Be there. Really.

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

Authorities searching for man indicted in death

Police briefs

Lubbock Avalanche-Journal

Wednesday, November 04, 2009

Authorities searching for man indicted in death

Authorities were still looking on Tuesday for Doneil Smith, 38, who was indicted last week in connection with the death of a Lubbock State School resident.

Lubbock County sheriff's deputies attempted to serve a manslaughter warrant on Smith on Friday, but could not find him, Chief Deputy Danny Downes said on Tuesday.

Smith, a former state school employee, is accused of recklessly causing the death of Michael Nicholson, 45, on June 6.

Reports indicate Smith restrained Nicholson by repeatedly sitting on him. Nicholson died of suffocation during a struggle, according to the medical examiner's report.

Officials ask anyone with information about Smith's whereabouts to call the Sheriff's Office at 775-1480 or Crime Line at 741-1000. Callers may remain anonymous.

A $50,000 bond is attached to the warrant, court records indicate.

Recommendations to Executive Commissioner Suehs about qualities needed in the next commissioner of DADS

September 3, 2009

Thomas Suehs, Executive Commissioner
Health and Human Services Commission
4900 North Lamar BoulevardAustin, TX 78751-2316

Dear Executive Commissioner Suehs,

On behalf of Community Now! please accept our sincere congratulations on your recent promotion to Executive Commissioner for the Texas Health and Human Services Commission. (HHSC) We look forward to working with you in your new position to develop a long range strategic plan to create a system that supports Texans with disabilities to live in their communities.

Community Now! is a statewide, volunteer, non-profit organization with a mission to support people with disabilities to live in community with the services and supports necessary to be successful. As you know, Texas continues to be the institution capitol of the United States with more people with intellectual disabilities residing in institutions than any other state. With almost 100,000 people with disabilities on waiting lists for community services, Texas continues to operate an unbalanced service system wasting hundreds of millions of tax dollars on archaic, dangerous institutions.

During the 80th Legislative Session, legislators allocated additional funds to comply with the Department of Justice Settlement with the Department of Aging and Disability Services. r However, history shows that institutions are not a safe environment no matter how much money is allocated. We are deeply distressed that the more horrific the reports of abuse and death at state institutions, the more that money is allocated to fix a system that is broken.

Clearly there is a vocal and active group of parents who insist that their choice to keep their adult loved ones in state institutions is honored. Clearly the voices of those parents and people with disabilities who choose to live in the community and languish on waiting lists are not being heard. Community Now! is represented by families who have seen their families destroyed because of their belief that their family member with a disability should live with their family. There are also people with disabilities who are active with Community Now! who are either waiting for their name to come up on an endless list or who are struggling to maintain their services because of an underfunded, poorly monitored community provider system.

Our hope and sincere recommendation is that you will be able to lead a fundamental shift away from the institutional bias and take the leadership role with the Legislature and HHSC professionals to actively create and implement a plan of action that will judiciously get everyone out of institutions who want out and close the facilities no longer needed. Texas continues to band-aid a gushing artery which has brought our vulnerable citizens to a life that is full of violence, a life of frantic waiting, or a life of inadequate community services. None of these options are acceptable. None of them.

We need you to step up and let our legislators know that our current systems are failing, that Texas is grossly mismanaging money by attempting to fund a dual service delivery system. We need you with your sense of budget expertise and program cost analysis to communicate a vision that will utilize tax payer dollars wisely AND provide exceptional services for Texans with disabilities based on the real choices people are making. And people are not begging to go into institutions. They are willing to wait up to 10 years for a shot at their American Dream. 100,000 people are making this choice.

Soon, you will be making a decision about a new Commissioner for the Department of Aging and Disability Services (DADS). This leader is the pivotal person to lead these reform efforts. Those who represent Community Now! are weary, disappointed and frankly disgusted with the previous DADS administration. We as the consumers of DADS services have been admonished diminished, unwelcomed, ignored, retaliated against and patronized by the very leaders put in place to serve us. Our sincere hope is that all individuals who played a part of the past administration are terminated with all haste.

We make the following recommendations to you and your search team as they consider the appointment of the next Commissioner at DADS:

We recommend that the next Commissioner is recruited from another state with a proven record of reforming long term care services. This is necessary as previous Commissioners and leadership have “grown up” in the failed Texas system and have little vision past these failures.
We recommend that the next Commissioner is a leader with the conviction to make recommendations to our legislators that serve the choices of the vast majority of Texans, which is community services, not institutional care.
We recommend that the next Commissioner actively seek out, recognize and welcome ALL consumers and family members of DADS services.
We recommend that the Commissioner seek creative ways to communicate with consumers and family members not only through traditional channels, but also through open, creative methods that build relationships based in trust rather than fear and admonishment.
We recommend that the Commissioner actively communicate the status of DADS progress in meeting the conditions of the DOJ settlement through public hearings and other methods that allow for feedback from consumers and families.
We recommend that DADS serve as a facilitator for the Promoting Independence Advisory Committee rather than control and manipulate the proceedings and outcomes of this critical committee born from the precepts of the Olmstead Act.
We recommend that the new DADS Commissioner immediately take action to hold key leadership accountable by terminating administrators at state institutions for people with intellectual disabilities as appropriate.

Our sincere hope is that your final decision for the new DADS Commissioner will bring to Texas a person with integrity, vision, who is proactive and will work hard every day to serve the people they are charged with to live a quality life in their community.

We look forward to further communication with you regarding our recommendations.

