Inside the Rural Psychiatric Hospital Staff Call a ‘21st Century Asylum’

Birkl had been “acting out and throwing food around the facility,” according to a police affidavit. While the woman was “cleaning up the mess [Birkl] had created,” he hit her “with a closed fist,” and then proceeded to hit her two more times in the head. When another worker tried to intervene, Birkl also hit that worker on her back and head, police alleged.

Birkl was arrested and charged with two counts of felony assault; both women were sent to the hospital with head injuries, and the second worker complained of numbness in her left arm.

A dozen current and former workers who spoke to VICE News said the incident was far from a one-off. Instead, they describe Meadows as a facility rife with violence directed at both workers and other patients, in poor condition, and providing less than the bare minimum of resources to patients. 

“It’s like a 21st century asylum,” Jordan Zimmerman, a mental health technician who worked at Meadows from October 2021 until May, told VICE News. “Patients are telling me that they would be better off where they were, that this place is making them worse.”

After the attack allegedly committed by Birkl, it was back to business as usual at the rural psychiatric hospital, workers said, and aside from removing the patient from the facility, management didn’t address the incident with employees. 

“They ignored it,” Zimmerman said. “And they continue to bring in dangerous people.”

These employees, as well as former patients, say the hospital ignored a lot of things. 

While some patients told VICE News that the “help” they received at Meadows made things even worse for them, workers claim the hospital, operated by a multibillion-dollar conglomerate as part of the largest network of private psychiatric facilities in the country, is run by a managerial team that refused to listen to workers’ repeated pleas for increased staffing and security to prevent incidents like the assaults Birkl allegedly committed. This culminated in a contentious unionization campaign where several pro-union staffers have been terminated for a variety of reasons but which they say is due to their organizing activity. 

In one case, the center explicitly told a worker in her termination letter that she was fired for attempting to organize a union.

 In response to an emailed list of more than two dozen questions, Meadows Psychiatric Center told VICE News that “the Hospital declines to comment on the allegations set forth in your email below other than to state that these allegations are untrue and wholly unfounded,” before responding to two issues raised regarding the unionization campaign.

“It’s a shame that this is what mental health care looks like in this region, when it’s really not therapeutic at all,” said Theresa Hencinski, a 22-year-old who worked as a mental health technician at the facility for more than two and a half years before she was fired immediately after putting in her two weeks’ notice.

“When you mix capitalism and human services together, especially something like institutionalized mental health care,” Hencinski continued, “it doesn’t tend to pan out very nicely.”

The Meadows Psychiatric Center, which is located less than 15 minutes from Pennsylvania State University, describes itself as “a 119-bed private behavioral health care facility on a spacious 52-acre rural campus.” The facility opened in 1984, and in 2020 it served more than 2,000 patients.

“We count on patients who want to return to us for treatment, for physicians who want to refer their patients to us, and for payers who want to connect their members to us,” the hospital’s top executive states in a “welcome message” to prospective patients and their families posted on the facility’s website. “We are here and ready to answer the call to support and serve, and look forward to meeting you where you are and helping you continue on your recovery journey.”

For some former patients who spoke to VICE News about their time at the facility, however, Meadows did more harm than good. 

Saje Smith had just turned 21 when she checked herself into Meadows in October 2020, after suffering what she describes as a psychotic break. 

“I was under a lot of pressure and just kind of snapped,” Smith, a mother of three, told VICE News. “I had no support system at the time and was going through a lot and honestly thought everyone including [my] children would be better off without me.”

But of the six days Smith spent at the Meadows, she says bluntly: “I absolutely hated it.” 

Smith said that while most of the Meadows staff she dealt with were “beyond kind and helpful,” there was one psychologist she described as emotionally abusive toward her. She said she never got her medication on time and was once forced to wait for it for an hour and a half while experiencing a panic attack. And she said that violence from other patients was often overlooked or ignored; during her first morning there, Smith recalled, a woman experiencing psychosis whom she described as a “complete menace” began playing with her hair, “and I was told to just let it happen so she wouldn’t hit me out of anger.”

Smith also said the food was not only bad but also inadequate. “I specifically remember one morning all I got was grapes and an orange sent to me,” Smith told VICE News. 

Most worrying of all, Smith believes that her situation was made out to be worse than it was so she could be held beyond three days, which is the amount of notice required by Pennsylvania before a person can leave a facility.  

She’s still scarred by the experience to this day, saying it made her “way less likely” to seek mental health treatment. “I’m constantly worried that anytime I say anything about it, they’ll think I’m crazy and send me back,” Smith said. “I’m too horrified to ever go back to any inpatient facility to the point I try to ignore my mental health problems and pretend they’re not there.” 

