In its 10-K, Psychiatric Solutions disclosed that it was spending 54.6 percent of its total revenue on salaries, wages and benefits. This was a slight decrease from 2006, when it spent 55.2 percent of its total revenue on the so-called SWB package.
The Centers for Medicare and Medicaid Services, part of the U.S. Department of Health and Human Services, puts out an annual report used to develop its Medicare psychiatric payment system. Its 2007 survey of all psychiatric care facilities shows that about 65.8 percent of all revenue is spent on staffing at the average psychiatric hospital.
Daniel Kramer
Caregiver Tabitha Etheridge comes in after school each weekday to help with Amanda.
Daniel Kramer
Sometimes a close hug from mom Loretta Lilley is what it takes to calm Amanda.
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So Psychiatric Solutions and its hospitals are spending more than 11 percentage points less on staffing than the average psychiatric hospital. It also appears to be practicing economics by hiring a significant number of part-time employees. "As of December 31, 2007, we employed approximately 21,800 employees, of whom approximately 14,800 are full-time." This means that 7,000 employees were part-time, roughly 32 percent of its workforce.
Psychiatric Solutions responded to inquiries from the Houston Press by e-mail. The company's statement ignored questions about its own corporate operations and hiring policy and instead just couched its answers in terms of West Oaks. In total, it read:
"Our doctors, nurses, and therapy staff are sincerely committed to providing the best possible treatment to our patients in a manner which is caring, respectful, and focused principally on the safety and well-being of the patient.
"We work closely with the state of Texas, the Joint Commission, CMS and other regulatory agencies in order to ensure full compliance with all applicable requirements.
"West Oaks, like most health care providers, employs some part-time staff to allow for flexibility as patient populations shift.
"All staff are required to complete an orientation and extensive clinical training led by certified instructors before they go into clinical areas. Many programs are facilitated by the facility medical staff and all are approved by applicable oversight groups.
"Our staffing levels meet or exceed State requirements at all times."
Another Psychiatric Solutions facility, Cypress Creek in Houston, has also been sanctioned by the state in the past year. Its violations in two separate incidents resulted in $65,000 in fines and mirrored those cited at the West Oaks facility.
Mary says when she went to visit her sister Renee, she saw a male and a female staff member flirt and then grope each other right in front of her. She said the same sort of thing occurred among the patients, and the staff made no attempt to stop the activity. In addition, she says, staff members often reacted angrily, screaming and slamming doors themselves, which often sparked crying on the children's part. Patients who were going out of control were ignored, she says, and her mom was almost hit in the head with a chair thrown by a patient.
Patients were mocked by doctors and staff, she says. For example, one girl having trouble manipulating her silverware in order to feed herself was laughed at by staff members, who didn't help her either, Mary says.
In a somewhat bizarre twist, Frederick Williams, the tech who got in a fight with 41-year-old Vidaurre that led to the patient's death, has retained an attorney to represent him in a lawsuit against West Oaks, claiming he never should have been put in the position of providing one-on-one care to Vidaurre because he'd never been trained to do something like that.
Williams was alone with Vidaurre in the smoking area of the hospital when Vidaurre, who had been agitated for days, punched him in the face. A fight broke out in the locked courtyard area which has no video cameras, buzzer or alarm system. By the time it was over, Mario Vidaurre was dead. The autopsy report showed Vidaurre had suffered multiple rib fractures, laceration of the heart and injuries to his intestines, back, abdomen, chest, wrist, face, neck, buttocks, shoulders, both forearms and both knees.
Attorney Kerry Guidry of Robert Kwok & Associates says Frederick Williams was seriously injured as well.
"He broke his hand, had surgery on his hand, knocked his head open, cut it pretty severely and then his mental anguish and the mental aspects of taking another man's life. Even in self-defense that's taken a heavy toll on him."
Williams was no-billed by a grand jury that found he acted in self-defense, but an investigation by the Texas Department of State Health Services found that "the facility staff failed to protect the patient's rights to a safe environment and therefore resulted in the patient's death."
Williams's suit hasn't been filed yet, but it's going to say that they didn't properly train Williams as a one-on-one caretaker of someone as violently disturbed as Vidaurre and they didn't staff adequately, Guidry says. "It's pretty obvious he never should have been there by himself."
If Williams had been trained a little better, if there had been more help available, or if there had been an alarm system in the hospital's smoking area where the two men were by themselves, Guidry says Mario Vidaurre might not have died.
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Muhammad "Mo" Aziz is the attorney who took on West Oaks when Chaz Vidaurre came to him with the story of his brother's death. Although it looked for a while as though West Oaks was going to settle the case, Aziz says it now appears it will be tried, and he has filed the lawsuit alleging medical malpractice.