Author Archives: Dunn Firm - Morgan Claire Dunn

$19.85 MILLION, KARMA AND THE HMS ACADIA

Karma is a Sanskrit word meaning “action.” Generally, we understand it to mean the consequences of one’s actions. The word “karma” is commonly used to indicate bad karma, and the word “merit” is often used to indicate good karma. The law of karma is best described as “cause and effect” because every action (or cause) has a corresponding consequence (or effect). If you plant good causes, you will reap good effects, and if you plant bad causes you will reap bad effects.

There have been many quotes about karma.  “Karma is a cruel mistress.” “For the keynote of the law of karma is equilibrium, and nature is always working to restore the equilibrium whenever through man’s acts it is disturbed.”

Karma comes at unexpected times and in unexpected ways.  Case in point, recent statements made by Christopher Hunter, the current CEO of Acadia Healthcare. In August, in response to a question about the recent damning Senate Committee report about Acadia, Mr. Hunter stated: “Yes. I would say we just haven’t seen any real impact from the Senate hearing in the report. … And so, it’s also not overly material from a financial standpoint to begin with.”

About six weeks after Mr. Hunter’s heartless statement, the Justice Department announced that Acadia agreed to pay $19.85 million to settle an investigation into Acadia.

The United States contended that between 2014 and 2017, Acadia knowingly submitted false claims for payment to Medicare, Medicaid and Tricare for inpatient behavioral health services that were not reasonable or medically necessary. In particular, the United States contended that Acadia admitted beneficiaries who were not eligible for inpatient treatment and failed to properly discharge beneficiaries when they no longer needed inpatient treatment and had improper and excessive lengths of stay.

The United States further alleged that Acadia knowingly failed to provide adequate staffing, training and/or supervision of staff, which resulted in assaults, elopements, suicides and other harm resulting from these staffing failures. In addition, Acadia allegedly failed to provide inpatient acute care in accord with federal and state regulations, including, but not limited to, by failing to provide active treatment, to develop and/or update individualized assessments and treatment plans, to provide adequate discharge planning and to provide required individual and group therapy.

Despite this punitive payment and financial hit, Mr. Hunter had this to say, “The allegation that Acadia systematically holds patients longer than medically necessary is false and goes directly against everything we do and stand for when it comes to patient care.”

It is curious that Mr. Hunter believes those claims to be false after Acadia agreed to pay almost $20 million to make those claims go away.

Of course, karma was just beginning for Mr. Hunter. Since Mr. Hunter focuses on the financial bottom line alone, we can assume he must be greatly concerned that Acadia’s stock hit a 52-week low of $42.56 on October 31, 2024. Acadia shares are down more than 44% since the beginning of the year. In fact, Acadia’s stock price has not been this low since November 2020.

Even still, karma was not through with Mr. Hunter. In September 2024, the Justice Department and Inspector General, through Robert DeConti, the inspector general’s chief counsel, stated that the $20 million settlement does not impede investigators from exploring allegations regarding more recent activities.

And so, on September 27, 2024, Acadia disclosed that it received a request for information from the U.S. Attorney’s Office for the Southern District of New York, a grand jury subpoena from the U.S. District Court for the Western District of Missouri, and that it expects similar requests from the U.S. Securities and Exchange Commission related to the Company’s patient admissions, as well as its length of stay and billing practices.

On October 18, 2024, the New York Times published an article titled “Veterans Dept. Investigating Acadia Healthcare for Insurance Fraud.” The article stated that the Veterans Affairs Department is investigating whether Acadia is defrauding government health insurance programs by holding patients longer than is medically necessary. The New York Times also stated that several former Acadia employees in Georgia and Missouri have also been interviewed by agents from the F.B.I. and the inspector general’s office of the Health and Human Services Department. 

In a separate press release, Acadia Healthcare said the company is cooperating fully with authorities in response to that on-going government investigation.

Naturally, Mr. Hunter a/k/a Captain Smith continued to steer the HMS Acadia toward the iceberg. In addressing these reports, he stated they are inconsistent with Acadia’s policies and do not reflect the medical complexities involved in behavioral healthcare. Dear Captain Smith… An organization is defined by its conduct, not by its CEO’s words.

Karma had one last present for Mr. Hunter. Acadia, its former CEO, its current and former Chief Financial Officers, and of course, Christopher Hunter were all named as defendants in a recent class action lawsuit filed in Tennessee. Acadia, Mr. Hunter and the other defendants were sued for allegedly violating securities laws following Acadia’s September 27, 2024 announcement about the federal grand jury subpoena.

Not coincidentally, Acadia’s stock price fell 16% alone on September 27, 2024, wiping out over $1 billion in market capitalization.

$1 billion in market capitalization.

It gets worse.  When Captain Smith was brought aboard the HMS Acadia on April Fool’s Day in 2022, the market capitalization of Acadia was $6.04 BILLION.  Market capitalization is regarded as the most accurate value of a publicly listed company.  What was Acadia’s market capitalization at the close of business Friday, November 2, 2024? $3.9 billion. So, after ramming into the side of the iceberg, Mr. Hunter/Captain Smith steered the HMS Acadia to a $2.14 BILLION dollar, 35% loss in the company/stock value.

As the HMS Acadia fills with water and starts to list, we are certainly justified in asking Mr. Hunter / Captain Smith, “Is it overly material now … that is, from a financial standpoint to begin with?”

