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match limited by state law. From

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the Center for Investigative Reporting and

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PRX, this is Reveal. I'm

0:43

Al Letzen. When

0:46

Trina Edwards was 12 years old, she

0:49

had a really active imagination. I'm

0:52

a Pisces, so I'm already in my head as

0:54

it is. Her window in

0:56

Anchorage, Alaska looked out at a parking

0:58

lot of a bank. Nothing special, just

1:00

your average bank parking lot. But

1:03

for Trina, that ordinary asphalt

1:05

was like a stage. Every

1:08

person that pulled in or

1:11

drove away, I would

1:13

look and I would make a story. Just

1:15

a random story about that person's life.

1:18

No fact at all whatsoever, but that

1:20

was their life in my head. The

1:24

mailman, the bank tellers, the customers,

1:27

regular people going about their business. They

1:30

became Trina's characters. I

1:32

swear on everything I love, I was reading

1:35

one of my journals and

1:37

I was like, who the hell is Bill Frank?

1:40

And why is he always in my journals?

1:43

She'd assigned them names and backstories. That

1:46

man got paid every Thursday

1:49

and would be at the

1:51

bank hashing his check right

1:55

after work. And he

1:57

has a stressful life because he has seven kids.

2:00

and two baby moms. These

2:02

stories helped Trina pass the time

2:05

because she wasn't able to do the things

2:07

many other 12-year-old girls do, like

2:09

hang out with friends or be dragged by a

2:11

parent on a boring errand to the bank. Trina

2:15

was locked in a psychiatric

2:17

facility for children owned

2:19

by a company called Universal Health

2:21

Services. She had no idea when she'd get

2:23

out. Trina was a foster

2:25

kid. And what she didn't

2:27

know until much later is that she was

2:30

caught in the middle of a dysfunctional relationship

2:32

between an overstressed child welfare

2:35

system and a Fortune 500 company. One

2:38

had too few foster homes for all the

2:41

kids they'd taken in, and

2:43

the other was looking to fill beds. This

2:46

week, we're revisiting our episode about

2:49

Universal Health Services. Over

2:51

the past few years, the company

2:53

has been the subject of several

2:55

lawsuits and a Department of Justice

2:58

investigation that raised alarming allegations. Universal

3:01

Health Services denies it's done anything

3:03

wrong. Mother Jones reporter

3:05

Julia Lorry has found that despite

3:07

all the scrutiny, child

3:09

welfare agencies keep sending foster

3:12

kids to UHS facilities, often

3:15

for months at a time. And

3:17

we should note, this hour deals

3:19

with child abuse, sexual assault, and

3:21

suicide and may not be appropriate

3:24

for all listeners. Julia begins

3:26

her story in Alaska. Hi.

3:33

Hi, I'm Julia. It's nice

3:35

to meet you. Hi, I'm Trina. Hi,

3:38

I am. I

3:41

first met Trina in the spring of 2023 in

3:44

Anchorage, Alaska, in the parking lot of

3:46

her apartment building. She lives there

3:48

with her two toddlers. What is that?

3:51

It's a microphone. A microphone? Yeah.

3:54

You wanna say hi? Trina's wearing jeans and

3:56

a gray hoodie. She's 23. Say

3:58

hi. Hi. I love you. I

4:01

love you. Love you. We

4:09

end up spending most of the day

4:11

together, and Trina has this unfiltered way

4:13

of operating that's disarmingly charming. The

4:16

way you drive is frustrating. We

4:20

drive, apparently too slowly according to Trina,

4:22

to a pizza place for lunch. Trina's

4:26

kids play nearby while she shows me photos

4:28

from her time at the psychiatric facility. It's

4:30

a place called North Star Behavioral Health.

4:34

There's Trina at Thanksgiving holding a turkey made

4:36

out of Oreos and candy corn, and

4:38

one of her on Halloween with lime green wings on

4:40

her back. Dad wanted it to be a slutty

4:43

Tinker Bell, but it couldn't be a slutty

4:46

Tinker Bell. Not slutty, you have many many

4:48

layers. Your dress is going beyond your knees.

4:52

Trina didn't get the costume she wanted. The

4:55

reality is, she didn't have a say about much

4:57

in her life. Everything was

4:59

controlled by the facility. When you

5:01

slept, what you ate, what you wore,

5:03

who you talked to on the phone, what

5:06

medications you took. And

5:08

when one kid got in trouble, they often

5:10

all suffered the consequences. Trina

5:12

remembers having her Harry Potter book taken

5:14

away when one girl acted out and

5:17

her unit was put on lockdown. I

5:19

was halfway in. Who got my book

5:21

taken away, bro? I wanted to know

5:23

if they kissed or not. So

5:26

how did Trina end up at North Star? Well,

5:29

first, she went into foster care in

5:31

2012 after she reported being

5:33

sexually abused by her mother's boyfriend. She

5:36

was just 12 and she was having

5:38

flashbacks and trouble sleeping. Then

5:41

she mentioned to her foster mom that she

5:43

was having suicidal thoughts. So

5:45

Alaska's Office of Children's Services sent

5:47

Trina to North Star. When

5:49

she was admitted, Trina told the hospital psychiatrist

5:52

that she never had a plan or

5:54

intention of killing herself. These

5:57

details are in court documents and medical records.

6:01

Trina never believed she needed to be

6:03

in a locked psychiatric facility. But

6:06

she says it was often overwhelming to live with people

6:08

who did need that high level of care. Like

6:10

her former roommate who used to hallucinate and talk

6:13

to someone named Sally. She's like,

6:15

you're so funny. Sally's a real person. She's

6:17

standing right next to you. And I said,

6:19

tell Sally to back the f***

6:21

up. Don't play with me, bro. These

6:24

girls had mental issues and it sucks

6:26

that I'm laughing about it. But

6:28

I had nothing wrong with me. I was

6:30

just a troubled child who didn't listen to

6:32

rules. When

6:35

Trina arrived at North Star, she assumed a foster

6:38

family would pick her up the next day. She

6:41

couldn't have been more wrong. Instead,

6:44

she would be put on

6:46

multiple psychiatric medications, experience isolation

6:48

and violence, and cycle

6:50

in and out of North Star for more than

6:52

five years. Instead

6:54

of parents, she had staffers. I

6:57

had a love-hate relationship with the staff people.

