State Abuse

Despite reforms, abuse in state institutions remains high.

Link to Texas Observer story

by DAVE MANN

Published on: Monday, April 19, 2010

Despite reforms by state lawmakers, abuse and neglect of Texans with mental retardation in state-run institutions has increased the past three years, according to an Observer analysis of state data. Reforms enacted in response to a high-profile abuse scandal have left the facilities with fewer residents and more staff, yet confirmed allegations of abuse rose 57 percent between 2007 and 2009. However, the number of abuse cases has dropped slightly so far in 2010, indicating that perhaps the latest reforms are having some effect.

For the past four years, Texas’ 13 sprawling, state-run institutions for the mentally retarded—formerly known as State Schools and which the Legislature recently renamed State Supported Living Centers—have been the source of horrific tales of abuse. Since 2005, investigations by the U.S. Department of Justice and numerous media outlets, including theObserver (see “Systemic Neglect,” May 1, 2008), have documented hundreds of instances in which Texans with mental retardation were beaten, neglected and, in some instances, killed by the staff charged with caring for them. In the most famous incident, workers at the Corpus Christi State School recorded a “fight club” video in which mentally disabled residents were forced to beat each other.

The abuse scandal was rooted in years of under-funding by the Legislature. Low pay and astronomical staff turnover, which ran as high as 70 percent in some facilities, led the institutions to hire low-grade employees—and in a few instances convicted felons—who never should have been caring for vulnerable, and often volatile, residents.

Despite reforms passed in the past two legislative sessions—including a 12-percent funding increase and nearly 3,000 additional caregivers—the number of abuse and neglect cases remains high.

Confirmed cases of abuse in State Supported Living Centers rose 57 percent between 2007 and 2009, according to an Observer analysis of state data, from 458 incidents in 2007 to 719 last year.

In the first six months of fiscal year 2010, which began in September, confirmed cases of abuse and neglect have dipped by 19 percent. State Supported Living Centers are on pace to report 580 cases of abuse in 2010, which while lower than 2007’s peak, is still historically high.

The facilities are now closely monitored by Justice Department inspectors, and some reforms have already had an effect. In the past six months, State Supported Living Centers have added more than 1,000 full-time employees, according to state records. And the facilities have fewer residents, as state officials transfer more disabled Texans into small, community group homes. State Supported Living Centers now employ nearly 13,000 workers to care for about 4,000 residents.

While the slight decrease in abuse cases so far in 2010 is encouraging, the Legislature’s refusal to give State Living Center employees a pay increase may hamper reform.

State Supported Living Center workers are on average the lowest-paid state employees, according to the Texas State Employees Union. Direct care workers earn a starting salary of roughly $8 an hour. Parents and families of residents have often blamed abuse and neglect partly on low pay.

It’s worth noting that confirmed cases of severe physical and sexual abuse have remained fairly constant the past three years, according to state data. But there’s been a sharp increase in confirmed incidents of “neglect,” which don’t involve physical violence by the staff, but usually consist of incompetent oversight of residents: allowing residents to fall from bed or leave the facility or harm themselves and others. In other words, the kinds of incidents you would expect from a staff that’s largely earning fast-food wages.

When asked if low salaries contributed to the increase in neglect, Cecilia Fedorov—a spokesperson with the Department of Aging and Disability Services, the state that oversees State Living Centers—said, “I don’t believe there’s ever an excuse for abuse, neglect or exploitation.” She added that salaries at state institutions are a “legislative question,” and not up to the agency.

The agency did ask the Legislature for a salary increase last session for State Living Center workers, and lawmakers denied the request.

Without a pay increase for direct care workers, it’s questionable whether the recent decline in abuse numbers will continue and whether Texas’ institutions for the mentally disabled can be adequately reformed.

Download abuse statistics for State Supported Living Centers in 2008 at www.txlo.com/ssabuse08

Download abuse statistics for State Supported Living Centers in 2009 at www.txlo.com/ssabuse09

Download abuse statistics for State Supported Living Centers in 2010 at www.txlo.com/ssabuse10

Slipping Through the Cracks

by Emily Ramshaw

April 21, 2010 | LINK HERE

Cameron Maedgen knows he’s dangerous. The autistic, brain-damaged and often suicidal 19-year-old — turned over to the foster care system as a drug-addicted infant — has violent outbursts and a fascination with guns. He's been jailed three times and admitted to a San Angelo-area psychiatric hospital six times since January.

