Nick Petito saw a lot during his six-month stint at North Star Anchorage hospital.
Petito was not a therapist. He was not a social worker. He was the maintenance manager and was responsible for fixing any physical problems at Alaska’s only children’s psychiatric hospital.
He was required to work in every part of North Star’s East Anchorage campus, fixing holes in the drywall, setting up pulled fire alarms, and keying doors.
Petito stated that as the days grew into months, he “watched it quickly turn to absolute chaos.”
He said that the hospital was experiencing escalating destruction. “It got so bad that we were having multiple Riots every week.” “I mean riots all out. We took care of the maintenance. They would tear down the walls and then tear up the rooms.
Petito is just one of many former employees who have described long-standing problems at North Star. These issues seemed to get worsened in recent months as understaffing and poor management decisions pushed the hospital to its edge .
Public records show the increasing chaos. Petito was at North Star for six months. From April to September 2022 Anchorage police responded to 71 calls to the hospital campus. These were reports that included escapes and assaults. The same time last year, police were only called 34 times, or about half as often.
North Star has been warned by three different levels of regulators: the federal, state, and the organization that accredits hospital quality and safety. In November, the powerful Joint Commission issued a ” preliminary refusal of accreditation” to North Star, pointing out a unnamed “condition that… poses an immediate threat to patients.” Hospitals who lose this accreditation could face severe repercussions including being unable to accept Medicare or Medicaid. Hospitals have the option to appeal. Anne Marie Lynch, CEO of North Star, stated that the company is trying to address these issues.
Three former employees, including a therapist and a psychiatric assistant, were willing to talk with the Daily News about their experiences at North Star. Petito was the former maintenance manager. Two other former employees confirmed the details, but they declined to identify themselves publicly because of concerns about professional repercussions.
They all agreed on the same point: The hospital failed in its duty to properly train, hire and retain staff capable of managing a volatile patient population. One worker claimed that teachers from Anchorage School District who were supposed teach lessons to patients refused entry to the hospital due to dangerous conditions. Another worker said that at-risk children were able to escape regularly due to faulty fire alarm protocols and understaffing.
North Star refuted some of the claims of former employees. However, they said that patient privacy laws prohibit them from discussing specific patients and cases. Lynch wrote that the hospital has a staff of “to regulations and for safety reasons” and is actively seeking new workers. Lynch responded to the claims of a former employee that multiple riots occur every week.
Lynch also shared a statement almost word-forword taken from marketing materials on a ” About North Star Behavioral Health page on the company’s website.
The statement stated that “our dedication is shown every day as we assist young people and their families with difficult problems.” Our commitment is evident in the professional guidance and counseling that we provide for children and the caring response that we give to families.
Lynch also cited North Star‘s patient satisfaction data, which showed that patients were more satisfied with statements like “I understood my treatment plan goals,” and “I understand how important it is to follow my discharge plan.”
North Star’s children, some as young as four years old, are among Alaska’s most vulnerable children. They are sent to live in a locked facility, away from their families, with the promise of treatment for acute psychiatric or behavioral problems.
Regulators are a problem
The federal Centers for Medicare & Medicaid, the Alaska Division of Behavioral Health and The Joint Commission, all three regulators, have documented serious problems at North Star this past year.
First, the Centers for Medicare & Medicaid Services inspected the hospital in April and June. They found problems, including situations that were “immediately jeopardy”, which could have put patients’ safety and health at risk. If hospitals don’t address these problems, they may lose the ability to bill federal health insurance. Lynch stated that the hospital had resolved the problems and was not under any “plan of correction” by the agency as of September.
[ Alaskan families claim their children were abused at North Star mental hospital .]
The Alaska State Division of Behavioral Health also found problems during an August on-site review of the hospital’s program for adolescent girl programs. The hospital’s doctors stated that understaffing was a problem for them. State reviewers found inconsistent and incomplete medical notes from patients, which contradicted their own records. This suggested that critical safety checks of 15 minutes were not being performed.
