Improving care environment proves difficult for Lubbock State School

By Sarah Nightingale AVALANCHE-JOURNAL

Sunday, August 30, 2009Story last updated at 8/30/2009 - 2:05 am

The last people to see Michael Ray Nicholson alive recounted a brutal scene.
Nicholson, who family say had the mental capacity of a 2-year-old, was slammed on the bed, laid on and choked with a towel.

His face turned blue. Others watched, but did nothing.

Then, the man, just a teenager when he first came to the Lubbock State School, died.

Reports obtained by The Avalanche-Journal show school staff told state investigators about the June 6 altercation between employee Donnell Smith and 45-year-old Nicholson.

The death, recently ruled a homicide, occurred more than four years after a U.S. Department of Justice investigation uncovered the school's failure to prevent abuse and neglect of the severely mentally disabled residents in its care. Particularly troubling, the report noted, was the death of 17 residents in an 18-month period, several of which were identified as potentially preventable.

Better and worse
The Texas Legislature, concerned about safety through the entire state school system, has allowed the schools to hire more staff, and Lubbock's school is trying to fill more than 100 new positions.
Even before that, state and school officials say they improved how they care for their mentally disabled residents.
In 2006, the year after the Justice Department investigation, the number of abuse and neglect cases dropped.
But public records obtained by The Avalanche-Journal through the Texas Public Information Act show the number of cases in 2007 and 2008 dramatically increased.
The school has fired 73 employees in four years, but as of yet, none have faced criminal charges.
Criminal action is needed to stop the abuse and neglect, said Lilly Nicholson, Michael's mother.
"The state schools can only turn over the information of abuse and neglect to law enforcement and fire the people responsible, they can not do more than that," she said.
"If the people working there are aware that there will be consequences, they will not be as likely to assault, injure or neglect the ones they are hired to care for. It's a disgrace that this is allowed to continue with no accounting."

A rocky road
The Lubbock State School - now officially named the Lubbock State Supported Living Center - is north of the city, on University Avenue. The facility opened its doors almost 40 years ago to care for people with mental retardation from a 54-county area.
The 243 residents at the school range from teenagers to the elderly and suffer from a spectrum of disorders. While some have jobs and live semi-independently in campus cottages, others are confined to bed; their physical and mental disabilities so severe that around-the-clock care is needed.
On March 12, 2005, the Department of Justice told the state it would investigate conditions at the school through a visit and a review of records relating to the care and treatment of residents. That took place the week of June 13.
More than a year later, the Justice Department published its findings: The school was failing.
Recognizing briefly "LSS is predominantly staffed by dedicated individuals," the 40-page report details how the facility "substantially departs from accepted professional standards of care for the residents."
The state entered into negotiations with the federal government, hoping to appease the Justice Department while avoiding a lawsuit, Laura Albrecht, spokeswoman for the Texas Department of Aging and Disability Services, told The Avalanche-Journal in July. DADS is the state agency that owns and operates the 13 state schools.
Those talks, Albrecht said, continued into 2008, as the Justice Department expanded its investigation to Texas' other supported-living centers. Similar problems, reports show, were uncovered at all of the schools.
This May, the state and the federal government reached an agreement on how the state should fix the problems. The 50-page settlement mandates the state implement training, improve medical procedures and keep better records. A state-paid "expert monitor" at each school will oversee the progress, according to the report.
Albrecht said in a July interview that changes in Lubbock began long before the May agreement.
"We started making changes in 2005," she said. "I think we are making great strides at the state schools."

Making changes
The Lubbock school's 226-acre site is a maze of administrative, care, activity and cottage buildings that's neat and well kept.
The problems highlighted by the Justice Department were not evident in a recent Avalanche-Journal tour of the facility.
Not featured in the 2006 report, for example, is a workshop where residents who are able to can work to earn money. There are also opportunities for arts and crafts, some of which are sold in the school's Hearts and Hands store, and a foster-grandparent program in which seniors dedicate hours of their time to residents, about half of whom have no family that visit.
And there are dedicated staff, from the caregivers who have worked here for decades, to the therapists working Aug. 7 to help Ronnie Beck - who is severely physically and mentally disabled - learn to use a computer, which employees hope will help him communicate.
Members of the school's administration said in August they wish people would see the positives.
"We have a lot of great staff, we can't overlook the work they do here," said Superintendent Kristin Weems. "It takes a certain person to interact with (the residents) every day. It can be a big buff man, or a tiny woman. It's all about their belief system and values.
"We've never said this is a job for everyone," continued Weems, who said the residents, many of whom have a dual diagnosis of mental retardation and psychiatric problems, can pose serious challenges for caregivers.
Challenges that can have deadly consequences.