7:00

Because as hard as they made North Star for her, they

7:02

were also there for milestones. When

7:05

Trina got her first period, it was a staff member

7:07

who taught her how to use a tampon. It's

7:10

intimate, you know? And so

7:12

for them to know all of

7:14

my first times, my

7:17

first crushes, you know,

7:19

my first everything,

7:26

it's a lot, you know? And I just wanted

7:28

a family.

7:31

I just wanted a mom

7:34

and a dad to teach me all of

7:36

my firsts. I

7:38

first talked to Trina in 2022

7:40

when I started investigating the placement of

7:43

foster kids at places like North Star.

7:46

Since then, we've kept in touch over the phone and

7:48

had long conversations where

7:50

she would be parenting in the background. Mommy,

7:53

I have a puppy. You're

7:55

a puppy? Yeah. As I asked

7:57

her questions about her life at North Star. Mommy

8:00

A Minute. How are you sending?

8:02

Your it day. That Northstar

8:04

liquid it would look like.

8:08

Every morning at North South stream of as she

8:10

was required to write in a journal. They.

8:12

Would make ask what. On.

8:14

A scale from one to ten How we ceiling.

8:17

And losses damn building. How do you think I'm

8:19

feeling? And. After this writing

8:21

exercise they would go to breakfast. Three,

8:24

Not like lots of kids that north

8:26

was heavily medicated. Suit put on an

8:29

anti psychotic that made her groggy. You

8:31

can't go to breastfeed. And

8:33

pick out what you want to eat for breakfast if

8:35

you don't take your medication in the morning. Trina.

8:38

Had a caseworker at Alaska's Office

8:40

of Children's Services. They were supposed

8:42

to check. In on her once a month. But.

8:45

Trina says she rarely heard from them. At

8:48

times she didn't even know who her

8:50

caseworker was. Treated tried doing

8:52

more. Start every which way. She.

8:54

Got insights and got kicked out of group

8:56

therapy more times and she can point. I'm

8:59

not gonna sugar coat it. I was not a star

9:01

player. When. She realized that wasn't

9:03

working. She decided to follow the rules to

9:05

a T. But. That didn't work either.

9:08

I'm doing everything you're telling me to do on

9:10

foreign the program. I'm being good, a handgun and

9:12

problem taking the medication it's making me so I.

9:15

Am. I still end up with the

9:17

same result. Nobody. I'm

9:19

alone. Though

9:22

I will. You just gotta keep doing it. The

9:26

forces keeping Trina in North Star were

9:28

much. Bigger than whether she behaved are

9:30

not. The Office of Children's

9:32

Services and Alaska has been. In shambles

9:34

for years. More than half

9:37

of Keith workers leave every year. There

9:39

are three times as many foster kids

9:41

as there are licensed foster. Homes Alaska

9:43

put kids in foster care at a

9:45

rate that's among the highest in the

9:47

country, and two thirds of foster kids

9:49

in Alaska are indigenous. Trina is part

9:51

you back. To stop be

9:53

were like you really don't need a beer,

9:55

you disarm and foster home. her

9:59

medical right it's back this up. During

10:01

one particularly long stay, Trina's discharge

10:04

was pushed back twice because there wasn't

10:06

a foster home for her to go to. She

10:09

stayed there for another six months. No

10:13

one from Alaska's Child Welfare Agency would

10:15

do an interview on the record, but

10:17

in an emailed statement, they said that

10:19

foster children are placed at North Star

10:21

based on medical diagnosis and would be

10:23

approval of a judge. But

10:26

the agency said that finding placement for

10:28

kids with behavioral health needs is a

10:30

nationwide challenge, and they admitted

10:32

that some kids do experience delays while they wait

10:34

for a lower level of care.

10:46

Universal Health Services is the publicly traded

10:48

company that owns North Star. It's

10:51

the largest psychiatric hospital chain in the United

10:53

States that you've probably never heard of. They

10:56

keep their branding off their facilities,

10:58

but UHS operates one in six

11:01

inpatient psychiatric beds across the country.

11:03

The company brought in $14.3 billion

11:05

last year. Haley

11:15

Morrissey didn't know much about UHS back

11:18

in 2013. She was

11:20

a recent college graduate. She'd studied fine

11:22

art and psychology, and she was

11:24

looking for a job. And then a

11:26

friend of mine told me that, oh,

11:28

there's this place called North Star in Anchorage,

11:30

and it's always hiring. Haley

11:32

worked at North Star when Trina was there,

11:34

and as a recreational therapist, she felt like

11:36

she was putting her training to good use.

11:39

By 2018, she was on an outreach team

11:42

marketing the facility in the community. That

11:45

included reaching out to Alaska's Office of

11:47

Children's Services. We would send

11:49

out care packages just being like, hey, we're

11:52

thinking about you guys. Thank you for

11:54

all you do. The little nod, it

11:56

shows that North Star is still there.

12:00

reminded the agency workers to

12:02

practice self-care. There were

12:04

North Star branded coffee mugs and lip balm

12:06

and stress balls. Over

12:08

time though, Haley began to have second

12:10

thoughts. She watched foster kids come

12:12

back to North Star again and again, and she

12:15

says the facility was chronically understaffed.

