Months before the state moved to suspend most operations at a Union County youth psychiatric center, investigators had documented possible abuse and faulty treatment.
An October 2017 state investigative report — issued less than two months after the center opened it doors — detailed an accusation that an employee for Anderson Behavioral Health choked a patient.
But Cardinal Innovations Healthcare, which oversees psychiatric treatment for Medicaid patients in Mecklenburg and 19 other counties, continued to send patients to Anderson for treatment after the incidents and other alleged problems.
The timeline raises questions about whether the state and Cardinal acted quickly enough to protect patients.
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Cardinal said in a statement that it has a robust investigation process in place to address concerns and complaints about a provider.
"We routinely have staff on-site monitoring the delivery of care and the health and safety of our members," the statement said. "As soon as concurrent investigations substantiated concerns, the state and Cardinal Innovations acted quickly and in the best interest of the individuals on site."
But an advocate for patients said that there’s a question of whether regulators are assertive enough in protecting the rights of North Carolinians who need healthcare.
"It really raises a question about the quality and value of this service more broadly in our state,” said Corye Dunn, director of public policy for Disability Rights North Carolina.
The state cited "imminent danger" for patients at Anderson Health Services and suspended operations on June 1. Anderson treats teenagers as young as 13 with histories of physical and sexual abuse, suicide attempts, sex trafficking and assault.
State reports released this week said patients stole drugs and obtained a knife, a hammer and a wooden chair leg that was wielded as a weapon, according to a June 1 report. One girl ran away three times in 11 days, requiring police to use bloodhounds to help track her down.
Anderson has filed an appeal, disputing the state's allegations.
Since its contract began in August, Cardinal said it sent 18 patients for treatment at Anderson Health Services.
Cardinal is a local managed entity that acts as an insurer for N.C. Medicaid recipients. Cardinal came under scrutiny last year when state leaders and others harshly criticized N.C. Department of Health and Human Services oversight of Cardinal when audits found alleged misspending, including taxpayer money used for high-priced parties and retreats, chartered flights and pay bonuses.
Since then, the state took over Cardinal, ousting its former leadership.
Cardinal temporarily stopped sending patients to the boys' unit at Anderson within two months of the facility opening, Cardinal said.
That freeze lasted from November until January, when Anderson submitted a formal plan of correction.
Three months later, state reports said staffers at Anderson in April used zip ties to restrain a 14-year-old girl who was attempting to run away. She was zip tied for more than an hour and no staffers intervened to help free her, the report said. State investigators called the incident "serious abuse and neglect," and suggested a $3,000 fine.
Cardinal said it froze referrals again — this time to both the boys and girls dorms at Anderson — when a grievance was filed on May 1. Cardinal also alerted DHHS authorities. Cardinal said that due to privacy laws, it could not give details on that grievance.
"Given our concerns, we proactively worked to identify alternative treatment settings for our members at the facility," Cardinal said in a statement.
Following the state's June 1 action, Cardinal said it began formally moving out patients.
The state's actions against Anderson Health comes a few months after another treatment facility, Strategic Behavioral Center in Charlotte, also faced allegations of abuse.
A month later, the state allowed Strategic to admit new patients, saying surveys found the south Charlotte psychiatric center made changes to comply with regulations.
Dunn, of Disability Rights, said people are often surprised at how many chances it is possible for providers to get “especially when we’re talking about vulnerable populations — in this case children with serious mental health needs.”
In part that's because regulators are limited by what the law allows them to do, she said. But there is also a question of whether within those confines, regulators are adequately assertive in protecting the rights of North Carolinians who need healthcare, she said.
"People with disabilities who need services and taxpayers deserve better than what we’re getting,” she said.