Restraints Still Killing Patients at Centers
Randy Steele was out of control, a 9-year-old whirlwind in a furniture- throwing rage, when two orderlies at the San Antonio treatment center stepped in Feb. 6 to calm him down.
They did a lot more than quiet him.
After Randy was forced face down on the floor, he started vomiting. Then he stopped breathing.
Officials at Laurel Ridge Residential Treatment Centersaid this week that preliminary investigations into Randy's death show that the aides followed proper procedures for restraining patients -- some of the same procedures, apparently, that resulted in the death of 16-year-old Roshelle Clayborne at the same Texas facility just 2 1/2 years ago.
They are also some of the same procedures that continue to kill people in institutions across the United States.
Although federal regulations have been adopted to curb the misuse of restraints in psychiatric hospitals, the government has not yet moved on similar rules for residential treatment centers such as Laurel Ridge.
And, despite fervent talk in Congress last year about passing stronger measures to prevent the abuse of restraints, legislation that would strictly regulate the use of these potentially deadly methods in hospitals and treatment centers has not made it through the U.S. House of Representatives.
*
The victims keep piling up.
There's Randy Steele, who had been a resident at the San Antonio center for one month before he died.
There's Sabrina Elizabeth Day, a 15-year-old North Carolina girl who died Feb. 10 after being held down by three workers at a group home in Charlotte.
There's 17-year-old Joshua Sharpe, who tried to run away from a Milwaukee residential treatment center Dec. 28 because he lost a Monopoly game. He ended up losing his life during the restraint that followed.
And there's Macy Stafford, a 51- year-old who died Dec. 10 following an argument with hospital staff in Dallas over keeping his light on past curfew. Like Roshelle Clayborne, Stafford was restrained and shot with drugs before he died, his family's attorney says.
"There have been eight deaths that we know of since August, and that's just what we know about," said Curtis Decker, executive director of the National Association of Protection and Advocacy Systems, a federal agency charged with protecting the rights and safety of patients. "I'm very concerned that this keeps happening."
A 1998 investigation by The Courant, later confirmed by the federal government's own investigators, found that the deaths officially reported as restraint-related represent a mere fraction of those that occur.
Because there is no requirement that such deaths be reported, The Courant found that restraints probably account for one to three deaths every week in psychiatric hospitals, treatment centers and group homes across the nation.
Restraints involve a variety of physical holds and mechanical devices to control a patient's movements. They are intended to prevent a dangerous patient from harming himself or others, but The Courant and federal investigators found that restraints are used too frequently and for improper reasons, and that the methods are often dangerously incorrect.
U.S. Sen. Christopher J. Dodd, D- Conn., who sponsored restraint-reform legislation passed by the U.S. Senate last fall, said the continuing deaths underscore the need for lawmakers' efforts to reach fruition.
"Maybe the legislation wouldn't have saved these lives, but it would minimize this from happening again," Dodd said. "It can save some lives and we should get on with it."
The state of Texas has chosen not to act. Just one week before Randy Steele died at Laurel Ridge, the board of directors for the Texas Department of Protective and Regulatory Services voted against more stringent rules.
"I was pleading with them to adopt these rules," said Aaryce Hayes, a program specialist with Advocacy Inc., a private nonprofit organization in Austin. "And then we had another death. I'm just sick. This is a very clear indication of why we need something to happen on the federal level."
The federal government has a major stake: It provides billions of dollars in funding to hospitals and treatment centers annually.
Although the Senate passed Dodd's measure last November, the legislation is now stalled in the House Commerce Committee awaiting action. The bill would prohibit use of restraints or seclusion except when needed to protect the patient, staff or other residents of a facility.
Dodd's measure, co-sponsored by Sen. Joseph I. Lieberman, D-Conn., also would require the reporting of any deaths tied to use of restraints or seclusion, and impose new training requirements on mental health workers.
*
Although Dodd doesn't believe there's any reluctance by House members to pass the legislation, advocates for the mentally ill fear that groups representing hospitals, doctors and residential treatment centers will persuade lawmakers to weaken -- or abandon -- the legislation.
These same industry groups already are waging an intense battle to water down some of the key aspects of federal regulations passed last June by the Health Care Financing Administration, advocates say.
"They are very rich and they have a lot of say and they are fighting very hard to pressure HCFA," Decker said.
The HCFA regulations, which for the first time give psychiatric patients in hospitals protections against being restrained for punishment or for the convenience of staff, are still open to final revisions.
A coalition of nine groups representing the mentally ill says the industry groups are now using the nation's largest accreditation organization to influence the HCFA rules before they are finalized this spring.
As proof, the coalition points to a proposal from the Joint Commission on the Accreditation of Healthcare Organizations to substitute its own restraint guidelines in place of the more stringent ones issued by HCFA last June.
While the federal rules require that a physician or a licensed practitioner authorize a restraint and have a face-to-face visit with a patient within the first hour, the joint commission guidelines would allow "competent and trained" staff to begin a restraint, and for an evaluation to be made "promptly."
"Hospitals don't want to have a professional accountable for making those decisions, and oppose public reporting of deaths and injuries," said E. Clarke Ross of the National Alliance for the Mentally Ill.
"Now the hospitals are using the joint commission to undermine what the government of the United States has done to protect people," Ross said. Advocates are quick to point out that the Joint Commission is funded by the health care industry and most of its directors are chosen from the industry's ranks.
Industry groups contend the so- called one-hour rule is impractical. They say they are working with regulators and the joint commission to find reasonable compromises.
