Family says Arbour Health System tried to commit their daughter with fraudulent ‘section 12’ form

The parents of a deceased Massachusetts teenager are seeking to expand their case against the country’s largest psychiatric hospital company, alleging that staff used a fraudulent medical form to try to commit their daughter.

An Arbour Health System counseling center tried to have Yarushka Rivera involuntarily hospitalized in 2008 without having her examined by a psychiatrist or other qualified professional, her parents said in court documents. A social worker at the outpatient Arbour center in Lawrence used a commitment form presigned by the doctor, who had not seen the teen, they said.

The parents allege this was routine practice at the center, where the only psychiatrist on staff presigned a stack of commitment forms.

Mark Pearlstein, attorney for Universal Health Services, which is based in Pennsylvania and owns the Arbour system, denied the parents’ claims. He said the social worker consulted with the psychiatrist by phone, and that state Department of Mental Health rules allow doctors to initiate commitment without examining the patient.

The form, known in Massachusetts as a “section 12,’’ allows an ambulance to take patients at risk of harming themselves or others to an emergency room against their will, for a more in-depth evaluation before committing them to a psychiatric hospital.

In Rivera’s case, the form stated that she said she wanted to kill herself after breaking up with a boyfriend. But doctors in the hospital emergency room decided she did not need to be hospitalized, according to court documents.

The US Court of Appeals plans to hear arguments Tuesday in the parents’ case against Universal, which centers on allegations that the company submitted fraudulent bills to the state Medicaid program for Rivera’s care and that of other patients. The company denies these claims.

The US Supreme Court heard the case in May and sent it back to the Appeals Court for further review. If the Appeals Court sides with the parents, as it did once before, it will return the case to the US District Court. Among the issues the District Court is expected to decide is whether to allow into the case the claims of illegal commitment forms.

Arbour, which includes five psychiatric hospitals and 13 counseling centers in Massachusetts, has been cited repeatedly by state regulators over poor care and inadequate staffing at its facilities. Universal, a fortune 500 company, is the target of federal criminal and civil investigations at its hospitals nationwide, including those in Massachusetts.

Jennifer Honig, an attorney at Mental Health Legal Advisors Committee, a state agency that advocates for mentally ill residents, said she often represents clients who believe the section 12 law was abused. In these cases, patients usually say the doctor did not do a thorough exam or relied too heavily on relatives’ opinions.

“People want to feel safe going to their regular clinic and not worry about being whisked off to the hospital,’’ Honig said.

Rivera’s parents, Julio Escobar and Carmen Correa, allege that unlicensed and unsupervised therapists at the Lawrence center diagnosed Rivera with bipolar disorder. They say a nurse working without adequate supervision prescribed an antiseizure medication sometimes given for mood disorders.

Rivera, 19, developed a seizure disorder after she stopped taking the drug, and in October 2009, soon after graduating from Essex Agricultural and Technical High School, suffered a seizure and died.

The family and its attorney, Thomas Greene of Boston,not blame Arbour for Rivera’s death. Instead, they contend that the company defrauded government insurance programs by charging for services provided by therapists unqualified to care for their daughter. Universal has argued that the issues raised are a matter of compliance with state regulations, not of federal fraud.

In the new allegations, the parents said Rivera’s school called them because she was upset after a breakup in September 2008. They took her to the counseling center, where she saw the center’s clinical director, social worker Edward Keohan. He filled out the commitment form that had been presigned by Dr. Maria Gaticales and that listed her as the applicant for involuntary hospitalization.

State law was amended in 2010 to allow social workers to begin the commitment process.

In court documents, Universal has moved to dismiss these claims, pointing out that the form asks doctors to check a box indicating whether they personally examined the patient or not. Neither box is checked on Rivera’s form.

The company argued that this option shows doctors are not required to examine the patient in an emergency.

Keohan was later disciplined by the board that licenses social workers for completing the form under Gaticales’s name. In a letter from his lawyer, Andrea Daly, to the board in June 2014, she argued that he should not be blamed for “questionable practices’’ instituted by Arbour before he became clinical director.

He acknowledged that he followed “the policy,’’ but said he took steps to consult with a doctor if the doctor was not available and it was an emergency, the letter said.