Meadows workers who spoke to VICE News described a facility with few resources for patients or workers. 

“Therapists and staff members are the ones paying for most of that stuff out of pocket,” said one current staffer, who spoke to VICE News on condition of anonymity for fear of retaliation. “To get something as simple as a pack of Crayola markers is like pulling somebody’s tooth.” 

Angel Rodriguez, who worked as a mental health technician at Meadows for two years, said that though the center said it would pay for things such as socks, crayons, and markers for the patients, the facility never delivered, so workers would have to pay out of pocket.

“If a new patient came in off the street with no clothes, just scrubs, the hospital hardly ever had any clothes for them,” Rodriguez said. “We would bring clothes from [home], or go to Walmart and purchase clothes and donate to the patients who needed it.”

Saelah Rodriguez (no relation to Angel Rodriguez),spent several days at the facility last November as a patient. She described the water from the water fountains as “murky.” Smith said the water was “absolutely disgusting.”

“It looks like piss,” said another current employee, who also requested to stay anonymous for fear of retaliation. “And no matter how much we push back on maintenance, they always insist it’s totally fine and there’s no issues.” 

Other former patients who spoke to VICE News said their brief time there made them reluctant to seek help in the future. 

Jordyn Beam, 21, checked into Meadows last December after struggling with panic attacks and other issues. “When I went to Meadows, the only personal objects I had were a book and my medication, and the clothes I was wearing,” Beam told VICE News. “They never gave me clothes to change into the three days I was there.”

Beam had recently started taking an antidepressant, and was also on antibiotics after a dog bite. But for the three full days she was there, Beam says she wasn’t given either medication, though she says she repeatedly asked for them. Instead, she says a psychiatrist prescribed her Klonopin, something she says she never agreed to take and was opposed to taking because of a family history with addiction.

Eventually, after asking “every single nurse on the floor” for her medication, Beam said she was finally told the facility couldn’t find her medication. 

Finally, Beam’s mother called the facility and said she was coming to pick her up. Beam said Meadows responded by threatening to “302” her, which in Pennsylvania means an involuntary admission, because they claimed she was suicidal. 

Beam’s mother later filed an emailed complaint against Meadows with the Pennsylvania Department of Human Services and the Joint Commission, the Meadows’ accreditor. In an email, a spokesperson from the Joint Commission told VICE News that it “was not previously aware of the concern you inquired about at The Meadows Psychiatric Center.”

Following the publication of this story, a spokesperson from the Department of Human Services told VICE News in an email that the agency “licenses facilities that provide care to promote recovery and wellness for individuals with behavioral health needs, and abuse or exploitation in any form jeopardizes that mission.” 

“DHS is committed to ensuring that reports of abuse are investigated and handled urgently.”

After an inspection of the facility last year, the Department of Human Services cited Meadows for violations regarding adequate treatment as well as not completing “appropriate discharge planning” for patients leaving the facility. The citation referred to one patient who was having suicidal ideations up to 24 hours before their discharge despite regulations saying they had to deny suicidal ideations for 72 hours before being discharged. In February 2022, the agency verified that Meadows had completed a “plan of corrective action,” the inspection report says. 

Numerous violations were also found after an inspection in May and June 2020, according to the reports. The agency found Meadows was back in compliance in August 2020.

“It makes me very hesitant to go back to a place like that,” Beam said of her experience at Meadows. “You have to be really struggling, and for someone already having such a rough time, for it to be even more stressful and frustrating and just bad overall, it sucks.”

“It didn’t help,” she added. “If anything, it made it worse.” 

Tami Kraynak, a registered nurse supervisor who worked at Meadows for more than nine years, said that working at the facility “has always been chaotic, but a controlled chaos and something we loved to do.” When the pandemic began, however, the chaos soon became uncontrollable. 

The root of the problem, Meadows employees said, was a dire staffing shortage. 

Zimmerman said that two technicians such as himself would sometimes be tasked with handling over a dozen patients at a time. Although management at the center insisted they were following a ratio of one staff member per every five patients, Hencinski said “that just wasn’t the case.” 

“They were putting profit before us and the patients,” Dawn Taylor, who worked as a nurse at the Meadows for nearly five years, told VICE News. “All they cared about is just filling beds—regardless of the safety issue, regardless of how patients were getting treated.”

“It was getting deplorable,” Taylor added. “It was almost embarrassing to say you worked there.”