12:18

Yeah, you'd have people that were in

12:20

director positions kind of being like, okay,

12:22

well, this person quit and this person

12:25

quit. So, okay, we only have one

12:27

therapist now. One

12:29

of those therapists was Jason Fidelli. He

12:32

started at North Star in 2016. So he overlapped with

12:35

Trina and Haley and he saw

12:37

new tasks constantly being added to

12:39

his roster. As those

12:42

responsibilities were added, the amount

12:44

of time spent with the

12:46

patient decreased significantly to where

12:49

maybe you'd be able just to do a check-in

12:51

with the patient. Hey, how are you doing? You

12:53

feeling good? You do, are you suicidal? What's

12:55

going on? Some kids would get maybe

12:57

five, 10 minutes at the

12:59

most. Those minimal check-ins

13:02

were so common they had a

13:04

name. They used to call it a touch and go, you

13:07

know, just a fly-by. It's

13:09

like, just check in, do a fly-by.

13:11

How's everyone doing? It's

13:15

not real therapy. Foster

13:19

kids who spent time at North Star told

13:21

me similar stories. They talked

13:23

about not getting much therapy, feeling abandoned

13:26

there, being over-medicated, and

13:29

consistently they talked about violence,

13:31

including Trina. They had

13:34

pinned me down to the floor. I remember

13:36

one of the staff members' knee on

13:38

my back. Medical records show that staffers

13:40

thought she was part of a plot to

13:43

run away and I could feel like the

13:45

weight of his body on top of me.

13:47

Like, I don't know why you need to hold

13:49

me down so much. She was

13:52

12 and about to experience

13:54

what the kids call booty juice and

13:56

what the industry calls a chemical

13:58

restraint. It's an injection

14:00

that's only supposed to be used to sedate

14:03

kids when they're at risk of harming themselves

14:05

or others. And they had

14:07

pulled my pants down, like

14:10

forcefully ripped my pants down and gave it

14:12

to me in the butt. And I feel

14:14

like that's something that you shouldn't

14:17

be doing to a child

14:19

inside a facility like that. Trina

14:23

passed out when she woke up.

14:25

I'm in this secluded room by myself and I

14:28

can't even open the door. Like

14:30

I can't get out of the room. That's like feeling

14:32

like it's closing in on me, you know? And I'm

14:34

trying to tell them like, I can't breathe. Like I'm

14:36

really gonna go through a panic attack if you don't

14:38

open this door. Trina

14:42

says staffers wouldn't listen to her and

14:44

kept her in isolation until eventually

14:46

she fell asleep. I

14:51

interviewed more than 50 people for

14:53

this story, including former patients,

14:55

former staffers and other experts.

14:58

I reviewed dozens of lawsuits, also

15:01

a Justice Department investigation, where

15:04

I found similar allegations that

15:06

UHS facilities were understaffed, held

15:08

patients too long and improperly

15:11

used restraints and seclusion. No

15:13

one from Universal Health Services would talk to me

15:15

for this story, but the company did

15:18

respond to written questions and they

15:20

denied all these allegations. They

15:22

said they have policies in place to ensure that

15:24

staffing levels are appropriate and

15:26

restrictive practices are quote, used as a

15:29

last resort to ensure safety for patients

15:31

and staff. They

15:33

also claim that they are quote, striving to

15:35

eliminate the use of restraints and seclusion.

15:43

The violence, the understaffing, the influx

15:45

of foster kids, these are not

15:47

new issues at psychiatric facilities. Ronald

15:51

Davidson is a psychologist and the former

15:53

director of the Mental Health Policy Program

15:55

at the University of Illinois at Chicago.

15:58

And as part of the federal consent. degree he

16:00

spent two decades monitoring facilities where

16:03

Illinois foster kids were sent. My

16:06

staff and I essentially flew

16:08

around the country looking at these

16:11

facilities and were horrified

16:13

at what we found. They

16:15

found that understaffing was often at the

16:18

root of violent and punitive disciplinary tactics.

16:20

When there aren't enough staffers, the staffers

16:22

who are there more quickly resort to

16:25

restraint and seclusion. We

16:27

asked him about Trina's experiences. You

16:30

don't put hands on

16:32

a child who's been physically or

16:34

sexually abused, pull their

16:37

pants down, and

16:39

shoot a syringe in their butt and

16:42

think that that's going to be a

16:44

therapeutic response to a child in crisis.

16:49

It's not just wrong. It's

16:51

insane. Ron

16:53

says a psychiatric hospital with

16:55

enough trained staffers can almost

16:57

always deescalate tense situations. The

17:00

problem is staffers are expensive. When

17:03

that is not part of your business model,

17:07

then you immediately jump to the use

17:09

of restraints and quiet rooms

17:11

where you can simply lock the door

17:13

on your problems and walk

17:16

away with money in your pocket. Understaffing

17:19

wasn't the only chronic problem Ron observed.

17:22

He said many of the children he saw

17:25

could have been treated in an outpatient setting

17:27

and didn't need to be institutionalized. We

17:30

asked him about suicidal ideation, the reason Trina

17:32

was sent to North Star to begin with.

17:35

It's an issue with a lot of nuance. It

17:38

requires a meaningful evaluation to determine how

17:40

furious the threat of suicide is. Is

17:43

she really suicidal? We're just an angry outbursts?

17:45

Is she asking for help? And

17:48

is the child truly at risk? The

17:50

decision to send Trina straight to North Star?