Karma can be oh so cruel.

And as the HMS Titanic plunges toward the bottom of the icy ocean, shouldn’t families, patients and people suffering from any mental illness ask themselves, “why in the world would I subject myself to the HMS Acadia after it plowed into the iceberg and is sinking to the bottom of the North Atlantic?”

Get someone else to rearrange the deck chairs.

LIFE AND DEATH

Eight years ago today, Martha (Morgan’s mom) and I were forced to endure perhaps the worst personal tragedy any parent can face. I remember every second, of every minute, of every hour of that horrific dark night.

For us, it will always be a personal tragedy. But the world, and all of Morgan’s friends, have moved on.  As they rightly should. And seeing that, I get comfort knowing that so many of Morgan’s friends are embracing life … as she could not. And so …

This year, there is no “call to arms.”

This year, there is no inspirational message to share.

This year, there is no personal story of Morgan’s to share.

None of Morgan’s messages from her journals.

This year … there is simply life … and death.

Consequences and Ramifications?

On October 25, 2024, Acadia Healthcare is hosting and presenting the event, the 20th Annual Renewed Eating Disorder Conference in Nashville, Tennessee.

First, by all accounts, the organization, “Renewed, Eating Disorders Support” does good work in the State of Tennessee. No vitriol is directed at them … other than addressing their host and presenter of the event at issue.

The event’s keynote address is entitled, “Adventures in Treating Eating Disorders: Sharing Wisdom from a Cumulative 75 years of Practice.” The overview of this talk includes: “The overall goal of this presentation is to provide eating disorder practitioners from all disciplines and all levels of experience valuable knowledge and insight to enhance their effectiveness.”

So, with that in mind …

Is this the talk where practitioners from all disciplines learn that raping and/or sexually abusing patients is a bad thing?

Or is this the talk where practitioners from all disciplines learn that residential treatment centers can employ persons who allegedly commit rape and/or sexual assault but so long as the bottom line is not negatively impacted, you can ignore the rape and/or sexual assault and not be transparent about it?

Or is this the talk where practitioners from all disciplines learn that treating eating disorders is expensive because it demands the highest level of skill from experienced treatment providers? But since that impacts the bottom line too much, you get out of the eating disorder treatment field and adopt an addiction focused regiment which is far less expensive to implement?

Or is this the talk where practitioners from all disciplines can learn that even though a scathing Senate Committee Report was published which eviscerates your organization, so long as it doesn’t impact you from a financial standpoint, that Report is simply not material?

With all of the recent controversies and issues surrounding Acadia, aren’t we justified in believing that reputable eating disorder organizations would shy away from sponsoring or supporting any event in which Acadia is involved? After all, there is precedent. In 2019, after the Timberline Knolls – Jacksa abusive misconduct came to light, NEDA returned a $10,000 donation Timberline Knolls had made. Surely, because of Timberline Knolls and Acadia’s recent issues, in order to show support for the victims of misconduct and criminal behavior and to make a loud statement against grossly negligent entities, organizations would withdraw their sponsorship and pull out of that event.

Instead, let’s look at the sponsors listed for the October 25th event:

Within

ACUTE Center for Eating Disorders and Severe Malnutrition


Alsana


Blue Ridge Eating Disorder Care Center


Center for Change


Eating Recovery Center and Pathlight Mood & Anxiety Center


Equip


Focus Treatment Centers


Healing at Hidden River


Koru Spring


Laureate Eating Disorders Program


Monte Nido


Odyssey Eating Disorder Network


Rogers Behavioral Health


SunCloud


The Emily Program


The Renfrew Center

Like Captain Renault’s quote in the movie Casablanca, “round up the usual suspects,” we see the usual list of corporate entities in the eating disorders field.  

It would appear as if no one … absolutely NO ONE … demands accountability or seeks to impose consequences for reprehensible conduct. So long as money continues to be the primary motivator for the owners of treatment centers, apparently there will be no demand for repercussions for bad behavior. And as a result, the families who are suffering are further victimized. Patients, loved ones, being sexually abused and/or raped by employees. Our most vulnerable population being preyed upon.

And all we hear is silence.

Where is the integrity?

Where is the dignity of human life?

Where is the placing the needs of the patient and families who suffer from this illness first and foremost?

I don’t think I have ever been more disgusted with the eating disorder community. So, some people may wonder why don’t I just leave then?

I don’t have much of a choice.  In 6 days, I will mark 8 years since my daughter, Morgan died.  That personal tragedy put me on this path … this macabre journey which has exposed corruption and dysfunction far greater than any I exposed or experienced in 40 years of practicing law.

I also strongly believe the memory of my daughter, and the memory of others who have died from this insidious illness have been soiled by not just the bad actors in the community, but those who refuse to stand up against the bad actors in the community.

By those who refuse to take a stand. By those who just conduct business as usual. By those who refuse to draw a line in the sand and say, “No more will we stand with those who hurt our most vulnerable population.”

Until then, the message being sent by this community is … a healthy return of investment to Acadia’s shareholders is far more important than providing life-saving care and preserving the dignity of life.

If you are not disgusted and sickened, you should be.

Marketers: What You Need to Know About Negligent Referral

Negligent referral is a cause of action in Texas (and in many states) which assesses liability against a person who refers another to the care and treatment of an incompetent third party and that third party causes harm to the person referred. Ordinarily, the referral itself is not enough. You must have know, or should have known, of incompetency or some other triggering factor which causes the negligence to manifest itself.

