The assassination of UnitedHealthcare CEO Brian Thompson on Dec. 4, 2024 has led to a national conversation about the ethics of health insurance companies when they deny coverage. It’s tragic that an individual act of violence creates a deeper conversation about healthcare in the United States than during the entire Presidential election cycle. But an act of violence does not fix anything, it just spreads the hurt. In my case, it also opened up old wounds.

When a health insurance corporation “kills” someone, our legal system is not designed well to hold it accountable. The “killing” is not with a bullet, but from a complete disregard for healthy care. UnitedHealthcare and Willow Springs, the residential care facility where my daughter was for about 7 weeks in 2014, were culpable in her death–but escaped criminal prosecution–and even a lawsuit. Did they even care?

Though Brianna left me a suicide note the night she died, she was murdered. UnitedHealthcare saved tens of thousands of dollars from Brianna’s death.

I share this story in the hope that, unlike an act of violence, it might make a difference.

Brianna is not a statistic. She was a person–and I don’t have the space to fully tell her story. My ex-wife and I adopted her and her two slightly older siblings through the foster-adopt program. She was five when she moved into our home, six when the adoption was official, and 17 when she died. Before she came into our lives she had been severely abused by her birth mother’s boyfriend, beaten with a hanger and locked in a closet for soiling her diapers. She was spotted in a 7-11 with hair falling out and severely malnourished. She also had fallen out of a second story window when she was two and broken an eye socket that led to surgery. While Brianna could see out of both eyes, her brain only used one eye, meaning it was really tiring for her to read and she lacked depth perception. So while she had a wicked arm to throw a softball, she struggled to hit or catch it. When a child experiences this level of trauma, she struggles and no amount of love can make the pain that trauma caused disappear.

Brianna, despite all the trauma, was also a charming child with a wonderful, loving spirit. She could be strong-willed, shy and sensitive, but behind it all, she simply wanted to be accepted and loved. Brianna always took great care to make gifts for us at Christmas. She loved her birthday–the one day when she got to be the center of attention. Below from her 16th birthday in 2013, as everyone chants “mordida” (“bite” in Spanish), she got her head shoved into her piece of cake. The experience delighted her. She adored her siblings–even if she didn’t always get along with them. She was devoted to her friends. But still she was a challenge to parent–but manageable. Brianna could call you nasty things one second and when she had calmed down, it was like nothing had happened from her perspective, even if you had not yet recovered.

That changed as her siblings were finishing high school and growing up. She had uncontrollable anger that did not seem to calm, did self-harm, and eventually expressed suicidal ideation–all of which led to a series of short-term hospitalizations, which sometimes led to helpful in-home supports for her and us. Those supports tended to be time-limited or would cease and not return when she was hospitalized again. Early on, she had a longer-term residential hospitalization at a facility in Scottsdale that United Healthcare cut off prematurely, but in that case she had made some therapeutic progress and a transition back to school was feasible. We had hope.

However, no solution presented itself. We tried many things beyond therapy, including adopting two puppies when our prior dog passed away. Brianna was crushed when Jackie (pictured above at Christmas) died on Super Bowl Sunday in 2014. She soon went online to discover Chloe (the black puppy), and we, of course had to adopt her sister Coco (the brown one), too. But the result was still a series of short-term hospitalizations. The scenario generally played out with a behavior crisis in the home, a call to the crisis team, Brianna running away, the crisis team calling the police, the police eventually finding Brianna, the crisis team making an assessment that led to an admission to the ED, then waiting for a hospital social worker to evaluate her at the ED (which can take hours), then Brianna would wait for a bed to open at a short-term facility which often took about 24 hours. Short-term facilities would hold her usually up to 10 days with the goal of stabilization. This cycle repeated eight times over a year (and this is the abridged version–leaving out juvenile justice issues from domestic violence perpetrated by Brianna that also involved the crisis team and police). At her last short-term hospitalization in Oct. 2014, Brianna was given an added diagnosis, Borderline Personality Disorder, and we were told that Willow Springs in Reno, NV specialized in dialectical behavior therapy (DBT)–something Brianna had unsuccessfully done as an outpatient in groups–as the best option. It took a lot of effort from Quaker Friends to escort Brianna to the airport from the facility, so I could fly with her on Oct. 22 to Reno, so she could be admitted. The hope was that more individualized, intensive DBT in a residential setting might be the breakthrough that helped us move forward.