17:53

It had ramifications way beyond that

17:55

first day. Because

17:57

there's a pattern that plays out for kids who are sent

17:59

to facility. like North Star. Unfortunately,

18:02

in many hospitals, the door

18:04

only swings one way. You

18:07

become a patient and you stay

18:10

a patient and whether you're there for

18:12

a week or a

18:14

month, more often than not, you're going to be

18:16

readmitted even more angry and

18:18

more upset and

18:20

maybe stay longer because of the

18:22

mistreat or the failed treatment that

18:24

you received. Ron

18:26

saw these problems play out at more than 400 facilities

18:30

across the country, including ones

18:32

owned by Universal Health Services. As

18:35

far as UHS goes, they're the biggest

18:38

elephant in the room, obviously. They dominate

18:41

the marketplace. We

18:46

know that UHS dominates the marketplace

18:48

when it comes to Alaska's foster

18:50

kids. As of 2023, two-thirds of the foster

18:52

kids sent to psychiatric

18:55

facilities went to places owned

18:57

by the company. In its

18:59

expense of care, at North

19:01

Star, more than $900 per

19:03

night. Medicaid usually foots

19:05

the bill. But

19:08

I wanted to see just how often

19:10

child welfare agencies across the country send

19:12

foster kids to UHS facilities. So

19:15

I submitted records requests to every state. 38

19:19

responded. And the

19:21

data showed that between 2017 and 2022, foster kids were

19:25

admitted to UHS facilities more than 36,000

19:27

times. In

19:36

the handful of photos of Trina at

19:38

North Star, she's usually smiling. Even

19:40

in a photo taken on admission like a mug shot,

19:43

Trina smiles against the gray backdrop. But

19:46

her writing at North Star, that

19:49

tells a different story. She

19:51

brought her essays and journal entries to one of our

19:53

visits. I don't want you to feel like

19:59

you need to share everything. if you

20:01

don't want to, you know? No, this

20:03

is my authentic self. This is me

20:05

at Doorstar. She starts reading

20:07

one of her essays. Close

20:10

Doors. Growing

20:15

up, it's hush-hush. Never say

20:17

what happens in the home. You

20:19

listen because they put fear in your heart.

20:22

They say this like, do you want to

20:24

be taken away from us? Trina

20:27

takes long pauses, big, deep breaths,

20:30

then keeps going. She just asks,

20:33

are you okay? Can we help you with

20:35

anything? Are things good

20:37

at home? There are days I

20:40

wish I had never told them what happened

20:42

behind those Close Doors. It's

20:47

a painful last thought. Trina

20:49

had spoken up about being sexually abused at

20:51

home. She had spoken up

20:53

about her suicidal thoughts. But

20:55

now, Northstar felt like a punishment for all

20:57

this speaking up. Sometimes,

21:00

she was suggested silent. Trina

21:11

had spent a total of two years

21:13

at Northstar, when just before her

21:15

15th birthday, she got some news. She

21:18

was being moved to another facility

21:20

owned by Universal Health Services in

21:22

Utah. That's next

21:24

on Reveal. Support

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23:04

Al Letzin. We've been

23:06

talking about Trina Edwards. As

23:09

a teenager, she spent years cycling in

23:11

and out of North Star, a

23:14

locked psychiatric hospital in Anchorage. And

23:17

Trina was getting worse. Her

23:19

medical records say she was depressed,

23:21

oppositional and bullying other kids. So

23:24

in 2015, Trina learned she was being transferred

23:27

to a different locked facility

23:29

owned once again by Universal

23:32

Health Services. This one

23:34

was 3,000 miles away in Utah. Trina

23:38

was nervous. She was nearly 15 and

23:42

she'd never left Alaska before. On

23:44

the plane, she had on scrubs, two

23:46

security escorts were by her side, and

23:48

Trina says she was placed in handcuffs.

23:51

It was humiliating. I'm in

23:53

society now. I'm not hidden behind

23:56

closed doors. Other human beings can

23:58

see me in heaven. I

24:01

love you. Criminal. She

24:04

was headed to Copper Hills, a

24:06

sprawling campus on the outskirts of Salt Lake

24:08

City. Once again, Trina

24:11

felt stuck, and she

24:13

considered her options. If I run

24:15

away from this place, I don't have money for

24:17

a plane ticket. I mean, thousands

24:19

of miles away. From

24:22

the outside, Copper Hills actually

24:24

looks nice. If you

24:26

look at their website, there's equine

24:28

therapy, river rafting, and yoga. But

24:31

inside, the facility was spiraling

24:33

out of control. Mother

24:36

Jones reporter Julia Lorry interviewed multiple

24:38

former staffers and picks up the

24:40

story from here. Five

24:43

months before Trina arrived at Copper

24:45

Hills, Utah's Department of Human Services

24:47

sent a letter to the facility's

24:49

CEO. It said

24:51

that Copper Hills was understaffed and

24:53

improperly using seclusion rooms. The

24:56

facility could face sanctions if things didn't change.

24:59

They were very unhealthy

25:01

financially and culturally. Around

25:03

this time, Brian Blohm became the

25:06

facility's new CFO. He

25:08

was brought in around the same time that Trina got there in 2015.

25:12

He was there to help make Copper Hills more efficient.

25:15

We made some changes, we cut a lot of costs. But

25:17

Brian had his limits. Take

25:20

the details of his bonus plan. Part

25:22

of my bonus plan was

25:24

based on EPOB, Employees Per

25:27

Occupied Bed. This

25:29

is industry jargon for the ratio

25:31

of staffers to patients. The

25:33

goal was to minimize the cost of staffers.

25:36

He tried to crunch the numbers. I'm

25:38

being paid a financial bonus for running

25:41

staffing at lower than the state

25:43

requirements. I

25:45

thought that was weird to incentivize a leader

25:49

to not meet the state

25:51

regs financially. He took the

25:53

problem to his higher up. He said, hey, the

25:55

EPOB is too low, it needs to be higher. You

25:57

can do it. You can just do it. it.

26:00

And finally I'd said, it's

26:02

literally under the state regs. Like, we can't

26:04

run at this. Look, I showed them the

26:07

book. And then they kind of

26:09

had to cave. Brian

26:11

was the CFO for four years. When

26:14

I asked UHS about his comments, the

26:16

company said they would never encourage unsafe

26:18

staffing levels. And they added

26:20

that Brian was fired, which is true. He

26:23

was fired for retaliation. He

26:25

said he was the victim of discrimination. And

26:27

he filed a complaint with Utah's Labor

26:29

Division. But Brian

26:31

says the problem at Copper Hills wasn't

26:34

just staffing levels. There was

26:36

also a push to fill beds. Copper

26:39

Hills had a marketing team that pitched the

26:41

facility across the country, from school

26:43

districts to child welfare agencies to

26:45

native reservations. They go

26:47

to these referral sources and they say, we redid

26:50

this. Our food's really good now. You know, we

26:52

have five open spots on girls and two on

26:55

boys. Like, you got anybody? You got

26:57

anybody? Kids flew into

26:59

Copper Hills from all over Nevada,

27:01

New Mexico, Idaho. Brian

27:03

says he felt pressure to make sure the

27:05

facility was taking in kids, even kids who

27:07

weren't a good fit. You said,

27:10

yeah, we got five referrals yesterday, but they

27:13

were all very violent and it's not going to be

27:15

safe. They'll probably get laughed at and say,

27:17

we'll make it safe. You got to

27:19

have the doors open. Other staffers

27:21

have corroborated a lot of what Brian

27:24

said. One told me that

27:26

the pressure to fill beds meant making fast

27:28

decisions on the referrals that would come in

27:30

each morning. Because if you don't

27:32

hurry and make a decision, they might decide to go

27:34

somewhere else. Anna

27:36

was the clinical director at Copper Hills.

