NPR’s Ari Shapiro talks to Wall Street Journal reporter Stephanie Armour about her investigation of how many psychiatric hospitals with troubling safety records continue to receive accreditation.

ARI SHAPIRO, HOST:

At a psychiatric hospital in Atlanta, a 19-year-old patient died while being restrained by staff. It was deemed a homicide. At a similar facility in Dallas, a patient attacked a doctor who later died of his injuries. These psychiatric hospitals and more than a hundred others around the U.S. stayed fully accredited even after cases of patient abuse, sexual assault and other major violations. That’s the finding of an investigation by The Wall Street Journal, and reporter Stephanie Armour joins us now. Welcome.

STEPHANIE ARMOUR: Thanks for having me.

SHAPIRO: You looked at hundreds of pages of state inspection reports from psychiatric facilities all over the U.S. Tell us the pattern you found.

ARMOUR: Well, what I found with the analysis is that hospitals that have significant and serious violations were able, in many cases, to retain their full accreditation by a third-party accrediting organization. And what these hospitals then do is they use this accreditation – it comes with a gold seal of approval – on their websites, on brochures. And they use it to recruit new patients even at the same time that they are under federal investigation for these violations or even, in some cases, where the violations are so severe the federal government has cut them off from all Medicare funding.

SHAPIRO: Yeah. That was one of the things that really struck me in this story – is that in cases where the problems were so pervasive, the federal government said the hospital would no longer get Medicare money, still the hospital retained its accreditation.

ARMOUR: That’s correct. And we found examples where the hospital retained their accreditation even after they had lost all their Medicare funding. And you have to understand; for the federal government to cut off Medicare funding is a very, very rare occurrence because it generally means the hospital goes out of business. But what’s also really interesting about this is that the federal and state governments have largely farmed out safety oversight of psychiatric hospitals and actually all hospitals in the United States to these third-party accrediting organizations. They go in. They inspect a hospital. They certify the hospital, and that hospital is then able to get Medicare funding.

SHAPIRO: You write that one organization has a virtual monopoly on these inspections of psychiatric hospitals. It’s called the Joint Commission. They decide whether a hospital gets accredited or not. When you showed them your findings, how did they explain their decision to let hospitals keep accreditation even after these egregious lapses?

ARMOUR: Well, they say that their role is very much to work with a hospital that has problems to help them improve, that they are not a, quote, “regulator,” that they do not go in and punish a hospital. And they actually say that this process that they have allows hospitals to be much more forthcoming with them about potential problems.

SHAPIRO: Do you find that a reasonable explanation?

ARMOUR: Well, we did find that hospitals that – the Joint Commission said, look; hospitals tend to get better after a violation when they retain their accreditation. But we found in our analysis that the vast majority of hospitals actually went on to have further violations.

SHAPIRO: So if there’s more than a hundred psychiatric hospitals around the U.S. that have had egregious violations and yet still advertise this gold seal of approval, what does that mean for people who might be considering placing a loved one or themselves into a psychiatric hospital? What kind of guarantee can people have of safety?

ARMOUR: There is, I think, a concern that there’s a false sense of safety that hospitals are able to promote and advertise. You have to also understand that the Joint Commission, which inspects and reviews hospitals often in lieu of regular state inspections – all of their surveys and inspections are private, where – if a state survey is done, in most cases, someone who’s considering a hospital can go check it out to see what the problems have been. But the Joint Commission – thanks to a federal law, all of their inspections are private. So there’s very little information really that patients can get on what may be going on at a hospital.

SHAPIRO: Stephanie Armour is a health policy reporter for The Wall Street Journal. Thanks for joining us today.

ARMOUR: Sure. Thank you for having me.

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