GEO Care has rocky record in Texas

According to the following piece at, Geo Care, one of the for-profit bidders to take over most of the New Hampshire prison system for maybe the next 20 years, is earning fines in Texas for deficiencies in care at its new forensic mental hospital there. In 2007 the state closed another GEO-run prison. In 2009 inmates rioted at a second company prison in Texas over poor living conditions. A federal grand jury is also probing the construction of the hospital and a GEO-run prison. Both were built by a different private contractor, and GEO is not implicated in those investigations. 

CCJR Staff

As East Texas public-private psych facility struggles, state plans more privatization
By Andrea Ball
Published: 9:38 p.m. Saturday, July 21, 2012

Sixteen months after the Montgomery County Mental Health Treatment Facility opened in Conroe, the state's first publicly funded, privately run psychiatric hospital is facing at least $53,000 in state fines for serious shortcomings in patient care.

The private operator, Geo Care, is a subsidiary of Geo Group, a private prison company that has drawn attention in recent years because of deaths, riots and sexual abuse at some units in Texas and other states.

Geo Care spokesman Pablo Paez declined to comment to the American-Statesman. Montgomery County Commissioner Ed Chance said all deficiencies cited by the state have been fixed.

Meanwhile, the facility's construction, by a different firm, is the target of a separate federal grand jury inquiry.

The problems come to light as the Department of State Health Services prepares to privatize one of the 10 public psychiatric hospitals it oversees. If Geo Care bids on the ongoing privatization effort — and it has expressed interest to public officials in doing so — its work in Montgomery County could be a harbinger of what taxpayers can expect if a for-profit company wins control of a public state hospital.

This week, the agency will accept bids from contractors seeking to run one of those facilities for at least 10 percent less than the current cost, a move that could save the state millions of dollars each year. If an offer is accepted, a private company could be running a state hospital by the end of the year.

The privatization process also comes at a time when the public psychiatric hospitals are mired in their own problems. Last month, former Austin State Hospital psychiatrist Charles Fischer was indicted by a Travis County grand jury on charges that he sexually abused five patients under his care at the facility.

Since March 2011, the Montgomery County hospital has been comprehensively reviewed three times by State Health Services. All three visits have found problems, including unauthorized restraint and seclusion of patients, incomplete medical records, failure to show patient consent for medications and failure to report serious injuries to the state.

The hospital also did not adequately monitor patients, kept patients for months after they had been deemed competent to stand trial and had overly restrictive phone policies, according to reviews.

A June 2011 report stated that one patient seriously injured himself and then ate fecal matter, but the incident was not reported to the state as required or addressed through his treatment plan. Classes designed to help patients recover were described as "bedlam," and numerous patients refused to attend, the report states.

A review this spring by a team from the state hospital division indicated many of the same problems.

In one case, a patient was required to clean up his own feces and urine, the report states. In another case, a patient hurt himself in isolation, but staffers were afraid to enter the room to help him, according to an email written by state hospital accreditation/certification coordinator Jo Ann Elliott, who was part of a team reviewing the facility.

"While in seclusion for four hours, patient banged his head on the seclusion room window and walls, causing lacerations to both eyes and a bruise to head. Patient threatened staff if door was opened," Elliott wrote to other members of the team. "Why was mechanical restraint not considered to protect patient from self-harm?"

Such incidents alarm mental health advocates.

"You should have such training where you know how to deal with it when someone is doing that to themselves, period," said Robin Peyson, executive director of NAMI Texas, an advocacy group for people with mental illness.

Chance said that the hospital took the state's concerns seriously, making staffing changes, adopting new rules and providing additional training to employees.

"Although deficiencies have been reported by (state) regulatory staff in the past, Geo Care has promptly taken steps to address each concern." Chance said.

Geo's history in Texas

Geo Group is best known in Texas for its rocky history in the prison system. In 2007, officials shut down the company's Coke County Juvenile Justice Center in West Texas, citing unsafe and unsanitary conditions. In 2009, inmates at the Reeves County Detention Center, also in West Texas, rioted over the quality of health care and other complaints.

Although state records don't indicate such extreme conditions at the Montgomery County hospital, State Health Services proposed in May that the facility pay a $107,000 fine for its deficiencies. Last week, the state tentatively knocked that fine down to $53,000, but the decision is not final.