27:39

That's not her real name. She didn't

27:41

want to be identified because she still works in

27:43

the field and didn't want to face professional repercussions.

27:47

Anna's job was to oversee patient care.

27:49

She and Brian were high up at Copper Hills while

27:51

Trina was there. And around

27:54

2016, both say they were

27:56

informed of a new goal. Increase

27:58

the length of patient's day from about seven

28:00

months to about a year. They

28:03

say they were instructed to hold patients

28:05

until their insurance ran out rather

28:08

than discharging them when they were ready. Maybe

28:10

they're ready to go home today and maybe

28:13

it's their birthday tomorrow but you know we have two

28:15

weeks approved we'll just plan the travel for two weeks

28:17

you know and maxing those out. Even

28:19

though we might have a resident who you know

28:22

after six months is good to go

28:25

and ready to step down we

28:27

were encouraged to keep them longer

28:29

because they would help to create stability on

28:32

the unit. Keeping

28:34

the kids longer. Foster

28:36

kids fit well into this vision because

28:39

often there were no family members clamoring

28:41

to get them out and

28:43

Anna says the caseworkers on the outside they

28:45

were often relieved to have a place to

28:47

put the kids. She says there

28:49

was an upside for the unit too. We

28:52

have a really stable kid on the unit who's

28:54

not creating behavior problems and assaulting people

28:56

and then the clinical team's been

28:58

told research shows that they're really gonna benefit

29:00

the most that they've been here a year

29:02

so let's do our best to keep them

29:04

here here at all costs. She

29:07

never saw that research and Brian he

29:09

remembers being told the same thing. If

29:12

we have the ability to keep them off the street

29:14

or out of their abusive

29:16

home or away from their

29:18

bad influence friends or whatever then

29:21

every day that they're here safe with us

29:23

is better for their life. This

29:26

lingering at Copper Hills is in

29:28

effect what happened to Trina. She

29:31

became a stabilizing member of the unit.

29:34

Her resistance turned into something

29:37

like acceptance. She

29:39

remembers the exact moment it happened

29:42

when a staffer took her on a walk and talked

29:44

to her. Her name was Callie. She's

29:47

pretty cool. Like what what was

29:49

it about her doing that

29:52

that made you change your mind? I don't

29:56

know everyone else was kind of talking to me like I was

29:58

stupid and she just kind of talked to me like. I

30:00

was an adult. So

30:03

I started acting like one for her. Would

30:07

it be fair to say that that kind of shocked

30:10

you and made you want to

30:12

like, to act like one? No, it looks like a

30:14

myth of that and like, just realizing

30:16

that I'm not leaving. Trina

30:20

felt a sense of resignation, but at the

30:22

same time, things did start to go better.

30:25

She started earning fake money based on

30:27

good behavior called copper cash. And

30:30

buying snacks at the campus store. She

30:32

participated in more activities for well-behaved

30:34

kids like car washes and a

30:36

cheerleading routine. For

30:38

Trina, the tiniest bits of freedom that were

30:40

offered at Copper Hills were a big deal.

30:42

There was a lot of downtime where the

30:44

door was just open, you know,

30:46

like you could freely just

30:48

go outside. After

30:50

more than a year, Trina finally left

30:53

Copper Hills. She was discharged

30:55

to a less restrictive place, a group

30:57

home in Anchorage. And this time

30:59

when she flew back to Alaska, she wore

31:01

normal clothes, her own shoes, no handcuffs. But

31:05

the following months were hard for Trina. She

31:08

testified in the trial of her mother's partner,

31:10

whose sexual abuse led her to foster care

31:12

to begin with. He

31:14

was convicted and sentenced to 39 years in prison. Soon

31:20

after, things started going downhill at the

31:22

group home. This period is a

31:24

blur to Trina now, but medical records show

31:26

it was a dark time. She

31:28

was sent to North Star twice in

31:30

quick succession, both after serious suicide threats

31:32

or attempts. I

31:34

think that probably a lot of people would

31:37

hear something like that and say, well, it sounds like

31:39

this person needed help. I

31:41

don't think that the help that

31:43

North Star was giving me was

31:46

the help that I needed. I

31:49

think I needed someone to sit down and

31:52

not judge me. I think I just

31:54

needed someone to say,

31:58

yes, it's okay. to

32:00

have a thought, to want to die. And

32:03

yes, it's okay to feel this way because the stuff

32:05

that you went through is such a young age. By

32:13

late 2016, it looked like

32:15

Trina's North Stars Day was going like her

32:17

other North Stars days. She

32:19

was unhappy. She was resistant

32:21

to treatment. Her psychiatrist expected

32:24

her to stay a full year. When

32:27

she was admitted, she was asked to list three

32:29

things she wished for. They

32:31

were to get out, to go to school, and

32:34

to find a foster family. Then,

32:37

just before she turned 17, it all

32:40

happened. A foster family

32:42

came through, and it was actually someone Trina

32:44

already knew, a former North Star dancer.