Knew or should have known of damning information.

In short, if you know, or in the exercise of reasonable care, you should have known of some damning information or evidence perpetrated by an entity, and you refer someone to that entity without disclosing that information, you could be liable should that person be harmed.

The shortest version? “It could be yo’ ass.”

Which brings us once again to Timberline Knolls.

Timberline Knolls and Acadia use marketers throughout the United States. In my time in the community, I have had the privilege of getting to know several of their marketers.  Most all are personable and very likeable.

But being upbeat, likeable and personable must always take a backseat to being responsible, transparent and placing the needs of the population you serve first and foremost.

And so, arises duty. The duty of honesty. The duty to disclose. The duty to investigate. The duty to place the needs of families suffering from eating disorders above your own wants or perceived needs.

As a marketer, families have the right to know, and (in my legal opinion) you have the duty to disclose:

  1. A patient of Timberline Knolls claims to have been raped in May and that when first reported, the staff at Timberline Knolls did nothing.
  • That patient has filed a lawsuit against Timberline Knolls.
  • A former employee of Timberline Knolls, Michael Jacksa was indicted for sexually abusing six (6) former patients at Timberline Knolls in 2019.
  • CBS News Chicago Investigators stated that a record of 911 calls for service to Timberline Knolls showed dozens of calls related to criminal sexual abuse or sexual assault since 2018.
  • The Lemont Police Department stated that it had received 546 calls for service from Timberline Knolls from 2023 – 2024.
  • Since 2020, [after Jacksa] the Lemont Police Department claims to have received reports from patients saying they had been sexually assaulted or abused, many of whom were juveniles.
  • The New York Times published a report indicating that Acadia Healthcare allegedly held patients longer than was necessary and often against their will at certain facilities. The report also claims Acadia trumped up patient symptoms in reports to payers to extract more reimbursement.
  •  The United States Senate Committee on Finance conducted a two-year study of four major companies, including Acadia, providing mental health services to children and adolescents and found numerous alarming issues. 

These issues are material and relevant to a family vetting a place of healing with whom they entrust their beloved family member.

As a marketer, you can probably get away with not disclosing that the CEO of Acadia looks upon a family’s loved one as part of a “difficult population,” and that Acadia intends to simply let “the people that deal with this population” handle the many troubling issues. Notwithstanding that those are the people contributing to the very problems.

But as of now, as marketers, and whether you market to families, primary care physicians, or any third parties, you are on notice of the many problems at Timberline Knolls.  You cannot claim nor feign ignorance.

You have a strong, undelegable duty.

If you choose to continue to conduct business as usual and one of the souls you are responsible for referring is harmed by substandard care or by predators, you could be liable.

Govern yourself accordingly.

$$$

“And so it’s also not overly material from a financial standpoint to begin with.”

            Chris Hunter, CEO, Acadia Healthcare, August 1, 2024

Mr. Hunter’s statement was made to investors at an Acadia quarterly meeting. The statement pertains to Acadia’s response to a scathing report issued by the Senate Committee on Finance.

The question and answer were as follows:

Ben Hendrix

“And just if I could ask 1 on the legislative and regulatory backdrop. Your peer, UHS, noted little fallout to date regarding the Senator Wyden investigation into RTC. So I was just wondering kind of what you’re preparing for or expecting could come down the line from a legislative perspective, whether it be transparency, oversight, minimum staffing, et cetera?”

Chris Hunter

“Yes. I would say we just haven’t seen any real impact from the Senate hearing in the report. I think we believe that the people that deal with this patient population every day, and that certainly includes our referral sources, as well as the various regulatory oversight bodies that are routinely in these facilities, understand that this is just a really difficult population. I think they also understand that our facilities are providing high-quality care to this population, and we demonstrate that routinely with the outcomes that we’re able to achieve. And so we just haven’t seen impact. I’d also point out that our RTC business is small. We only operate 9 facilities. It’s about 11% of our revenue. And so it’s also not overly material from a financial standpoint to begin with.”

This statement was made on August 1, 2024.

Mr. Hunter’s statement was made approximately six (6) weeks after a scathing report was issued by the Senate Committee on Finance. A few of the more alarming conclusions were as follows:

  • Children suffer routine harm inside Residential Treatment Facilities (“RTF”). The risk of harm to children in RTFs is endemic to the operating model. 
  • Horrific instances of sexual abuse persist unremediated inside RTFs. 
  • RTFs often employ unqualified or inadequately trained staff and that staff routinely fail to discharge their duties. RTF staffing failures have led to tragic incidents, including child fatalities, and childrens’ repeated exposure to risk. 
  • State and federal oversight authorities fail to effectively identify and address harm to children in RTFs. When RTFs correct deficiencies, their efforts are remedial rather than company wide.

Mr. Hunter made this statement after he knew or should have known of the existence of 194 pages of statements made by victims, parents and former employees of residential treatment centers. These 194 pages are embedded here:

Click to access survivor_testimony_submitted_into_the_record_by_chairman_wyden_during_hearing.pdf

Mr. Hunter made this statement after he knew or should have known a patient in Timberline Knolls was allegedly raped three (3) times by an employee of Timberline Knolls in May 2024. These alleged rapes were reported to the staff at Timberline Knolls that same month.