It did not work out that way. I did attend a parent workshop the weekend of Nov. 14-16 designed to develop skills so as to de-escalate situations. Two of which are helpful for everyone. First, assume a person is doing their best (given their state of mind and understanding of the environment)–this helps build trust and avoid judgment and a defensive response. Second, affirm the underlying emotion (e.g., frustration), but not the behavior (e.g., screaming and swearing at you). While the weekend was helpful in that way, Brianna who was initially glad to see me, by the end had stormed out of our in-person therapy session. And as in all our prior ones that I joined on the phone (before Zoom) we had not made progress. Brianna was on a restricted list due to her behaviors at the facility, and not taken off it until around Dec. 1. Being off the restricted list, while a step in the right direction–was no where close to therapeutic progress. I sensed Brianna was struggling more than other patients there. The facility also indicated it can take a significant amount of time for progress.

On Dec. 10, I received an email from her therapist at Willow Springs:

Hello Dave~

I just received word from utilization and review that Brianna’s continued stay in treatment has been denied. They are doing an expedited appeal but this decision may not be overturned. I mention this to you because it might be beneficial to start making aftercare appointments for Brianna. It is recommended that at minimum there is a therapy appointment within 7 days of discharge and a psychiatry appointment within 30 days of discharge. It would be ideal to step down to an Intensive outpatient program or a partial hospitalization program. Have you begun contacting any aftercare yet?

We have a couple options at this point:

1)      Wait and see if the denial is overturned

2)      Schedule a discharge for as soon as Friday or Saturday so you don’t accrue financial costs

3)      Contact our business department regarding self pay

I will be heading out for the day today but will be in tomorrow if you’d like to discuss things further.

The email shocked my world. I had no idea this was even a possibility. Below is a partial copy of the denial letter I received the next day (redacting names and added information). Brianna had not made therapeutic progress. She does not know that she can not return to the high school she was attending because of how much time she had missed, but I also had not confirmed she could attend Compadre, the alternative school, that she was supposed to attend.

The expedited appeal was to take place on Friday, Dec. 12, 2014. As the parent–and the one most familiar with Brianna–I WAS NOT PERMITTED TO BE PART OF THE APPEAL. Nor did I have access to whatever Willow Springs might have been reporting to UBH related to any supposed progress. I was supposed to hear back from the facility that Friday–and did not.

However, on Monday, Dec. 15 I received notification that the expedited appeal had been denied, as seen below.

At this point I had two choices, privately pay $620 a day or $4,320 a week–for care that had not yet shown to be effective OR travel to Reno, take my daughter home, even though we had done no work on a transition plan. Her sister was due to arrive home from college on that Friday–and I thought that might help. Essentially, a devil’s choice–two bad options.

Whether it’s UBH and/or Willow Springs that was responsible–releasing an at-risk 17 year-old with no transition plan (other than “you can do it, Brianna”) was malpractice.

I reached out to the therapist in the early afternoon the next day, Tuesday, Dec. 16 to say things were not going well. She responded: “I’m sorry to hear this Dave, but I am glad there seems to be a peer in the house she will interact with. Keep discussing aftercare with Brianna and encouraging an outpatient experience. I would dislike very much if she ended up back in a residential or acute setting because she is not following through with outpatient work. I’d even mention that to her.”

I would never hear from anyone at Willow Springs again.

On December 18th (ten years ago to the day of publishing this), I wrote the following after Brianna had been home for three days to Willow Springs and to UBH (UBH received only the second half of the letter–Willow Springs received both). NO ONE CALLED ME OR EMAILED ME BACK FROM EITHER PLACE AFTER RECEIPT.

Below is what Brianna had written on her bedroom mirror (picture taken after her death and the room was cleaned-though the mirror was not touched for years).

I have redacted names.

To: Chief Nursing Officer, Willow Springs Residential Treatment Center
The Joint Commission, accrediting agency for Willow Springs
Brianna’s therapist
From: David Wells, parent of Brianna Wells (patient at Willow Springs Oct. 22-Dec. 15)
Date: December 18, 2014
RE: Inadequate transition planning services making a bad situation far worse