"A lot of our members are telling HCFA directly that the regulations are unworkable in real-life, real- time situations," said Rick Wade, a spokesman for the American Hospital Association.
The joint commission also denies the advocates' charges.
"We are not being used as a tool of the provider community," said Margaret Van Amringe, a Joint Commission vice president.
Van Amringe said that her agency is focusing on ways to prevent restraints, and that the HCFA regulations were issued without enough input from doctors and hospitals, and were motivated in part by political concerns.
"There were political pressures to solve the problem quickly," she said, referring to the response of Congress and advocacy groups to reports of restraint-related deaths.
*
While there has been some movement to strengthen regulations for hospitals, those housed in residential treatment centers have little protection. HCFA is expected to issue its first draft of restraint regulations for treatment centers later this year.
These centers have been increasingly criticized as expensive, ineffective and staffed with poorly trained workers. In a December report on children and mental health, the U.S. Surgeon General said "there is only weak evidence for their effectiveness," even though 25 percent of all national child mental health spending goes to these facilities.
Tightening rules for these facilities would go a long way toward reducing the use of restraints, experts say.
"The state cannot stop these things from happening, but they can send a clear message to providers that they won't be tolerated," said Hayes, the Texas advocate.
Yet Laurel Ridge has received mixed messages from the state of Texas.
Although state investigators urged that the center's license be revoked following the 1997 death of Roshelle Clayborne, that finding was appealed by Laurel Ridge and eventually overruled by the state's top regulators.
A one-year probation was ordered instead, during which the facility had to abide by a corrective action plan. But since Laurel Ridge was taken off probation in December 1998, records show the state has been summoned numerous times to investigate charges of improper restraint use and other violations.
State officials said Thursday they are still determining the cause of Randy Steele's death and whether the center or its workers bear responsibility.
But a spokeswoman for Laurel Ridge insisted last week that preliminary findings show the facility isn't at fault.
"I can tell you," said Donna Burtanger, "that we followed the proper procedures."
Hamilton, Elizabeth and Eric M. Weiss. "Restraints Still Killing Patients at Centers." Hartford Courant, 20 Feb. 2000.
*****
29 kids in 2 1/2 years died in state's care-- 2 stopped breathing while restrained recently
SAN ANTONIO - Two boys who stopped breathing as they were restrained recently in mental hospitals are among at least 29 children who died in the last 2 1/2 years in state-regulated youth institutions and foster homes.
Asphyxiation, suicide, drowning, car accidents and medical problems were some of the causes of death. The children ranged from ages 10 days to 17 years old. Most were teenagers.
The Associated Press obtained child death statistics for residential treatment centers, foster homes and mental retardation homes from the Texas Department of Protective and Regulatory Services under the Texas Public Information Act.
Twenty-nine children died - 10 in fiscal year 1998, 11 in fiscal year 1999 and eight so far in fiscal 2000, according to the protective agency.
The state's fiscal year ends Aug. 31.
Two youths died in institutions of the Texas Department of Mental Health and Mental Retardation. Both were teenage boys who killed themselves at the Austin State Hospital, agency spokeswoman Laurie Lentz said.
The Texas Department of Health, which licenses psychiatric hospitals, would not disclose any child death information. It cited a new law that the agency contends prohibits it from releasing details of hospital complaints to the public.
State Rep. Patricia Gray, D-Galveston, the lawmaker who wrote the bill, said she did not intend for it to keep the public from learning about hospital complaints.
Held to the floor
At least one child - 14-year-old Willie Wright - died at a psychiatric hospital in Texas this year. Willie stopped breathing in March as he was held to the floor by workers at Southwest Mental Health Center in San Antonio.
Willie was banging himself into a wall when three mental health workers restrained the 250-pound boy, said hospital president Fred Hines.
"It [physical restraint] is something we hate to use, but we're dealing with the absolutely sickest kids there are in terms of psychiatric problems," Mr. Hines said. "We get kids that get totally out of control."
A cause of death for Willie has not been determined by the Bexar County medical examiner's office.
The Texas Department of Health completed its investigation and did not find any state violations, Mr. Hines said.
9-year-old's death
Police did not file charges in connection with the youth's death or in the February death of 9-year-old Randy Steele of Nevada, who stopped breathing after he was restrained by workers at Laurel Ridge Hospital's residential treatment center in San Antonio.
As two workers held Randy to the floor, he vomited and stopped breathing, police said. He died the next day at a general hospital.
The Bexar County medical examiner's office ruled Randy had an unusually enlarged heart for his age and size and that he died of "excited delirium" during a struggle.
The Texas Department of Protective and Regulatory Services continues to investigate the death, agency spokeswoman Marla Sheely said.
Another Laurel Ridge Hospital patient, 16-year-old Rochelle Clayborne, died after she was restrained during a scuffle with staff members in August 1997. The state later found the hospital violated some state standards regarding restraint use.
An internal memorandum obtained from the protective services agency cites five other child deaths in Texas dating to 1990 in state-regulated facilities in which the use of restraint played a role.
Of the 29 children who died statewide during the 2 1/2-year period, 15 lived in foster homes while 14 were in residential treatment centers, psychiatric hospitals or mental retardation group homes.
There are approximately 11,000 children in foster care in Texas, including residential treatment centers, Ms. Sheely said.
How some died
A review of the children's deaths in Texas reveal a variety of circumstances:
A 2-year-old boy in Burleson died falling down stairs in May 1999 while in a reputable foster home, said Michael Kregg Phillips, a senior attorney with the protective and regulatory services agency.