"The facility is still getting its feet on the ground and is dealing with some startup issues as a new facility," State Health Services spokeswoman Carrie Williams said. "We need to see improvements, and we're giving them the opportunity to do that. We continue to work with them and expect them to get it right."

Plans for a psychiatric hospital in Montgomery County publicly emerged three years ago, when Texas legislators signed off on the idea to help ease the growing number of forensic patients, mentally incompetent criminal defendants waiting in jails to be transferred to a state hospital.

The 100-bed, $33 million hospital has a mock courtroom, a gymnasium, a library and other amenities. It brought 175 jobs to Conroe and saves the county from routinely having to drive inmate patients to Rusk State Hospital, more than 100 miles away.

The facility opened in March 2011. The county has a two-year, $15 million-per-year contract with the state to house forensic patients. Hospital staffers provide treatment such as medication and classes designed to make patients competent to stand trial. When patients regain competency, they are returned to their communities or local jails to await their legal proceedings.

State Health Services contracts with Montgomery County, which then pays Geo to run the facility. Geo won the contract through a competitive bid process, Chance, the county commissioner, said.

Although the county commissioners have the final say in decisions regarding the hospital, State Health Services plays a role in oversight by investigating complaints, receiving regular contract compliance reports and ensuring that the facility is providing appropriate services.

Chance said the Montgomery County operation has proved cheaper to run than the public psychiatric hospitals. In May, the commissioner told the Senate Health and Human Services Committee that costs to run the Conroe hospital were as much as 31 percent cheaper than at other state facilities.

That's exactly what legislators said they wanted when they directed State Health Services to solicit bids to privatize a public psychiatric hospital by this fall.

Exactly what a privatized hospital would look like is unclear, as the proposals have not yet been submitted. How much money would be saved is also an unknown. Individual hospital costs vary greatly because of differences in the number of patients served and the services they provide. Austin State Hospital, for example, has a $47 million annual budget; the El Paso Psychiatric Center runs for $13 million.

But State Health Services has already laid out numerous guidelines for what it would expect of a contractor. The agency, for example, would have to approve all employees in key positions, such as the superintendent or clinical director. The Department of Family and Protective Services would investigate abuse, neglect and exploitation complaints, as it does now at the public hospitals. The contractor would also need to continue the hospital's accreditation with the Joint Commission, which sets performance standards for medical facilities.

Federal investigation

Meanwhile, the construction of the facility has come into the spotlight.

In September 2009, Montgomery County commissioners hired Alliance Development Inc., to build the hospital. The Shenandoah-based company also constructed the Joe Corley Detention Facility, which is owned by the county and is run by Geo Group. It opened in August 2008.

Now, the construction of the jail and the hospital are part of a federal grand jury investigation. In May, the U.S. attorney's office in Houston issued a subpoena to the county, asking for records, contracts, subcontracts and other information related to the development of those projects. They also wanted to know how the county chose Alliance Development for the jobs.

Chance said the county has complied with the subpoena and turned over the required documents.

"I'm absolutely confident there's nothing wrong," he said.

Commissioners are also talking about selling the hospital. Chance said that consideration of a sale is a routine part of the county's annual assessment of its assets and that no decision has been made. But Geo Care has already indicated to Montgomery County Judge Alan Sadler that it might be willing to pay $50 million for the hospital, said Doris Golemon, Sadler's aide.

"The judge said that he even expects them to offer more," Golemon said.

How that potential sale would work, what legal hurdles might arise and what that would mean for State Health Services is unclear.

"It's something we'd have to evaluate," spokeswoman Williams said. "We'd need specifics from the county. We'd be looking very closely at how a sale could impact services and whether that would line up with lawmakers' original intent for the facility."

Sen. Tommy Williams, R-The Woodlands, who was instrumental in gathering legislative support for the county hospital in his district, said through a spokesman last week that he did not have time to talk to the American-Statesman about the latest developments with the facility. But the senator continues to support the hospital, said spokesman Jason Baxter.

"He's for whatever works, and he thinks privatization is working in Montgomery County to provide the most services to the most people," Baxter said. "Yes, they've had hiccups, but the county is taking actions to address those."

Contact Andrea Ball at 912-2506