Mr. Hunter made this statement even though a record of 911 calls for service to Timberline Knolls obtained by CBS News Chicago Investigators showed dozens of calls related to criminal sexual abuse or sexual assault since 2018.

Mr. Hunter made this statement even though the Lemont Police Department stated that it had received 546 calls for service from Timberline Knolls from 2023 – 2024.

Mr. Hunter made this statement even though on at least eight occasions since 2020, the Lemont Police Department received reports from patients saying they had been sexually assaulted or abused, many of which involved juveniles.

I have not yet verified the veracity of the statements from the Lemont Police Department nor the Chicago CBS News Investigators. But what incentive would they have to prevaricate?

“And so, it’s not overly material from a financial standpoint to being with.”

With the reports and allegations of abuse from third parties, I can scarcely envision a more damning statement proving that patient safety takes a back seat to profits.

546 calls for service from Timberline Knolls from 2023 – 2024.

Dozens of 911 calls related to criminal sexual abuse or sexual assault at Timberline Knolls since 2018.

194 pages of statements made by victims, parents and former employees of residential treatment centers.

At least 1 daughter raped three times by an employee of Timberline Knolls before Mr. Hunter’s statement.

“And so, it’s not overly material from a financial standpoint to being with.”

Acadia and its feckless CEO are evaluating human suffering utilizing a measuring stick marked with dollars and cents alone.

And they have determined that human suffering, assaults, rapes, and egregious conduct are not material if they do not impact the bottom line.

From a financial standpoint.

Timberline Knolls

Dante’s seminal work, “The Divine Comedy,” is regarded as one of greatest writings in Western Literature. It is divided into three parts: Inferno, Purgatorio and Paradiso.

This literary masterpiece discusses “the state of the soul after death and presents an image of divine justice meted out as due punishment or reward” as it describes Dante’s travels through Hell, Purgatory and Heaven. There are nine circles of the Inferno, or Hell, followed by Lucifer contained at its bottom.

We now know there is a tenth level not addressed by Dante.  This level is Timberline Knolls in Lemont, Illinois. 

On August 21, 2018, Michael Jacksa, then a counselor at Timberline Knolls was arrested and charged with assaulting a 29 year old patient at Timberline Knolls during two counseling sessions between May and June of 2018. 

Jacksa was accused by patients of digitally penetrating their vaginas and buttocks, putting his hands beneath their clothing, fondling their breasts and forcing them to give him oral sex. During his first bond hearing on Aug. 21, Jacksa reportedly admitted to police that he “probably went too far.”

This “probably went too far” conduct manifested itself by him being indicted for his reprehensible conduct directed toward a second victim. According to those charges, between Dec. 1, 2017 and Jan. 10, 2018, Jacksa was treating an out-of-state woman for eating disorders, anxiety and past sexual abuse. The patient alleges that Jacksa sexually assaulted her during four therapy sessions at Timberline Knolls. The prosecutor said the second woman came forward after seeing media reports.

According to the prosecutor, at least six other former patients of Jacksa’s from across the country have contacted the Lemont Police Department stating that Jacksa allegedly engaged in “inappropriate sexual behavior” during their respective therapy sessions.

But that is not the end of Timberline Knolls and Acadia’s problems.  Not nearly.

On September 1, 2024, a New York Times report published a scathing article about Acadia Healthcare, the publicly traded company which owns Timberline Knolls. The article and its follow up can be found here:

In short, the New York Times report indicated that Acadia Healthcare allegedly held patients longer than was necessary and often against their will at certain facilities. The report also claims Acadia trumped up patient symptoms in reports to payers to extract more reimbursement. The Report stated: “Acadia has exaggerated patients’ symptoms. It has tweaked medication dosages, then claimed patients needed to stay longer because of the adjustment. And it has argued that patients are not well enough to leave because they did not finish a meal,” the New York Times alleged. “Unless the patients or their families hire lawyers, Acadia often holds them until their insurance runs out.” 

This Report allegedly included at least 12 of the 19 states where Acadia operates psychiatric hospitals. Dozens of patients, employees and police officers notified authorities that the company was detaining people in ways that broke the law, the report stated, citing records. It is unknown whether Timberline Knolls is part of that conduct.

Acadia stated the assertions are inaccurate.

But that is not the end of Timberline Knolls and Acadia’s problems.  Not nearly.

The United States Committee on Finance conducted a two-year study of four major companies providing mental health services to children and adolescents.  One of the four companies? Acadia Healthcare.

The findings of that study were released on June 12, 2024.  The study can be found here:

Click to access sfc_report_warehouses_of_neglect.pdf

The testimony before the Committee and the Exhibits supporting the study can be found here:

https://www.finance.senate.gov/hearings/youth-residential-treatment-facilities-examining-failures-and-evaluating-solutions

The study’s findings can be summarized as follows:

  • Children suffer routine harm inside Residential Treatment Facilities (“RTF”). The risk of harm to children in RTFs is endemic to the operating model. 
  • Children inside RTFs often do not get the treatment they need for mental and behavioral health needs, despite RTFs being reimbursed with federal dollars to provide intensive services. 
  • Horrific instances of sexual abuse persist unremediated inside RTFs. 
  • The use of restraint and seclusion in RTFs allows for unchecked abuse. RTF staff have too often ignored federal restraint and seclusion regulations, resulting in daily use of restraint and seclusion in some instances.  
  • RTFs often employ unqualified or inadequately trained staff and that staff routinely fail to discharge their duties. RTF staffing failures have led to tragic incidents, including child fatalities, and childrens’ repeated exposure to risk. 
  • RTFs are often non-homelike environments, exposing children to unsafe and unsanitary conditions. 
  • RTFs often fail to effectively maintain connections between children and their communities and to plan for childrens’ discharge to the community for ongoing care. 
  • RTFs often employ carceral technology to monitor children, creating environments that feel more like detention facilities than therapeutic settings. 
  • State and federal oversight authorities fail to effectively identify and address harm to children in RTFs. When RTFs correct deficiencies, their efforts are remedial rather than company-wide.
  • Exploiting corporate structures can enable RTF operators to evade oversight. 