In El Paso, three teenagers living at a residential treatment center were killed when their van crashed during a field trip in April 1999.
A 15-year-old boy living with a foster family in Houston was killed in August 1999 after an argument with a neighborhood youth during a basketball game. The other boy's 18-year-old brother returned and shot the foster child in the head, police said.
In Tarrant County, the Jefferson Home for Children, a residence for mentally and physically handicapped youths, closed in February after the state revoked its license following a 13-year-old girl's death. There were no allegations of abuse or foul play, but the death should have been reported, Mr. Phillips said. Other violations also were cited.
Children who live in foster homes, group homes or residential treatment centers often have serious emotional or behavioral problems, Ms. Sheely said. Some also have severe medical troubles.
"It's a real different kind of population. These are difficult kids," Ms. Sheely said, but she added that any child's death in an institution or foster home is seriously scrutinized by the state.
"One child death is too many," she said.
Shannon, Kelley. "29 Kids in 2 1/2 Years Died in State's Care-- 2 Stopped Breathing While Restrained Recently." Dallas Morning News, 18 Apr. 2000.
*****
Teen died after banned restraint used
Moments before a 17-year-old died in their care last week, employees at a Mason County wilderness program held the youth in a restraint outlawed a year ago because of its lethal potential, officials at the camp said Tuesday.
Charles Chase Moody is at least the fifth youth to die in Texas since 1988 after being restrained in a facility or program run by the Brown Schools. Officials for the Nashville-based company acknowledged the deaths and the fact that Moody had been placed facedown in a prone position.
"Our staff was not trying to take this man into a prone position, but they ended up falling to the ground in the course of things," said Diane Huggins, a Brown Schools spokeswoman. The company offers youth behavioral treatment services at 21 facilities nationwide, seven of which are in Texas, including the San Marcos Treatment Center and the Oaks Treatment Center in Austin.
"When they went to the ground, they did fall forward," Huggins said of the three staff members who restrained Moody. "This young man was a pretty big fellow: He's 6'1" and weighed 180 pounds. From our own looking into things and knowing how our staff responded, we know that they did the best job that they could to respond appropriately."
Moody, who investigators say was having difficulty breathing when sheriff's deputies arrived at the camp, died before paramedics arrived.
Authorities have not released an autopsy or commented on the cause of death, pending a toxicology report.
However, Moody's father said investigators told him that his son died from asphyxiation.
"He vomited and nobody even knew it," said Charles Moody, a Dallas defense lawyer who once represented the Brown Schools in a case involving a restraint-related death. "I cannot imagine how somebody could vomit and be unconscious and nobody knew it until the sheriff arrived. That doesn't happen. There are many, many unanswered questions."
Moody, who is divorced, said he did not know that his son, who was taking medication for anger issues and had been in a treatment facility before for drug and anger problems, had been sent to the On Track wilderness program in Mason.
The Mason County sheriff's office, the Texas Rangers and the Texas Department of Protective and Regulatory Services, which oversees such programs, are still investigating. Huggins said the staff members involved in the incident, whom she would not identify, have been placed on administrative leave with pay.
The state's rules on use of restraints on youth, dated August 2001, do not allow staff members to place a patient facedown and apply pressure to his back, the so-called prone restraint. Other forbidden restraints include any that keep the staff member from seeing the youth's face, restrict the person's ability to communicate or impair the ability to breathe.
Officials at the Department of Protective and Regulatory Services said they don't know how many people have died in the facilities they oversee, in part because their electronic database goes back to only 1998.
The Brown Schools is the oldest and largest youth behavioral program in the state, Huggins said, and each year treats thousands of troubled children and adults in its Texas facilities.
The other four Texas deaths associated with restraints at Brown Schools programs occurred not in the wilderness program but at facilities where "young people with more serious behavioral and psychological issues are treated," Huggins said.
The first death occurred in 1988 at South Austin's Healthcare Rehabilitation Center, which has since been renamed. An 18-year-old, Brandon Hadden of East Texas, died after being restrained in a straitjacket and held facedown on a bed, according to Michael Slack of Austin, who represented Hadden's mother.
"He started to vomit in their presence . . . and choked to death with two staff members continuing to hold him down," Slack said.
Charles Moody, who was the defense lawyer for the Brown Schools in that case, settled it during trial in 1997 for an undisclosed amount.
"I don't know exactly what I can tell you based on attorney-client privilege," Moody said. "But there wouldn't have been a settlement unless there was some question of liability."
In 1990, 17-year-old Diane Harris died in the Brown Schools' Seguin Community Treatment Center after five staff members placed her into a "basket hold," in which a person's arms are crossed in front of the chest. The center has since closed.
A grand jury did not issue any indictments, but it blasted the center in a report for "the inadequate training of the staff administering the hold."
"We have taken the unusual step of developing an official record . . . into the bizarre way (Harris died) so that this tragedy will not have to be repeated," the report said. "Even though the hold was not authorized under the center's own policies, apparently it was routinely used with the knowledge and consent of the center's management."
Slack's firm, Slack & Davis LLP, also represented the family of 16-year-old Roshelle Clayborne, who died in 1997 at the Brown Schools' Laurel Ridge facility in San Antonio. According to a state report, Clayborne died of an irregular heartbeat after a violent struggle with hospital staff, during which they put her in a restraint.
During the altercation, Clayborne said she couldn't breathe, according to the report, which was obtained through the Citizens Commission on Human Rights, an international watchdog group that focuses in part on institutional health care.