The state regulator urged North Star to “hire more staff to ensure services were being rendered safely and with high quality care.”
Lynch stated that the hospital is cooperating and is working with the state to implement a “plan for correction”.
On Nov. 2, the Joint Commission issued a “preliminary denial of accreditation” to North Star. On Nov. 2, the Joint Commission issued a “preliminary refusal of accreditation” to North Star. This was a serious consequence. According to Joint Commission data, North Star had been accredited in at least seven surveys over the past seven years.
The Joint Commission identified conditions that “threat patients” and listed 11 areaswhere inspectors discovered “performance issues” at North Star. The Joint Commission cited the following: “The patient has the right not to be neglected; exploitation; verbal, mental and sexual abuse; and rel=”noopener” target=”_blank”>11 different areas where inspectors found “performance issues” at North Star.
Lynch, the CEO, stated that the hospital provided “full cooperation” during compliance surveys by regulatory agencies.
She wrote that “When there is an opportunity to improve facility operations, we immediately implement the appropriate plans to address it.”
Only game in town
Universal Health Services, which is a publicly traded for-profit corporation, owns North Star. It also has 335 facilities that provide inpatient behavioral healthcare services around the world. Universal Health Services had an annual revenue of approximately $11 billion in 2020. According to the Alaska Department of Health, $122 million was paid by Alaska in Denali KidCare reimbursements for North Star over the past five year.
North Star has existed since the 1980s when it was known as Charter North. It served both children and adults. The State of Alaska had considered purchasing the DeBarr Road building to relocate the Alaska Psychiatric Institute. However, this plan was canceled in 2000. Universal Health Services bought the hospital in a 2003 deal. The Daily News reported that the expansion of the hospital with a new 60-bed facility was seen as an opportunity for children to be sent home from Outside when the hospital opened in 2006.
Advocates questioned the operation of North Star even then.
The Daily News reported that “Advocates also raised concerns about staffing and medication at North Star’s existing treatment centres and psychiatric hospitals,” in 2006.
The hospital was the only place where children under 13 years old could be admitted for psychiatric reasons in the state at that time. This is still true twenty years later.
There are many ways for kids to North Star. A typical example is one who has a combination disorder of mood and behavior, and threatens suicide or causes harm to another person. Curt Wengel is a Anchorage child psychiatrist and medical director for Alaska Behavioral Health. This Anchorage non-profit used to be known as Anchorage Community Mental Health Services.
Wengel stated that family members, or legal guardians in the case of foster children, might take their child to the emergency room for an assessment to determine if they should be admitted to hospital.
Wengel stated that if parents are so concerned about safety that their child is staying awake at night, it’s likely that the child needs to be admitted.
He stated that the idea was to reduce the severity of the situation by spending time in hospital. However, this treatment does not necessarily resolve the longer-term, deeper problems. Outpatient therapy is a method of treating children who have trouble sleeping. A clinician would visit the child once per week. Wengel stated that children in other parts of the United States spend a shorter time in psychiatric hospitals, perhaps a week to ten days. Not at North Star.
Wengel stated, “When I first arrived in Alaska, they told me that the average stay at North Star was around 30 days. My jaw dropped to the floor.”
Wengel explained that Alaska has historically been unable to offer extremes to children — such as a locked psychiatric unit or a therapist who might only see one or two kids per month. There are many children who do not require hospitalization, but still need to spend at least an hour with a clinician.
Wengel stated that there is often limited infrastructure and limited availability for patients below the inpatient level and those above the outpatient level. His organization launched recently a “partial Hospitalization” program for children and adolescents to fill that gap. Children spend 9 a.m. to 3 p.m. in a therapeutic setting, but return home at night to their families.
Children are kept in hospital for many months because they don’t have the option to leave the hospital, but they still receive support. Wengel stated that psychiatric medicine is risk-averse. Hospitals won’t discharge children if there’s still a significant risk.