Surely, this scathing report must have had an immediate and severe impact on Acadia Healthcare with far fewer referrals and a commitment to investigate and improve. Uh … no.

In an August 5, 2024 call with investors, Chris Hunter, CEO of Acadia Healthcare, said the behavioral health provider had not seen any negative effects from the report. 

Hunter stated: “Residential treatment centers comprise around 11% of Acadia’s revenue… We believe that the people that deal with this patient population every day, and that certainly includes our referral sources, as well as the various regulatory oversight bodies that are routinely in these facilities, understand that this is just a really difficult population.”

That a boy Chris! Don’t address the damning evidence in the Committee’s Report but do insinuate blame on your patient population.  Profits, profits uber alles! Well played, sirrah. 

But that is not the end of Timberline Knolls and Acadia’s problems.  Not nearly.

In August 2024, a lawsuit was filed against Timberline alleging staff member Erick Hampton sexually assaulted a 24-year-old patient, Jane Doe, three times in May 2024.

Doe, who has bipolar and borderline personality disorder, was seeking treatment at the facility for suicidal thoughts. Despite reporting the assaults to a staff member via her roommate, no prompt action was taken, allowing Jane Doe to be raped a third time.

The lawsuit also alleges that Doe was falsely accused of having a secret affair with a staff member and was forced to leave the facility, after less than two weeks, out of fear. The lawsuit claims the assaults worsened her mental health condition, yet Hampton faces no criminal charges.

Worsened her mental health conditions. Rape will certainly do that.

So, in the past four months, Acadia, the parent company of Timberline Knolls:

  1. Was the subject of a scathing Senate Finance Committee Report on systemic abuse of children and adolescents;
  2. Was the subject of a scathing New York Times Report alleging system abuse of children and adolescents;
  3. Was the subject of a scathing lawsuit alleging one of Timberline Knolls employees raped a patient three times while under their so-called care.

Timberline Knolls should have still been reeling from the Jacksa incidents and implemented wholesale changes and improvements to prevent instances of abuse from happening again. Instead?

It is business as usual. According to Acadia’s CEO, its bottom line has not been impacted and families are still referring their loved ones to Timberline Knolls. Acadia marketers are drumming up business with no thought about the possible harm nor consequences.

So, what can be done? For one, complaints with all of this information can be sent to the Attorney General of Tennessee (where Acadia is based); the Attorney General of Illinois (where Timberline Knolls is based); to the Joint Commission; to the REDC and published widely on social media.  Attempted collaboration can be undertaken with the law firms representing the latest victims at Timberline Knolls. Those things can certainly be done. But the question remains …

What are you prepared to do?

Why HAES is Dead in the Eating Disorder Community and … Crossing a Sacred Boundary.

Why is HAES dead in the eating disorder community? Because the ASDAH wanted it that way by taking HAES in a different direction.

Some people opined that ASDAH does not involve eating disorders. And yet, weight stigma and individualized eating are certainly part of the eating disorder realm. So, to that extent, yes ASDAH was formerly involved in the eating disorder community.

Some people attempted to argue that HAES was not part of the eating disorder lexicon. And yet, there are therapists, marketers and third parties who naively seek, “HAES aligned doctors, therapists, nutritionists” for people who suffer from eating disorders.

Certainly, the abandoned HAES principles align with some aspects of the eating disorders community. These principles included:

  1. Weight Inclusivity– Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.
  • Health Enhancement– Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.
  • Respectful Care — Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.
  • Eating for Well-being — Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.
  • Life-Enhancing Movement — Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose.

When viewed through an intelligent, rational lens, who can argue with those principles? I certainly agree with them.

If HAES still embraced those noble principles and was being conveyed in an intelligent manner, there would be far fewer issues and HAES would be further on its way to being respected, if not adopted by more medical and mental health professionals. Sadly, it is not.

In 2022, ASDAH (the entity which owns the HAES trademark) had a seismic shift in its vision and mission. As was its right. Now, ASDAH is attempting to redefine health through a sociopolitical construct and is openly stating that it is aligning with other social justice movements. [their words] Again, any organization has the right to pivot in the direction it deems best for its members and donors. But as it pivots, to the extent that ASDAH and HAES were once part of the eating disorder narrative, they no longer are. With regard to eating disorders, HAES is dead.

ASDAH seeks to “dismantle the medical industrial complex.” [their words] ASDAH does not say how it intends to undertake this dismantling or what it seeks to substitute in its place.  ASDAH also states, “One of the main roots of the current Health at Every Size® community was a group of fat activists known collectively as the Fat Underground who began questioning their healthcare experiences and the advice they received from healthcare professionals.”

