This story was produced with the Better Government Association, a nonprofit news organization based in Chicago.
AUSTIN — Gregory Manley feared he would never be released from Loretto Hospital’s psychiatric ward.
The 53-year-old father of two was admitted to the hospital in October 2018, but he said he never saw a psychiatrist and grew desperate to get out.
On his fifth day, Manley opened his third-floor hospital room window on a supposedly secure unit and peered down at the limestone window sills and lintels jutting from the red brick walls.
“I used to climb a lot,” recalled the former construction worker, who shimmied up and down metal scaffolds on job sites. “Loretto’s got some big window sills, and I thought, ‘I could scale down.’
“As soon as I stepped to the next windowsill, I lost my footing.”
He plunged to the ground. The world went black.
At the time of Manley’s fall, Loretto Hospital had been under new leadership and had issued at least $4 million in annual contracts to a friend and business partner of the hospital’s new chief financial officer.
Among the changes was an overhaul of the hospital’s billing system and revamping one of its largest sources of Medicaid revenue: the 58-bed, locked psychiatric unit that occupies the entire third floor.
That new psychiatric contract proved central to the care of Manley and other behavioral health patients.
A Block Club Chicago and Better Government Association investigation — analyzing public health inspection reports, police records and lawsuits — shows problems in patient care and safety increased at Loretto following the leadership change in late 2017 and early 2018.
Soon after Loretto brought on current President George Miller and installed Dr. Anosh Ahmed as chief financial officer and chief operating officer, Loretto issued the $4 million in annual contracts to Ahmed’s friend and business partner, Sameer Suhail.
The hospital — which serves low-income patients, many of them Black and Latino — experienced safety breakdowns and violence. In Manley’s case, investigators found a staff member even falsified records to cover mistakes.
In the three years after 2018, federal and state health inspectors increasingly cited the hospital for serious staff shortages that led to patient jeopardy and harm — especially in the psychiatric unit, records show.
Chicago police separately reported an uptick of assaults, batteries and violent incidents inside the facility.
And under the new administration, the hospital reported an unprecedented $12 million operating loss in 2019 while the building itself was encumbered by $556,000 in liens from tax authorities and construction contractors.
A Loretto spokeswoman previously told reporters the hospital saw increased revenue and expanded critical health care for the community it serves under the contracts with Suhail’s firms.
But now the hospital is under scrutiny over insider contracts, political ties and Block Club reports about how COVID-19 vaccines intended for the West Side instead went to Trump Tower and people and businesses connected to the hospital’s new leaders.
The Illinois Attorney General’s Office confirmed last week it has opened an investigation into Lorreto following the Block Club and BGA reports.
A spokesperson for the attorney general declined to provide details on the scope of the inquiry, saying only that it concerns “potential misuse of charitable assets.”
Suhail and Ahmed severed their business ties in May following Block Club and BGA reports, Suhail’s attorney said.
The hospital’s claims of improved patient care are under question, as well.
Since his ordeal, Manley has filed a lawsuit against Loretto in which he accuses the hospital of medical malpractice. Loretto spokeswoman Darlene Hill said she could not comment on the pending suit but wrote in an email that drug abuse and violence have increased among the population Loretto serves.
“As a result, the hospital has experienced an uptick in violent incidents,” Hill wrote. “Unfortunately, sometimes whatever our community is experiencing, we experience. We commit to always being transparent and remaining fully compliant with” the Illinois Department of Health.
Suhail attorney Joseph Hylak-Reinholtz — who previously also represented Loretto and Ahmed — told reporters the contract with Suhail’s psychiatric firm, Metropolitan Behavioral Associates, was not a significant source of profit for Suhail. “I don’t know if that business is breaking even after expenses,” Hylak-Reinholtz said.
“Is it perfect? No. But every day we’re trying to do the best we can to provide [services] to a community that very much needs mental health care,” Hylak-Reinholtz said. Still, the Metropolitan contract did benefit Loretto financially, he said, increasing the hospital’s daily per-bed Medicaid reimbursement from $450 to more than $600.
Suhail spokesman Dennis Culloton issued a brief statement saying “the case involving Mr. Manley, filed by a medical malpractice law firm, is in litigation, and neither Metropolitan Behavioral Associates nor Dr. Sameer Suhail are a party to the suit.”
A ‘Safe Setting’
Manley offered a rare eyewitness view inside Loretto during an interview with the BGA and Block Club, which checked his account against government inspection reports and documents released in the pending medical malpractice lawsuit he filed against Loretto last year.
Manley was admitted to Loretto as the new administrative team made sweeping changes to the hospital’s psychiatric wing.
Suffering from bipolar disorder and crippling bouts of depression, Manley said he had been institutionalized in several Chicago-area mental health treatment centers over the years.