He said, “In medical practice it’s not uncommon for someone to say that if the level required care doesn’t exist then the next highest level is the most appropriate.”
Lynch, North Star’s CEO, was also in agreement.
She wrote that “If the patient does not meet the criteria for our program, they may stay longer because they lack access to other programming in our system or the Alaskan behavioral health system.”
When kids do leave, unless they are ready for the outpatient therapist-appointment scenario, “residential treatment” — also long term, usually a minimum of six months — is the usual recommendation, Wengel said.
Universal Health Services owns about 25% of the outside residential treatment placements Alaska Medicaid will cover.
Repairing broken things
In April 2022, Nick Petito was appointed North Star’s maintenance manager. This job involved repairs to the three hospitals, one in Palmer and two in DeBarr Road. He and his crew were summoned to clean up the mess after things spiralled out of control.
Petito was responsible for making keys for new employees. Petito said that the high employee turnover, particularly for lower-level employees, could be measured in new keys. He would make 10 to 15 sets of keys, and then get 8 or 10 back within a few shifts.
He said, “People would work for 2 days and then be like, “Nope, I’m no doing that.”
Lynch, North Star CEO, claims that this is false and that Petito was not in charge of key card management.
She wrote, “We disagree with the statement as it is inaccurate.” Petito maintained that key cards were part and parcel of his job.
Petito stated that there was one bright spot. He would sometimes be sent to North Star’s Palmer facility on Clark Wolverine Road. This facility was a complete contrast to the Anchorage campuses which are much larger.
Petito stated, “Amazing setup.” “I mean, it’s impressive. The manager has the kids playing all day. They are doing yoga. They are creating art. They’re all playing instruments, I went out.
Petito noticed something was very different about North Star. He says that patients at the North Star units where he worked felt like they had little structure and no place to go.
Petito stated, “I have worked 10 hour days and you just watch the children pace down the hall.” They do that because it’s all they do. They just walk up and down the hall.”
Petito believed that the absence of structure was directly fueling the destructive outbursts that he would end-up repairing. He said that once, patients ripped the door out of its frame.
“With the children sitting inside all day — kids stew.” He said that they get bored.
A parent expressed similar concerns about boredom during the state’s review the program for girls aged 12 to 17. They only watch TV once a day, and they watch the same movie every time.”
Petito was also concerned about how fire drills were conducted. He said that high turnover meant workers were not being trained in how to handle a hospital fire alarm.
He said that patients would find a weakness in the system, which allowed them to unlock the doors when an alarm was triggered. He said that there were multiple instances when children, who had been admitted to Anchorage because they were considered a threat to their safety or the safety of others, would escape to the streets.
He said, “They were all directly involved in the fire drills.”
Lynch, North Star CEO, stated that the facility had “modified our fire pulls.”
“Obviously, you start to feel depressed.”
Petito met Anthony Irvin, an employee whose keycard wasn’t used much at the hospital. He worked there for six weeks.
Irvin says that he is also studying for a master’s in social work. He was hired in mid-August as a “Mental Health Specialist II”.
The majority of non-medical, hands-on care that mental health specialists provide is for patients. This includes things such as making sure they get up and brush their teeth. According to a former worker, entry-level mental health specialists are paid $16 per hour. If they stay on for more than two years, they can get a bonus up to $10,000.
Irvin was assigned to a unit for adolescent girl. They were subject to “unit restriction”, which meant that they couldn’t even use the elevator to get to the cafeteria. Instead, they had trays of food delivered to them. Irvin claims he asked the managers why the girls couldn’t leave the unit.
He said, “But I knew the answer: There isn’t staff to supervise them.”
North Star did not respond to Irvin’s assertion but stated that its safety rules were in place.
Lynch, the CEO wrote that “To ensure safety for patients and staff, we rigorously review and continually update protocols.”
He felt that the girls’ moods and behaviors were being affected by the restriction on the units.
Irvin stated that if you are stuck in one corridor, on one level, you will feel depressed.