ASDAH also states, “We remain committed to the ongoing learning from liberation thought-leaders in Black liberation, fat liberation, crip/disability justice, queer liberation, womanism, intersectional feminism, and many more known and not-yet-known movements working towards the liberation of all people.” [Nothing about eating disorders.]

That is truly what ASDAH is about. Fat activism. The liberation of all people who it perceives as being victimized. Social justice issues. So long as ASDAH stays out of the eating disorder community, I say, “Best of luck to you, knock yourself out and do what you believe you must do.”

Especially since I agree that lack of access to medical and mental healthcare for minorities, the poor, the disenfranchised is a huge societal issue and needs to be addressed. We clearly do not have enough people of color who are medical and mental healthcare professionals. Research studies in the past have disproportionately focused on white persons. BMI as an accurate, modern measure of health is lacking. Medical and mental healthcare providers in minority communities are grossly lacking.

But what is also lacking are workable, logical, fact and science-based solutions to these very real problems.  ASDAH is not providing them. HAES activists are not providing them. Real life workable solutions, with greater knowledge and wisdom of medical and mental health care issues are not being proposed nor debated.

It is one thing to illuminate issues to be addressed. It is something very different and far more complex to illuminate workable solutions to those problems which do not violate the Constitution or require wholesale revolution and overthrow of the US government.

Nonetheless, with its pivot exclusively to social justice activism leaving eating disorders behind, there are still some therapists and third parties who continue to use the now outdated term, “HAES aligned.” Third parties do not have the luxury of using the term “HAES” to fit whatever narrative they wish to use. In fact, should you wish to utilize the trademarked term HAES in a way that does not align with ASDAH’S militant vision, it has the right to demand you cease and desist from further use of this term. ASDAH has the right to protect its trademark to ensure it is being used in compliance with its extremist vision. In fact, if it does not protect its trademark, it can waive its rights to exclusively use the term HAES. ASDAH can legally prevent any mental health provider from utilizing the HAES trademark if that provider does not adhere to ASDAH’s current vision and mission.

Based upon some of the past tactics utilized by the ASDAH Militant Fat Activists and their cronies, ASDAH will undoubtedly resort to that tactic.  Its current tactics include excessive bullying on social media directed against therapists and others who disagree with their views on Palestine and other ASDAH mandated issues. Harassment. Making those who disagree with them feel afraid, unsafe and minimized.  There can be no rational debate. No intellectual exchange of ideas or views. They bully those who they perceive are weaker than them. But they are cowards.  They will not directly and openly confront those who oppose them. Those whom they perceive are stronger than them. They hide behind their keyboards.

But then they erred. In the most egregious manner possible. After my last post on this issue, on the Facebook page of one of their advocates, they came after me.  Oh, certainly not directly since it is far easier to block those who disagree with your views and as such, live in an echo chamber. All manner of slurs and slanders were directed at me.  And quite frankly, I am ok with that. Attorneys live with that type of derision every day.

But there is one line that no civilized person ever crosses. One sacred line. And that is when a child dies as a result of eating disorders, you never, never state nor even imply that a parent subjected that child to substandard medical treatment and as a result, was even partially at fault for her tragic death. Only a subhuman monster would tread that dark path.

If that messaging appears on your social media page, you have the absolute duty to immediately remove that message, apologize to the parent and perhaps, look at your own ethics and morals.

However, that line was crossed in an intentional and malicious manner. When given the opportunity to walk back those words, or to delete the offensive messaging, not one of these activists stood up or even spoke out against that messaging.

When the Militant Fat Activists came together to blame me for “allowing my daughter to endure” alleged negligent medical care and ipso facto, blamed me for causing her death … and not one person called out that reprehensible statement, that conduct is unforgivable. This time, they attempted to bully someone who cannot be bullied. This time …

This time… for all parents whose children died from eating disorders; for all therapists and mental health care professionals who have been harassed by the Militant Fat Activists; for persons who have been bullied because they do not embrace ASDAH’s extremist political views … it is our turn now. 

And it is their time to be afraid.

HAES is DEAD

Health at Every Size (HAES) was intended to be an approach to public health that encouraged individuals to adopt healthful behaviors such as balanced nutrition, enjoyable regular physical activity, and stress management regardless of weight. A 2012 study indicated that adopting these habits could lead to better health outcomes regardless of BMI. BMI was exposed for its flaws.

However, the Association for Size Diversity and Health (ASDAH), the organization behind HAES abandoned those principles. It abandoned what ethics it may have once had. It abandoned all reason, logic, facts and wisdom. Instead, it replaced the aforementioned qualities with a close minded, illogical slavish dedication to social injustice and enforces its myopic views through bullying, back stabbing and subterfuge.

To the extent that HAES principles ever had any relevance or impact on eating disorders, those days are over.

When you look at ASDAH’s 2023 Form 990 tax filing, the words “eating disorders” do not appear one time. On its Form 990s, there is a section in which ASDAH sets forth its mission as follows: “COMMITTED TO THE PRACTICE OF THE HEALTH AT EVERY SIZE (HAES) PRINCIPLES, ASDAH ENVISIONS A WORLD THAT CELEBRATES BODIES OF ALL SHAPES AND SIZES, IN WHICH BODY WEIGHT IS NO LONGER A SOURCE OF DISCRIMINATION AND WHERE OPPRESSED COMMUNITIES HAVE EQUAL ACCESS TO THE RESOURCES.”