Another story about the atrocities at Lubbock SS

Local News
082209 LOCAL NEWS 1 AVALANCHE-JOURNAL
The mother of a man who died at the Lubbock State School this summer said reports show her son, whose death was ruled a homicide Friday, was "body slammed" against a wall and "choked until he turned blue."
State school death a homicide
By Sarah Nightingale and Robin Pyle AVALANCHE-JOURNAL
Saturday, August 22, 2009Story last updated at 8/22/2009 - 1:52 am
The mother of a man who died at the Lubbock State School this summer said reports show her son, whose death was ruled a homicide Friday, was "body slammed" against a wall and "choked until he turned blue."
Lilly Nicholson also said the report indicated an employee restrained her son by "sitting on him."
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Lubbock County Medical Examiner Sridhar Natarajan ruled Michael Ray Nicholson's death a homicide Friday morning, noting his cause of death as physical altercation with asphyxia.
Nicholson, 45, died at the state school on June 6 while in the care of six employees, who have since been fired.
"Since the death occurred during a physical altercation between individuals the manner of death is classified as a homicide," the autopsy report reads.
Charges have not yet been filed in the homicide. Capt. Greg Stevens said police officials presented on Friday morning a manslaughter case to the Lubbock County Criminal District Attorney's Office. Employees of the office will decide if any charges will be filed.
No suspects have been named.
The mother said she hoped authorities would prosecute those involved.
"This was a senseless thing," Nicholson said. "There was nothing else wrong with Michael. He was murdered."
Just before death
Lilly Nicholson said state reports show her son died while staff struggled to undress him.
The family has received numerous reports they requested from the Lubbock State School - now officially named the Lubbock State Supported Living Center - and the state agencies that oversee the school.
An Avalanche-Journal request to view the documents was recently declined by the Lubbock Department of Disability and Aging Services (DADS) and is awaiting a final decision from the Attorney General's office.
Nicholson said her son - who suffered from Obsessive Compulsive Disorder in relation to the clothes he wore - refused to dress on June 6 while "his one set of clothes" was being washed. Because of the condition, he was "allowed to be naked in his room," she said.
"They did dress him, but they killed him in the process," she said.
Michael Nicholson had a history of psychiatric and behavioral problems with episodes of combative behavior, according to the medical examiner's report.
Nicholson described her son Friday as someone who "did not know how to fight and never seriously injured anyone in his entire life."
"He could be obstinate, contrary, and frustrating when he could not communicate his needs and desires," she said.
Nicholson, who kept her son at home for 15 years, said he "had no physical problems (but) required constant care to keep him safe and healthy."
"He was in special ed classes from the time he was 5 years old, but never was able to advance. He was non-verbal," she said, adding, "he was a joy to us. He was truly innocent and loved the beautiful things in life. He loved to dance, sing and watch cowboy movies."
Nicholson said staff at the school "got carried away."
"If they hadn't done what they did, Michael would be alive today," she said.
According to the medical examiner report, Nicholson was partially on a bed and positioned for a period of time during which his head and neck were abnormally stretched. He was on a mattress with an individual lying over a portion of his upper torso.
He then became unresponsive, the report reads.
Natarajan said there were multiple areas of bruising, abrasions and lacerations on Nicholson's body, though none of those injuries were fatal. The medical examiner also found multiple areas of old bruising on the body.
Most concerning to Nicholson was evidence in the state reports that now dismissed school employee Donnell Smith restrained her son by "laying on him six or seven times."
A-J attempts to reach Smith were unsuccessful. His number is not listed in the phone book, and other numbers The A-J obtained for him were disconnected or went unanswered.
Nicholson said neurosurgeon Dr. Patrick Cindrich had told staff Nicholson was "not to be restrained, period," because of the potential it would cause detriment to a healed broken neck he suffered earlier. The man's neck was broken at the school, his mother said.
A 2006 Department of Justice report investigating practices at the school prohibited the use of manual restraints on school residents.
A report from a division of the Texas Department of Family and Protective Services noted Smith didn't believe he had restrained him because he laid on him, rather than restraining his arms, Nicholson said.
The report, Nicholson said, documents Smith stating he "wasn't going to put up with any of Mike's nonsense."
She said Smith was "agitating" Nicholson by "mocking him and making fun of him" and that after realizing her son was not breathing it was "too long before CPR was performed."
Three other staff, she said, were present in the room while Smith restrained Nicholson, causing him to "turn blue and stop breathing."
"No-one came to his aid," she said.
Investigations
Six state school employees - Smith, Jessica Santos, Abrisha Henderson, Amiya Harper, Craig Stevenson and Omar Jordan - were fired from the school after the incident.
The firings were made when a Texas Department of Family and Protective Services investigation confirmed their involvement in the physical abuse and neglect of Nicholson.
"The department has a zero tolerance policy regarding abuse and neglect of the residents in our care," said Laura Albrecht, spokeswoman for the Texas Department of Aging and Disability.
"We believe we took swift actions when we received those confirmations (of abuse and neglect) from adult protective services."
The employees had been with the Lubbock State School from about six months to three years, Albrecht said.
None of them were listed in the Lubbock phone book, and The A-J wasn't able to reach Santos, Henderson or Stevenson through numbers obtained elsewhere.
The Lubbock State School houses approximately 300 people with the diagnosis of mental retardation. The 24-hour residential facility, located at 3401 N. University Ave., sits on a 226-acres site about three miles north of the city.
The school and others in the state have been under scrutiny by legislators and government officials for years.
In 2008, nearly 270 employees were fired or suspended for abusing or neglecting residents in the state schools, records published earlier this year show.
In June, just days before Nicholson's death, Gov. Rick Perry signed legislation aimed at improving security and oversight at the facilities.
To comment on this story:
sarah.nightingale@lubbockonline.com l 766-8796
robin.pyle@lubbockonline.com l 766-8742
shelly.gonzales@lubbockonline.com l 766-8747