Angel Rodriguez, the mental health technician and another former Meadows worker, formerly served in the Coast Guard and the Army, the latter as a combat medic. He said that a lack of training provided by the center, compounded by the staffing shortages, made for a dangerous environment. 

“The Meadows isn’t equipped to handle severe cases,” Rodriguez said. “The training they give you is very basic. If you don’t have any experience outside of training, you’re left in the weeds.”

In March 2021, Rodriguez had to physically restrain one patient from attacking another. He wasn’t hit, but when the situation was resolved, he realized he had “tweaked” his leg and was having trouble walking. 

“If there wouldn’t have been a shortage of staff, or people not understanding what to listen for or to observe,” Rodriguez said, “I probably wouldn’t have gotten injured, because the situation wouldn’t have gotten to that point.”

Angel Rodriguez was later diagnosed with nerve damage, and says he now walks with a cane and sees a physical therapist even now, more than a year later. “It’s changed everything I’ve done,” he said. 

Keeley Allen, 22, started working at the Meadows in March. On April 20, she was attempting to restrain a patient when she was headbutted in the jaw. “I had a severe headache and neck pain for about a week,” Allen told VICE News. “The Meadows just kind of said, ‘We’re sorry that happened.’” 

But even when workers speak out about the threats to their safety, they said, they haven’t been taken seriously. 

“They turn it on us and blame it on how we deal with the patients, like it must be our fault,” a third current employee who spoke to VICE News on condition of anonymity said, summarizing the center’s attitude as: “If you would de-escalate better, these things wouldn’t happen.’”

The problems took a toll on workers’ mental health as well.

Hencinski, who is 22 and graduated from college in May, said she loved working with patients at the facility, but that sometimes “shit would just hit the fan, like really bad.”

“There would be physical restraints multiple times a day, patients trying to fight each other and other staff members,” Hencinski recalled. “There were times when I just felt very unsafe. I know there were times when patients and other staff felt super unsafe.”

Meadows is just one hospital owned by Universal Health Services, a multibillion-dollar, publicly traded healthcare company that has approximately 90,000 employees. Universal Health Services runs dozens of hospitals and operates 335 “behavioral healthcare inpatient facilities,” including Meadows—making it the largest chain of private psychiatric facilities in America. 

Universal Health Services did not respond to a detailed request for comment about the claims made against the Meadows center.

In 2016, BuzzFeed News published a deeply reported investigation based on hundreds of interviews with current and former employees at Universal Health Services hospitals, many of whom said they were “under pressure to fill beds by almost any method,” including exaggerating patients’ symptoms—such as making them seem suicidal—to make their cases seem more severe.

In July 2020, Universal Health Services settled with the Department of Justice for $117 million to resolve claims of Medicare fraud in 18 federal jurisdictions covering a period from 2006 to 2018. The government alleged that Universal Health Services had “billed for services not rendered, billed for improper and excessive lengths of stay, failed to provide adequate staffing, training, and/or supervision of staff, and improperly used physical and chemical restraints and seclusion.”  Universal Health Services continues to deny wrongdoing and said at the time that the settlement “is not an admission of liability but merely a resolution of a civil claim.”

In May 2021, a federal administrative law judge for the U.S. Department of Labor found that UHS of Delaware–one of the company’s subsidiaries–and a hospital it operated in Florida were responsible for at least 55 violent attacks on workers between January 2016 and July 2018. (The judge also found the company allowed surveillance footage to be destroyed in “bad faith.”)

Since 2017, OSHA has cited Universal Health Services and its many subsidiaries for nearly two dozen violations, and fined UHS facilities in four states at least $301,000 for allowing employees to be exposed “to acts of workplace violence caused by patients.” The U.S. Department of Labor later sued UHS of Fuller, which oversees a hospital in Massachusetts that OSHA  had fined more than $70,000 for such violations, for not complying with a subpoena to provide video footage as part of an investigation. A federal court last year ordered the company to pay the Department of Labor more than $30,000 for not complying with the subpoena. 

“The work culture and environment [at the Meadows] is just, ‘Well, that’s how it is working in psych,’” a current worker at the Meadows said. “But I believe that feeds into the stigma surrounding mental health about how all people who have mental illnesses are violent. And that’s not true.”

Kraynak, the registered nurse supervisor, reached her breaking point in February. 

Kraynak had witnessed staffing shortages and unsafe conditions at the rural psychiatric hospital become “magnified” during the pandemic, endangering workers and often leaving patients worse off than when they arrived, she told VICE News. 

“We were sending emails to our higher-ups saying, ‘Staff are getting very injured, like people are going out with concussions and broken bones. Give us some security, anything,’” Kraynak said. “But it just fell on deaf ears.” 

