Sierra Tucson fined over deficiencies in psychiatric care

The local rehab center Sierra Tucson has agreed to pay a state fine of $4,000 for failures in caring for its most seriously ill psychiatric patients.

In its investigation, the state found that Sierra Tucson had repeat and ongoing deficiencies with the services provided in its acute psychiatric unit. The deficiencies “posed a high potential risk to the health and safety of patients,” a state survey says.

The facility holds two state licenses — a medical license for its 15-bed psychiatric unit and a residential facility license for its lower-level, 124-bed residential treatment center.

The for-profit center, owned by Tennessee-based behavioral health giant Acadia Healthcare, has paid prior fines to the Arizona Department of Health Services for violating its own policies. It is also the defendant in two pending wrongful death lawsuits involving patients.

In agreeing to pay the latest fine, Sierra Tucson’s executive director, William D. Anderson, signed an enforcement agreement with the state, acknowledging that the facility is subject to frequent state monitoring visits and that further violations could result in further action, including losing its license. As of now, the facility is in compliance with all state rules and regulations, Arizona health officials say.

In a statement to the Star on Friday, Anderson said the safety and well-being of its residents is Sierra Tucson’s “utmost priority.” Anderson also said his facility has a good working relationship with the Arizona Department of Health Services.

“We are very proud of the care we provide and the thousands of lives that we have improved and saved because of the treatment received at Sierra Tucson,” the statement says. “All of our clinicians and staff are committed to our patients and continuously work towards providing higher quality, clinical care in accordance with Arizona Department of Health Services standards.”

The latest civil penalty was determined after a state investigation conducted in January. The facility paid the fine May 9, state documents show.

Five Sierra Tucson patients have died since 2011, all of them men. Autopsy reports concluded that three of them died of suicide. Autopsies on the other two — a man who died of drug toxicity and another whose body was discovered two weeks after he disappeared from the facility — were inconclusive.

The facility helps patients with addictions, mood disorders, chronic pain, eating disorders and trauma through its “Sierra Model” of integrating therapies such as massage, yoga and acupuncture with traditional psychiatry.

Sierra Tucson, on 160 acres north of Tucson, has earned a reputation as “rehab to the stars.” The cost to patients starts at more than $1,000 per day. Since not all insurers cover it, many families must pay out of their own pockets.

The state’s findings about Sierra Tucson’s care for patients, outlined in its Jan. 6 survey and supporting documents:

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• Failed to ensure a patient with multiple medical problems, including a history of head injuries, had a physical examination within 48 hours of admission. This posed a “high risk” that the patient’s medical needs would not be met, the state report says.
• Failed its own policy on patient rights by threatening a patient with law enforcement if she did not follow a registered nurse’s instructions to be discharged and enter a transport vehicle.
• Failed to ensure a patient with anorexia nervosa was appropriately discharged from acute psychiatric care to a lower level of care.
• Failed to complete a medical discharge summary for three patients who left treatment against medical advice.
• Intake and meals for a severely anorexic patient were not recorded, and Sierra Tucson did not ensure a registered nurse assessed and directed the patient’s care.
• Did not ensure a registered nurse completed an updated assessment for a patient who was readmitted to Sierra Tucson’s psychiatric unit after transfer to an outside hospital.
• A patient was discharged and sent to an airport with no money and no identification.

Sierra Tucson’s lower-level residential facility was on a provisional license, with stepped-up monitoring by the state, from June 10 through Oct. 31 of 2015 after state officials found it had not been following its own policies on keeping track of patients’ whereabouts.

The state could have decided not to license Sierra Tucson at the end of the provisional period. Surveyors from the state ultimately determined there were enough improvements to restore the license.

As part of restoring its license in October, Sierra Tucson had to pay the state $35,000 in civil penalties — $27,000 related to an investigation into the Aug. 27, 2015, patient suicide of a 59-year-old California man, plus $7,500 following an investigation into the Jan. 23, 2015, suicide of 55-year-old Richard Lecce, a Pennsylvania man whose family has since sued the facility for wrongful death.

Sierra Tucson at the time also agreed to some new rules, including excluding certain patients from admission — those with a current or active diagnosis of schizophrenia; a current or active diagnosis of dementia; five suicide attempts in a lifetime; three attempts in the previous 12 months; or an attempt within 72 hours of the requested admission date.

The facility has had to pay other, smaller fines to the state, including $1,000 for transferring Lecce from one of the high-level psychiatric beds to the lower-level residential facility.

Lecce had been assigned one-on-one observation by a staff member while in the acute high-level psychiatric unit.

When he was transferred to lower-level care, the one-on-one monitoring stopped, though there was no note in his record to discontinue it, a state report says.

The other wrongful death lawsuit against Sierra Tucson was filed by the mother of a 20-year-old East Coast man who was at the facility for drug rehabilitation. He was found unresponsive at 8:45 a.m. on April 13, 2014, and died two days later. An autopsy report said he died from drug toxicity and that it was unclear whether the death was intentional or accidental.

A 2014 state report into the young man’s death found problems with the facility’s pharmacy services, and found that staff members did not adequately check on his vital signs or follow the facility’s suicide assessment protocol.

The state report did not offer any clues as to how the 5-foot-8, 162-pound man acquired a toxic level of drugs in his system while in treatment.