Continued problems
News reports have shown abuse and neglect at most of the state's 13 institutions in the last few years. In Lubbock, there were 27 confirmed cases of abuse and neglect in 2005, according to data obtained by The A-J from the Texas Department of Family and Protective Services through the Texas Public Information Act.
The state took immediate action, Albrecht said.
And, in 2006, the number of abuse and neglect cases fell, with 11 cases confirmed by the DFPS.
In 2007 and 2008, however, the numbers rose.
There were 30 confirmed cases of abuse and neglect in fiscal year 2007 - the state fiscal year runs September to August - and 35 cases in 2008, according to state data.
Capt. Greg Stevens of the Lubbock Police Department said Wednesday his department investigated two of the 2008 cases on the grounds of suspected criminal activity.
Police reports obtained by an A-J open records request say in April 2008, a 44-year-old male resident was assaulted by staff member Marie Ryan, then 27, who hit him "with a closed fist 'hard' numerous times on the back" after he made a mess with some chips. A staff member testified the man was "in pain and had a painful expression on his face."

Ryan was fired from the school and received a probationary sentence of five years "deferred adjudication," after which the charges will be dropped.

Also in 2008, police investigated the April death of 23-year-old resident Maria Magdalena Urdiales, who choked on candy while on a school outing. Although the cause of death was determined "accidental," the report suggests Urdiales suffered from Pica, a disorder in which people routinely place foreign objects in their mouth and are at a high risk for choking.
DFPS data shows 26 confirmed cases of abuse and neglect in the first 10 months of the current fiscal year.

In March, police investigated one of those cases.

Stevens said an anonymous caller claimed a 60-year-old male resident was injured by a staff member. A summary of the police report reads the resident "was assaulted by an unknown person ... (who) is an employee of the school."

This month, police investigated a report of a 28-year-old male resident being "assaulted in the genital/groin area causing severe trauma to the area," according to a summary of the police report. The same resident, a January report claims, was injured previously by a staff member.
Stevens said only one of the closed cases from 2005 to 2008 will likely end in prosecution: A June 2007 reported assault of a male resident by a staff member who was attempting to restrain him, Stevens said, is pending prosecution by the Lubbock County Criminal District Attorney's Office.

The Nicholson case
The restraint of Lilly Nicholson's son may have resulted in his June death, reports show.
"(The staff) got carried away. If they hadn't done what they did, Michael would be alive today," the mother told The A-J on Aug. 21.
Lubbock County Medical Examiner Sridhar Natarajan ruled Nicholson's death a homicide, noting cause of death as physical altercation with asphyxia.
Nicholson had lived at the school since he was 15 years old.
Six employees - Smith, Jessica Santos, Abrisha Henderson, Amiya Harper, Craig Stevenson and Omar Jordan - were fired in relation to the incident. Multiple attempts by The A-J to contact the employees have failed.

Staff testimony in state reports obtained by The A-J say Smith physically abused Nicholson and neglected to implement CPR when he became unresponsive.
In a statement made to school administrators, Smith said an interviewer "twisted his words." He also told staff he cared deeply about the residents he worked with.
More testimony in the reports states Santos, Henderson, Harper and Jordan also neglected Nicholson by not stopping the incident, a conclusion that Henderson, Harper and Jordan disputed. Stevenson, a probationary employee who was reported to have witnessed all or some of the incident, has not been notified by the state of any disciplinary action.
Police officials presented a manslaughter case to the district attorney's office last week. A decision on whether charges will be filed has not yet been released.

