Amid Gov. Gavin Newsom’s historic expansion of locked psychiatric care in California, a profit-driven system has flourished, pumping hundreds of millions of dollars to the country’s largest behavioral health care companies, with disastrous results for children and adults in crisis.
In “Failed to Death,” San Francisco Chronicle reporters Joaquin Palomino and Cynthia Dizikes uncovered hundreds of reported physical and sexual assaults in psychiatric hospitals operated by for-profit companies, which state officials allowed to operate at skeletal staffing levels despite a state law requiring safe nurse-to-patient ratios.
At least 18 people died between 2019 and 2024 following egregious safety lapses, even as hospital owners and investors reaped massive earnings. Two-thirds of those deaths were linked to California’s largest psychiatric chain, Signature Healthcare Services, a private company that the Chronicle revealed built its empire through financial tactics that shifted money from its hospitals to outside firms controlled by its founder and CEO.
To pierce the secrecy surrounding Signature, reporters scoured and analyzed decades of often overlooked public records — including federal and state cost report data, mortgages and municipal bond disclosures — and contacted hundreds of hospital employees and former patients.
They secured legal waivers for patient medical records, providing unprecedented insights into the care provided in Signature hospitals. They also spent months building trust with key sources, some of whom risked their careers to share confidential documents, including internal complaints and communications.
The Chronicle’s investigation revealed how Signature and its owner and CEO have prospered through an array of business and real estate deals that saddled their hospitals with debt, while their facilities amassed a staggering record of harm.