When you look at ASDAH’s 2022 Form 990 tax filing, the words “eating disorders” do not appear one time.

When you look at ASDAH’s 2024 Conference, not one session, not one time are the words, “eating disorder” mentioned … other than noting the words are included in the title of the “Inclusive Eating Disorder Education” being listed as a proud sponsor.

HAES and eating disorders … never the twain shall meet.

ASDAH has become an extremist, racist organization which not only does not address eating disorders, it does not care about eating disorders.

Damning evidence supports that statement.

From Lindo Bacon, PhD regarding her banishment from ASDAH:

“I suggest ASDAH engage in more honorable and dignified business practices.”

“That blog piece is predicated on a phone conversation with me that was recorded without my consent, behavior that is unethical at least, possibly illegal depending on what state it was conducted in, and initiated a cyber-bullying campaign. Is this collusion befitting a professional organization?”

“Regrettably, the primary organization representing the HAES ideology failed to navigate this evolution gracefully, fostering a toxic culture marked by intolerance and punitive attitudes.” 

“I don’t want to exist in a climate where a leadership committee distorts the truth, publicly shames and exiles any member, and damages the reputation of an individual promoting HAES, especially not when that member contributes generously to ASDAH and to the HAES community. I don’t want to exist in a climate where people are shamed for holding, discussing, or challenging ideas―or pressured to shame themselves in an accountability statement or else risk being cast out of the community.”

Racism is color blind.  The following statements made by ASDAH demonstrate that the word “inclusion” actually means exclusion of everyone who is not in their tribe and who do not slavishly follow ASDAH’s radical agenda.

The following are ASDAH’s words:

“We have been visioning and planning different ways to not only take back the HAES narrative, but to place it in the hands of the most marginalized in our community.” 

“Notably, we discussed our vision of revising the Health at Every Size® principles and writing a Health at Every Size® book authored by fat, Black, Brown, neurodiverse, disabled, transgender, and queer activists.” 

“We at ASDAH, the holder and protector of the Health at Every Size® and HAES® trademarks, are committed to promoting an inclusive vision of Health at Every Size® which centers those most marginalized and harmed by fatphobia and the healthcare system.”

“ASDAH has taken action to center Black, fat, and transgender community members in the last two years. We have revised our leadership structure to be less hierarchical.” 

“In order to keep our community safer for fat, Black, and Brown folks in ASDAH spaces, we are setting boundaries as the natural consequence for causing repeated harm.”

ASDAH had a three part series entitled, “Suffocating Whiteness.”

ASDAH’s website defining its purpose, values and vision do not mention eating disorders … not one time.

ASDAH does not care about eating disorders.  It only cares about its fat liberation/social injustice movement. ASDAH states, “Health at Every Size® is not a liberatory framework or social justice movement in and of itself, but rather aims to align with other movements in order to further the journey towards liberation for all.”  That too is a misrepresentation. ASDAH and HAES epitomize the very definition of a social justice movement.

Again, using ASDAH’s own words:

“Considering what is happening to Palestinian people in Gaza and the West Bank; white supremacy, racism, colonization, forced displacement, ethnic cleansing, apartheid and genocide, those of us who claim to be for liberation, including healthcare providers aligned with HAES®, must stand up for what is right. The liberation for fat people, Black people, indigenous people, queer & trans people, AND Palestinian people are interlocked. Our liberation is tied up in one another’s. There is no hierarchy of oppression. If we are all to be free, we must take measured action. And if we are to support the health and well being of all people, we must take strong stances and demand change.”

ASDAH’s statement ended with these words:

“We will open with reading of a statement by Fat Rose in solidarity with Palestine and close with community processing and healing time.

From the river to the sea, Palestine will be free. All of our freedoms rely upon it.”

Many Jewish people interpret, “From the river to the sea” as a call by Palestinian militant groups for the dismantling of Israel and the removal or extermination of its Jewish population. For historical reference, see Nazi Germany in the 1930s.

And the meaning behind ASDAH’s statement, “Our freedoms rely upon genocide against Jews and Israel?” Certainly a strong stance albeit absolute pablum.

ASDAH claims to take strong stances. So, what constitutes these strong stances?

How do the strong stances of ASDAH manifest? We know these stances include publicly lynching Lindo Bacon, its now former, most renowned ambassador for three reasons:

  1. Lindo Bacon is white;
  2. Lindo Bacon is thin, and;
  3. Lindo Bacon is Jewish.

Lindo Bacon put HAES on the map.  Her advocacy was responsible for its growth. And yet today on the ASDAH, there are as many references to Lindo Bacon as there are about eating disorders.  Zero.

ASDAH’s strong stances include blatant acts of bullying in Facebook groups against any therapist who dares to stand up to ASDAH and its anti-Semantic position. This bullying has gotten so bad that therapists have removed themselves from groups and started other groups.  Groups more appropriately named “Weight Inclusive.”

ASDAH’s own literature, mission and vision (or lack thereof) evidence that HAES has nothing to do with eating disorders. And yet, there are still therapists, nutritionists and others who look for “HAES aligned medical or mental health providers.” And the question which must be posed to them is simply … Why?

If the statistics are to be believed, 30 million Americans will suffer from an eating disorder in their lifetime.

Globally, 70 million people suffer from an eating disorder.

One study found that people with anorexia are 56 times more likely to commit suicide than people without an eating disorder.

One person dies from complications from eating disorders every 52 minutes.