I have also submitted a second-level appeal with United Behavioral Health, and I find the insurance company at primary fault here for what has been an EXTREMELY traumatic three days since returning from Willow Springs Monday around midnight.
However, it’s clear to me that Willow Springs failed miserably in its transition planning services for a patient who therapeutically was clearly not ready to be released and the insurance had cut off. While I have included [Brianna’s Therapist] on this for transparency purposes, I want to make it clear that I find this to be an organizational failure, not her personal fault.
I was notified via email from [Brianna’s Therapist]on Wednesday afternoon, Dec. 10 that insurance had been denied and that an urgent appeal was underway. We talked and stayed in communication the next day—and she provided me a copy of the rejection letter since I do not have a home FAX machine. The business office also informed me of the denial on Thursday and I indicated I would not sign any form agreeing to pay for time after the insurance denial. I also began a grievance process through the Arizona Department of Administration regarding the insurance company’s decision. [Brianna’s Therapist] does not work on Fridays but she had notified a number of other staff members. I presumed on Friday I would hear at some point the status of the urgent appeal. I heard nothing (even though the urgent appeal was heard at 1:29 p.m. CST (or 11:29 a.m. PST) and the denial letter is dated December 12th).
Consequently, I presumed the urgent appeal was successful at least for a short-term extension of her stay, so I was taken by surprise when I checked my email at 8:30 a.m. (MST) on Monday, December 15th and discovered via an email from the Arizona Department of Administration that the urgent appeal had been denied. I called the insurance company, arranged to get a FAX via the internet and was able to review the denial—noting the same basis as the original denial.
We had family therapy scheduled for Monday at 9 a.m. (PST or 10 a.m. MST). However, Brianna wasn’t there instead [Brianna’s Therapist] and I discussed logistics of my picking her up—including my need to book a flight, setting up in take for intensive outpatient therapy (which I had begun looking into the prior week). She asked me whether I wanted Brianna to be told she was getting discharged. I had no idea, and asked her for advice—she suggested Brianna not be told she was discharging—only that I was visiting. That turned out to be bad decision.
In the meantime, I continue to get mailings from United Behavioral Health which show approved stays (they arrive about 10 days later—so I still haven’t received the original denial letter). What I’ve noticed is that after consistently approving multiple day stays, something changed for Tuesday, Dec. 2—only one day was approved, as well as Dec. 3 and Dec. 4. Weekends tend to be approved in a three-day block, but on Monday, December 8th, again just one day was approved. Likewise, on Tuesday, December 9th and then as already discussed after December 10th insurance terminated.
Surely Brianna is not the first patient for whom insurance has terminated prematurely, and surely Brianna is not the first patient with insurance through United Behavioral Health. Willow Springs which has been in existence for more than 25 years should have in place some kind of precautionary transition plan that should be going into place—especially for patients like Brianna who clearly had not yet developed the skills to successfully transition. Likewise, they should have developed clear warning signs that might be specific to particular insurers.
Such a plan most certainly should have kicked into place on December 8th when for a fourth time only one day was approved, yet it did not. And, in fact, only a late in the day email on Wed., Dec. 10 at 4:13 p.m. MST (my time) with a generic subject line “Willow” that I read and responded to at 4:39 pm. MST gave me any notice of such a major change in events. That email focused on my options, not any key transition plan.
Yet at this time, Brianna hadn’t been told about a change in her school or been prepped for changes in her room because someone else stayed there for a while (she had been told about another person using her room) or new developments with her brother and his girlfriend. In addition, Brianna was part of a community at Willow Springs. Even if you want to be discharged, the ritual good byes are important. Brianna was denied even that.
Everyone at Willow who had worked with Brianna had to be keenly aware that she had not built sufficient skills yet, and that a sudden discharge with no diligent transition work was setting her up for failure.
In the insurance second-level appeal, I detail her behaviors since discharge in more detail. You should find it very disturbing. I have to live that experience.
I am deeply disturbed by the lack of planning, coordination and foresight shown by Willow Springs. As there should be a readiness plan for such occurrences—and my experience demonstrates that such a plan is lacking or that the institution fails to consistently use their plan.
 
To: United Behavioral Health
From: David Wells, parent of Brianna Wells
Date: December 18, 2014
RE: Second Level Appeal of Denial of Residential Treatment at Willow Springs for Brianna Wells
SERVICE DENIED AFTER DEC. 10, 2014
Member ID: (redacted)