State schools report shows an agency in breakdown

Link here
By R.G. Ratcliffe - Express-News
AUSTIN — During a year of “fight clubs” at a state school for the mentally disabled, deaths from neglect and abuse at others and a federal crackdown on Texas, the agency charged with managing the problem apparently was in turmoil of its own.
According to an investigative report obtained by the San Antonio Express-News/Houston Chronicle, the headquarters staff of the state school system had a turnover of two-thirds in an eight-month period and the director was suspended for treating her employees in a “demeaning and abusive manner.”
Denice Geredine, director of the state school system, was suspended for five days last April after the Department of Aging and Disability Services found she had created a “hostile” work environment by berating staff and publicly reprimanding her employees.
Geredine's division had a 67 percent employee turnover from July 2008, when she became supervisor, through last February.
The agency also investigated Geredine's boss, Assistant Commissioner Barry Waller, for a “demeaning manner in the workplace” for allegedly yelling at employees. No formal action was taken involving Waller.
Geredine currently is on leave due to two deaths in her family. Her husband, Thomas, defended her actions as supervisor during a difficult period.
“She was just trying to make a difference,” Thomas Geredine said. “She was just trying to hold people accountable. When you hold people accountable, they turn on you.”
Agency spokeswoman Laura Albrecht said DADS commissioners continue to monitor and evaluate Geredine's conduct.
“Many times when you are correcting problems and implementing changes, there will be challenges,” Albrecht said.
Most of the focus on problems in the state school system has been on the 13 facilities around Texas and undertrained staffers who earn about $20,000 a year.
But the investigative document obtained by the newspapers under the Texas Public Information Act raises questions about how firmly the state headquarters has been overseeing the system.
The U.S. Justice Department of last December announced that 53 of 114 deaths of state school residents in a one-year period could have been prevented. The state signed an agreement with department officials in May, pledging to spend $112 million over the next five years to improve standards of care.
In March, videos surfaced allegedly showing Corpus Christi State School staff members forcing mentally disabled residents into fights for entertainment. Jury selection began Monday in a trial of the first of six employees charged in the case.
Under an emergency declaration this year from Gov. Rick Perry, the Legislature passed laws to reorganize the state school system and add more than 1,000 employees for direct services for the mentally disabled.
One of the chief sponsors of that legislation, Sen. Jane Nelson, R-Flower Mound, only learned this week from a reporter that Geredine had been suspended and that there had been high headquarters turnover.
Nelson's legislation will eliminate Geredine's job and replace it with an assistant commissioner over state schools with a facilities manager below that position.
Of the 22-member staff positions under Geredine's management in February, a majority described her as “unprofessional, bullying, abrasive” and a majority described their work environment as “stressful, hostile, a roller coaster ride of manic to calm, crisis driven.”
The report said Geredine required her staff to work on weekends or cancel sick leave without pay. Geredine said those staffers would “volunteer to rearrange their time off.”
The employees said that because of the high employee turnover rate, “the wealth of knowledge and experience ... is gone and not being replaced.”
Geredine said her bosses had an expectation that she would “turn over” the staff because there had been low performers in the unit. Geredine said she was proud of the turnover in her staff.

Trials begin for 4 charged in fight club

By CHRISTOPHER SHERMAN Associated Press Writer © 2009 The Associated Press

July 5, 2009, 8:26AM

link to article

McALLEN, Texas — This week jurors in Corpus Christi are expected to watch the graphic abuse of the developmentally disabled on grainy cellphone videos showing the state's most vulnerable wards forced to fight each other for the entertainment of those responsible for protecting them.

Four former employees of the Corpus Christi State School go on trial Monday for their roles in the orchestrated, late-night "fight club" uncovered in March after the disturbing images were found on a lost cellphone.

For the state, the case tears open a subject it has been at pains to close.

At the end of May, the Legislature gave final approval to a $112 million settlement with the U.S. Department of Justice for widespread mistreatment found at the state's 13 residential facilities for the developmentally disabled. As part of the settlement the state plans to hire 1,000 more staff for the facilities. The agency's civil rights investigation found at least 53 deaths from September 2007 to September 2008 stemming from what it considered preventable conditions.

Last month Gov. Rick Perry signed legislation aimed at improving oversight of the facilities that house nearly 5,000 Texans, including installation of video cameras in common areas. It also changed the facilities' name to State Supported Living Centers. And nearly two weeks later, Adelaide "Addie" Horn, head of the agency charged with overseeing the state schools announced she would retire in August.

Laura Albrecht, a spokeswoman for the Department of Aging and Disability Services, said the agency continues making unannounced visits to the Corpus Christi facility and cameras are being installed. She said the settlement with the Justice Department was "a big step that will certainly bring improvements and changes to the system."

But Monday, jurors will meet Timothy Dixon, 30, D'Angelo Riley, 23, and Jesse Salazar, 25, all charged with multiple counts of causing bodily injury to a disabled person. In a separate courtroom, Stephanie Garza, 21, will face a lesser charge of not intervening to stop the fights. Two other former employees are scheduled for trial later this year.

"These people did horrific things," said Jeff Garrison-Tate, of the advocacy group Community Now!, which has called for the closure of the state schools in favor of community-based services. "But they were given silent permission for these heinous acts."

"They need to send a message to all the other state employees in there that they're accountable," he said.

District Attorney Carlos Valdez did not return calls for comment. Defense attorneys for the accused declined to comment, citing Judge Sandra Watts' request that they not speak to the media.

In March, Corpus Christi Police announced that arrests were imminent in what they described as a "fight club" case at the Corpus Christi State School. Nearly 20 videos, dating back to 2007, found on a cellphone turned in to police showed school staff forcing residents into late-night bouts, even kicking to egg them on. Eleven staff members were identified in the videos and six, who were present in videos where investigators believe an injury occurred, were charged.