After several failed attempts to convince management to take her and her co-workers’ concerns about conditions at the facility seriously, Kraynak raised another option with her colleagues in early February. “What do you guys think about a union?” she recalls asking. 

Several were immediately on board. “The way things were going, I didn’t even know how much longer I could work there, because I didn’t feel safe and I didn’t feel my nursing license is safe to practice there,” Taylor said. “Either way, I may be gone, so why not?” 

“It started as a passing joke, like yeah, we should definitely get a union,” Hencinski said. “‘Fuck this job, this place sucks.’ And then slowly, it started to become a reality.” 

Kraynak was excited, but nervous. She knew the repercussions could be swift, and  remembers thinking, “God, I’m gonna get fired.”

The organizing campaign came together rapidly, and on Feb. 28, Kraynak and her co-workers filed for a National Labor Relations Board election to join a Pennsylvania-based Local 668 of the Service Employees International Union. 

On March 2, Meadows management called a “mandatory meeting that was put together real fast in response to the petition being filed,” according to Kraynak—but Kraynak and Taylor were separately told their attendance wasn’t needed. Two days later, Kraynak and Taylor were separately fired, at least partially for their organizing activity. Taylor said she was told during her termination interview that she was fired for organizing; for Kraynak, the facility put it in writing. 

In its termination letter, Meadows accused Kraynak of exhibiting “aggressive behavior including but not limited to verbal or physical abuse/threats, swearing, or intimidating behavior directed toward (or in the presence of) a patient, visitor, or facility employee,” according to a copy of the letter obtained by VICE News. 

Kraynak denied this, and said she had “never” been accused of such behavior before she was fired. Zimmerman, their colleague, describes Kraynak and Taylor as “two of the nicest women I’ve ever met.” Another co-worker told VICE News that Kraynak “was the supervisor who always listened to everything that you had to say.” Another called them “exemplary employees.” 

The Meadows seemed to agree. In a June 2021 Facebook post, the Meadows said Kraynak “was nominated by her peers [for employee of the month] for her continued focus on patient safety and her positive, exemplary interaction with patients.” A September 2021 post recognized Taylor for “her dedication in keeping families and guardians informed of their child’s progress, engaging patients in treatment, always picking up additional shifts, and keeping the children’s unit clean and organized.”

On February 15, less than three weeks before they were fired, Kraynak was used in a Meadows employee recruitment video that’s still on the center’s Facebook page. 

But when Meadows fired Kraynak, the center also noted, explicitly, that she was fired for her organizing activity. “As a member of the nursing administration supervisory team, you have engaged in significant and sustained efforts to organize staff employees for a union which is in direct conflict with the conduct expected from employees who are supervisors and are in a leadership position at The Meadows Psychiatric Center.”

The National Labor Relations Act defines a “supervisor” as someone who has the ability “to hire, transfer, suspend, lay off, recall, promote, discharge, assign, reward, or discipline other employees, or responsibly to direct them, or to adjust their grievances, or effectively to recommend such action.” Though they were labeled as “supervisor” in their job titles, Kraynak and Taylor say they did not have the power to hire, fire, schedule, or discipline employees in their roles at Meadows. 

“Employers have argued that [licensed practical nurses] are supervisors because they tell the nurse’s aide what room they’re going to take during a shift, and the board has repeatedly said, ‘No, that’s not a supervisor,’” Cathy Creighton, the director of Cornell University’s School of Industrial and Labor Relations Buffalo Co-Lab and a former National Labor Relations Board field attorney and union-side labor lawyer, told VICE News.  

Asked if she’d ever seen an employer explicitly put in writing that an employee was being fired for working to organize a union, Creighton responded: “Nope.” 

On June 24, after investigating Meadows’ charge that the SEIU, Kraynak, and Taylor tainted the election, the NLRB finally issued a decision. “Based on that investigation, I have decided to dismiss your charge because there is insufficient evidence to establish a violation of the Act,” NLRB Pittsburgh Regional Director Nancy Wilson wrote in a letter dismissing the claim. 

Still, Meadows Psychiatric Center maintained that Kraynak and Taylor’s firings were justified. “The Hospital discharged these individuals because they were Nurse Supervisors and the Hospital concluded that their efforts on behalf of the Union to organize the employees whom they supervised were unlawful and inherently intimidating,” Meadows director of business development Nichole Rutter told VICE News in an email. “The Hospital respects the rights of its employees to make informed, unbiased decisions about whether or not to they want to join a union and will not tolerate any supervisor engaging in any unlawful effort to improperly influence this important decision.”

