U.S. official critical of state's living center agreement

Link here to Corrie Maclaggan's Austin American Statesman article

The U.S. Department of Justice's civil rights chief said Friday that an agreement with Texas on fixing state institutions for people with mental disabilities "falls short" on moving people out of the facilities.

"There are just so many people who are being warehoused in these institutions, and I think that's a tragedy," Thomas Perez , assistant attorney general for civil rights , said in an interview in Austin. He was in town to speak at a National Conference of State Legislatures redistricting law seminar.

Last June, the Justice Department and Texas entered into an agreement to improve health care and speed up investigations of abuse and neglect at the 13 facilities now known as state supported living centers. It was the culmination of a federal investigation that began in 2005 at the Lubbock facility after reports of abuse and neglect and later expanded to the other institutions.

Perez, an appointee of President Barack Obama, took office in October — months after the Texas deal was signed. It's not clear whether his objections — which signal a departure from what the Obama administration said at the time the deal was announced — could affect Texas. He said he inherited the agreement and needs "to respect that on a certain level." But now, he said, he'd like to implement far more aggressive agreements with states.

"The paradigm prior to our arrival was: 'Let's just make sure that the facilities are safe,'" he said. "The new paradigm is: 'Question No. 1 — What is your plan for moving eligible people into communities? Step two ... What is your plan for ensuring that the facilities are safe?"

Texas' philosophy, one state official said, "may be a little different."

"In Texas, we support choice," said Stephanie Goodman, a spokeswoman for the Health and Human Services Commission , referring to the options of living in institutions or smaller group homes or enrolling in state programs that help people with disabilities live at home.

Still, the state is committed to ensuring that the population of the institutions continues to decline, said Cecilia Fedorov , a spokeswoman of the Department of Aging and Disability Services. About 4,300 now live in the institutions, down from 5,428 in 2000.

Texas allows people who want to leave state supported living centers to skip over a waiting list for home-based programs, and last year the Legislature expanded the number of spots in home-based programs available to living center residents.

"We need to be doing everything we can to make successful transitions for people who wish to move," Fedorov said.

Perez said that an ideal agreement would have specific numbers of people that the state should move out and timelines of when that should happen.

The Texas agreement requires the state to identify people who want to move out of the institutions, help them make that transition, and make sure their needs are met in their new setting, Fedorov said. But there are no specific numbers on how many people should move out.

Without those specifics, said state Rep. Elliott Naishtat , D-Austin, a member of the House Committee on Human Services, "what we're dealing with is wishful thinking at best."

At the time the agreement was signed, U.S. Attorney General Eric Holder praised it.

"The Justice Department is committed to protecting the fundamental rights of all our citizens," Holder said in a June 2009 press release. "This agreement reflects that principle by protecting the civil rights of some of Texas's most vulnerable residents."

In the 1990s, Texas closed two state institutions as part of a lawsuit settlement. Later, the state considered closing more, but after heated hearings, decided not to.

Susan Payne of College Station, whose sister, Diane Ward , lives at Denton State Supported Living Center, said she finds it "very offensive" that Perez would say people are being "warehoused."

"Family members of people who live at the state supported living centers are very, very aware of the options in the community, and the families have chosen this as the best setting," Payne said.

But Perez said that moving people out of institutions is long overdue.

"It's a heck of a lot easier to have everybody in one setting," he said. "But ease should never trump what is right, and what is constitutional."

cmaclaggan@statesman.com; 445-3548

Disturbing findings in wake of 'fight club'

By TERRI LANGFORD

Copyright 2010 Houston Chronicle (Link)

March 22, 2010, 10:24PM

Criminal fingerprint checks show at least 36 employees continued to work on the state payroll while caring for the mentally disabled — despite being arrested for felonies ranging from indecent exposure, to aggravated assault, child rape and murder.

Of those 36 with arrests, 17 had felony convictions and the remaining 19 still face trial, according to Texas Department of Aging and Disability Services records released to the Houston Chronicle Monday.

The release of the records, first requested six weeks ago, came on the eve of a House committee meeting Tuesday in which lawmakers will discuss for the first time what improvements have been made regarding care at the facilities in the wake of last year's shocking “fight club” incident in Corpus Christi.

While that's less than one percent of the 11,785 DADS employees who were fingerprinted and work at 13 State-Supported Living Centers, formerly known as state schools, the newest reform shows how pre-employment criminal background screens failed to alert the state to employees with criminal records.

Current pre-employment screening only checks for convictions in Texas. The fingerprint checks linked employees to convictions and arrests outside of Texas. Of the 17 with convictions, 13 have been terminated or resigned. The other four are still in “process” according to the agency, which released the numbers without comment.

“Of course it still matters. That amount of people has control over a handful of residents who are unable to communicate abuse or neglect or ward off that type of aggression,” said Beth Mitchell, senior managing attorney for Advocacy Inc., a group that has fought for better care of the mentally disabled in Texas. “You don't want someone like that corrupting other staff. That's what we saw in Corpus Christi. It only took one staff to corrupt a group of staff in the fight club.”

Cell phone fight videos

The incident, at what has now been renamed Corpus Christi State-Supported Living Center, was discovered by police a year ago when a lost cell phone had videos of mentally disabled residents fighting. Voices of the residents' state caretakers could be heard encouraging the residents to fight one another. Since then, four former DADS workers have been convicted as a result.

The fingerprint checks and another new reform, random drug testing — which snared 23 DADS employees who tested positive for drug use — are the only significant progress seen in the year since the cell phone video surfaced and since DADS entered into a settlement late last year with the U.S. Department of Justice.

A “baseline” report on the Corpus Christi facility, the first of 13 to be conducted on each center as part of that DOJ agreement, shows little has been done since the fight club scandal put Texas' care of the mentally disabled in the spotlight.