Dixon is believed to have shot the videos, though other staff members can been seen pointing cellphone cameras toward the brawls. None of those charged still works at the facility, which housed about 340 residents.

At the time, Horn called the fights "unconscionable" and the initial cause appeared to be a lack of supervision on the overnight shift. Guards to provide around-the-clock security were hired and trained. Perry sent his chief of staff Jay Kimbrough to investigate.

Since then, a lawyer representing residents who were involved in the fights has filed sued the state.

There were 229 confirmed allegations of abuse or neglect at the Corpus Christi State School between fiscal year 2004 and fiscal 2008, according to the Texas Department of Family and Protective Services. The agency investigated 5,443 allegations of abuse and neglect at the school during that five-year period.

The school's director remains in place to the consternation of some who say that even if director Iva Benson did not know about the fights, the incidents showed a disturbing lack of supervision.

"They (those charged) were probably the ones instigating the fight clubs, but my concern is how can you have it going on as long as it did without the administration knowing about it?" said Beth Mitchell, the managing lawyer for Advocacy Inc., a non-profit with federal authority to monitor abuse and neglect at the facilities. "Why aren't they being held accountable for not properly supervising their schools?"

State schools have room to improve

By Matt Phinney (Contact)Saturday, June 27, 2009

(Link to article)

Supporters of state-supported living centers say a new law providing more oversight to the 13 facilities will go even further to protect the thousands of residents who live in them, while at least one advocacy group says a need continues for sweeping change to the state system.
This month, Gov. Rick Perry signed a bill that includes random drug-testing for employees, harsher penalties for abuse and neglect of residents and more surveillance at the facilities, which previously have been known as state schools. Some of the measures already have been in place in the state-operated facilities, said Cecilia Fedorov, media officer with the Texas Department of Aging and Disability Services.
That agency oversees the state facilities and regulates private immediate-care facilities for people with mental retardation as well as contracts with providers for community-based services, she said.
Among other things, the new legislation allows for enhanced training on how to recognize possible abuse or neglect, and what the reporting requirements are, as well as the ramifications of not reporting or preventing abuse and neglect.
“I think (the law) is just added benefits,” Fedorov said. “We already have a lot of safeguards in place, and this will allow us to screen even further. The top priorities at all times is the health and quality of life for our residents. This allows us to strengthen that.”
In addition to the law, 1,190 new employee positions will be open statewide for the centers.
That number hasn’t been broken up by individual facilities, Fedorov said.
About 4,600 people live in the 13 state facilities, according to The Associated Press, which is more than six times the national average.
The San Angelo State School, in Carlsbad, had 276 clients as of March 31, and had 760 employees as of April.
Perry declared state school reform a legislative emergency during the most recent session after state lawmakers reached a $112 million settlement with the Department of Justice, which documented widespread mistreatment of residents and alleged their civil rights were violated.
The agreement developed from a series of federal investigations that found that at least 53 deaths statewide in the system from September 2007 to September 2008 were from preventable conditions, indicating lapses in proper care.
After that report came out, there was talk of downsizing, consolidating and even closing some state-supported living facilities, said state Rep. Drew Darby, R-San Angelo, a member of the state’s Human Services Committee.
The talk eventually turned from downsizing to providing more resources to help the facilities protect their residents, led in part by families of residents at the facilities, Darby said.
“I think right-thinking people started working to come up with solutions that addressed the concerns of the Department of Justice and those in the community who believe there needs to be more resources,” Darby said, “while being sensitive to the many hundreds of parents and professionals that believe state-support living institutions are the best place for their loved ones.”
However, Jeff Garrison-Tate with the advocacy group Community Now! said there is no need for 13 state facilities and calls for complete reform of the system. The group works to ensure that people with disabilities who reside in state institutions get a chance to live in community settings.
His daughter has been on a waiting list for years, hoping to enter a community service center, which includes group homes and foster care.
Garrison-Tate said many residents at the state facilities do not have guardians and do not want to be in such large settings.
He said there is a waiting list of 88,000 people wanting to live in community service centers.
“I believe that everyone who wants to leave should have the opportunity to do so per federal law,” he said. “And whenever every one of those folks that wants out gets out, we need a long-range strategic plan to determine if we need these facilities in Texas. I believe we would not need that many.”
A report released this month indicated 27 people were fired or suspended at the San Angelo facility during the 2008 fiscal year. One of the 27 firings or suspensions was considered a Class I violation, physical or sexual abuse that may cause serious physical injury. Thirteen were Class II, which are nonserious physical injuries or exploitation, three were for emotional or verbal abuse and 10 were for neglect.
Fedorov said the number of people disciplined show the agency’s strict employee code of conduct is working to protect the residents.
The new law is a good start, Darby said, but the key for the state is to continue to provide the facilities with the resources to protect the residents.
Garrison-Tate disagrees. He said that while there are many good employees at the institutions, “There is a culture of abuse and neglect in these facilities that goes beyond any amount of money that we dump into these places,” he said.
“History shows we put money into this, and it doesn’t work.”
Garrison-Tate said the law includes worthwhile provisions, such as creating an independent ombudsman position and increasing penalties. However, he doubts that adding cameras in common areas will make a significant difference because most abuse takes place in bedrooms or bathrooms, where cameras cannot be installed.
Fedorov called the cameras “another layer of security. The more eyes you have looking at the situation, the less likely you are going to have abuse or neglect,” she said, adding that the cameras won’t be added quickly because the process must go out for bids, and some construction work will be required to install the systems.
Fedorov also said the state has increased by thousands the number of slots available for people who receive community-based services, she said.
Fedorov described the hiring process as “pretty intense,” including a lengthy orientation, security and background checks and training.
The employee turnover is high during the first six months of employment, which is a probationary period, she said.
The turnover rate is lower after the second year of employment, she said.
Many people who last more than two years make a career out of working at the facility, she said.
PROVISIONS OF SENATE BILL 643
Following is a list of provisions in a new law designed to protect residents at the state’s 13 state-supported living centers.
Establishes the Office of Independent Ombudsman and a new assistant commissioner who will oversee all state-supported living center operations.
Enhances abuse and neglect investigations by notifying and including the Health and Human Services’ Office of the Inspector General in criminal investigations.
Creates a hotline number that is linked to the SSLC Ombudsman’s office to report allegations of misconduct.
Requires video surveillance cameras in all common areas to prevent, deter and detect abuse and neglect.
Requires FBI fingerprint background checks and random drug-testing on employees.
Increases penalties for employees who abuse or neglect residents, or fail to report abuse or neglect.
Requires the Department of Aging and Disability Services to contract with an independent patient safety organization to conduct mortality assessments to determine if deaths could have been prevented.
Helps ensure that the facilities are in compliance with the recent U.S. Department of Justice settlement agreement.
Renames the state schools to SSLCs to more accurately depict the residential care services provided to residents.
Designates the Mexia State School as the forensic SSLC to house high-risk, court-committed residents.
Source:Source: Governor’s office

