals often aren’t interested in patients committed against their will, he said.
Private contractors that operate psychiatric hospitals sometimes can get better deals from Medicaid managed care companies than state-run institutions can, making it possible for the state to reduce its costs in some cases, Hepburn said. States that privatize psychiatric hospitals rarely save much on operational costs but can reap some savings on capital and maintenance expenses, he said.
That could be a problem in Kansas, because the KDADS request for proposals specified the state wouldn’t pay the full cost of running Osawatomie State Hospital. The request instructed bidders to seek to restore federal payments and to use a “mix of state general funds, third party payments and other sources.”
But if done right, privatization can provide comparable or better care at less cost to the state, Hepburn said.
“It sounds like what Kansas is trying to do is very reasonable,” he said. “It can be a win-win situation.”
Boyer, with Disability Rights Florida, offered a note of caution. States considering privatization need to establish strong oversight, including penalties for poor care, he said — something that hasn’t happened in Florida.
“It takes a lot for the state to do anything about” problems at the hospitals, he said.
Meg Wingerter is a reporter for KCUR’s Kansas News Service, a collaboration of KCUR, Kansas Public Radio and KMUW covering health, education and politics in Kansas. You can reach her on Twitter @MegWingerter.