Despite its insistence that it wants Meadows employees to make “unbiased decisions” about unionizing, the company entered into an agreement with a Texas based management-side labor consultant “to persuade employees to exercise or not to exercise, or persuade employees as to the manner of exercising, the right to organize and bargain collectively through representatives of their own choosing,” according to U.S. Labor Department records. 

In the months leading up to the election, at least three more vocal pro-union leaders were fired—and they all told VICE News they believe they were fired for their organizing activity.

Angel Rodriguez and his wife, Nia—who worked as a mental health technician at the center for two years—held a union meeting at their house on Feb. 23. Within three months, they were both fired.

On March 14, Nia Rodriguez was fired for pushing a patient. Rodriguez said the patient was trying to attack her and was too close for her to de-escalate the situation, so she pushed her off. 

Like Kraynak and Taylor, Nia Rodriguez was recognized by Meadows as an outstanding employee, as the center posted that she was a “healthcare hero” in January 2021. “Nia is often cited in satisfaction surveys as an outstanding team member and her co-workers can always count on her,” the center’s Facebook post says. 

Nia Rodriguez said that on three different occasions she went to a supervisor for help, telling her that the patient had been “stalking” her, but says the supervisor “took it as a joke.”

The NLRB ultimately dismissed Rodriguez’s claim that she was fired in retaliation for her organizing, saying the board’s investigation “did not establish that the Employer had specific knowledge of” Nia’s “support for the Union.” In its response to VICE News, Meadows pointed to the NLRB’s dismissal as proof that the allegations contained in this story are unfounded: “The Union recently filed a charge with the NLRB alleging that Nia Rodriguez was discharged because of her support of the Union, and the NLRB dismissed this charge finding that the Union’s allegations had no basis in fact,” the spokesperson said in an email. 

An SEIU spokesperson told VICE News that the union “expected [the NLRB] to dismiss the charge” against Nia because she did push the patient. Still, the spokesperson said, “we know they fired her because of her union involvement… Nia was still defending herself.”

On April 27, Angel Rodriguez was fired too, after refusing to sign documentation saying he voluntarily submitted to a drug test. 

The Rodriguezes are partners in a hemp farm and make CBD products, something they both told VICE News that Meadows knew about while they were working there. When Angel was hired, he passed a drug test, but soon after Nia was fired, he says, “all of a sudden they started getting complaints of somebody smelling like they were smoking marijuana in the facility.”

On May 2, two days before voting began, Zimmerman told VICE News he was fired for an incident several weeks prior where he briefly stepped out of a room where kids were painting and into a hallway. “I heard screaming in the hallway and I walked out, while still having an eye view of the kids to see what’s going on,” Zimmerman said. “Because, again, [they] didn’t give us proper staffing.”

The same day Hencinski voted for the union, she put in her two-week notice while still wearing a mask bearing the SEIU’s colors; on her way home, she said, the facility called her and told her she wouldn't be needed for the last two weeks of work. When she questioned why she was being terminated early, she says, she was told only that Pennsylvania is an “at-will” state.

Meadows employees will find out the results of their union election on Friday, when the NLRB holds a ballot count, NLRB spokesperson Kayla Blado told VICE News.  

But the problems at Meadows, employees allege, have remained. One employee still at Meadows told VICE News that morale is “nonexistent.” 

“A lot of the people they did fire were really, really good staff that brought morale up just because of their work ethic and their personalities,” the employee, who asked to remain anonymous out of fear of retribution, said. “They got rid of a lot of really important, strong mentors for new staff.”

A current worker called the union vote “our last-ditch effort, honest to God,” to change the culture at Meadows. “If somebody signs up to try to take care of other people, they don’t deserve to get maimed in the process,” said the worker, who also requested to stay anonymous due to concerns of retaliation.

The company has recently begun to address the staffing shortage, another pro-union employee said—but by using “traveling nurses” who are contracted with an agency rather than employed by Meadows. “I feel guarded and threatened,” another employee, also anonymous due to concerns of retaliation, said. “Everything [management] does, they put fear in people. And I hope they realize that fear is the biggest motivator for [joining] a union.” 

“It’s more like a dictatorship, like North Korea, and they’re Kim Jong Un,” the employee added. “They tell us what to do, and we do it. And if not, we get executed and they find another body.” 

As for the patients, Hencinski doesn’t see them getting the standard of care they deserve unless major changes are made at Meadows. 

“People pay a lot of money to come here to get the help that they need to get stabilized and then move on with their lives,” she said. “A lot of our patients walk out of there even more traumatized than before they got in there.”

This story has been updated to include comment from the Department of Human Services.

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