While the March 10 monitoring report of Corpus Christi State-Supported Living Center revealed “a number of good practices in place,” it also noted “a number of the areas in which there is a need for improvement.”

For example, in the past year, the state has yet to establish a “zero tolerance” of abuse at Corpus Christi, there are no full-time psychiatrists on staff in the Corpus facility and no standard diagnostic procedure in place for residents with psychiatric problems.

“It's pretty clear from the report that they're really far behind in meeting the criteria of the DOJ settlement,” Mitchell said.

Also, the DADS staff in Corpus has not come up with better ways to monitor the physical and nutritional needs of their residents and are not able to pinpoint those residents who are at-risk of abuse.

“The Facility is at the very beginning stages of implementing the process of screening individuals to determine if they fall into an at-risk category,” the report stated.

Documentation problems

In many areas, the monitors noted the Corpus Christi facility failed to keep proper documentation on residents. Dental care records were missing, as was proof that staff reviewed some residents' medication and allergies. The current forms being used at the Corpus Christi center failed to document residents' vocational strengths, needs or preferences.

A spokeswoman for state Rep. Patrick Rose, D-Dripping Springs, the chair of the House Committee on Human Services, said Rose would not be making any comments about the report until Tuesday's meeting. Calls to other members, including state Rep. Abel Herrero, the committee's vice chair, were not returned.

terri.langford@chron.com

Report: State facility for people with disabilities lacks psychiatrists, trained therapists

Report: State facility for people with disabilities lacks psychiatrists, trained therapists

Posted using ShareThis

By Corrie MacLaggan

AMERICAN-STATESMAN STAFF

Published: 8:54 p.m. Friday, March 19, 2010

Nine months after Texas and the U.S. Department of Justice entered into a settlement to improve health care and more quickly investigate reports of abuse and neglect at state institutions for people with mental disabilities, the facility in Corpus Christi doesn't have staff psychiatrists, has therapists who are ill-equipped to work with people with complex needs and doesn't have a clear zero-tolerance policy for abuse and neglect.

That's according to a new report on the Corpus Christi State Supported Living Center, the first issued by monitors reviewing the 13 institutions as part of the settlement. On Tuesday, the state House Committee on Human Services is set to examine progress at the facilities.

"The state-supported living centers, specifically Corpus Christi, are overwhelmed in meeting their responsibilities for caring for people with intellectual disabilities," said state Rep. Abel Herrero , D-Robstown , who is vice chairman of the committee and whose district includes the Corpus Christi facility.

The report says that the culture appears to be changing for the better at Corpus Christi, where last year staff members were found to have been organizing fights among residents. Staff members seemed to know to report suspected abuse and neglect immediately, and when asked how, they consistently flipped over their badges to show a sticker with instructions. And residents "appeared happily engaged" in activities, the report said.

But it also said that people who might benefit from alternative communication devices don't have access to them, and that residents are over-prescribed psychotropic drugs.

"We agree that there are many areas of concern, many areas in which we need to make changes and improvements," said Cecilia Fedorov , a spokeswoman for the Department of Aging and Disability Services .

The preliminary report about Corpus Christi — reports on the other institutions are expected by summer — isn't evaluating whether the facility is adhering to the settlement terms. That comes later, and the monitors will review each facility every six months until it has been in compliance for a year — a process Fedorov said could take five years or more.

The settlement is the culmination of a Justice Department investigation that began in 2005 at the Lubbock State School after reports of abuse and neglect and later expanded to the other facilities.

In addition to the changes required by the settlement, the Legislature last year mandated video cameras in common areas (they're in place in Corpus Christi but not yet elsewhere); random drug testing of the 12,500 employees (16 have been fired for testing positive, and seven resigned instead of getting tested); and fingerprint background checks for employees and volunteers (these are taking place, officials said).

"Although there are encouraging signs of progress, we still have a long way to go in making the system the best it can be for this vulnerable population," said state Sen. Jane Nelson, R-Flower Mound, chairwoman of the Health and Human Services Committee and author of reform legislation.

In the report on Corpus Christi, the monitors noted that the limited availability of psychiatry services — there are two part-time consulting psychiatrists but no full-time staffers — "appears to have a negative impact on the delivery of services."

Fedorov said that the department is "aggressively recruiting" to find two staff psychiatrists. "We, like everybody who does deal with behavioral health, are competing for very few licensed and qualified psychiatrists," she said.

On the drug issue, the report gave an example of a resident whose behavior deteriorated after his mother's death. He threw temper tantrums, destroyed property and manipulated staff members.

Instead of a behavior management program, "the psychiatrist is prescribing potentially hazardous and dubiously effective drugs to stop the behaviors," the report said.

Beth Mitchell, managing attorney of Advocacy Inc., which advocates for Texans with disabilities, said the communication aid issue raised in the report shows how far behind the centers are in providing adequate care.

"Communication is often the reason people have behavior problems," she said. "If you can't communicate, you act out."

Mitchell also said she's worried about the lack of a clear zero-tolerance policy. "This is a place where people were being beat up, and you don't have zero tolerance?" she said.

Fedorov said that the department does not tolerate abuse and neglect, but that "we need to take steps to make sure that the policy is even more clear to everybody who comes on campus."

As part of a new legislative requirement, Gov. Rick Perry in February appointed an ombudsman for state supported living centers. George Bithos , a dentist and ordained Greek Orthodox deacon, has been visiting campuses since starting the job.

"I have found very dedicated people and people that are open to being looked at," Bithos said. "I've been impressed with the quality of the people, yet I'm aware that there are problems \u2026 that we'll need to take very seriously."

cmaclaggan@statesman.com; 445-3548