Report faults Texas treatment of mentally disabled

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By JEFF CARLTON Associated Press Writer © 2010 The Associated Press

May 27, 2010, 4:17PM

AUSTIN, Texas — A mentally disabled man with feces on his hands and legs was found shoeless and pantless wandering through a field in 14-degree weather. Officials say overwhelmed staffers at the state institution where he lived were occupied with other assignments.

A report released Thursday examining conditions at the Lubbock State Supported Living Center found more problems with a state-run facility a year after Texas lawmakers agreed to spend $112 million to improve conditions under threat of a Justice Department lawsuit. The federal government had documented widespread mistreatment of the mentally disabled in Texas.

Among the problems cited by independent monitors at the Lubbock facility was a critical shortage of nurses, resulting in significant medication errors. The facility has 50 vacancies in its nursing department, which is budgeted for 105 employees.

The report also says the Lubbock center has a 60 percent annual turnover rate among employees who directly care for the mentally disabled. Low wages make it difficult to find loyal employees, officials acknowledged. Staffers who work directly with mentally disabled residents make about $22,400 a year in Lubbock.

"This is not easy work, and the pay is not extraordinarily high," said Chris Traylor, commissioner of the state agency that oversees Texas' 13 institutions. "In order for staff to be retained in this work, you have to have a heart for what you are doing."

At least 13 workers have been fired since July for the abuse, neglect or exploitation of residents, according to the report. A member of the monitoring team called the abuse hot line to report neglect of a female resident who appeared to need help. When taken to the hospital, she was diagnosed with a urinary tract infection, an infection in her mouth and pneumonia.

The monitoring team criticized the school for having six workers caring for 20 residents, "all of whom were totally dependent on staff for every activity of daily living."

Medical record keeping was another problem. In one case, a Feb. 24 abdominal x-ray of a resident showed a coin in the lower intestine, but it was not in the resident's medical record and went unreported to the medical team until March 17.

Other problems include grouping too many residents with behavioral issues together, creating tired workers by forcing them to work mandatory overtime, high levels of aggressive incidents among residents and significant underreporting of medication errors.

The report was not entirely negative. It praised the Lubbock facility for its staff's knowledge on reporting abuse and neglect and efforts to serve residents in an integrated setting. It also said communication between medical departments was impressive.

The report was based on monitoring done during a one-week period in mid-March.

The monitors were permitted in the facility as part of an agreement with the Justice Department. It resulted from a series of federal investigations that found that at least 53 deaths from September 2007 to September 2008 were from conditions considered preventable, such as pneumonia, bowel obstructions or sepsis, indicating lapses in proper care.

The Lubbock report and others across the state are considered baseline reports. The institutions will be inspected every six months beginning in July to make sure they are in compliance with the Justice Department settlement. Texas has until the end of 2013 to bring their facilities into compliance.

"It does instill us with a sense of urgency," Traylor said. "We are focused on long-term improvements that will last long after the settlement agreement is concluded."

The 13 institutions are home to about 4,300 residents with significant intellectual and developmental disabilities. The facilities employ nearly 13,000 people.

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Associated Press writer Jim Vertuno contributed to this report.