SAN ANTONIO — The federal government is set to terminate Medicare and Medicaid funding for Laurel Ridge Treatment Center, where three patients died in 2025 and others were placed in “immediate jeopardy” amid a string of noncompliance with safety regulations, according to federal records.
The Centers for Medicare and Medicaid Services notified the psychiatric hospital April 15 that it is terminating its participation agreement effective April 30, according to Thomas Vazquez, assistant press officer for the Texas Department of Health and Human Services.
“Our priority is protecting the health, safety and well-being of people served by the facilities and providers we regulate,” Vazquez said in an emailed response to Public Health Watch. “Texas Health and Human Services Commission is working quickly to find placements for Medicaid patients located at the facility.”
In an email Friday to Public Health Watch, Laurel Ridge CEO Ashley Sacriste acknowledged the termination notice but said staff was working to comply with the federal requirements to maintain participation.
“The Centers for Medicare & Medicaid Services (CMS) has informed Laurel Ridge Treatment Center that, in their opinion, the facility does not currently meet the requirements for participation in the Medicare program,” she wrote. “We are hopeful that we can work collaboratively with CMS to clarify the basis for its findings and to demonstrate the facility’s ongoing compliance.
“We are deeply committed to providing high-quality care to each patient we serve and are determined to address any areas of concern in order to successfully participate in the Medicare program. We are taking all efforts to remain a provider of choice and fulfill all obligations. At present, the facility is open and fully functional, and we will continue to provide care for all patients currently with us. For nearly 40 years, Laurel Ridge Treatment Center has provided lifesaving and life-improving care to the individuals we are privileged to serve.”
Laurel Ridge operates a 330-bed facility on 29 acres in north-central San Antonio that it describes as “one of the largest freestanding psychiatric hospitals in the United States.”
Three patients died inside Laurel Ridge last year, compared to just one death in the previous four years, according to police, state and federal records reviewed by Public Health Watch.
A dozen former hospital staffers who spoke to Public Health Watch said the deaths came after a series of policy changes at the hospital in 2024 that reduced staff-to-patient ratios.
The changes followed Sacriste’s appointment as CEO in July 2024 following the abrupt resignation of Jacob Cuellar, who was charged in June 2024 with sexual abuse of a child not affiliated with the hospital. He pleaded not guilty and is awaiting trial in Bexar County.
Some of the hospital staffers told Public Health Watch they had worked at Laurel Ridge for more than 15 years but had decided to step down after their jobs became too difficult and risky.
A Public Health Watch review of 911 calls made from Laurel Ridge since 2021 shows that monthly calls for “assault” or “assault in progress” cases nearly tripled after Sacriste took over as CEO.
Three deaths
The first two deaths last year at Laurel Ridge came within just weeks of each other. Federal inspectors and some former staff members have since raised questions about whether staff was checking regularly on all three patients as required.
On March 3, 2025, a 44-year-old man with schizophrenia and mild intellectual disability died in his room after being admitted that day with suicidal thoughts, according to a federal survey in May. He had been placed on psychiatric medication after being admitted, but the Bexar County Medical Examiner’s Office concluded that he died of natural causes complicated by his mental health episode.
“The decedent had been admitted to inpatient treatment for a psychotic episode and was sleeping alone in a seclusion room under observation when he was found unresponsive,” according to the autopsy report from the medical examiner’s office. “There is no evidence of significant trauma or toxicity that would have caused or contributed to death.”
The man began acting out, and was administered two psychiatric drugs and placed in seclusion, according to the police report and a May CMS report.
The Texas Administrative Code requires that patients put in seclusion be monitored at least every 15 minutes, but nobody checked on him for nearly an hour until he was found “unresponsive and bleeding from his mouth,” the May survey says.
The man’s family declined to be interviewed about his death.
Less than two weeks later, on March 15, 2025, a 42-year-old patient was found dead in his bed.
His death, too, was attributed to natural causes, hypertensive heart disease, with no contributing factors from the medication found in his system, according to the medical examiner’s office.
Seven months later, on the morning of October 12, 2025, a 26-year-old woman who had been struggling with heroin withdrawal was also found unresponsive in her bed, according to a CMS survey from November.
The woman had been admitted two days earlier for suicidal ideation, and had high blood pressure at 7 p.m. the day before, but the nurse failed to communicate this to her doctor, according to the report.
Staffers at Laurel Ridge did not check her regularly throughout the night, however, according to the CMS survey. She was checked only twice and was found dead at 9 a.m. the next day.
Her family could not be reached for comment, but the medical examiner once again attributed her death to natural causes. She was morbidly obese and had an enlarged heart, both of which contributed to her death, according to the autopsy report.
“There is no evidence of significant toxic ingestion or trauma that would have caused or contributed to death,” the report found.
‘Admit, admit, admit’
Staffing issues at Laurel Ridge have likewise persisted.
On the day the 44-year-old man died in early March of last year, there were four staffers overseeing 25 patients in a unit that should have had at least five staffers. Twelve of 14 units were not adequately staffed, and some had 29 or 30 patients when they were supposed to have 25, according to the CMS survey.
“I have seen other CEOs in the past where if we don’t have the staff we don’t bring in patients because it becomes unsafe not only for the staff, but for other patients that are there,” said a mental health technician who worked in Laurel Ridge for almost 20 years before stepping down last year. “Now it’s like, admit, admit, admit, and there is no staff.”
More problems surfaced in March and April of 2025. Staffers rushed a 16-year-old patient to another hospital’s emergency room after the teen took methamphetamine provided by another patient. In other unrelated incidents, seven teenage girls were involved in a “riot” at the facility, and three patients escaped, according to police reports and the CMS survey.
Inspectors also flagged the facility during this period for failure to stop the flow of contraband into the facility. In August, a patient hurt herself with a razor blade she was able to sneak in, according to an CMS survey.
The staffing ratios at Laurel Ridge were worsened by the removal of walls that separated units in several buildings. With the units divided, a separate registered nurse was required for each unit. Without the wall, one nurse could oversee more patients, former staffers told Public Health Watch.
This arrangement made it harder for nurses and mental health technicians to stop dangerous situations from escalating, the former staffers said.
“If a patient attacked another patient, we could separate them because of that wall,” one said. “Now it’s just a wide-open area.”
Laurel Ridge issued a plan of corrections to CMS in November 2025, and the staff-patient ratio has improved. But staffers who recently left the facility don’t believe things are getting better.
At least 30 employees have left or been fired since Sacriste arrived, according to current and former staffers, who described a “toxic” work environment.
“Staff are leaving because they are tired,” one mental health tech told Public Health Watch. “They are tired of being hurt. They are tired of working under extremely unsafe situations.”