Due to your denial of the urgent appeal, which I was notified of by the Arizona Department of Administration, on Monday morning, December 15, I had to book a flight and fly 750 miles to Reno on Monday and have my daughter discharged and return around midnight that night. I have locked all knives as well as medications, so that she cannot access them. I keep the key with me at all times.
Since arriving home, my daughter has been EXTREMELY angry, not been sleeping, not eating, refused meds, and refused to attend the intake for the intensive outpatient therapy, which your representative had said she could do instead of inpatient residential care. My daughter has indicated she will not participate in the intensive outpatient therapy or any therapy for that matter.
I have two holes in walls in my home (for which I’ll be sending you a bill) from her uncontrolled anger. I have had a folding chair thrown at me. She has gone into verbally tirades toward me numerous times (at least four or five times a day)—becoming increasingly aggressive by moving her body toward me or trying to block my way—and it has taken my skillful use of tools I’ve developed to escape these situations without bodily harm and further escalation. A less skilled person would have already been physically assaulted by her. Last night she assaulted her brother and his girlfriend in Phoenix with a police report filed. Her release to me for prior domestic violence pending a disposition of charges scheduled for a hearing on January 5, 2015 may need to be revoked (i.e., a warrant issued for her arrest) because she’s become a danger to others. She wears long-sleeves, but her mother noticed cut marks on her arms, suggesting she may be cutting again—not surprising given the trauma caused by the time and manner of her release.
Her anger and aggressiveness can be documented by numerous people who have both witnessed it as well as heard it when she’s engaged in while I have been in phone conversations. If I did not have a lock on my bedroom door and the ability to exit if needed through an outside door as part of my bathroom, I would fear for my personal safety.
I have no control over her—and she leaves the house now for extended periods of time. And this is all in just the first three days since we’ve returned home.
I have the Arizona Department of Administration’s Contracting Department reviewing to see whether you have properly followed the residential treatment criteria in our policy.
The link provided in the letter is no longer correct (you should update it). Assuming I found the correct link when the page redirected to a main page: https://www.providerexpress.com/html/guidelines/levelOfCareGuidelines/pdf/mhRTC.pdf.
I find these guidelines excessively vague.
I find in your letter a presumption that when a patient like my daughter is no longer engaging in self-harming activities like cutting and is med compliant and shows signs of stabilization in a controlled environment that she can be released EVEN IF she has shown ZERO therapeutic progress.
Please keep in mind that we met weekly—once I was there in person, otherwise by phone for family therapy sessions.
WE HAD ZERO SUCCESSFUL THERAPY SESSIONS. Brianna frequently shut down and often refused to participate, discuss issues or asked to leave.
BRIANNA SHOWED NO SIGNS OF LEARNING NEW DIALECTICAL BEHAVIORAL THERAPY SKILLS IN THE CONTROLLED SETTING AT WILLOW SPRINGS, AND SHE HAS DEMONSTRATED NONE OF THOSE SKILLS SINCE RETURNING HOME.
Anyone who has been in a residential care setting for nearly two months-becomes part of the community there. How with such an abrupt cut off of service, and rapid discharge, could Brianna be emotionally prepared for release? Especially when she demonstrated no new skills while being there. Brianna never had a pass to leave the facility. In mid-November she refused to see me multiple times. She’s only recently been taken off restrictions, though she tells me she was on a food watch where you’re not allowed into your room for an hour after meals because she hadn’t been eating properly. In addition, a lot has changed here, including the school she’ll attend—her old school can’t accommodate someone who has missed as much time as she has, and I now have her on an Individual Education Plan. Transition planning one would expect would be critical to any successful discharge. None of that occurred—and that has made what would have been a challenging situation many, many times worse.
After spending thousands more insurance dollars on her care, due to your negligent handling of her case, I now have a daughter who is arguable in even worse shape than when she was admitted. The only thing that has changed is due to a parent-training session I attended in Reno, I’m more skilled in trying to deal with her.
Because she is out of control, I cannot keep her safe, and her behavior may endanger the safety of others. The consequences of this decision will be borne by you—I’ll start with the bill for repairing my walls because she was discharged before she was therapeutically ready and without proper transition planning in place. Should any harm fall to her, like with the 60 Minutes Episode that aired at the same time this decision took place, you can expect a lawsuit.
I hardly expect this decision will end her serial hospitalizations—you’ve again been pennywise and pound foolish.
Barring a major change in her behavior, I would like her made immediately re-eligible for residential treatment at a facility in Arizona.

One might ask, why we didn’t seek to have her readmitted to a hospital. One reason is that path had failed repeatedly. Two, while I was trying multiple ways to find assistance I was battling the Christmas holidays and that we had no services already in place as she came home. I had to set them up–and see if I could get Brianna into a school. And, three, Brianna would have run away if I had tried and she was now going much farther from home when she left.

In my post-divorce three-bedroom house, Brianna had her bedroom. With her sister home from college, she was using my bedroom, and a friend of my son was staying in the other bedroom, so I was sleeping on the couch. Brianna was gone a lot and rather than connect with her sister and high school friends, she found a new group of troubled teens and connected with another family that had its own challenges (their oldest son was using one of my bedrooms and a daughter had briefly used Brianna’s room when she was hospitalized). Brianna briefly dropped by on Christmas and then left, and we were close to submitting a missing person’s report when her sister and I returned home on the evening of Sunday, Dec. 28 to find Brianna home. She made some disturbing indications with hand gestures that she had been around guns. However, for the first time since she had returned, I was able to have a conversation with her. She even shared with me a bit of a chocolate bar. I went to bed that night hopeful again.