The treatment center was placed on probation for a year in 1997. The lawsuit was settled out of court in 1999 for an undisclosed amount.
A year later, 9-year-old Randy Steele died of suffocation at the same facility after a violent outburst. Two hospital workers held the boy down, during which he vomited and began having trouble breathing, state officials said at the time. He later died.
What happened to Chase Moody is less clear.
According to Brown Schools officials, the Richardson teenager and two other boys became aggressive toward staff members about 8:30 p.m. Oct. 14. Moody was the only one placed in the restraint hold.
Huggins said every employee receives training in proper crisis prevention techniques, and in this case the fall to the ground was unavoidable.
"When situations like this happen, it is very devastating," Huggins said. "The young people we serve come to us with emotional, behavioral and psychological problems. We do everything that we can to keep them safe, and these are some unfortunate cases."
But critics such as Jerry Boswell, president of the Austin chapter of the Citizens Commission on Human Rights, say these cases are occurring too frequently.
"The more you look at a situation like this, the more incensed you get," Boswell said. "How many children have to die . . . before you lose a license in this state?"
And Slack, whose firm reviews "hundreds" of cases involving care facilities each year, said more such cases are inevitable unless lawmakers address the issue.
"We're talking about very fundamental errors in judgment that were committed," Slack said.
But caring for troubled youth with such problems is an evolving process, Huggins said.
"It behooves all of us in our industry to continue to look at safer ways to handle patients," she said. "Obviously we need to continue to re-examine the way that we're handling situations and try to find safer ways to deal with them."
Osborne, Jonathan. "Teen Died After Banned Restraint Used." American Statesman, 23 Oct. 2002.
Randy Steele was out of control, a 9-year-old whirlwind in a furniture- throwing rage, when two orderlies at the San Antonio treatment center stepped in Feb. 6 to calm him down.
They did a lot more than quiet him.
After Randy was forced face down on the floor, he started vomiting. Then he stopped breathing.
Officials at Laurel Ridge Residential Treatment Centersaid this week that preliminary investigations into Randy's death show that the aides followed proper procedures for restraining patients -- some of the same procedures, apparently, that resulted in the death of 16-year-old Roshelle Clayborne at the same Texas facility just 2 1/2 years ago.
They are also some of the same procedures that continue to kill people in institutions across the United States.
Although federal regulations have been adopted to curb the misuse of restraints in psychiatric hospitals, the government has not yet moved on similar rules for residential treatment centers such as Laurel Ridge.
And, despite fervent talk in Congress last year about passing stronger measures to prevent the abuse of restraints, legislation that would strictly regulate the use of these potentially deadly methods in hospitals and treatment centers has not made it through the U.S. House of Representatives.
*
The victims keep piling up.
There's Randy Steele, who had been a resident at the San Antonio center for one month before he died.
There's Sabrina Elizabeth Day, a 15-year-old North Carolina girl who died Feb. 10 after being held down by three workers at a group home in Charlotte.
There's 17-year-old Joshua Sharpe, who tried to run away from a Milwaukee residential treatment center Dec. 28 because he lost a Monopoly game. He ended up losing his life during the restraint that followed.
And there's Macy Stafford, a 51- year-old who died Dec. 10 following an argument with hospital staff in Dallas over keeping his light on past curfew. Like Roshelle Clayborne, Stafford was restrained and shot with drugs before he died, his family's attorney says.
"There have been eight deaths that we know of since August, and that's just what we know about," said Curtis Decker, executive director of the National Association of Protection and Advocacy Systems, a federal agency charged with protecting the rights and safety of patients. "I'm very concerned that this keeps happening."
A 1998 investigation by The Courant, later confirmed by the federal government's own investigators, found that the deaths officially reported as restraint-related represent a mere fraction of those that occur.
Because there is no requirement that such deaths be reported, The Courant found that restraints probably account for one to three deaths every week in psychiatric hospitals, treatment centers and group homes across the nation.
Restraints involve a variety of physical holds and mechanical devices to control a patient's movements. They are intended to prevent a dangerous patient from harming himself or others, but The Courant and federal investigators found that restraints are used too frequently and for improper reasons, and that the methods are often dangerously incorrect.
U.S. Sen. Christopher J. Dodd, D- Conn., who sponsored restraint-reform legislation passed by the U.S. Senate last fall, said the continuing deaths underscore the need for lawmakers' efforts to reach fruition.
"Maybe the legislation wouldn't have saved these lives, but it would minimize this from happening again," Dodd said. "It can save some lives and we should get on with it."
The state of Texas has chosen not to act. Just one week before Randy Steele died at Laurel Ridge, the board of directors for the Texas Department of Protective and Regulatory Services voted against more stringent rules.
"I was pleading with them to adopt these rules," said Aaryce Hayes, a program specialist with Advocacy Inc., a private nonprofit organization in Austin. "And then we had another death. I'm just sick. This is a very clear indication of why we need something to happen on the federal level."
The federal government has a major stake: It provides billions of dollars in funding to hospitals and treatment centers annually.
Although the Senate passed Dodd's measure last November, the legislation is now stalled in the House Commerce Committee awaiting action. The bill would prohibit use of restraints or seclusion except when needed to protect the patient, staff or other residents of a facility.
Dodd's measure, co-sponsored by Sen. Joseph I. Lieberman, D-Conn., also would require the reporting of any deaths tied to use of restraints or seclusion, and impose new training requirements on mental health workers.
