CONCORD, NH – The Department of Health and Human Services has chosen a private, for-profit company that has primarily worked with adults in jails and prisons to provide behavioral health care to children and young adult patients admitted to Hampstead Hospital.
Signing a deal will take longer than the department had hoped after the Executive Council voted, 5-0, last week to table the two-year, $52.5 million contract with Wellpath Recovery Solutions, based in Nashville. The company did not respond when asked to identify locations where it provides behavioral health care to children in a non-correctional setting.
Commissioner Lori Shibinette told councilors prior to the vote that delaying the decision too long could impact the department’s ability to finalize its purchase of Hampstead Hospital in mid-May. Rejecting the contract, she wrote in her memo to the council, would have “considerable impact” on the state’s ability to provide mental health care to children and young adults.
When Councilors David Wheeler and Ted Gatsas asked to table the 138-page no-bid contract, they said they’d been given just days to review it. They also noted concerns raised by the State Employees Association about Wellpath’s primary focus on prisons and thousands of lawsuits alleging substandard care.
Most lawsuits have been brought against Correct Care Solutions, which was merged with Correctional Medical Group Companies in 2018 to form Wellpath Recovery Solutions.
These lawsuits include nearly 1,400 federal cases filed against Correct Care Solutions as of 2018, according to the Project On Government Oversight, an independent watchdog group.
The “fact sheet” the employees union sent councilors also referenced a CNN investigation of lawsuits brought against Correct Care Solutions in connection with 70 deaths between 2014 and 2018.
It did not include an August investigative report from the U.S. Department of Justice that said Wellpath was providing insufficient care to patients in a California jail for their mental illness. Nor did it mention a February report from the Disability Law Center that called on Wellpath to stop using drugs as “chemical restraints” for patients under its care at Bridgewater State Hospital correctional facility. The Massachusetts Department of Corrections disputed the center’s findings.
Christine Turgeon, communications manager for the union, said the number of lawsuits that turned up in a simple Google search was concerning.
“We thought it was a red flag,” she said. “We think there was a lot that was not discussed or shared. That is why we put together the fact sheet. There was no time to read (the contract) and do due diligence and look into the company’s history.”
The proposed contract has also raised concerns for NAMI NH, said Executive Director Susan Stearns.
“Based on what I know of this company, I am indeed concerned about their experience with this population since these (Hampstead Hospital patients) are not juveniles in detention centers but children in psychiatric crisis,” she said. “So we are looking forward to hearing more information.”
Councilors did not return messages. They meet again next week.
‘Center of excellence’
The council approved Shibinette’s request in October to use $15.1 million in federal pandemic relief to buy the 111-bed Hampstead Hospital and transform it into a “center of excellence” for psychiatric care for children ages 5 to 17 and possibly young adults up to age 25. The state currently contracts with the hospital for inpatient treatment for children.
Buying the hospital is one of several investments Shibinette and Gov. Chris Sununu have championed in the last year as the pandemic has exacerbated the need for mental health treatment and emergency services for children and adults. On Tuesday, 10 children and 32 adults were waiting for a treatment bed to open up. At one point in the pandemic, there were nearly 50 children waiting for Hampstead Hospital’s 16 beds.
When asked whether Wellpath Recovery Solutions has ever treated children outside a correctional setting, Health and Human Services spokesman Jake Leon said the company provides treatment for children and adults and referred the Bulletin to Wellpath Recovery Solutions’ website.
Asked the same question, Judy Lilley, vice president of corporate communications and public affairs, said the company has operated state psychiatric facilities and treated youth and adults for nearly 20 years. She did not identify a non-correctional facility that treats children. Like Leon, she referred the Bulletin to the company website.
The website for Wellpath Recovery Solutions lists 13 centers, all but one of which treat people involved in the criminal justice system. The exception is the 350-bed South Florida State Hospital, which treats only adults.
