Second of two parts
Children are locked in an Anchorage mental hospital without justification because child welfare authorities don't know what else to do with them.
That fact is confirmed by sworn statements from the heads of Alaska's Office of Children's Services and North Star Behavioral Health System. The state says it affected fewer than a dozen patients last year.
But I believe it is worse than that. I talked to more than a dozen former employees and patients of North Star, and to advocates and lawyers who have spoken to scores more.
These other sources say North Star's prison-like, acute-care units routinely house and drug many children whose real need is consistent discipline and a caring home. They also describe chaotic, understaffed units where injuries are common and teens are controlled by threats, sedation and restraint.
Some youths with neglectful or abusive parents have spent essentially their entire childhoods drugged and cycling through foster homes and the hospital before finally getting to supportive homes or, after becoming adults, refusing treatment.
These young adults said they were able to begin normal lives only after they got out of the system and got off drugs that made them feel like zombies.
Today I am presenting what I learned while investigating North Star and how I judged that information. My thoughts on what should be done are at the end.
Kids, locked up
In 2013, a pair of girls, ages 10 and 12, were admitted to North Star on an emergency basis after they messed with their foster mother's Facebook page, opened the bathroom door without knocking and rubbed their scabies rashes on furniture.
It was a weekend and an OCS worker couldn't find another placement. The girls stayed in the hospital for 63 days.
That case is documented by records obtained by a lawyer advocating for change at North Star. Other stories come from former patients and staff and cannot be independently verified.
I was refused an interview with officials at North Star in a letter from CEO Andy Mayo that cited privacy laws and positive statistics about the hospital.
I followed up offering to obtain releases from former patients, but a spokesperson responded that the hospital has no form for such a release and that even with one, an interview would be unethical. She also said the sources of the positive statistics were confidential.
The hospital disputes criticism of its care and says it does not hold patients who medically don't need to be there.
The state refused an interview as well, referring me to an attorney in the Department of Law. That attorney provided answers to some written questions, including confirming that last year 11 patients stayed in North Star, on average, 20 days longer than they had a medical need for.
OCS and the hospital have a cozy relationship and little external oversight of how they handle kids in their care. An OCS psychiatric nurse who manages referrals to the hospital spent almost her entire career working there before being hired by the state, according to her deposition.
When doctors want to put an adult in a mental hospital or on forced medication, they need a court order. Teens sent by OCS to Alaska Psychiatric Institute are reviewed by a doctor and magistrate. Psychological admissions to Providence Alaska Medical Center go through emergency room doctors.
But with North Star, the nurse said, OCS can send a minor under its control to intake staff, who assess the youth and then call an independent psychiatrist for an admission decision. In those cases, the doctor usually never sees the patient or reads the assessment until after the admission, she said.
North Star has financial incentives to admit children to the hospital.
Universal Health Systems, known as UHS, owns North Star and hundreds of other hospitals. Its shares are traded on the New York Stock Exchange.
Often, many beds are empty in the three acute-care units for children and teens at the main Anchorage hospital on DeBarr Road. On average, the units combined are only about half filled, according to Mayo's deposition.
The state also has a financial incentive to use North Star. Medicaid pays directly for care rather than the Office of Children's Services. Programs more appropriate for troubled foster children might not be covered.
Medicaid is a federal program administered by the state. It pays $728.41 a day for the care of Alaska OCS kids at North Star. In 2017, the agency averaged 14 children a day there. The total bill for that care was $15.8 million.
In 11 OCS cases last year, a third-party review of patient records disallowed Medicaid reimbursement because care at North Star was not medically justified. Those unnecessary stays lasted from three to 30 days, totaling 218 days. With Medicaid denied, the state treasury directly paid North Star $158,793.
But were those disallowed days the only unnecessary time spent in the hospital? Lawyers, advocates and former patients and staff I talked to said many more patients are inappropriately held there.
"It's like 'One Flew Over the Cuckoo's Nest.' These guys aren't even crazy," said attorney Jim Davis of Alaska Legal Services, who said he has talked to dozens of former North Star patients as he challenges long stays and involuntary medication in a pair of lawsuits. "They're regular kids."
UHS and many of its hospitals across the country have been under investigation since at least 2013 by the FBI and other federal agencies. Among the public allegations were charges the company made money by holding patients in mental wards longer than necessary.
North Star says that doesn't happen in Alaska.
Stories from inside
Among the seven former patients I interviewed, two, a young woman and a young man, said they did get benefit from being at North Star, although they felt stays lasted too long and they had other complaints. Plenty of Alaska children and teens do have mental health problems and need inpatient therapy.
But the other five former patients I talked to said they did not benefit or were harmed by being in North Star.
Zaniella McCormick, now 23 and working on a degree in criminal justice, said she left North Star with more problems than she had when she entered.