*
Although Dodd doesn't believe there's any reluctance by House members to pass the legislation, advocates for the mentally ill fear that groups representing hospitals, doctors and residential treatment centers will persuade lawmakers to weaken -- or abandon -- the legislation.
These same industry groups already are waging an intense battle to water down some of the key aspects of federal regulations passed last June by the Health Care Financing Administration, advocates say.
"They are very rich and they have a lot of say and they are fighting very hard to pressure HCFA," Decker said.
The HCFA regulations, which for the first time give psychiatric patients in hospitals protections against being restrained for punishment or for the convenience of staff, are still open to final revisions.
A coalition of nine groups representing the mentally ill says the industry groups are now using the nation's largest accreditation organization to influence the HCFA rules before they are finalized this spring.
As proof, the coalition points to a proposal from the Joint Commission on the Accreditation of Healthcare Organizations to substitute its own restraint guidelines in place of the more stringent ones issued by HCFA last June.
While the federal rules require that a physician or a licensed practitioner authorize a restraint and have a face-to-face visit with a patient within the first hour, the joint commission guidelines would allow "competent and trained" staff to begin a restraint, and for an evaluation to be made "promptly."
"Hospitals don't want to have a professional accountable for making those decisions, and oppose public reporting of deaths and injuries," said E. Clarke Ross of the National Alliance for the Mentally Ill.
"Now the hospitals are using the joint commission to undermine what the government of the United States has done to protect people," Ross said. Advocates are quick to point out that the Joint Commission is funded by the health care industry and most of its directors are chosen from the industry's ranks.
Industry groups contend the so- called one-hour rule is impractical. They say they are working with regulators and the joint commission to find reasonable compromises.
"A lot of our members are telling HCFA directly that the regulations are unworkable in real-life, real- time situations," said Rick Wade, a spokesman for the American Hospital Association.
The joint commission also denies the advocates' charges.
"We are not being used as a tool of the provider community," said Margaret Van Amringe, a Joint Commission vice president.
Van Amringe said that her agency is focusing on ways to prevent restraints, and that the HCFA regulations were issued without enough input from doctors and hospitals, and were motivated in part by political concerns.
"There were political pressures to solve the problem quickly," she said, referring to the response of Congress and advocacy groups to reports of restraint-related deaths.
*
While there has been some movement to strengthen regulations for hospitals, those housed in residential treatment centers have little protection. HCFA is expected to issue its first draft of restraint regulations for treatment centers later this year.
These centers have been increasingly criticized as expensive, ineffective and staffed with poorly trained workers. In a December report on children and mental health, the U.S. Surgeon General said "there is only weak evidence for their effectiveness," even though 25 percent of all national child mental health spending goes to these facilities.
Tightening rules for these facilities would go a long way toward reducing the use of restraints, experts say.
"The state cannot stop these things from happening, but they can send a clear message to providers that they won't be tolerated," said Hayes, the Texas advocate.
Yet Laurel Ridge has received mixed messages from the state of Texas.
Although state investigators urged that the center's license be revoked following the 1997 death of Roshelle Clayborne, that finding was appealed by Laurel Ridge and eventually overruled by the state's top regulators.
A one-year probation was ordered instead, during which the facility had to abide by a corrective action plan. But since Laurel Ridge was taken off probation in December 1998, records show the state has been summoned numerous times to investigate charges of improper restraint use and other violations.
State officials said Thursday they are still determining the cause of Randy Steele's death and whether the center or its workers bear responsibility.
But a spokeswoman for Laurel Ridge insisted last week that preliminary findings show the facility isn't at fault.
"I can tell you," said Donna Burtanger, "that we followed the proper procedures."
Hamilton, Elizabeth and Eric M. Weiss. "Restraints Still Killing Patients at Centers." Hartford Courant, 20 Feb. 2000.
*****
29 kids in 2 1/2 years died in state's care-- 2 stopped breathing while restrained recently
SAN ANTONIO - Two boys who stopped breathing as they were restrained recently in mental hospitals are among at least 29 children who died in the last 2 1/2 years in state-regulated youth institutions and foster homes.
Asphyxiation, suicide, drowning, car accidents and medical problems were some of the causes of death. The children ranged from ages 10 days to 17 years old. Most were teenagers.
The Associated Press obtained child death statistics for residential treatment centers, foster homes and mental retardation homes from the Texas Department of Protective and Regulatory Services under the Texas Public Information Act.
Twenty-nine children died - 10 in fiscal year 1998, 11 in fiscal year 1999 and eight so far in fiscal 2000, according to the protective agency.
The state's fiscal year ends Aug. 31.
Two youths died in institutions of the Texas Department of Mental Health and Mental Retardation. Both were teenage boys who killed themselves at the Austin State Hospital, agency spokeswoman Laurie Lentz said.
The Texas Department of Health, which licenses psychiatric hospitals, would not disclose any child death information. It cited a new law that the agency contends prohibits it from releasing details of hospital complaints to the public.
State Rep. Patricia Gray, D-Galveston, the lawmaker who wrote the bill, said she did not intend for it to keep the public from learning about hospital complaints.
Held to the floor
At least one child - 14-year-old Willie Wright - died at a psychiatric hospital in Texas this year. Willie stopped breathing in March as he was held to the floor by workers at Southwest Mental Health Center in San Antonio.
Willie was banging himself into a wall when three mental health workers restrained the 250-pound boy, said hospital president Fred Hines.