But Loretto “felt more like a prison than a hospital,” Manley said in an interview with his attorney present. “It seems like they’re warehousing patients rather than trying to help them.”
Manley was admitted to Loretto as suicidal, so the hospital’s treatment goal was to provide “a safe setting,” a state inspection report said.
Manley’s lawsuit said he never saw his psychiatrist during his five days at Loretto in October 2018.
Loretto administrators initially told state inspectors staff checked on Manley every 15 minutes to ensure his well-being, records show. However, the hospital’s performance improvement director later conceded to inspectors that a hospital worker had “falsified the 15-minute check documentation.”
Suhail attorney Hylak-Reinholtz said every staff member allowed into the psychiatric ward was thoroughly vetted and staff levels and procedures were “within the law and within the range of what we should be doing from a quality perspective.”
“We make sure they’re adequately qualified to do what they are doing,” he said. “Would we like more psych doctors on staff? Probably so.”
When Manley plunged from Loretto, he fractured his spine and pelvis.
Hospital staff found him with his arms tucked beneath his abdomen. “I just wanted out,” he told first responders, according to a health inspection report.
Government health inspectors investigated Manley’s escape attempt and cited Loretto for failing to ensure his safety.
“I mainly filed the suit to try and help some of the other patients who are in there,” Manley said in his BGA/Block Club interview. “A lot of them, maybe they came from the streets, they don’t have a voice.”
Loretto denied any wrongdoing in court filings in response to Manley’s lawsuit. Similar denials were issued by Dr. Thodur Ranganathan, who, with Suhail, ran Metropolitan Behavioral Associates, the company contracted to provide psychiatric services at the hospital.
Ranganathan was Manley’s admitting physician and attending psychiatrist at Loretto, lawsuit records show. He filed an affirmative defense alleging Manley caused his own injuries by intentionally prying open the window, failing to follow medical instructions to remain in his room and deceiving staff by not informing them of his desire to escape.
Ranganathan’s attorney declined a request for comment. Ranganathan separately told reporters in a brief email, “I have spent majority of my time in helping clients with chronic severe mental illness and worked in safety net facilities including community mental health agencies to provide competent and compassionate care for that population.”
Health Citations And Arrests
State and federal inspectors cited Loretto for 40 health code infractions in the three years after 2018, compared to 15 deficiencies in the previous three years, from 2015 through 2017, a BGA/Block Club review of government records found. It was among the most-cited hospitals in the state in the 2018-2020 time period.
Among the latest citations were four in which government health inspectors cited Loretto for placing patients in “immediate jeopardy,” the most serious infraction.
Hospitals can face decertification from the Medicaid program if these violations are not quickly corrected.
Loretto had no immediate jeopardy citations in the previous three years, government records show.
Two of the immediate jeopardy citations after 2018 came because the hospital failed to ensure sufficient numbers of nurses were staffing critical units, records show. During one 2018 tour of Loretto’s cardiac unit, a government health inspector observed 16 patients on monitors. The nurses’ station was empty and the phone was ringing with no one to answer it.
And more than a year after Manley’s botched escape attempt, inspectors in November 2019 issued an immediate jeopardy citation after Loretto mishandled another distressed patient’s care.
In that case, a 25-year-old man experiencing homelessness walked into Loretto’s emergency room and explained calmly that he was hearing voices telling him to kill himself, according to a nurse’s notes summarized in a government inspection report.
The man sat in the waiting room for three hours, then walked into a bathroom and tried to hang himself, that report stated. His absence wasn’t noted for nearly three more hours, after he called 911 to say he “could not get up and no one can hear him.”
A Loretto nurse opened the bathroom door to find the man sprawled on the floor with shoelaces and a lanyard around his neck and screws missing from the wall where he’d tried to use a bathroom device to hang himself, according to the report.
A second Loretto nurse told inspectors, “These types of patients know what to say to be admitted and he was looking for a place to stay.”
Statewide, the number of deficiencies at all Illinois hospitals ticked up 10 percent over the same six-year period from 2015 through 2020, according to separate data from the Association of Health Care Journalists. But Loretto was one of a small number of hospitals that doubled the number of public health deficiencies, the BGA and Block Club found.
Separately from those government health inspection reports, Chicago police reported 19 alleged assaults at Loretto in the three years after 2018, compared to 12 in the previous three years, from 2015 through 2017.
And there were 37 police reports of alleged batteries at the hospital since 2018, compared to 27 in the three previous years.
Assault and battery reports at all other Chicago hospitals also ticked up during that period, but at a rate of 28 percent citywide. The rate at Loretto rose 44 percent.
