Universal Health Services: Alaska's Foster Kids and Overwhelmed Child Services = "Gold Mine" for North Star Behavioral Health

October 27, 2023

Former foster child Trina Edwards cycled in and out of North Star Behavioral Health in Anchorage, where she experienced physical and chemical restraints, seclusion and a feeling of hopelessness from thinking she’d never get out.

The company that owns one of Alaska’s main psychiatric hospitals for children made over $13 billion in revenue last year, profiting greatly from states, including Alaska, placing foster children in their care.

That’s according to a story in the magazine Mother Jones, which also found that the North Star Behavioral Health’s owner, Universal Health Services, kept foster kids in understaffed facilities, overused physical and chemical restraints and billed insurance for unnecessary services.

Julia Lurie spent a year investigating UHS for the Mother Jones story, poring over court documents from lawsuits and interviewing child welfare experts and policymakers, as well as former North Star employees and patients.

One of the central figures in Lurie’s story is a former patient in Anchorage.

Julia Lurie: So Trina Edwards is a former foster kid. She spent years cycling in and out of North Star, the psychiatric facility. She’s 23 years old now, but she was admitted to North Star for the first time when she was 12 years old. And she was admitted for suicidal ideation and for threatening to run away from her foster home. And she was really overwhelmed by what she saw there, kids being physically restrained, and in some cases injected with sedatives, kids being held in seclusion. And she would experience some of those things that she had observed that first time, being physically restrained and chemically restrained. And one particularly striking thing is that Trina didn’t feel like there was any end in sight. On some occasions, according to medical records, she was ready for discharge, but she would stay there for months because she had nowhere else to go. There were no foster homes available for her.

Casey Grove: You talked to her about her experiences there, and you actually have some audio from those conversations. Here’s a clip from Trina herself:

Trina Edwards: I’m being good. I haven’t gotten in trouble. I’m taking the medication that’s making me feel like … I still end up with the same result. Nobody. Nothing. I’m alone. They’re like, “Well, you just got to keep doing it.”

Casey Grove: So, Julia, is what Trina experienced, is that typical?

Julia Lurie: It does not seem to be unusual, unfortunately. I talked to a number of former foster kids who went to North Star. And the similarities in their stories were really striking, you know, folks saying that there had been physical and chemical restraints and seclusion and staying there even after a caseworker or therapist said that they were ready to go.

Casey Grove: So North Star, it’s not unfamiliar here in Anchorage, where I am. But I don’t think maybe as many people in Alaska know who actually owns North Star, and that’s a company called Universal Health Services. What can you tell me about them, about UHS, not only as a company but I guess also its reputation around the country?

Julia Lurie: Sure. UHS is a publicly traded, Fortune 500 company. It is the largest operator of psychiatric hospitals in the country. For years, it’s been the subject of a number of damning government and media investigations. And these investigations have had strikingly consistent allegations. So, for example, they alleged that facilities admit patients who don’t need to be there to begin with, that they improperly use physical force and chemical restraints, and that they keep patients longer than necessary. And I should say, UHS has consistently denied those allegations.

Casey Grove: Gotcha, yeah. Different sources described UHS’s children’s psychiatric hospitals as both “dumping grounds” and “gold mines.” And I wonder if you could explain that to me. Why do some people call them dumping grounds? And then also, why are they so lucrative?

Julia Lurie: So to understand that, I want to back up and talk about two different parts of this system. So on the one hand, there are child welfare agencies. So in the case of Alaska, it’s the Office of Children’s Services. Child welfare agencies are often very overwhelmed. They’ll often have way more foster kids in care than they have foster homes. And kids with behavioral health needs in particular, especially teenagers, can be hard to find foster homes for.

The other part of the equation is UHS or a place like North Star, which consistently has beds to fill. And again, they would say that they are admitting patients only for clinical need. But the reality is that they get paid when patients come, and Medicaid pays North Star $938 a night for foster kids.

So on the one hand, you have an overwhelmed child welfare agency, and on the other hand, you have a place like North Star. Both of those groups benefit from a foster child being placed at North Star. I want to be clear about the fact that I think there are a lot of individual good actors in each of these scenarios. I’m not saying that OCS caseworkers or the therapists at North Star or any individual people who are on the ground are intentionally doing harm by any means. But I think that the reality of the situation is that you have two groups that serve to benefit from the other. And then you have foster kids who are sort of caught in the middle. If there’s nowhere else for you to go, then there’s not a whole lot that you can do.

Casey Grove: Yeah. So what is the result that you see, either with Trina or other kids, you know, spending time at these facilities? What is the upshot for their lives going forward?

Julia Lurie: I think spending a lot of time in a facility like North Star can really stick with you. Trina and a lot of the kids that I spoke to talked about how it’s really difficult to trust people. It can be really difficult just to be around other people, a lot of social anxiety, and then feeling behind in other parts of their lives, too. Not feeling like they had, necessarily, a proper education or they really even had the opportunity to think big and dream about what they would want to do if and when they got out. So Trina, for example, she’s in some ways a very social person. She’s very friendly. But on the other hand, she’s the first to say this, she does not like being around people. She has a hard time trusting people. The memories from her years at North Star are really hard for her to carry.

Casey Grove: So you’ve got North Star. There’s the state, the foster care system. But, I mean, is there any, you know, sort of positive movement, I guess, on this issue?

Julia Lurie: The bottom line is it’s hard, because OCS, you would think, would be the ones advocating for kids. And like I mentioned, OCS is pretty overwhelmed. There are some lawsuits. So there have been some individual kids who have sued either North Star or OCS. And then, separately, there is an ongoing class action lawsuit of foster kids against OCS. Among their many allegations is that they are placed unnecessarily in places like North Star, because there’s nowhere else for them to go. And then, again, I think at an individual level, there are certainly people who care about kids, whether it’s a caseworker or a therapist, whoever it may be, but I think at a systems level, a lot of the pressure is coming from lawsuits.

Source: Casey Grove, “Alaska foster kids were a ‘gold mine’ for North Star Behavioral Health’s owners, reporter finds,” Alaska Public Media, Oct. 23, 2023, URL: https://www.ktoo.org/2023/10/23/alaska-foster-kids-were-a-gold-mine-for-north-star-behavioral-healths-owners-reporter-finds/