Four teens recently escaped from Palmetto Summerville Behavioral Health facility and escaped. All were later caught.

SUMMERVILLE -- Nestled behind a weathered wooden fence on a compact, tree-lined campus, Palmetto Summerville Behavioral Health blends in with the bustling suburb around it. One state lawmaker living nearby didn't even realize it was there.

But the 60-bed treatment center on Midland Parkway and its sister facility in North Charleston have long been on the radar of area police agencies. Officers have been called to the complexes dozens of times in recent years for reported escapes, assaults and other disturbances.

What's more, Palmetto's parent corporation, Pennsylvania-based Universal Health Services (UHS), has a history of similar problems and reported safety violations at facilities it owns in other states. Among other things:

--North Carolina regulators last year threatened to revoke the license of one of UHS's Charlotte centers where a 15-year-old was stabbed in the eye with a rusty nail by a fellow resident.

--A UHS-owned center in Winston-Salem, N.C., was cited for various issues, including an incident in which a teen was reportedly forced to perform oral sex on his roommate.

--Virginia officials last month froze admissions at three UHS-owned facilities for troubled children in Norfolk and Portsmouth, Va., until safety and treatment issues are corrected. In particular, officials cited a need for greater staffing and supervision at the facilities.

The company's Lowcountry facilities had attracted little attention from the general public. But that all changed on April 20, when four Washington teens with violent pasts escaped from Palmetto's Summerville facility while being treated for behavioral problems.

Though the teens were later caught, Palmetto has come under intense scrutiny for accepting out-of-state kids with criminal histories at a complex guarded by little more than a privacy fence.

Some state lawmakers are now calling for a ban on the practice after learning that one of the D.C. teens had been charged with attempted murder. And the district agency that sent the teens to Summerville has suspended further placements at Palmetto while the treatment center reviews its security protocols.

Supporters say Universal Health Services and its centers provide valuable treatment options for severely troubled kids struggling with such problems as sexual aggression, substance abuse and post-traumatic stress.

Critics have questioned whether the Forbes 500 health management corporation is putting profits ahead of care by placing young sex offenders and criminals in facilities not designed or staffed to accommodate them.

UHS, which has some 200 facilities throughout the country, is certainly profitable. The corporation reported net revenues of $5.6 billion in 2010 and a 42 percent surge in revenues in the first quarter of this year.

UHS insists that the bottom line is ensuring that proper care and safety measures are in place at its facilities. In response to a list of questions from The Post and Courier about its facilities, the company issued a short press release defending its operations.

"UHS has always put patient and employee safety first at all of its behavioral health facilities," the statement read. "It's a hallmark of what we do, and we're proud of our track record of providing the highest quality of care for patients with special, and sometimes, mental health needs."

Importing problems?

Universal Health Services operates Palmetto Behavioral Health facilities in Summerville, North Charleston and Florence. The centers, which have a total of 260 beds, are part of a network of 17 youth treatment centers in South Carolina that house nearly 800 youths with mental illnesses, violent behavior and other problems.

Most are privately run, and the state has little say as to who is placed in these facilities or where they come from.

Palmetto officials have declined to answer questions about how many out-of-state offenders are housed at its facilities or what criminal charges they may face. In response to recent questions from The Post and Courier, Palmetto issued a release stating that its Summerville facility does not admit violent sexual predators, and that none of the four escapees are sexual or violent offenders.

That would seemingly contradict previous statements from officials in Washington, indicating that all four youths have histories of violence.

The District of Columbia Department of Youth Rehabilitation Center placed the four teens who escaped from the Summerville center. The agency has been sending youths to Palmetto for the past two years for specialized treatment, and it places juveniles in other UHS facilities around the country, said Chris Shorter, the agency's chief of staff.

The district pays Palmetto about $300 per day for each youth placed in its centers, based on treatment needs, Shorter said. Before the recent incident, the arrangement had worked well, he said.

Still, some state lawmakers remain concerned by the practice and are pushing for restrictions on the age, residency and level of criminal offender allowed at these centers.

State Rep. Chris Murphy, R-Summerville, said 15 to 20 out-of-state youths from around the country were being treated at the center on Midland Parkway when he toured the site on a recent afternoon.

"We do not need to be importing other state's problems," said Murphy, who represents the area where the facility is located.

Palmetto officials declined to discuss specific details of patient cases, citing confidentiality laws. They did say that the center plans to install additional security cameras and a new 12-foot chain-link fence designed to prevent climbing.

Palmetto officials said they are talking with state legislators about ways to further improve security. They also announced last week that a new executive director had been named for the Summerville facility.

Murphy said he welcomes the security improvements, but "they are still a long way off from where they need to be."