In response, ASDAH has taken HAES away from mental health and turned it into an outlet to rail against society for all of society’s ills, both real and imagined.

So, for those who still look for “HAES aligned” treatment providers, you now know that to which you are condemning your clients/patients.

Our families deserve better.

Her Place of Serenity

Maruyama Park is the oldest park in Kyoto, Japan.  Home to numerous shrines and temples, its beauty is best captured through serenity, soulful reflection and feelings of peaceful calm which take over your mind, your heart and your soul.

It has a gentle stream flowing through the park. A stream home to Japanese carp, turtles and beautiful cranes. Often times, the only sounds you hear are the trickling of the water…

The sounds of the cranes …

The breaking of the surface of the water by the koi.

One shrine, an homage to a woman, a mother, a warrior embracing 7 children clinging to her in fear as a typhoon threatens their existence.

Temples, large and awe-inspiring leave one with a feeling of insignificance as the immensity of time eternal is brought home through deep gonging of bells signify the remembrance of those who have passed before us.

Respectfully sitting back and taking in the solemn ceremony honoring an ancestor as a monk rhythmically chants and plays his instruments.

Walking through a place of final repose for those who have departed, the silent reverence permeating the atmosphere.

In the Park, answers to questions that have plagued a person can perhaps be found. Or they remain elusive and out of reach.

And what better place to leave a part of my beloved daughter, Morgan.

In that stream.

At that time.

The perfection as her bodily remains envelope rocks and stones in the stream, expanding, disbursing, becoming one for all time with this incredible place of peace. Of serenity. Of love.

As with the other times when I have left parts of her at places she loved or wanted to experience, I am torn, a father in pain. In some ways, I am once again saying good-bye to her. And yet, as I leave her perhaps symbolically, in far greater places, I know and must surely embrace the knowledge and understanding that she would want precisely that.

In some ways, her journey in this existence continues as she becomes one with some of the great natural treasures to grace our planet.

Morgan Becoming One

And from her journey, so too, does my journey continue. If just one parent, one daddy or momma, is spared the anguish I must endure on a daily basis through the work or the path I currently tread, then those little diamonds left in the ocean, the white smoke spreading through a gentle stream, the parts of her left throughout our existence could have greater meaning.

In doing so, perhaps in Morgan’s words, “I can seem to help everyone else, I just can’t save myself,” become a stronger legacy for not just her, but for those she loved … and who loved her.

Land of the Rising Sun

Japan is a land of enigmatic mystery. Stretching backwards in time, nothing has been undone. The rich tapestry of symbols, of images, of the people, of its virtues, have not been eliminated.  But instead, built upon.

Modern skyscrapers near ancient Shinto temples hundreds of years old. Bullet trains cutting through the countryside, past dense forests and farmlands in aged plots. The cherry blossom as important as the skyscraper.

The samurai code of bushido. Embracing honor, courage, skill in the martial arts and loyalty to the family and society.

Beauty, both subtle and gross, surrounding you wherever you look.

And yet.

Japanese society embraces collectivistic values, emphasizing conformity and group harmony. As a consequence, deviations from norms can create discord in the community. Mental illness is considered to be one such deviation as it threatens the traditional lifestyle upheld by Japan.  These beliefs have led to a growing stigma towards those who struggle with mental health issues in Japan. Especially eating disorders.

For centuries, traditional Eastern cultures like Japan have practiced collectivism, an integrative worldview emphasizing the family, the village, and other communal bodies. While Western Cultures tend to be individualistic and are concerned with how the world affects the self, Easterners consider the self in relation to the world, including how personal actions may affect the collective whole. In this way, Western culture celebrates achievement whereas Easterners emphasize social harmony.

Japanese conceptions of mental illness tend to be more conservative than others worldwide. In questionnaire-based studies of both native Asians and Asian Americans, researchers have documented that these cultures are characterized by conservative attitudes toward mental illness, often viewing mental illness as a weakness rather than a legitimate affliction. Some researchers speculate that part of the reason that Asians do not see mental health as an important factor in life is an overall lack of understanding. While many American schools teach the importance of mental health, Asians may not have as deep an understanding of the topic, as it is primarily displayed on TV and not often discussed in a family or school setting.

When we consider stigma in the United States, for the most part, it grossly pales in comparison to the stigma associated with mental health in Japan. And so, to learn more about cultural stigma, to Japan surely I must go.

Through my friendship with Elissa Myers, the former Executive Director of the Academy for Eating Disorders, along with Something for Kelly, I will be meeting with one of the foremost eating disorder professionals in Japan, Dr. Kazuhiro Yoshiuchi. He is an Associate Professor at the University of Tokyo. He has a long list of achievements, publications and accomplishments.

We will also be meeting with Mika Omari, PhD, an Abe Fellow. The Abe Fellowship Program is a research scholarship program encouraging international multidisciplinary research on topics of international concern.

Naturally, we will be sharing information on recent breakthroughs in the treatment of eating disorders in the United States. Information and studies obtained from some of the foremost eating disorder professionals here in the United States will be shared with colleagues in Japan. For this, we are so grateful.

I hope that the medical/mental health professionals in Japan will see us as “Good Will Ambassadors” and that we can be a bridge allowing our professionals to start to collaborate internationally on a greater level.

When we all find a way to work together, to share our knowledge, that translates into many more lives being saved. And that universally is the one goal we all share.