"It [physical restraint] is something we hate to use, but we're dealing with the absolutely sickest kids there are in terms of psychiatric problems," Mr. Hines said. "We get kids that get totally out of control."
A cause of death for Willie has not been determined by the Bexar County medical examiner's office.
The Texas Department of Health completed its investigation and did not find any state violations, Mr. Hines said.
9-year-old's death
Police did not file charges in connection with the youth's death or in the February death of 9-year-old Randy Steele of Nevada, who stopped breathing after he was restrained by workers at Laurel Ridge Hospital's residential treatment center in San Antonio.
As two workers held Randy to the floor, he vomited and stopped breathing, police said. He died the next day at a general hospital.
The Bexar County medical examiner's office ruled Randy had an unusually enlarged heart for his age and size and that he died of "excited delirium" during a struggle.
The Texas Department of Protective and Regulatory Services continues to investigate the death, agency spokeswoman Marla Sheely said.
Another Laurel Ridge Hospital patient, 16-year-old Rochelle Clayborne, died after she was restrained during a scuffle with staff members in August 1997. The state later found the hospital violated some state standards regarding restraint use.
An internal memorandum obtained from the protective services agency cites five other child deaths in Texas dating to 1990 in state-regulated facilities in which the use of restraint played a role.
Of the 29 children who died statewide during the 2 1/2-year period, 15 lived in foster homes while 14 were in residential treatment centers, psychiatric hospitals or mental retardation group homes.
There are approximately 11,000 children in foster care in Texas, including residential treatment centers, Ms. Sheely said.
How some died
A review of the children's deaths in Texas reveal a variety of circumstances:
A 2-year-old boy in Burleson died falling down stairs in May 1999 while in a reputable foster home, said Michael Kregg Phillips, a senior attorney with the protective and regulatory services agency.
In El Paso, three teenagers living at a residential treatment center were killed when their van crashed during a field trip in April 1999.
A 15-year-old boy living with a foster family in Houston was killed in August 1999 after an argument with a neighborhood youth during a basketball game. The other boy's 18-year-old brother returned and shot the foster child in the head, police said.
In Tarrant County, the Jefferson Home for Children, a residence for mentally and physically handicapped youths, closed in February after the state revoked its license following a 13-year-old girl's death. There were no allegations of abuse or foul play, but the death should have been reported, Mr. Phillips said. Other violations also were cited.
Children who live in foster homes, group homes or residential treatment centers often have serious emotional or behavioral problems, Ms. Sheely said. Some also have severe medical troubles.
"It's a real different kind of population. These are difficult kids," Ms. Sheely said, but she added that any child's death in an institution or foster home is seriously scrutinized by the state.
"One child death is too many," she said.
Shannon, Kelley. "29 Kids in 2 1/2 Years Died in State's Care-- 2 Stopped Breathing While Restrained Recently." Dallas Morning News, 18 Apr. 2000.
*****
Teen died after banned restraint used
Moments before a 17-year-old died in their care last week, employees at a Mason County wilderness program held the youth in a restraint outlawed a year ago because of its lethal potential, officials at the camp said Tuesday.
Charles Chase Moody is at least the fifth youth to die in Texas since 1988 after being restrained in a facility or program run by the Brown Schools. Officials for the Nashville-based company acknowledged the deaths and the fact that Moody had been placed facedown in a prone position.
"Our staff was not trying to take this man into a prone position, but they ended up falling to the ground in the course of things," said Diane Huggins, a Brown Schools spokeswoman. The company offers youth behavioral treatment services at 21 facilities nationwide, seven of which are in Texas, including the San Marcos Treatment Center and the Oaks Treatment Center in Austin.
"When they went to the ground, they did fall forward," Huggins said of the three staff members who restrained Moody. "This young man was a pretty big fellow: He's 6'1" and weighed 180 pounds. From our own looking into things and knowing how our staff responded, we know that they did the best job that they could to respond appropriately."
Moody, who investigators say was having difficulty breathing when sheriff's deputies arrived at the camp, died before paramedics arrived.
Authorities have not released an autopsy or commented on the cause of death, pending a toxicology report.
However, Moody's father said investigators told him that his son died from asphyxiation.
"He vomited and nobody even knew it," said Charles Moody, a Dallas defense lawyer who once represented the Brown Schools in a case involving a restraint-related death. "I cannot imagine how somebody could vomit and be unconscious and nobody knew it until the sheriff arrived. That doesn't happen. There are many, many unanswered questions."
Moody, who is divorced, said he did not know that his son, who was taking medication for anger issues and had been in a treatment facility before for drug and anger problems, had been sent to the On Track wilderness program in Mason.
The Mason County sheriff's office, the Texas Rangers and the Texas Department of Protective and Regulatory Services, which oversees such programs, are still investigating. Huggins said the staff members involved in the incident, whom she would not identify, have been placed on administrative leave with pay.
The state's rules on use of restraints on youth, dated August 2001, do not allow staff members to place a patient facedown and apply pressure to his back, the so-called prone restraint. Other forbidden restraints include any that keep the staff member from seeing the youth's face, restrict the person's ability to communicate or impair the ability to breathe.
Officials at the Department of Protective and Regulatory Services said they don't know how many people have died in the facilities they oversee, in part because their electronic database goes back to only 1998.
The Brown Schools is the oldest and largest youth behavioral program in the state, Huggins said, and each year treats thousands of troubled children and adults in its Texas facilities.