Checking for problems

David H. Zoellner, managing attorney for Columbia-based Protection and Advocacy for People with Disabilities Inc., said he understands the community's safety concerns, but his organization is leery of additional barriers placed in the way of kids who need care.

"Even if a juvenile has some disciplinary actions pending, he or she should be entitled to treatment if they need it," he said. "We would prefer they not be in big facilities or facilities out of state, but sometimes that may be necessary."

Zoellner said representatives of his organization have visited Palmetto's centers at various times and "have not found any particular problems with the treatment of kids there."

The state Department of Health and Environmental Control inspects the centers every two years. DHEC reported finding six violations at the Summerville facility during a 2007 inspection and three during a 2009 visit. State officials have offered no details about those violations, but have said the problems were corrected.

The Post and Courier requested access to those inspection records on April 25, but was told by a DHEC official that it would take some time to retrieve and review the documents for confidentiality issues. The newspaper's request was still pending at press time.

DHEC estimated that it could take at least another week to retrieve these public documents, at a cost of $475 to the newspaper. By contrast, North Carolina officials furnished hundreds of pages of detailed documents from facility inspections at no charge within hours of the newspaper's request this month.

Police, meanwhile, have been regular visitors to Palmetto's centers. Summerville police have been called to the Midland Parkway facility 128 times since February 2006, including 19 calls for missing persons and runaways, 42 reports of assaults and three reports of sexual assaults, records show.

In one incident from October 2009, a 15-year-old boy was accused of attacking and beating a 64-year-old woman after he slipped away from the center by ducking out a side door, police said.

The woman is now suing the center, accusing Palmetto Summerville Behavioral Health of gross negligence and recklessness in the incident.

North Charleston police have been called to Palmetto's Speissegger Drive facility 98 times in the past five years, including 13 runaway and missing-person calls, 22 assault calls and six reports of sexual assaults, according to police.

Care and profits

Three former Palmetto staff members told The Post and Courier that the company's facilities are understaffed and ill-prepared to deal with hard-core, young offenders who have come in through out-of-state placements in recent years.

The workers spoke on the condition of anonymity, citing fear of reprisals.

One ex-worker at the Summerville center provided the newspaper with a copy of a complaint she sent to a corporate help line in 2008 detailing safety concerns brought on by a lack of staff.

At the time the facility was owned by Psychiatric Solutions Inc., which was taken over last year by Universal Health Services.

The worker stated that the third shift at the facility had only four workers and a medical technician to oversee 54 residents. "There are multiple occasions where, because of understaffing, a female staff member is left alone with over a dozen male residents, some of the residents being dangerous sex offenders," the complaint read.

The worker said nothing was ever done about her complaint.

Palmetto officials insist the facility meets and typically exceeds staffing requirements put in place by the state.

State regulations, however, do not specify staffing ratios at treatment centers like Palmetto, according to Thom Berry, a DHEC spokesman. The regulation says only that "qualified personnel shall be employed in sufficient numbers to carry out the functions of the facility."

In 2006, the nation's largest health care union issued a report alleging that understaffing and poor case management at Universal Health Services' behavioral treatment centers led to sexual abuse, runaway patients, assaults and other problems.

The Service Employees International Union report, titled "Failure to Care," documented more than 50 incidents of abuse, improper treatment and alleged violations at UHS facilities across the country.

Prefacing the report, four members of the National Alliance of Professional Psychology Providers wrote a statement of concern that the findings illustrate a crisis in the nation's health care industry that places "earnings and exorbitant profits above the public interest at the expense of quality services to those in need."

In a statement, UHS declined to discuss specifics of the allegations or specific patient cases, stating simply that no two facilities are the same and that "programs, services and the continuums of care at every location are based on the needs of each individual community."

"All throughout the organization, everyone is committed to providing the best possible treatment for our patients in a safe, caring and respectful environment," the statement went on to say.

John Caccavale, a California psychologist who serves as the psychology alliance's executive director, said his group remains concerned about the level of care offered by mega-corporations like Universal Health Services.

Regulators will cite and fine these operations, but they are loathe to shut them down because budget cutbacks in most states have limited options for placing folks who need mental health treatment, he said.

"For the corporations, the profits you can make in this system are unbelievable, and you can get away with giving substandard care and no one really gives a damn," he said.

Sign up for our daily newsletter

Get the best of The Post and Courier, handpicked and delivered to your inbox every morning.

We're improving out commenting experience.

We’ve temporarily removed comments from articles while we work on a new and better commenting experience. In the meantime, subscribers are encouraged to join the conversation at our Post and Courier Subscribers group on Facebook.