Head of agency in charge of Texas state schools plans to retire

link to article
By JIM VERTUNO Associated Press Writer © 2009 The Associated Press
June 25, 2009, 4:39PM
AUSTIN, Texas —

The head of the Texas agency in charge of the state's troubled institutions for the mentally disabled announced Thursday she is retiring, effective Aug. 31.
Department of Aging and Disability Services Commissioner Adelaide "Addie" Horn has led the agency since February 2006.
The institutions were the target of a federal civil rights review following allegations of abuse and neglect of the mentally disabled. State lawmakers reached a five-year, $112 million settlement with the U.S. Justice Department that requires the state to improve living conditions and medical care.
State lawmakers recently passed new security measures at the 13 state supported living centers after a 2008 report outlined widespread mistreatment of residents. Dozens of people have died under questionable circumstances and hundreds of employees have been disciplined for mistreating residents.
Texas has about 4,600 residents living at the large institutions.
In a statement, Horn said, "It has been my privilege, and one that I have never taken for granted, to have served individuals who are aging and have disabilities."
Horn was director of long-term care services at the state Health and Human Services Commission before being name first deputy commissioner of DADS. She was put in charge of the agency on Feb. 1, 2006.
Health and Human Services Commissioner Albert Hawkins' praised Horn's "strong leadership on behalf of individuals who need her agency's services, no matter the setting or disability."
But some advocates for the disabled sharply criticized her tenure.
"Commissioner Horn is ultimately responsible for the operations of state institutions in Texas and has failed miserably in this regard. Her retirement ends an era of arrogance and gross negligence in the management of the safety and civil rights of our most vulnerable Texans," said Jeff Garrison-Tate of the advocacy group Community Now!, which has called for Texas to close the large institutions.
Spurred by the reports of abuse and neglect, lawmakers and Gov. Rick Perry moved to improve security and oversight at the institutions. Earlier this month, Perry signing into law a bill that requires video surveillance in common areas. It also gives new powers to the state Office of Inspector General to help local prosecutors pursue cases of abuse, neglect or exploitation. Staff would be subject to drug tests and criminal background checks.
"Commissioner Horn has been a tireless advocate for Texans with disabilities," said Sen. Jane Nelson, R-Flower Mound, chair of the Senate Health and Human Services Committee that drafted many of the changes.
"We are grateful for her service on behalf of the State of Texas and, in particular, our most vulnerable citizens," Nelson said.

Keep spotlight on state schools

opinion from the San Antonio Express News (link)

In 1974, the families of residents of Texas state schools for the mentally disabled filed a lawsuit against what was then known as the Texas Department of Mental Health-Mental Retardation over poor conditions at the schools.
Eventually the class action lawsuit represented 2,000 of the 7,000 residents in state schools, and required 17 years of internal reforms and legislative fixes before it was finally resolved.
In 2004, the newly created Texas Department of Aging and Disability Services assumed operation of the state schools.
Four years later, DADS was once again under scrutiny for deplorable conditions and poor treatment in the schools.
First, a Department of Justice investigation uncovered widespread abuses and lapses in care that violated the residents' constitutional and statutory rights.
Then videos emerged of fights between residents organized by staff at the Corpus Christi State School.
Now Gov. Rick Perry has signed into law a measure that will once again overhaul the state schools.
The legislation adds 1,160 new positions, tougher background checks on employees, more monitors and video surveillance in common areas at the 13 facilities in the system.
Perhaps the most important component in the new reforms is the creation of an Office of Independent Ombudsman to respond to resident complaints and investigate reports of abuse or neglect.
An ombudsman with real authority is the best internal guarantee that substandard practices don't return.
Ultimately, however, elected officials are responsible for the state schools.
The governor and lawmakers must make sure that a system that is supposed to care for the state's vulnerable, disabled citizens doesn't once again end up failing them.
It shouldn't require a class action lawsuit or a federal government inquiry to guarantee decent care in the state school system.

Perry signs bill overhauling state schools

(link)

hmmm. Look at all that money...

AN OVERHAUL FOR STATE SCHOOLS

Gov. Rick Perry approved new protections and more money for state schools residents.

$48 million: Cost of emergency package to generally improve the schools

$418 million: Cost of community living options for residents

$112 million: Cost of improvements required by the Justice Department.