32:47

Trina told her psychiatrist she was very excited and

32:49

happy about this. She was discharged

32:52

early. By that point,

32:54

she'd spent a total of three and a half of

32:56

the past five years at UHS

32:58

facilities. That included 891 nights

33:00

at North Star. After

33:09

Trina got out, her experiences being

33:12

institutionalized for so long stuck with

33:14

her. Her questions were

33:16

endless. When is an appropriate time to

33:18

shower? Does my foster

33:20

mom think I'm weird if I eat a snack

33:23

right now and then I'm hungry again in like

33:26

five minutes? She found herself waiting

33:28

for a staffer with a key card to go

33:30

from room to room. Like, I'd

33:32

walk up to my room door, and

33:34

I'd wait like a couple seconds, and

33:36

then I would be like, oh, I could just open my

33:38

door. Like, I don't have to wait for my mom to

33:41

open my door. While

33:43

Trina was navigating her new life outside

33:46

of treatment centers, UHS found

33:48

itself in a PR crisis. First,

33:51

the media outlet Buzzfeed spent two

33:54

years investigating the company, and

33:56

found that staffers were under pressure to fill beds, quote,

33:58

by almost every single person in the country. any

34:00

method. But what really

34:02

caught the attention of the local media

34:05

were surveillance videos the reporter uncovered. They

34:08

showed violence, abuse, and chaos,

34:10

including at UHS facilities in Alabama

34:12

and Oklahoma. New at five o'clock

34:15

a former shadow mountain employee speaks

34:17

out after a scathing internet article

34:19

accuses the Tulsa facility of child

34:21

abuse and... WVTM 13's Chip

34:23

Scarborough has the video that we

34:26

caution some viewers may find hard

34:28

to watch. UHS strongly

34:30

disputed BuzzFeed's findings but

34:33

BuzzFeed wasn't the only one scrutinizing

34:35

UHS. By that point the Department

34:37

of Justice was on the case too. They

34:40

were talking to whistleblowers from UHS facilities

34:42

across the country and

34:44

the DOJ was in the process

34:46

of investigating not just individual facilities

34:48

but UHS as a corporate entity.

34:51

The crisis was escalating. New Port East 911,

34:53

where is your emergency? New

34:57

Port New Vegas Health Center. What's going on?

35:00

We have a resident that is

35:02

coded blue. This call came

35:04

in 2018 from a resident of a

35:07

UHS facility for kids in Virginia. She

35:10

was a teenager concerned about another

35:12

patient. They're trying to help her

35:14

but I just had to call because I

35:16

don't trust it. They have been telling her

35:18

she's doing this to herself and

35:20

she's taking it and I just really worry

35:22

because I'm not sure they're doing what

35:25

they need to do to take care

35:27

of her medically. Laving

35:30

Nicole Kefir died that night

35:32

of an allegedly preventable adrenal

35:34

deficiency. She was a

35:36

foster child, 17 years old. The

35:39

state investigated and found

35:41

that the center had violated more than

35:43

a dozen regulations. Laving's

35:46

sister sued and settled with

35:48

the facility last year for an almost

35:50

close demand. I

35:53

tried to talk to UHS about all of this. Raven's

35:56

death, the DOJ investigation, kids

35:58

being held in jail. even when

36:00

it wasn't medically necessary. In

36:03

their written response, they said leadership offered

36:05

its deepest condolences about Raven's death and

36:09

said, quote, this was the only death of

36:11

a patient while in the care of

36:13

the facility. They

36:15

also addressed the DOJ investigation and said

36:17

a portion of those allegations occurred under a different

36:20

owner. They were adamant the

36:22

company did nothing wrong. And

36:24

when it comes to foster children, UHS said none

36:27

of them get admitted unless they need to be

36:29

based on a doctor's order. They

36:31

added that the kids haven't been successful in

36:33

other settings. They've disrupted many foster homes due

36:36

to their quote, extreme behavioral

36:38

issues. Many

36:41

of the former foster kids I talked

36:44

to agreed they were difficult kids and

36:46

they did need mental health services. But

36:49

they said facilities like North Star made

36:51

them worse rather than better. They

36:53

talked about this cycle. You're

36:56

put in a locked building, separated from

36:58

society, surrounded by violence with no idea

37:00

when you'll get out. And

37:03

you become more traumatized. You

37:05

start acting out more, giving them reasons to

37:07

keep you there. And

37:09

this all has long term consequences.

37:11

When I first been there, I

37:13

was really like outgoing, like happy.

37:16

I came out with more problems than I

37:18

entered. I got used to the world being

37:20

cold. I don't expect anything more. I have

37:22

really been anxiety now. Like I can't go

37:24

into public really. I've never been able to

37:27

connect with anybody. I feel like I

37:29

have to kind of watch what I say because what I say

37:31

can lead to like vegan booty juice.

37:35

These former foster kids are adults now.

37:38

They're out in the world and they're

37:40

still feeling the impact of a childhood locked

37:42

up. In

37:48

2020, Universal Health Services settled with

37:50

the federal government to resolve claims

37:53

that will now sound familiar. The

37:55

UHS admitted patients who didn't need to

37:58

be there to begin with. that

38:00

had flouted staffing requirements, didn't

38:02

provide adequate treatment and use

38:04

restraints and isolation improperly. The

38:07

settlement was for $117 million, just 1% of UHS's revenue

38:09

that year. UHS

38:16

said it wasn't an admission of liability

38:19

and it settled to avoid distractions and

38:21

the high cost of litigation. In

38:25

a moment, how UHS's strategy to

38:27

settle and move on has paid off.

38:31

You're listening to Reveal. From

38:46

the Center for Investigative Reporting and

38:48

PRX, this is Reveal. I'm

38:50

Al Letzen. Soon

38:52

after Universal Health Services agreed to the

38:54

settlement with the Department of Justice, the

38:57

company was facing a new kind of pressure.

39:00

This one was coming from an

39:02

unlikely but powerful advocate. Paris

39:04

Hilton is a new breed of

39:07

celebrity, famous for

39:09

being famous. La

39:11

Pa. That's all

39:13

from the documentary, This is Paris. In

39:16

the 2000s, she was entertaining millions

39:18

as a fixture of reality TV

39:20

and the tabloids, but

39:22

all the glitz covered up a painful past.