When I woke up on the morning of Monday, Dec. 29th, I found this note on top of me on the couch. Brianna was gone.

Despite the note, Brianna did not kill herself, she was murdered that night. I suspect as much as Brianna wanted to die, she did not really want to die–but she put herself at intentional risk. While the murder has remained unsolved, I knew what killed my daughter–the negligence of UnitedHealthcare and Willow Springs.

When you lose a child in this way, there’s always an empty space in your heart and well-spring of emotions that can erupt at any moment. For Brianna’s memorial service I wrote a poem that captured my relationship with her that is a fitting way to end this story.

My beautiful cylindropuntia bigelovii, teddy bear cholla

I love you and always will.

You had a heart of gold.
But if you fully knew that
you would have spent it on candy and a huge Polar Pop from Circle K.

You were exuberant around our family dogs. When Jackie died, you found Chloe on the internet-and soon both Chloe and her sister Coco were part of our family.

Now they are a piece of your heart that I cling to.

On our birthdays and Christmas, you always had a card and some kind of gift-whether it be something you made or sharing a precious possession.

But the most precious part was always you.

When I gaze on photos of the young you, I want to wrap my arms around you like a teddy bear.

Your birthday planning began months and I mean like six months ahead, so eager you were for a day that could be all about you.

How much I wish we could have made every day as special as those birthdays.

Which is why you’d love today because you reached more people than you could imagine on even your longest birthday party invite list.

You weren’t always honest. In fact, telling the truth required more trust in us than you had. We’d look for missing containers of frosting and margarine…and like archeologists we’d find the empty remnant under the sofa or in a desk drawer or by the bed.

When I showed how Grandpa Rod used to make candy from melting chocolate chips and peanut butter in the microwave, a new favorite food was born.

And no matter where I hid the chocolate chips, there always seemed to be some missing the next time I looked for them.

Not that you, my teddy bear, would tell me.

I asked you a few months ago if you knew where that small white Tupperware bowl was.
I won’t tell you what the last food item I cleaned from your bedroom was.

It was in that small white Tupperware bowl with a blue lid under your nightstand.

Chocolate and Peanut Butter don’t spoil.

Neither does my love for you, Teddy Bear.

You never quite got why dad always eschewed the family car.

For you cars were comfortable.

For dad, they were wasteful carbon-emitting machines.

So you grew up riding bikes everywhere. First, we squished you into a kiddy trailer, but soon you were cycling.
I bought a tandem trail-a-bike to attach to our tandem bicycle. There you and your sister were on that back tandem trail-a-bike arguing away as you sort of pedaled while your brother and I chuckled—yes, three kids and a proud dad traveled together on one immense bike. Quite a spectacle for all to see.

We sometimes wobbled, but we did not fall down.

That’s what dads are for.

As you got your own bikes and we’d ride to Quaker Meeting, you and your brother and sister would fight for who would get to ride with dad on the tandem bicycle.

Not out of love or maybe a little.

But because you knew I’d do most of the pedaling work.

As you got to Middle School and if you missed the bus and needed a ride to school, I’d offer the tandem.
You’d fuss and agree…only if I left you off out of eyesight of the school.

In High School, you’d want a ride to a friend’s house. I’d offer the tandem. It’s only three miles, I’d say.

You’d say, “I’m not going then.”

The battle for control had begun.

There was no beating you, so I had to learn not to play and sometimes walk away.

Growing up is tough, siblings graduate, move on, parents divorce, peers can be petty and mean, school work can become a chore, and the future weighs upon your shoulders.
This would be tough for anyone, but especially someone as sensitive as you.
Speaking what was deep within you was too scary, too revealing,

So those coals of irritation, frustration, and fear would build and erupt into a storm.

My cylindropuntia bigelovii, teddy bear cholla

You would test me.
Sometimes I passed the test,
And sometimes I didn’t,
But I always tried.
And I think deep down you knew that, because you said as much in a sad but loving note you left for me.

You left notes that we’d find that were microscopes into your soul.

I love you and always will, but those thorns made it so hard to get close, especially in the last year.

Sometimes you threw barbs, hit and even bit and it hurt.

The storm would pass and you would be back to saying “hey, dad” again.

Oh, I’ll miss that and the phone calls I’d get if you got home before me, “Where are you, dad?”

Parents always want to protect their children and especially you.

In recent months nothing we could do would soothe your pain, but on December 28th you said something so simple, and so sweet, “Dad would you like part of my chocolate bar?”

Thank you for sharing it with me.

When I awoke on December 29th you weren’t home.
And now home will never be the same.

But my incredible cylindropuntia bigelovii, teddy bear cholla

I love you and always will.