Separate health inspection reports also show staff allegedly abusing patients. In one instance from last year, a staff member dragged a psychiatric patient into a seclusion room and kicked her legs to force her inside, according to a health inspection report. The patient later complained of a “headache from getting my head slammed into the floor” during the violent encounter.
The Loretto worker was suspended for three days but then assigned to care for the same patient and others on the floor, a report said.
A $980,000 Contract For Psychiatric Care
Manley was admitted to Loretto five months after the hospital signed a $980,000-per-year contract for psychiatric services with Metropolitan Behavioral Associates, the company controlled by Suhail and Ranganathan, the Block Club and BGA investigation found.
Ranganathan maintained a busy practice: He was affiliated with at least three other psychiatric facilities, the state website says — although Ranganathan said that information is out of date.
Suhail — Ahmed’s friend and business partner — was Metropolitan’s CEO. According to a copy of the contract obtained by the BGA and Block Club, Suhail was given a $220,000 salary with potential for additional compensation and benefits.
Culloton, Suhail’s spokesman, said Loretto’s psychiatric care improved under the Metropolitan contract. “Metropolitan Behavioral Associates provides 24/7 mental health coverage to Loretto Hospital, which previously was only able to offer 40 hours of services a week,” Culloton wrote in an email.
“Many of these patients suffer conditions that have gone untreated for too long and often present the possibility of harm to themselves or others,” he said. “A fair reporting of other mental health programs through the Chicagoland area and the state would find that to be the case.”
Manley’s lawsuit alleges Ranganthan never saw Manley, even though he was the doctor who admitted him. Ranganathan performed “no initial or subsequent clinical evaluation” and failed to actively participate in or document Manley’s care, Manley’s lawsuit alleges.
Instead, the lawsuit alleges, two advanced practice nurses served as Manley’s designated physicians, while Ranganathan provided little if any supervision or communication.
According to Manley’s lawsuit, the only clinical progress note signed by Ranganathan was Manley’s discharge summary, which made no mention of Manley’s fall and injuries.
“The nurses were the only ones I saw. I don’t know how many times I asked to see a doctor,” Manley told the BGA and Block Club.
As part of the public health review of Manley’s case, state health inspectors cited Loretto for failing to get a separate patient’s consent when administering a powerful mood stabilizer.
Manley recalled one orderly offering him pills. “He came in my room and said they had some medicine for me. I asked what, and he said, ‘Oh, it’s something for your diabetes.’ I said, ‘I don’t have diabetes.’ He said, ‘It’s just something to help you relax.’
“I didn’t take what they were trying to give me.”
Manley said he recalls more effective care during his stays at other psychiatric facilities. He remembers staff frequently checking in, regular therapy from psychiatrists, and discharge plans to set goals for returning home.
“Loretto’s behavioral health unit doesn’t operate like it is supposed to at all,” Manley said.
Manley said he spent hours in bed staring out the broad, smudged window.
“I didn’t really do much. They would peek in every once in a while, but I don’t think it was every 15 minutes. I really don’t,” Manley said.
“If they had been giving me proper meds, and having a plan for me and for when I was going to get out, I would have gotten better and gotten out of there. But there was none of that. I was getting progressively worse. I didn’t know what they were going to do to me. I just wanted out of there.”
‘Maybe This Is My Chance’
On Manley’s fifth and last day at Loretto, he said, two nurses brought in his new roommate, a 35-year-old diagnosed with severe mental illness, according to government records.
“The first thing he did, he went into the bathroom and came back out completely naked and lay down in his bed and started playing with himself with one hand. With the other hand, he was sucking his thumb,” Manley told the BGA and Block Club.
For the first time, Manley said, he stopped looking out the bedroom window. He started looking at it.
“I never really did look at the window until my last day there,” Manley said.
The screen was fastened with just a few small screws, Manley saw. “I’ve been in the construction trade all my life. They’re called mini screws,” he said.
When Manley pulled the screen toward him, it popped out.
“I thought, ‘Well, sure, that outside window must be locked.’ It was a double-hung window that slid up and down. I tried that window and it opened also. I couldn’t believe it,” Manley said.
“That’s when I decided to leave. I thought, ‘Maybe this is my chance.’”
When hospital staff found Manley lying outside the hospital, they called a “Code Gold,” the alert for a patient escape attempt, government inspection reports show.
Manley said he has flickering memories of a woman running toward him. “She must have been the one who called 911,” he told the BGA and Block Club.
Manley said he was jolted awake as emergency medical technicians bounced his wheeled stretcher across the broken pavement.
“I looked up at the guy, I said, ‘You’re not going to bring me back in there, are you?’ He goes, ‘No, we’re going to Loyola.’
“I go, ‘Oh, thank God.’”
BGA intern Julian Gonzalez contributed to this report as a research assistant.
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