39:25

When Paris was 16, her parents

39:27

believed she was too rebellious and

39:29

sent her to a psychiatric facility

39:31

in Utah called Provo Canyon School.

39:34

I tell my story not so that

39:37

anyone feels bad for me, but

39:39

to shine a light on the reality of what happened

39:41

then and is still happening

39:43

now. Paris was

39:45

testifying before Utah's Senate

39:48

Judiciary Committee in 2021.

39:50

She was 39 and had recently

39:52

gone public with physical and sexual abuse

39:55

she endured as a teenager. It

40:01

was as if it was hell itself on

40:03

Earth. I cried

40:05

myself to sleep every single night praying

40:07

I would wake up from this nightmare. Paris

40:10

stayed there for 11 months. Universal

40:13

Health Services didn't own Provo Canyon when

40:16

Paris was there, but they bought it

40:18

three years later. And since

40:20

then, the damning allegations of abuse

40:22

have continued. Provo Canyon

40:24

School excuses their abusive behavior by saying

40:27

they are now owned by a new

40:29

company, Universal Health

40:31

Services. UHS,

40:33

you can't silence me. The

40:35

practice is used and the staff

40:38

employed remained and remain today the

40:40

same. Despite

40:43

mounting outrage, legal settlements, and a

40:45

celebrity speaking out, UHS

40:48

is thriving. And child

40:50

welfare agencies keep sending foster

40:52

kids to facilities with troubling

40:54

track records. In

40:56

the final chapter of today's show, which first aired

40:58

last year, Mother Jones reporter

41:01

Julia Laurie investigates how UHS

41:03

has become part of what

41:05

some call the Child Welfare

41:07

Industrial Complex. To

41:12

understand Universal Health Services, you have to go

41:14

back to the man who founded it, Alan

41:17

Miller. Alan grew up in

41:19

a working class neighborhood in Brooklyn in the 1940s. He

41:23

played basketball in college, did a stint in

41:25

the Army, and got his MBA from the

41:27

Wharton School. Always was competitive.

41:30

And once I got into something, I wanted to

41:32

be the best at it. This

41:34

is Alan in 2010 when he won

41:36

the Horatio Alger Award. The

41:38

award is given to people who are supposed to personify

41:41

the American dream, people who

41:43

went from humble beginnings to wealth and

41:45

sometimes fame. Justice

41:47

Clarence Thomas, Oprah Winfrey, and Billy Graham

41:49

have all won the award. When

41:51

Alan fits the mold, he's built

41:54

an empire of medical and psychiatric hospitals.

41:56

He's a billionaire today, the kind

41:58

who gets invited to talk on the the Fox Business

42:00

Channel. Welcome back. Earning's alert, Universal Health Services

42:03

is reporting after the bill last night, profit

42:05

and revenue up from a year ago. It

42:08

was 2018, and Alan was there to talk

42:10

about the company's financial growth and about growth

42:12

in the mental health industry. The

42:14

demand is so great that the business

42:16

is just a very sound business. And

42:19

we're and have been from the

42:21

outset a pioneer in mental health. Alan

42:25

started Universal Health Services in 1979, and

42:29

his timing was perfect. State

42:31

psychiatric hospitals were shutting down all over

42:34

the country, and private facilities stepped

42:36

in to fill the gap. In

42:38

the 1980s, the for-profit

42:40

psychiatric hospital industry exploded.

42:44

At the same time, more and more

42:46

kids were being placed in foster care, largely

42:49

because of new mandatory reporting

42:51

laws. People like

42:53

teachers, doctors, and social workers were

42:55

now required to report suspected cases

42:57

of child abuse or neglect. Reported

43:01

cases skyrocketed, from 60,000 in 1974

43:05

to about 3 million in 2000. And

43:08

all those kids, they needed places

43:10

to go. Well, along comes

43:13

large corporations with

43:16

beds to fill. And

43:19

they kind of parachute into

43:21

these different states and

43:23

counties with a solution, a

43:26

ready-made solution. You got

43:28

kids. We got beds. That's

43:30

Ron Davidson, the psychologist we heard from

43:32

earlier. He and his

43:34

team spent years evaluating psychiatric facilities, writing

43:37

reams of reports for the state of

43:39

Illinois. He later served

43:41

as a confidential informant for the

43:43

DOJ investigation into UHS. Of

43:46

those 400 reports that we did, you'll

43:48

find countless reports where

43:51

we not only slammed the

43:53

hospitals for the problems that we found, we

43:56

mercilessly slammed the Department

43:58

of Children and Families. You sit. For.

44:01

Ron. There were two groups to blame.

44:04

Feeling child welfare agencies. And

44:07

for profit companies like you Hs that

44:09

made money off. Of those feeling

44:11

agencies. This. Created what

44:13

he calls the Child Welfare

44:15

Industrial Complex. Foster care

44:17

kids are. Highly profitable

44:19

cash cow for corporations who

44:22

socially are not run by

44:24

the way by medical or

44:26

psychiatric assessments. Iran

44:28

by business people. For.

44:31

Things To Change runs as you

44:33

need more social services for struggling

44:35

families so that you were kids,

44:37

enter the foster care system to

44:39

begin with, and more community based

44:42

mental health programs so that kids

44:44

can stay home rather than being

44:46

institutionalized. Last year the

44:48

Department of Justice said something similar about

44:50

Alaska trainers. Home State Department of Justice

44:52

release findings in mid December about

44:54

an investigation of allegations of the

44:56

State of Alaska violated the Americans

44:58

With Disabilities Act when it comes

45:00

to children. Did you j

45:03

accuse the state of segregating kids with

45:05

mental health issues? In institutions instead

45:07

of providing them treatment in their

45:09

homes. Just like Ron said, it

45:11

was another damning report. But rather than

45:13

calling out you Hs this time the

45:16

D O J So this was on

45:18

Alaska for allowing kids to languish at

45:20

places like North Day. I

45:24

keep thinking about this deposition I read. it

45:26

came from the case of a former. Foster

45:29

kid named nice and Presley. He

45:31

was sent to Northstar again and again,

45:34

starting when he was just five years

45:36

old. And as an adult, he sued

45:38

Alaska's Office of Children's Services for negligence.