By JANET ELLIOTT and TERRI LANGFORD Copyright 2009 Houston Chronicle Austin Bureau

June 11, 2009, 9:03PM

ov. Rick Perry signed legislation Thursday meant to overhaul Texas’ troubled state schools, where dozens of individuals with mental disabilities have died preventable deaths or been the victims of abuse over the last several years.

“Our current system had some serious shortcomings. They were exposed,” said Perry, who had declared improvements for the state schools an emergency issue for lawmakers this past session.

As families and supporters of the 13-facility system watched, Perry printed his signature with his left hand. His right arm was in a sling because of a broken collarbone suffered in a bicycle fall Tuesday night.

The $48 million bill is the Legislature’s response to a federal investigation that found deadly lapses in health care and widespread abuse and neglect. It also renames the state school system. They will now be called “state-supported living centers” to reflect that the vast majority of residents are adults.

New protections include video surveillance in common areas, an effort to eliminate problems such as the fights between residents at Corpus Christi State School that police say staffers organized.

Employees will face enhanced criminal background checks, random drug testing and receive more on-the-job training. An Office of Independent Ombudsman will protect client rights. The law also creates state investigations of abuse and neglect complaints involving residents living in privately run facilities.

Community living options

Perry previously signed off on a settlement reached with the U.S. Department of Justice in its investigation of abuse and neglect at the facilities. That $112 million pact will add 1,160 new employees, many of whom will be direct care workers, as well as people who will monitor conditions at the facilities.

The settlement and the reform legislation together represent new spending of about $150 million over the next two years. Additionally, the state is spending $418 million in the next two years to create community living options, such as group homes or home-assisted care, for Texans with physical and mental disabilities.

About 8,000 people, including some now living in state schools, are expected to be able to live in less restrictive settings.

“Whether these Texans live in a state facility or in therapeutic community settings, we are obligated by basic human decency to provide them with a safe setting in which to live, learn and grow,” Perry said.

The governor praised conscientious state school employees, who “deal with daily challenges that most of us couldn’t imagine.” But he said that “bad actors” will be prosecuted; the new law increases penalties for employees who harm residents or fail to report abuse or neglect.

Recent problems

In December, the Justice Department announced that 53 of the 114 deaths of state school residents over a one-year period could have been prevented. The department also determined that restraints were used too often — some 10,143 times on 751 residents during the first nine months of 2008 alone.

Also documented: Some 200 staff members were fired in one 12-month period. Also, despite plans to move more residents out of the state schools, only 164 residents were placed in a community-based care facility in a 12-month period.

In March, video images allegedly showed Corpus Christi State School staff members forcing mentally disabled residents into fights for entertainment.

But critics who claim the state school system is outmoded say the settlement is deja vu all over again.

“We’re back,” complained Beth Mitchell, managing attorney for Advocacy Inc., a nonprofit group that works to protect the legal rights of disabled Texans. “It’s all the same stuff.”

Mitchell was referring to a series of pacts that ended a 1974 lawsuit that charged — like the recent Justice Department report did — that conditions within the system were not acceptable.

Monitors were called, better reporting of abuse was requested, she said, and now it seems the state is back where it was in the 1990s, when the suit was settled for the third time.

Critic says law is vague

Mitchell said the new pact is too vague in pinpointing exact timetables and plans for moving residents into the community. Also, the settlement is light on what type of qualifications the monitors should possess.

“There are no benchmarks or standards for what the monitors are supposed to follow to make sure the state schools have adequate treatment,” Mitchell said.

Mitchell also pointed to the fact that it does nothing to remedy the retention problems state schools have with its direct care staff, who guide residents in their daily activities.

In the past two years, 376 state school workers were fired for abuse and neglect, and 70 percent of those workers were entry-level aides, whose starting salary is about $20,000 a year.

Lawmakers did not approve a proposed pay raise for these staffers.

janet.elliott@chron.com

terri.langford@chron.com

State schools get $112 million

Link to article



Web Posted: 06/08/2009 12:00 CDT
By Terri Langford - Houston Chronicle
It's been a tough several months for the $500 million state school system for the mentally disabled.
First, the Texas Department of Aging and Disability Services (DADS), the operator of the residential facilities, found itself a federal target when it was named in December in a scathing U.S. Department of Justice report on the condition of state schools.
Investigators found that 53 of the 114 deaths of state school residents over a one-year period could have been prevented. They also determined that restraints were used too often — 10,143 times on 751 residents during the first nine months of 2008 alone.
Also documented: Some 200 staff members were fired in one 12-month period. And, despite plans to move more residents out of the state schools, only 164 residents were placed in a community-based care facility in a 12-month period.
But just as Texas officials began dealing with the Justice fallout, they were hit in March with disturbing video images that showed Corpus Christi State School staff members forcing mentally disabled residents into fights for their own entertainment.
Finally some good news out of the 81st Texas Legislature: a $112 million plan to improve conditions at the 11 schools and two centers.
“It allows DADS to continue with a clear action plan,” explained Cecilia Fedorov, a DADS spokeswoman.
The pact adds 1,160 new positions, most of whom will be direct care workers, and calls for people who will monitor conditions at the facilities.
“I hope it works,” said State Sen. Carlos Uresti, D-San Antonio, who sits on the Senate's Health and Human Services Committee. “Obviously, I think we can do more outside of the settlement.”
For Uresti, the most important component of the plan is the monitors.
“If things don't improve, those monitors will recognize that,” he said.
But critics, who claim the state school system is outmoded, say the Justice agreement is deja vu.
“We're back,” complained Beth Mitchell, managing attorney for Advocacy Inc., a nonprofit group that works to protect the legal rights of disabled Texans. “It's all the same stuff.”
Mitchell was referring to a series of pacts that ended a decades-old lawsuit that charged — like the recent Justice Department report did — that conditions within the system were not acceptable.
Monitors were called, and better reporting of abuse was requested, she said. And now, it seems the state is right back where it was in the 1990s, when the 1974 lawsuit filed on behalf of John Lelsz Jr., a severely disabled state school resident, was settled for the third time.
Mitchell said this federal-state pact is too vague when it comes to pinpointing exact timetables and plans to move residents into the community. Also, while there is a provision for more monitors, the settlement is a little light on what type of qualifications those people should possess.
“There are no benchmarks or standards for what the monitors are supposed to follow to make sure the state schools have adequate treatment,” Mitchell said.
DADS officials still were not sure how the new settlement will be different from the series of reforms made in the 1980s and 1990s as a result of the landmark Lelsz lawsuit.
“I'm not familiar with that particular lawsuit,” Fedorov said.
Mitchell also pointed to the fact that it does nothing to remedy the retention problems state schools have with the direct care staff, who escort and guide residents in their daily activities.
In the past two years, 376 state school workers were fired for abuse and neglect; and 70 percent of those workers were entry-level aides, whose starting salary is about $20,000 a year.
Lawmakers did not approve a proposed pay raise for these staffers. About half of all state school employees turn over each year.
But parents of state school residents, like Nancy Ward, who live in fear that the institutions will be closed, support the new pact.
“I am hoping that will help,” said Ward, who helps run the Parent Association for the Retarded of Texas and has watched the legal machinations for decades. Her 47-year-old daughter Dianne Ward, entered the state school system when she was 10 years old. Today Diane lives at Denton State School.
“For one thing, the work won't be as hard,” she said, if more workers are added. “A lot of them work two jobs.”