But his adoptive mother’s tireless effort to find her son structure — a group home or residential setting where he’ll be safe and well-treated — has been foiled by a single factor: his IQ score. The state calls Maedgen too high-functioning for a residential facility or for the in-home program it funds for people with disabilities. Karen Bartholomeo says her son is too low-functioning, and certainly too unstable, to go without them.

Maedgen isn’t the only one in this conundrum. Advocates say a rising number of autistic and mentally ill children are reaching adulthood without the prospect of services because their IQs are simply too high. The state limits admission to its state-supported living centers to disabled people with IQs under 70 — and generally caps community-based care at an IQ of 75. Just because an autistic person’s IQ averages out higher, these advocates say, doesn’t mean he or she can manage without care.

“There’s nothing for us,” Bartholomeo says, her voice tinged with desperation. “Right now, my only hope is that he doesn’t kill himself, that he doesn’t hurt anyone else and that he stays out of the prison system.”

In the inverse situation, advocates say, are people with disabilities whose IQs are just low enough to keep them in state institutions but who might be better served in the community. But if their IQs test above 75, they not only don't qualify for the state-supported living centers — they don't qualify for most community-based programs either.

IQ tests are designed to measure the mental ability of children and to identify people who have cognitive or developmental disabilities. They're one of several criteria state officials use to determine whether someone qualifies for services, either at home or in a residential setting. Though the tests and what they seek to measure are complex, "as degrees on a thermometer show a person's temperature, IQ tests measure intelligence calculated from questions or tasks found ... to reflect intellectual functioning," said Cecilia Fedorov, a spokeswoman with the Department of Aging and Disability Services.

Though some experts question the veracity of IQ tests, of which there are a half dozen different varieties, they're recognized by national organizations like the American Psychiatric Association and the American Association of Intellectual and Developmental Disabilities — and so are used by state agencies that need some barometer for offering care.

Currently, 15 percent of the 4,300 residents in Texas’ state-supported living centers have “mild” mental retardation classifications, meaning they have IQs between 50 and 70. Fedorov said local mental retardation authorities perform the initial IQ test when a person applies for services. “Once an IQ determination is made, individuals are not required to be re-tested,” she said.

The cut-off gives institutionalized people and their guardians little incentive to get updated IQ assessments, for fear they’ll be left without any services, said Beth Mitchell, an attorney with the nonprofit disability rights group Advocacy Inc. “The real issue is why we have to tie services to a number — and it’s because of a lack of funding,” Mitchell said. “But if this kid ends up bringing a gun to a public place, ends up getting shot by a cop because we couldn’t spend a couple of extra dollars for care, what’s the cost to society?”

Vicki Hill Riedel’s 22-year-old son, Ryan, faces the same barrier. He has Asperger’s, schizoaffective disorder and seizures — but his IQ is normal. Ryan didn’t last long at a psychiatric group home, which had no experience with autistic patients. He’s been taken to a Plano-area psychiatric hospital so many times that the local police called Texas’ Adult Protective Services division. Ryan faced the exact same hurdle at the local mental health/mental retardation authority — his IQ surpassed 80, so he didn’t qualify for care.

At home, Riedel says, Ryan sleeps half the day then plays video games, occasionally agreeing to do minor chores in return for a trip to a restaurant. Rather than enjoying their retirement, Riedel says, she and her husband are essentially forced to run an assisted-living facility in their home. They have no alternative. And when they grow too old to care for Ryan, he won’t either. “My son,” she said, “is on the leading edge of a tremendous number of children with various levels of autism who will be reaching adulthood very soon.”

Bartholomeo, a social worker at San Angelo’s Goodfellow Air Force Base, became Maedgen’s foster parent when he was 3 weeks old and weighed just 5 pounds. Born addicted to cocaine, he required years of extensive rehabilitation to catch up developmentally. Maedgen’s behavioral problems presented early and only worsened. He was diagnosed with depression, ADHD, bipolar disorder and then finally Asperger’s, a form of autism in which language develops normally. He was on six different medications at once.

Maedgen thrived with structure, but Bartholomeo could only find it for him intermittently. She got him admitted to a youth residential treatment center and then a youth home, but both times he was too tough for workers to handle. Back at home, he was bullied in school and started stealing — jewelry from Bartholomeo, then BB guns from the local Academy store.

Bartholomeo turned Maedgen back over to state custody before he turned 18, hoping he’d have better access to services than she could provide. But when there were no foster homes to take him, and she learned he would be sleeping on the floor of state offices, she brought him back home. She visited private facilities she couldn’t afford. She begged and pleaded with disability officials to put him in a state-supported living center or to find him a group home. But averaged together, his performance IQ of 60 and his verbal IQ of 130 put him at a score of 95 — at the low end of “normal,” and well above the state’s cut-off.

