Low-Bidding Mental Illness
In Texas, however, GEO Care has also run into trouble with its hospitals. The company has been fined tens of thousands of dollars by the Texas Department of State Health Services for a variety of bad practices at the Montgomery County hospital, which GEO Care has run since it opened in March 2011.
The host of violations documented by the state at the facility north of Houston range from unauthorized patient restraint and seclusion to keeping patients hospitalized for months after they’d been found competent to stand trial
Carrie Williams, spokeswoman for the state health services agency, confirmed that the agency had issued a notice of violation to GEO Care at the Montgomery County hospital with regard to patient care.
“I believe the exact figure in the notice was $107,500, but the final amount of the penalty won’t be known for another month or so,” she said.
The health services agency will make a recommendation to the legislature about the GEO Care bid. Williams declined to comment on whether that evaluation would include the company’s performance at Montgomery.
In e-mails to the Weekly, Paez insisted that should GEO Care take over the hospital, standards would be of the highest quality. He sent a spreadsheet showing that at both the Montgomery County hospital and one of GEO Care’s Florida facilities, incidents of forcible patient restraint and seclusion were “significantly below the rate at comparable state psychiatric hospitals in Texas.”
GEO critics say that the company’s record of abuses and problems is likely to continue if it gets the Kerrville contract.
Bob Libal, a member of a group called Grassroots Leadership, said in a press release, “I think that the GEO Care record in Florida, where the three deaths occurred, and in Montgomery County, where GEO Care is currently being fined by DSHS for lack of quality patient care, has already shown itself to be similar to what we’ve seen in the GEO correctional facilities.”
Grassroots Leadership is a nonprofit fighting to end the for-profit prison industry and is part of the coalition opposing GEO’s Kerrville bid. The coalition includes groups from the Texas ACLU to a board of the United Methodist Church. Their position is that hiring GEO to run that facility, while being proposed as a cost-saving move, could carry a high cost, not only in patient suffering but also in taxpayer dollars, in the long run.
The contract for operating the Kerrville hospital would be lucrative. The state spends about $27 million on it each year, or an average of $375 per night per bed –– and the 200 beds at Kerrville are usually all filled. Few people believe GEO Care could maintain the current level of care, cut spending by the required 10 percent across the board, and still make a profit.
Kerrville patients are almost all long-term residents (the average stay is 921 days) involved with the criminal justice system: They have either been found not guilty of crimes by reason of insanity or were ruled incompetent to stand trial, also because of mental health issues. Although the patients have been deemed not to be a danger to themselves or others, Williams said, “There is a level of security at the hospital, though it’s not our maximum- security facility.
“The thing to remember,” she said, is that, regardless of the backgrounds of the residents at Kerrville, “we make sure our patients are safe and well taken care of, and we will maintain those standards whether or not a hospital is ultimately privatized.” She would not confirm that GEO Care had submitted a bid to operate the Kerrville hospital, but another state employee did.
On one hand, say mental health experts, such a facility might be a natural fit for GEO, with its prison experience. On the other, those same experts note that the Kerrville patients have complex needs, and the state is already doing a good job, with very little room for further budget- cutting.
Correa, of the criminal justice coalition, knows GEO through its privatized prisons, “where we’ve seen their priority is to make money,” she said. “And to do that you cut salaries, you cut the care element. That’s our biggest concern.”
If the privatization of the Kerrville hospital is approved, she said, the results “are not going to be good for Texas.” Or perhaps for the citizens — and voters — of Kerrvile.
The hospital now employs about 535 people, with the usual state employee benefits — no small thing in a town of about 50,000. It’s Kerrville’s third-largest employer, ranking below only the school district and regional hospital.
Susan Garnett, deputy chief executive officer of Mental Health Mental Retardation of Tarrant County, said the Kerrville facility has a good reputation and good community relations. “Those are state employees, and both they and their community will likely have a good deal of input into the discussion to privatize that hospital,” she said. “And I would be surprised if that input was not taken seriously.”
Katherine Ligon, mental health policy analyst with the Center for Public Policy Priorities, sees a potential problem with turning over a state hospital to a private company that might decide to walk away from the contract if, for instance, the company begins losing money.
“What happens if GEO Care gets the bid approved and they’re providing services and then two years down the line they’re in the red? Will they just leave? And what happens at that point?” she said. The state would have to gear up to keep the hospital functioning, and during that time “what happens to those patients?”
Libal worries about handing Kerrville over to GEO because the residents are in such a poor position to advocate for themselves and to report abuse, neglect, or other problems.
GEO’s poor record at other facilities “makes me wonder how they will operate a state mental institution with a population that is both vulnerable and potentially volatile,” he said. His organization and the coalition it is a part of wrote to Gov. Rick Perry to outline their reasons for opposing privatization at Kerrville.
If GEO Care turns out to have the same kind of problems that GEO Group has racked up in its “long and troubled history in Texas,” Libal said, the savings to the state could disappear rapidly. “ GEO has paid millions in lawsuits over the deaths of prisoners. If that kind of liability were to fall on the Department of State Health Services, GEO’s cost-cutting measures might not save taxpayers money,” he said.