At 11, she needed protection after witnessing traumatic events at her home in Sand Point. But she said she didn't need the heavy drugs she was forced to take, which made her passive and groggy through much of her schooling. She improved when she stopped taking them but still has an involuntary twitch as a side effect.
Malerie McClusky, now 21, said she was first placed in North Star at age 10 after running away from a foster home. She said she never threatened harm against herself or others and was not mentally ill, but like many foster kids could be mouthy and difficult because of her life experience.
"They still diagnosed me with anything they can to keep me in there longer," she said. "I always tried to stay good, because I got threatened in North Star if you aren't good, we will booty-juice you."
"Booty juice" is what the young patients called a sedative shot given in the rear end. Along with a padded room, it was used as a disciplinary threat.
I reached Isaiah King, 19, at a conference where he was presenting on foster care problems. He was placed in North Star and other facilities repeatedly from the time he was taken from his parents at age 6 or 7 until he got into a stable foster home at 17.
King said he got out of that cycle by fighting off the injection of the sedative in the booty juice. After that, North Star would not accept him anymore. OCS then placed him in a stable foster home, he got off medication and is doing well.
Lilly Babino, 24, now working as a clerk, said her mother, a heavy user of alcohol and drugs, sent her to North Star when she was 14 over a misunderstanding, when her brother cut his hand on a can. OCS took over her custody while she was in the hospital.
Babino said she had never threatened to hurt herself or anyone. But she was forced to take drugs to address mood swings that she believes were normal for a teen.
"It was like, this medication isn't working for you, let's try another one. Let's up the dosage. And honestly, I don't think I needed medication," she said. "I ended up staying there like nine months, because they thought I was depressed. I was depressed about being stuck in North Star."
The former foster children said they saw North Star as a punishment. The threat of being sent there was used to control their behavior.
Their descriptions make it sound like prison: a locked facility with strip searches, control of reading matter, and even denial of art supplies like pencils that could be used as weapons.
For victims of child rape, North Star could feel like punishment for reporting abuse. Nevaeh Miller, whom I profiled in my last column, was raped by her stepfather for seven years before she was placed in North Star. She recalled getting the booty juice injection and isolation during that time because she scratched herself.
Miller said her recovery began only after her two years at North Star had ended.
In his letter, hospital CEO Mayo suggested that teen mental patients are not reliable sources of information about conditions at the hospital. But I also talked to six former employees who worked on the units, including specialists and registered nurses.
All said a large percentage of patients at North Star simply needed, as one said, "discipline, a hug and some boundaries," not hospitalization or drugs.
"You have kids in there because they got in a fight or they have really bad parents who have substance abuse problems," said Glenda Ness, a mental health specialist who now works at the Alaska Psychiatric Institute. "I don't see why a 5- or a 6-year-old kid should be in there, receiving all these strong medications, just because they cursed a kid at school and said 'I'm going to kill you' or something."
Ness and other former employees said children from neglectful homes arrived out of control and disruptive at North Star. They created noise and chaos in the short-staffed units, sometimes causing children with anxiety and depression to cower in fear.
"The kids who truly needed mental health help were being victimized by being put in with these other kids," said Linda Vick, who worked with children at North Star for five years. "We weren't able to help these kids clinically, because we were just trying to keep these kids from being assaulted or staff being assaulted."
In his letter, Mayo denied ever holding patients who don't need care.
"North Star categorically denies any assertions that patients are admitted to or held at North Star who do not meet criteria or have a legitimate purpose for stay at the facility. Such claims are false," he wrote. "The vast majority of North Star patients are referred for admission by a medical care provider, who has already determined the patient's need for services."
Demands for change
Amanda Metivier of the nonprofit Facing Foster Care Alaska has documented many patient stories from the hospital, including putting out fact sheets with former foster children's statements and photographs.
"Most of our kids have some kind of horror story at North Star," she said. "How much is this company making off of children and Medicaid? And they have all the control over how long they stay there?"
Attorneys at Alaska Legal Services have tried to put limits on North Star stays. Representing village tribal leaders, the organization has sued the Office of Children's Services and North Star to require judicial hearings for forced medication and commitment, similar to those required for adults.
They won hearings after 30 days, but a judge denied requiring a hearing after three days, as for adults. That case is continuing. A case regarding forced medication is in its beginning stages.
Similar issues have been raised elsewhere in the United States. In 2014, California's Mercury News published a year-long investigation of overly drugged kids in state care. New laws now force courts to monitor and limit drugging of foster kids, and the abuses have dropped dramatically.
In Alaska, we're way behind and children are suffering. Waiting for the courts to create new laws protecting them is wasteful and immoral.
The state should open alternative facilities, such as group homes, for kids who are too rough for foster homes but are not mentally ill. OCS is waiting for Medicaid to say it will pay before developing alternatives, but that's a lame excuse.
And the Alaska Legislature should adopt model laws used elsewhere in the country to stop the medical theft of young people's lives.
Email columnist Charles Wohlforth at email@example.com.
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