Breaking the culture
Albrecht said her department began working to fix problems noted in the 2006 Justice Department investigation as soon as they came to light.
"We did not wait for the final results," she said.
Albrecht said the schools "increased training for all employees, which includes training on abuse and neglect and recognizing the signs of abuse and neglect."
The DADS, she added, has "a zero-tolerance policy regarding abuse and neglect of residents in our care."
Published reports show that 268 employees statewide - including 27 in Lubbock - were fired or suspended for abusing or neglecting residents at state schools in fiscal year 2008. This year, 24 employees have been fired from the Lubbock school for abusing or neglecting residents, according to DADS data.

Despite those actions, the abuse continues.

"The number of incidents that we are investigating remains relatively steady," said DFPS public information officer Greg Cunningham.

Cunningham declined to comment further on the trend.

"We just do the investigations," he said, "DADS follows up on our findings."

Albrecht said Wednesday she "disagrees" things are not getting better.

"We are making improvements and we are making changes," she said. "We wish we had a crystal ball into the actions people take, but we take every possible step we can to train people and set an expectation that we do not tolerate abuse or neglect."

A tough job
New employees, Albrecht said, undergo two weeks of classroom training, are on a six-month probationary period and receive "ongoing" training at the schools.
Smith's employee file shows he completed more than 200 hours of training between accepting the job as an entry-level mental retardation assistant in 2006 and being fired in June. He was also employed at the school in 1997 and from 2003 to 2004, records show. Albrecht said he left voluntarily on both occasions.
The former employee was aware Nicholson was "not to be restrained for any reason," according to a letter sent to Smith and obtained by The A-J.
Smith's failure to act on his training is not the only evidence the school's standards are not always upheld.
Data on the DADS Web site showed eight instances in the current year in which the Lubbock school failed to properly educate staff, follow procedures that prohibit mistreatment of residents, or use proper restraint techniques. The school also failed recently - 21 out of 21 times - to administer drugs in compliance with physician's orders and failed to securely store drugs, according to state records.
Personnel problems, said a former employee who worked at the school for more than a decade, crop up because some employees "are just interested in the paycheck."
"Most of the people who work at the school are great people," said the source, who requested anonymity. "But some people either don't know they are abusing people or they don't think they will get caught."
The former employee, who left the school in 2008, said Thursday she had seen "a lot of people bring their problems to work and take them out on someone."
Stressful situations, the source said, are worsened by sometimes violent residents and by severe understaffing.
"You have people working 16 hours at a time and then when they ask for a vacation (supervisors) say they don't have enough people to cover," the source said. "I've seen people just walk out, say, 'I can't do this anymore'."
There are 785 positions at the Lubbock State School, Albrecht said. As of Aug. 10, 192 of those were vacant, a situation Albrecht said reflects more than 140 new positions approved by the Legislature, as well as attrition.
Weems said in an August interview the new positions - once filled - would help the school run more smoothly.
"We could always use more staff for care," she said. "We're very appreciative of recent legislative actions."

A different approach?
Lubbock resident Johnia Hudnall, who worked at the state school in the 1970s and cared for her Down syndrome son at home until he died in December, said it's not money, firings, or even the threat of a criminal record that will improve things.
"All the money in the U.S. Mint will not help until somebody cares," she said.
Hudnall, like some Texas advocacy groups, believes mentally disabled people would fare better in smaller settings.
"Smaller facilities lead to better care ... it could be more like a family," she said.
Other groups, however, say such care cannot be transferred to community settings.
"Folks who live here are folks who cannot get their basic needs met in the community because of medical issues or challenging behavior," said Weems, who added the school has about 100 fewer residents over the past four years because of efforts to relocate some who can move into the community.
Nicholson said last week an effort to place her son in a community home failed.
"He was placed in a community home for a short period of time, but (it) was not suited for his needs and he was placed back in the state school," she said.
To comment on this story:
sarah.nightingale@lubbockonline.com l 766-8796 shelly.gonzales@lubbockonline.com l 766-8747
LUBBOCK/As the Lubbock State School looks to fill new positions and improve its care, the June homicide of Michael Ray Nicholson reveals there's still much work to be done.