The August hospital review by the Alaska Division of Behavioral Health found many of the same problems.
Four of his coworkers quit shortly after Irvin began. Irvin stated that he was left with a job for only five people. According to Irvin, the bare-bones staff meant that children who were supposed to receive instruction from Anchorage Schools District teachers who came into the hospital to give lessons, sometimes didn’t get it.
According to the school district, it claimed that North Star served 350 students during the 2021-2022 school years, from pre-school through 12th grade. Although the district has a “memorandum o agreement” with the hospital, there is no financial contract.
North Star must provide at least one “designated behavioural health associate” for teachers to be in the classroom during instruction. The agreement states that such associates will be provided at a sufficient adult-to-student ratio to ensure safety for all students.
According to Irvin, there was sometimes so little staff that teachers would not come because of safety concerns. He said it happened about once per week.
He stated, “If there isn’t enough support and help, they (ASD teachers), don’t come.” “That will be an indicator of insufficient staffing.”
Anchorage School District didn’t answer the question regarding whether teachers will not be allowed to enter North Star because of safety concerns. Lisa Miller, spokesperson for the district, stated that safety is our main concern.
Irvin stated that the lack of workers led to many escapes, as there weren’t enough people to supervise children.
Irvin claims that he was doing laundry and a girl ran by him. This allowed a group of people into an area that was not permitted. He didn’t want his hands on the patient who was being aggressive so he left.
Irvin claimed that he was fired later for how he handled this incident.
Admissions
Jason Fedeli was an intake coordinator at North Star from 2016 to 2016, and then as a counselor. He retired from North Star in 2020, and now practices in Anchorage.
He was the intake coordinator and interviewed potential patients to determine if they were eligible to be admitted to the hospital. He said that sometimes it came down to which type of insurance the patient had. Accepting patients with private insurance meant that the hospital could receive reimbursements up to three times higher per night than what the hospital would receive to cover kids on public Denali KidCare.
Denali KidCare’s nightly reimbursement rates were around $900. Private insurers would be closer to the $2,500-$2,800 range.
Fedeli explained that sometimes, this meant that children who truly needed a bed wouldn’t be able to get one.
Fedeli stated that one child from the villages tried suicide and was in the emergency department for several weeks. “Intake” called his administrator and called another young man with private insurance. (The administrator) stated that we should bring the child with private insurance double.
He said that admissions to children who didn’t need full hospitalization or shouldn’t have been admitted to the hospital in some cases, depending on how many beds were available, seemed to be going in the opposite direction.
Fedeli stated that children in the custody of the state Office of Children’s Services were particularly vulnerable.
North Star stated that admissions to its programs are strictly based upon medical judgment.
Lynch wrote that all patients are evaluated by psychiatrists and admitted to the hospital. “ If the patient is not medically necessary for the care level, they are referred to appropriate care,” Lynch wrote.
Fedeli stated that understaffing was a problem even during the pre-pandemic years when he worked at the hospital. He said that while some children were supposed to be “one-to one,” which meant they were constantly supervised by staff members, it didn’t always happen. Fedeli stated that once, while staff were watching a basketball match on TV, one of the patients on one-to-1 broke open a battery. This caused internal chemical burns.
Fedeli stated that the staff at North Star are dedicated and have been with the hospital for many years.
They really do love these kids. They stand up against the administration. They help the children by spending their own money (on items for patients).
Some children find the support they need at North Star and are happier to be discharged than when they were there. He said, “This isn’t because of the administration. It’s because of staff and doctors there that really care.”
Fedeli still sees children who were in North Star at his practice. He said that they are all pretty convinced that it was one of the worst decisions they could have made. “More harm than it does good.”
The Anchorage Daily News originally published this story. It is republished with permission.
‘I watched it rapidly turn into absolute chaos’: Inside the deepening dysfunction at North Star psychiatric hospital https://t.co/ckVBm1wHvP
— Anchorage Daily News (@adndotcom) November 20, 2022