Advocates pleased with disability services gains in Legislature

Link to article

06:56 AM CDT on Thursday, June 4, 2009
By EMILY RAMSHAW / The Dallas Morning News eramshaw@dallasnews.com
AUSTIN – Faced with dangerous conditions inside Texas' institutions for the mentally disabled and a massive waiting list for community-based care, lawmakers didn't pick sides – they improved both.
They did it under pressure: from the U.S. Justice Department, from Gov. Rick Perry's office, from the national news media. And they owe much of their success to behind-the-scenes maneuvers by the Senate's key budget writer. But in the session that ended this week, the Legislature made landmark progress without playing favorites, gingerly balancing the competing interests of state school parents and advocates for independent living.
"The state has recognized that we need to provide resources for both types of care," said Rep. Drew Darby, a San Angelo Republican who started the session fearing that some of his colleagues might try to shutter the state school in his district. "We've had a blending of those needs this session – and a system we can all be proud of."
Advocates for the disabled say the progress made this session is staggering.
Lawmakers passed an emergency safety bill that creates an independent ombudsman to investigate injuries and deaths at state schools; requires fingerprinting, background checks and random drug testing of all state school employees; and installs security cameras in all facilities.
They agreed to a five-year, $112 million settlement with the Justice Department to hire more than 1,000 new state school workers, dramatically improve health care, and install independent monitors to oversee conditions at the facilities.
They gave approval for the family of a young man who was nearly beaten to death by a state school employee to sue the state; his mother had been trying for years.
And they provided an extra $200 million in state funds to provide community-based care for nearly 8,000 people stuck on long waiting lists – an unprecedented expenditure.
"It's a historic, monumental investment in the system," said Amy Mizcles, director of governmental affairs for the Arc of Texas. "They really worked on the entire system."
Investigation
The improvements follow a four-year federal investigation that found widespread civil rights violations across Texas' 13 state institutions for the mentally disabled, and years of media reports about abuse and neglect in the facilities. One of the most staggering came even as lawmakers were meeting – video of late-night "fight clubs" that employees at the Corpus Christi State School forced upon residents. The footage aired on Good Morning America and other national news programs.
The changes are largely the work of six key players.
Rep. Patrick Rose, D-Dripping Springs, and Sen. Jane Nelson, R-Flower Mound, served as the clearinghouses for reform ideas, refereeing the bitter debate over whether the state schools were even worth saving. Advocates for community-based care argued that the state schools were dangerous and inefficient; state school families said community care was inadequate and under-regulated.
Meanwhile, Perry chief of staff Jay Kimbrough used his experience reforming the Texas Youth Commission to devise a safety plan for the state schools. Sens. Judith Zaffirini, D-Laredo, and Eliot Shapleigh, D-El Paso, filed individual bills on almost every state school and community care problem – ensuring something would get through. And Sen. Steve Ogden, R-Bryan, the Senate's key budget writer, pulled the trigger, allocating hundreds of millions of dollars to improve care in the state schools and the community.
"I knew the state schools were in trouble, and I just started thinking, 'There has to be a solution to this,' " Ogden said. "I consider it to be one of the more significant things this budget has accomplished."
Schools stay open
The legislation doesn't close or consolidate any of the state schools. It's a relief to state school parents, who feared that's where lawmakers were headed and lobbied vigorously to keep all of them open.
That's a disappointment to many disability rights advocates, who testified on horrific abuse inside the facilities with the knowledge that their efforts to close the facilities – not reform them – might backfire.
"It's not some sort of philosophical turf battle; it's proven that what's best for people with disabilities is to live in the community," said Robert Stack, president and CEO of Community Options Inc., which operates group homes and foster care placements in Texas and other states. "The state schools really can't be fixed."
Nor do the measures provide a vision for the future of disability services in Texas. Efforts to create a strategic plan for Texas' state schools, which have watched their census decline as community care has expanded, passed the Senate but fell short in the House.
Any hard numbers capping the state school population were stripped out, over objections from lawmakers who fear the loss of jobs if facilities in their districts close.
"There's still so much fragmentation and confusion, so many significant problems, in the system," said Colleen Horton, public policy director for the University of Texas' Center for Disability Studies. "We're not stepping back to look at where we want to be in the future."