The other four Texas deaths associated with restraints at Brown Schools programs occurred not in the wilderness program but at facilities where "young people with more serious behavioral and psychological issues are treated," Huggins said.
The first death occurred in 1988 at South Austin's Healthcare Rehabilitation Center, which has since been renamed. An 18-year-old, Brandon Hadden of East Texas, died after being restrained in a straitjacket and held facedown on a bed, according to Michael Slack of Austin, who represented Hadden's mother.
"He started to vomit in their presence . . . and choked to death with two staff members continuing to hold him down," Slack said.
Charles Moody, who was the defense lawyer for the Brown Schools in that case, settled it during trial in 1997 for an undisclosed amount.
"I don't know exactly what I can tell you based on attorney-client privilege," Moody said. "But there wouldn't have been a settlement unless there was some question of liability."
In 1990, 17-year-old Diane Harris died in the Brown Schools' Seguin Community Treatment Center after five staff members placed her into a "basket hold," in which a person's arms are crossed in front of the chest. The center has since closed.
A grand jury did not issue any indictments, but it blasted the center in a report for "the inadequate training of the staff administering the hold."
"We have taken the unusual step of developing an official record . . . into the bizarre way (Harris died) so that this tragedy will not have to be repeated," the report said. "Even though the hold was not authorized under the center's own policies, apparently it was routinely used with the knowledge and consent of the center's management."
Slack's firm, Slack & Davis LLP, also represented the family of 16-year-old Roshelle Clayborne, who died in 1997 at the Brown Schools' Laurel Ridge facility in San Antonio. According to a state report, Clayborne died of an irregular heartbeat after a violent struggle with hospital staff, during which they put her in a restraint.
During the altercation, Clayborne said she couldn't breathe, according to the report, which was obtained through the Citizens Commission on Human Rights, an international watchdog group that focuses in part on institutional health care.
The treatment center was placed on probation for a year in 1997. The lawsuit was settled out of court in 1999 for an undisclosed amount.
A year later, 9-year-old Randy Steele died of suffocation at the same facility after a violent outburst. Two hospital workers held the boy down, during which he vomited and began having trouble breathing, state officials said at the time. He later died.
What happened to Chase Moody is less clear.
According to Brown Schools officials, the Richardson teenager and two other boys became aggressive toward staff members about 8:30 p.m. Oct. 14. Moody was the only one placed in the restraint hold.
Huggins said every employee receives training in proper crisis prevention techniques, and in this case the fall to the ground was unavoidable.
"When situations like this happen, it is very devastating," Huggins said. "The young people we serve come to us with emotional, behavioral and psychological problems. We do everything that we can to keep them safe, and these are some unfortunate cases."
But critics such as Jerry Boswell, president of the Austin chapter of the Citizens Commission on Human Rights, say these cases are occurring too frequently.
"The more you look at a situation like this, the more incensed you get," Boswell said. "How many children have to die . . . before you lose a license in this state?"
And Slack, whose firm reviews "hundreds" of cases involving care facilities each year, said more such cases are inevitable unless lawmakers address the issue.
"We're talking about very fundamental errors in judgment that were committed," Slack said.
But caring for troubled youth with such problems is an evolving process, Huggins said.
"It behooves all of us in our industry to continue to look at safer ways to handle patients," she said. "Obviously we need to continue to re-examine the way that we're handling situations and try to find safer ways to deal with them."
Osborne, Jonathan. "Teen Died After Banned Restraint Used." American Statesman, 23 Oct. 2002.
Restraints Still Killing Patients at Centers
Randy Steele was out of control, a 9-year-old whirlwind in a furniture- throwing rage, when two orderlies at the San Antonio treatment center stepped in Feb. 6 to calm him down.
They did a lot more than quiet him.
After Randy was forced face down on the floor, he started vomiting. Then he stopped breathing.
Officials at Laurel Ridge Residential Treatment Centersaid this week that preliminary investigations into Randy's death show that the aides followed proper procedures for restraining patients -- some of the same procedures, apparently, that resulted in the death of 16-year-old Roshelle Clayborne at the same Texas facility just 2 1/2 years ago.
They are also some of the same procedures that continue to kill people in institutions across the United States.
Although federal regulations have been adopted to curb the misuse of restraints in psychiatric hospitals, the government has not yet moved on similar rules for residential treatment centers such as Laurel Ridge.
And, despite fervent talk in Congress last year about passing stronger measures to prevent the abuse of restraints, legislation that would strictly regulate the use of these potentially deadly methods in hospitals and treatment centers has not made it through the U.S. House of Representatives.
*
The victims keep piling up.
There's Randy Steele, who had been a resident at the San Antonio center for one month before he died.
There's Sabrina Elizabeth Day, a 15-year-old North Carolina girl who died Feb. 10 after being held down by three workers at a group home in Charlotte.
There's 17-year-old Joshua Sharpe, who tried to run away from a Milwaukee residential treatment center Dec. 28 because he lost a Monopoly game. He ended up losing his life during the restraint that followed.
And there's Macy Stafford, a 51- year-old who died Dec. 10 following an argument with hospital staff in Dallas over keeping his light on past curfew. Like Roshelle Clayborne, Stafford was restrained and shot with drugs before he died, his family's attorney says.
"There have been eight deaths that we know of since August, and that's just what we know about," said Curtis Decker, executive director of the National Association of Protection and Advocacy Systems, a federal agency charged with protecting the rights and safety of patients. "I'm very concerned that this keeps happening."
A 1998 investigation by The Courant, later confirmed by the federal government's own investigators, found that the deaths officially reported as restraint-related represent a mere fraction of those that occur.
