Mental Anguish at Texas West Oaks Hospital

There wasn't sufficient staff to do the job with, Boutte says. Added to that, he says, "it just seemed like the people they had working there didn't know what they were doing. It was just a constant chaotic situation; everything was always up in the air."

In 2001, West Oaks was acquired by Psychiatric Solutions, Inc., which also owns Cypress Creek Hospital in Houston and Kingwood Pines in Kingwood in the Houston area. The company, headquartered in Franklin, Tennessee, owns other facilities in Texas, and its 2007 10-K filing to the U. S. Securities and Exchange Commission says it operates 90 owned or leased in-patient facilities, with more than 10,000 licensed beds in 31 states, Puerto Rico and the U.S. Virgin Islands. In a recent press release, it said it ranked 49th on Fortune magazine's 100 Fastest Growing Companies in America list.

The 10-K report of PSI (PSYS on the New York stock exchange) declares its operating strategy: "We intend to focus on improving our profitability by optimizing staffing ratios, controlling contract labor costs and reducing supply costs through group purchasing."

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.

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.