The state’s other mental health investments have included new statewide mobile crisis response teams; increased funding for community mental health providers; a 24-hour call and text line for mental health and substance abuse help; and replacing the former Youth Detention Center with a much smaller therapeutic care setting.
Under the proposed contract, Wellpath Recovery Solutions would begin with 55 beds, 12 of which would be used to create the state’s first psychiatric residential treatment facility for people 21 and younger with complex mental health needs as they transition from the hospital to their community. That population is currently treated out of state, according to Shibinette’s memo to the council.
Within one year of signing the contract, the company must add 10 beds. It would be responsible for hiring staff, operating and managing the hospital, and provisioning all psychiatric care, according to the contract. The state would retain ownership of the hospital.
“Operations at Hampstead will look a lot like they do today,” Leon said in an email. “Several key management positions at Hampstead will be part of the DHHS management structure, ensuring the strongest possible state oversight.” Those would include the chief executive and operating officer positions as well as compliance officer, general counsel, and contract manager, he said.
When the state was looking for a company to provide behavioral health care at the state hospital last year, Wellpath Recovery Solutions was one of four companies to submit bids. Wellpath scored second, behind Dartmouth Health, particularly in the staffing and retention categories.
Legal concerns
The August results of an investigation into prisoner care at a California jail found that while Wellpath had improved some services, the company was still failing to provide prisoners “constitutionally adequate” care. The investigation was carried out by the Civil Rights Division of the U.S. Department of Justice.
Wellpath began providing services at the jail in February 2019.
The company discouraged routine follow-up mental health care, and clinicians told federal investigations they were discouraged from providing scheduled psychotherapy to prisoners, according to the Justice Department’s report. When prisoners return to the jail from the psychiatric hospital, their hospital records are not integrated into their jail records, a step toward ensuring appropriate treatment continues, the report said.
Prisoners who are acutely suicidal, or who have decompensated to the point of becoming a danger to themselves, are placed in a “safety cell,” which does not have a bed, toilet, sink, or water, with only a grate in the floor for prisoners to relieve themselves, the report said.
The department said Wellpath was staffing the jail with a psychiatrist for 24 hours a week when an average of 100 or more prisoners were experiencing serious mental illness.
Leon and Lilley acknowledged the hundreds of lawsuits filed against Wellpath and Correct Care Solutions.
“While Recovery Solutions is not immune to litigation, the amount of lawsuits is low,” Lilley wrote. “For example, if you look at a comparable facility to Hampstead Hospital currently operated by (Wellpath Recovery Solutions), you would find that in the past five years, there has been one claim settled for less than $20,000. This is reflective of not only the high standard of care we provide, but also the emphasis Recovery Solutions places upon quality and effective patient care management.”
Lilley did not respond when asked to identify the facility.
She also said that litigation in the governmental health care industry is common: “The number of lawsuits filed against Wellpath over a period of many years should be measured in the context of overall patient outcomes and the number of patients treated during that time. Relative to community standards, Wellpath patient outcomes are excellent.”
She provided no information on its patient outcomes.
Leon said Health and Human Services is aware Wellpath Recovery Solutions has received “negative media coverage and complaints from advocates in some jurisdictions.” He said the department considered the lawsuits against Correct Care Solutions and is confident Wellpath Recovery Solutions’ contract with the state is different from those targeted in lawsuits.
“We have implemented many policies and procedures, including quality and financial monitoring and reporting, to ensure residents receive optimal care and Recovery Solutions strictly adheres to the terms of the contract,” he said.
The state will approve hiring, staffing plans, policies, and resumes, and oversee all services provided, he said. “Should any issues be identified, the department is explicitly prepared with tools in our toolkit to intervene immediately. In the event Recovery Solutions fails to perform services satisfactorily, provide required reports, or fails to perform any term or condition of this agreement, the department may give the contractor written notice of … default.”
This story was republished with permission from New Hampshire Bulletin under their Creative Commons license.