Senators express doubts about candidate for health, human services job

Austin lawyer has no experience running large organization.

By Corrie MacLaggan
AMERICAN-STATESMAN STAFF
Thursday, May 28, 2009

The man thought to be the frontrunner for Texas' top health and human services job is already being criticized as lacking experience and failing to fully grasp key issues.

Gov. Rick Perry's office has said Austin lawyer Lowell Keig is being considered to replace Albert Hawkins, who is retiring later this year after six years on the job. Two other people — a Washington, D.C., neurosurgeon and a New York resident who was until recently a federal health official — are also being considered, according to documents obtained from the governor's office by the American-Statesman under the state's Public Information Act.

Lowell Keig

Hawkins — who has said he'll probably leave in late summer or early fall — has one of the most demanding jobs in state government. He oversees five agencies, 50,000 employees and a $25 billion total annual budget, including state and federal dollars.

"Now, more than ever, we need a highly qualified chief executive experienced in running a complex organization," said Sen. Eliot Shapleigh, D-El Paso, a member of the Senate committee that confirms gubernatorial appointments. "What I fear is that Mr. Keig is in a long line of political appointees whose only value is loyalty to Perry."

This has been a tough legislative session for Perry appointees. The Senate earlier this month blocked the nomination of unemployed Burleson banker Shanda Perkins to join the state Board of Pardons and Paroles. And the nomination of State Board of Education Chairman Don McLeroy, who has been criticized for using the board to promote his conservative religious views, barely made it out of committee and faces opposition on the Senate floor. McLeroy began serving as chairman before the legislative session began.

Keig, 46, is general counsel at Youth & Family Centered Services Inc., an Austin company that provides health, education and assisted-living services to children, teens and people with disabilities in hospitals, group homes and residential treatment facilities in eight states.

He is a former chief of the attorney general's Elder Law and Public Health Division, where he managed more than two dozen people, according to his résumé. But he doesn't appear to have experience running a large organization, according to his job application.

In an e-mail Wednesday, Keig wrote: "Since no decision has been made, it would be premature for me to answer any questions at this time."

Though Perry has not formally nominated anyone, his office did submit Keig's name to Sen. Kirk Watson, D-Austin, Watson said.

"I believe he's the only person under serious consideration," Watson said.

Allison Castle, Perry's spokeswoman, said it's "part of our normal process to run possible candidates by their senator." But she added: "No decision has been made. We are still taking applications, and the interview process is ongoing."

Keig's fate could rest in Watson's hands. Traditionally, an appointee's state senator can block a governor's choice.

Watson, a lawyer, says he's known Keig for years through legal circles and that he's "still evaluating" whether Keig is right for the job.

Watson said he takes his role in the nominations process "very seriously" and that he's arranged for Keig to meet with several health and human services experts who will then advise Watson.

The health and human services commissioner oversees agencies that enroll Texans in food stamps, run the state's institutions for people with disabilities and prepare the state's response to public health events such as the swine flu.

"This is an enormous and complicated agency that has a direct, immediate and significant impact on the lives of Texans, and it's a mammoth part of the state budget," Watson said. "The first question of anyone that would be considered would be what experience they have to deal with budget, management and constituent issues."

Sen. Mike Jackson, R-La Porte, chairman of the nominations committee, said that although time is running out for the panel to consider any appointments before the legislative session ends Monday, it could consider them during a special session if the governor orders one.

If Perry doesn't announce his choice until after that, the committee wouldn't consider the appointment until the 2011 session. But under the informal arrangement, Watson could nix the candidate before then.

Dennis Borel, executive director of the Coalition of Texans with Disabilities, said Watson recently arranged for him to meet with Keig. Borel said Keig spoke of his desire to be of service to the public.

"He's a nice guy," Borel said. But he added: "He seemed to have not a great grasp of everything that's going to be involved at (the commission)."

Sen. Jane Nelson, chairwoman of the Senate Committee on Health and Human Services and a member of the nominations committee, said she has met with Keig but not with other applicants.

"He seemed very smart, capable," said Nelson, a Flower Mound Republican. She said the next executive commissioner needs to have "CEO-type skills," but that she didn't spend enough time with Keig to know whether he has those skills.

Keig has given thousands of dollars to Republican candidates since 2001, including at least $3,000 to Perry's campaign, according to records filed with the Texas Ethics Commission.

One of the other candidates is Betty W. Adams of New York, an adjunct professor at Columbia University who until recently served as deputy assistant secretary at the U.S. Department of Health and Human Services. Adams, who advised President George W. Bush on issues relating to Asian Americans, did not submit a formal application but had previously indicated an interest in the job, Castle said. Adams could not be reached for comment Wednesday.

The final candidate is Dr. Guy Clifton, who lives in Washington but is on the faculty of the University of Texas Health Science Center at Houston. Reached by phone Wednesday, Clifton said he was interviewed by members of the governor's staff about three weeks ago but has not heard back from them.

"I'm sure I scared them to death," said Clifton, who said he did not know Perry during their overlapping undergraduate years at Texas A&M University. "I was interested in what I need to do to make the Medicaid program more efficient in this state. It would involve considerable changes."

cmaclaggan@statesman.com; 445-3548

Lowell A. Keig

Age: 46

Residence: Austin

Occupation: General counsel and corporate compliance director, Youth & Family Centered Services Inc.

Experience: Elder Law and Public Health Division chief, Office of the Attorney General of Texas, Austin; private practice lawyer, San Antonio and Austin; prosecutor, Bexar County district attorney's office.

Education: B.S., Trinity University; law degree, University of Texas School of Law.

Source: Documents from Gov. Rick Perry's office