In the last year, Maedgen stole a handgun “because it was pretty,” fired it in a local park, then called the police on himself, Bartholomeo says. He sometimes stops taking his medicine, repeatedly cuts himself, then calls authorities to tell them he’s suicidal. And he’s become violent with his mother.

Bartholomeo recently found a state Medicaid program that gives Maedgen 16 hours a week of cleaning, grocery shopping and laundry help — but not the psychiatric or developmental services he needs. “If I could find a way to get his IQ down to borderline, then he would qualify for a group home, for a little bit of structure,” Bartholomeo says. “He’s got a disability.”

'Fight club' lawsuit against top officials to proceed Judge says 4 top officials won't be dropped; trial set for July.

By Corrie MacLaggan

AMERICAN-STATESMAN STAFF

Published: 9:56 p.m. Tuesday, April 27, 2010

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A judge has denied a request from four state officials who asked to be dropped from a lawsuit over a so-called fight club at a Corpus Christi facility for people with mental disabilities.

The officials — including now-retired Department of Aging and Disability Services Commissioner Addie Horn — had argued that they should be exempt from the suit because of qualified immunity, which protects government employees from being sued unless they knowingly violate the law or are clearly incompetent.

But in the ruling on the pretrial motion, U.S. District Judge Janis Graham Jack wrote that a jury could reasonably find that the officials "failed to exercise professional judgment by providing inadequate security."

The judge also denied the officials' request to dismiss the lawsuit.

State officials are appealing to the 5th U.S. Circuit Court of Appeals. The case is scheduled for trial July 2.

Jack granted a request by a fifth administrator to be dropped from the suit.

Robert Hilliard , a lawyer for three of the five residents suing administrators and on-site staffers, commended the ruling.

"This is the most important part of the case in making sure there is responsibility all the way up the food chain," Hilliard said. Holding top officials accountable, he said, "will prevent in the future the slow erosion of safety measures for the residents."

Lawyers for the residents argue that the officials should have known before the 2008 and 2009 fight club incidents that more security was necessary, in part because of a Department of Justice investigation that began in 2005 that concluded that the 13 Texas facilities fail to protect residents from harm. The Justice Department is still monitoring the facilities, now called state supported living centers, which are home to 4,300 Texans.

But Texas Attorney General Greg Abbott, who is representing the administrators, wrote in court documents that Horn and the others took action to address the issues raised by the Justice Department. For example, he wrote, Horn lobbied the Legislature to increase staffing for the centers and mandated retraining for staff on abuse and neglect.

"It is simply false, conclusory and self-serving for the plaintiffs to even suggest that the defendants 'did nothing' in the face of DOJ's allegations," Abbott wrote. "The evidence overwhelmingly demonstrates that the Defendants responded immediately to the DOJ's concerns."

In addition to Horn, the officials being sued are: Barry Waller , former assistant commissioner (he retired in December); Denise Geredine , former director of state schools (she now works elsewhere in the department); and Iva Benson , superintendent of the Corpus Christi State School (she has the same job, but the title has been renamed "director," and the facility is now known as Corpus Christi State Supported Living Center).

Deputy Commissioner Jon Weizenbaum was dropped from the suit because he did not directly oversee the institutions, Jacks ruled.

The suit was filed last year by the family of one resident; it was later expanded to include five residents. In court documents, residents say they were forced to fight other residents for staffers' amusement. The lawsuit says the residents were "punched, kicked, chased, smothered with pillows, wrestled, humiliated, threatened and terrorized." And it says staff members yelled at residents to "fight him, fight him ... beat him up."

Lawyers said in court documents that the officials failed to provide adequate supervision, security, staffing and monitoring of staff, and that they should have known more security was needed.

In 2007, there were 1,013 allegations of abuse, neglect or exploitation — and 51 confirmed cases — at the 430-bed facility, according to court documents. That year, administrators had seen enough of an increase in horseplay that a facility official sent a warning to staffers that such incidents would not be tolerated.

And state Rep. Abel Herrero, D-Robstown , had been demanding increased security at the facility since 2007, lawyers for the residents say. Herrero, whose district includes the Corpus Christi facility, said Tuesday that the judge's ruling demonstrates that "there is some evidence to show that the fight club incidents at the state school may have been prevented if those with supervisory authority had acted expeditiously, decisively and thoroughly in addressing the systematic deficiencies they knew — or should have known — existed at the time."