45:41

There's no recording of this deposition so I asked

45:43

them folks here at revealed to read at. Nathan's

45:46

lawyer is questioning an official from Lcs.

45:49

So. Nathan didn't really belong in North Star anymore

45:52

because he did meet that level of care.

45:54

And he was already stabilized, at least

45:56

as far as Northstar goes. But.

45:59

There wasn't any place. Else with the right level

46:01

of care to put him correct. So.

46:03

We just stayed locked up in a

46:05

psychiatric facility. Yes, For

46:08

months. Yes, Foster

46:17

kids have long suspected that they

46:19

were being warehoused and here the

46:21

last as child welfare agency confirming

46:24

that in this one case that's

46:26

exactly what happened. But instead of

46:28

taking responsibility they sifted the blame

46:31

the Office of Children's Services turned

46:33

around and sewage north. Both

46:36

ultimately saddled with Nathan Last. Year

46:38

for an undisclosed sum. Mile

46:43

there's another former foster kid suing

46:45

Sometimes when I think about it

46:47

a month or much like chronic

46:49

chance something you know maybe make

46:51

somebody elses life a little easier.

46:54

Trina is suing North Star and

46:56

you a check for battery and

46:58

false imprisonment. Her lawsuit is still

47:00

pending, but North Star they've turned

47:02

around and suit Alaska's Office of

47:04

Children's Services. The finger

47:06

pointing. Continues. Has.

47:16

Run. On

47:18

a windy spring day, I pick up

47:20

Trina and her kids from her apartment

47:23

on the outskirts of Anchorage. We drive

47:25

to Northstar. His.

47:34

Friends us A New Years. Of.

47:40

Wow. So.

47:44

And the press

47:46

impacts. We

47:49

saw coverages her tough a second. For

47:52

a second. Passing

47:55

through where we are right now

47:57

in my poems Illusion. I

48:01

don't know. Anxiety? mostly.

48:06

About being here specifically. Yeah,

48:11

I didn't. I

48:14

didn't realize how to manage. Growing

48:17

up in this society was.

48:20

As how does now. Who.

48:30

Is my childhood is in one

48:32

building. It's a lot. Who

48:38

are? It's a lot to take a. Train.

48:43

And I get out of the car. It's

48:45

a surreal moment behind us on the other

48:47

side of the car windows her kids are

48:49

in. The back seat watching the Lorax.

48:52

In front of us are the big

48:54

reflective windows of North Star, the window

48:56

she spent countless hours looking out of

48:58

when she was a child. What

49:00

do you think of the kids he might be like with

49:03

Anthem and Married. They're probably

49:05

thinking the same thing I thought. A

49:09

way to escape. Probably

49:14

just. Staring out

49:16

the window, Boars waiting

49:18

for. The next therapy session.

49:21

the happiness. Or class

49:23

or lines. They

49:28

had you on us. strict schedules, Are

49:30

still so on organized? because growing up

49:33

that's how I lived on a strict

49:35

schedule. I waked up a certain time,

49:37

I use a certain time I put

49:39

a certain time I breathe at a

49:42

certain time to go into being able

49:44

to do that whenever. A

49:47

lot to do with myself. You know, I

49:50

think that if you were to look up institutionalize

49:52

in a book, you'd see a picture of me.

49:56

Actually, the definition. Of institutionalized.

50:01

Trina takes it all in. She.

50:04

Points out the fence didn't play area

50:06

outside where there was always a deflated

50:08

basketball. The door she tried

50:10

to escape from once the bank with

50:12

customers. she's to make up stories about.

50:15

But her eyes keep coming back to the

50:18

windows. Like she's searching

50:20

for something. Else

50:22

or so I came here at it noted. The windows were.

50:26

Like mirror windows. Pc

50:28

yourself. So and people

50:31

would walk up. i'd being on the window think and

50:33

they could see me. Cry

50:35

for help. Mcgimpsey

50:39

Me Pedal. Business

50:42

or banging about it. After

50:53

Story came out of state representative

50:55

in Alaska introduced a bill to

50:58

address the problem of foster kids

51:00

lingering inside lox psychiatric facilities. It's

51:02

working his way through the legislature,

51:05

but it's unlikely to pass this

51:07

year. That

51:11

saw was supported by Julia Laurie from

51:13

Mother Jones. You'll find the link to

51:15

her written story on our website or

51:17

lead producers. This week when the Rowley

51:19

Price and Cancer Moszkowski they had help

51:21

from Julia Lorries savior Rodrigues added to

51:23

the show. Special thanks to my com

51:25

a dummy and thinks as well to

51:27

our partners at Mother Jones in Gordon

51:29

James was and Qt her son Roeder.

51:32

Sticky Freak is or digital producer

51:34

Victoria Bear Net scuse or General

51:36

Counsel or Production Manager Sir Stephen

51:38

Risk own into Lemme Cobb. Score!

51:42

Sound design by the dynamic duo to

51:44

breezy with Jim Briggs if Fernando my

51:46

men your router or interim executive producers

51:48

of Talkie Till Nice and Bread Myers

51:51

or see Music is by Camaraderie Lightning

51:53

Support for reveals provided by The River

51:55

and David Logan Foundation The Ford Foundation

51:57

to judge the In Chasm team. Carter

52:00

Foundation, The Jars and Logan Family

52:02

Foundation, The Robert Wood Johnson Foundation,

52:04

The Park Foundation, and the Helmand

52:06

Foundation. Reveal is a coal production

52:08

of the Center for Investigative Reporting.

52:11

M P R X Amount. Let's

52:13

and remember, there's always more to

52:15

the stores.