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Health & Science

Alan Chambers, 42

by Robin Fields and Christina Jewett , ProPublica - November 14, 2008 9:35 am EST

There are some things, Greg Chambers said, you never forget.

For him, it will forever be the sight of his twin brother, Alan, hanging from his closet door at West Oaks Hospital in Houston.

Alan Chambers, 42, was admitted under suicide watch in March 2007 after taking an overdose of pills and trying to cut his wrist, according a state and federal inspection reports.

Greg Chambers said his twin was suffering from deep depression and living apart from his wife and children.

West Oaks Hospital staffers were supposed to check on Alan every 15 minutes, and the facility’s log for March 22 said he had been checked as ordered.

But surveillance video showed a stretch of 26 minutes in which he was left alone, records from the U.S. Centers for Medicare and Medicaid Services say.

By the time a worker looked in on him, Alan had wrapped strips of linen around his neck and asphyxiated himself.

Greg, there for a visit, said he watched workers open Alan’s door and stand by stunned. Greg rushed past them to perform CPR but could not revive his twin, who was taken to the emergency room in a coma.

Afterward, Greg recalled, "I just collapsed. I started to cry. I just couldn’t believe this happened."

Alan died six days later. Regulators fined West Oaks $25,000, noting in records that the hospital failed to protect him from harm.

The Chambers brothers, Alan and Greg

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Tags: Psychiatric Solutions Inc.

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http://www.propublica.org/feature/alan-chambers-42/

Links

ProPublica's first story on PSI was co-published in the Los Angeles Times.

Two stories detailing problems at PSI's Riveredge Hospital in Illinois were co-published in the Chicago Tribune.

ProPublica: PSI Investigation

As Executive Promises Transparency, State Probes a Death, by Christina Jewett, Feb. 26, 2009
Psychiatric Hospital Pledged Change, But Some Problems Persist, by Christina Jewett, Feb. 26, 2009
Where Things Stand: Troubles With Private Mental Hospital Conglomerate, by Christina Jewett and Robin Fields, Dec. 31, 2008
Psychiatric Care’s Peril and Profits, by Christina Jewett and Robin Fields, Nov. 22, 2008

PSI Response

CEO Joey Jacobs Letter to ProPublica

Visualizations

Map: Problems at PSI Facilities
This interactive map shows the range of deficiencies and reported problems at PSI facilities nationwide
Map: The Growth of PSI
This interactive map charts the company's acquisitions over time

Videos and Vignettes

Mario Vidaurre, 41
Died after a struggle with a West Oaks staffer. Video of detective interview with staffer.
Steven Burton, 55
Failed to receive adequate doctor's care at Sierra Vista Hospital. Audio slideshow of 911 call
Crystal Marshall, 17
Died of a rare blood disorder after Cumberland Hospital delayed calling 911
Alan Chambers, 42
Asphyxiated himself at West Oaks Hospital

Document Dive

Notification of Intent to Revoke License of Whisper Ridge of Charlottesville, VA (PDF), Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services
Facility report describing patient assault on Jan 14, 2006 (PDF), Whisper Ridge
Police officers’ account of the same incident (PDF), Charlottesville Police Department
State report of patient assault on Jan. 14, 2006 (PDF), Virginia DMHMRSAS
Report on deficiencies at Sierra Vista Hospital, including Steven Burton's death (PDF), Centers for Medicare & Medicaid Services
Proposal to revoke the license of Manatee Palms Youth Services in Bradenton, Fla. (PDF), State of Florida
Order annulling the threat to revoke Manatee Palms's License, after the facility and the state settle (PDF), State of Florida
Report on excessive force at Manatee Adolescent Treatment Services in Bradenton, Fla. (PDF), Florida Department of Juvenile Justice Inspector General
Grand jury report about the Florida Institute for Girls, which was operated by PSI subsidiary Premier Behavioral Solutions (PDF), West Palm Beach County
Report on Sierra Vista Hospital's violations of federal anti-patient dumping laws (PDF), Centers for Medicare & Medicaid Services
Reports of an incident of a 12-year-old sexually assaulting a 5-year-old at Brynn Marr Hospital Part 1 (PDF) Part 2 (PDF), Centers for Medicare & Medicaid Services
Reports of medical errors affecting juvenile patients at Holly Hill Hospital in Raleigh, NC Part 1 (PDF) and Part 2 (PDF), Centers for Medicare & Medicaid Services
Report on Cypress Creek suicide attempt (PDF), Centers for Medicare & Medicaid Services
Investigator's statement on suicide attempt at Cypress Creek (PDF), Texas Department of Health and Human Services

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