Because there is no requirement that such deaths be reported, The Courant found that restraints probably account for one to three deaths every week in psychiatric hospitals, treatment centers and group homes across the nation.
Restraints involve a variety of physical holds and mechanical devices to control a patient's movements. They are intended to prevent a dangerous patient from harming himself or others, but The Courant and federal investigators found that restraints are used too frequently and for improper reasons, and that the methods are often dangerously incorrect.
U.S. Sen. Christopher J. Dodd, D- Conn., who sponsored restraint-reform legislation passed by the U.S. Senate last fall, said the continuing deaths underscore the need for lawmakers' efforts to reach fruition.
"Maybe the legislation wouldn't have saved these lives, but it would minimize this from happening again," Dodd said. "It can save some lives and we should get on with it."
The state of Texas has chosen not to act. Just one week before Randy Steele died at Laurel Ridge, the board of directors for the Texas Department of Protective and Regulatory Services voted against more stringent rules.
"I was pleading with them to adopt these rules," said Aaryce Hayes, a program specialist with Advocacy Inc., a private nonprofit organization in Austin. "And then we had another death. I'm just sick. This is a very clear indication of why we need something to happen on the federal level."
The federal government has a major stake: It provides billions of dollars in funding to hospitals and treatment centers annually.
Although the Senate passed Dodd's measure last November, the legislation is now stalled in the House Commerce Committee awaiting action. The bill would prohibit use of restraints or seclusion except when needed to protect the patient, staff or other residents of a facility.
Dodd's measure, co-sponsored by Sen. Joseph I. Lieberman, D-Conn., also would require the reporting of any deaths tied to use of restraints or seclusion, and impose new training requirements on mental health workers.
*
Although Dodd doesn't believe there's any reluctance by House members to pass the legislation, advocates for the mentally ill fear that groups representing hospitals, doctors and residential treatment centers will persuade lawmakers to weaken -- or abandon -- the legislation.
These same industry groups already are waging an intense battle to water down some of the key aspects of federal regulations passed last June by the Health Care Financing Administration, advocates say.
"They are very rich and they have a lot of say and they are fighting very hard to pressure HCFA," Decker said.
The HCFA regulations, which for the first time give psychiatric patients in hospitals protections against being restrained for punishment or for the convenience of staff, are still open to final revisions.
A coalition of nine groups representing the mentally ill says the industry groups are now using the nation's largest accreditation organization to influence the HCFA rules before they are finalized this spring.
As proof, the coalition points to a proposal from the Joint Commission on the Accreditation of Healthcare Organizations to substitute its own restraint guidelines in place of the more stringent ones issued by HCFA last June.
While the federal rules require that a physician or a licensed practitioner authorize a restraint and have a face-to-face visit with a patient within the first hour, the joint commission guidelines would allow "competent and trained" staff to begin a restraint, and for an evaluation to be made "promptly."
"Hospitals don't want to have a professional accountable for making those decisions, and oppose public reporting of deaths and injuries," said E. Clarke Ross of the National Alliance for the Mentally Ill.
"Now the hospitals are using the joint commission to undermine what the government of the United States has done to protect people," Ross said. Advocates are quick to point out that the Joint Commission is funded by the health care industry and most of its directors are chosen from the industry's ranks.
Industry groups contend the so- called one-hour rule is impractical. They say they are working with regulators and the joint commission to find reasonable compromises.
"A lot of our members are telling HCFA directly that the regulations are unworkable in real-life, real- time situations," said Rick Wade, a spokesman for the American Hospital Association.
The joint commission also denies the advocates' charges.
"We are not being used as a tool of the provider community," said Margaret Van Amringe, a Joint Commission vice president.
Van Amringe said that her agency is focusing on ways to prevent restraints, and that the HCFA regulations were issued without enough input from doctors and hospitals, and were motivated in part by political concerns.
"There were political pressures to solve the problem quickly," she said, referring to the response of Congress and advocacy groups to reports of restraint-related deaths.
*
While there has been some movement to strengthen regulations for hospitals, those housed in residential treatment centers have little protection. HCFA is expected to issue its first draft of restraint regulations for treatment centers later this year.
These centers have been increasingly criticized as expensive, ineffective and staffed with poorly trained workers. In a December report on children and mental health, the U.S. Surgeon General said "there is only weak evidence for their effectiveness," even though 25 percent of all national child mental health spending goes to these facilities.
Tightening rules for these facilities would go a long way toward reducing the use of restraints, experts say.
"The state cannot stop these things from happening, but they can send a clear message to providers that they won't be tolerated," said Hayes, the Texas advocate.
Yet Laurel Ridge has received mixed messages from the state of Texas.
Although state investigators urged that the center's license be revoked following the 1997 death of Roshelle Clayborne, that finding was appealed by Laurel Ridge and eventually overruled by the state's top regulators.
A one-year probation was ordered instead, during which the facility had to abide by a corrective action plan. But since Laurel Ridge was taken off probation in December 1998, records show the state has been summoned numerous times to investigate charges of improper restraint use and other violations.
State officials said Thursday they are still determining the cause of Randy Steele's death and whether the center or its workers bear responsibility.
But a spokeswoman for Laurel Ridge insisted last week that preliminary findings show the facility isn't at fault.
"I can tell you," said Donna Burtanger, "that we followed the proper procedures."
Hamilton, Elizabeth and Eric M. Weiss. "Restraints Still Killing Patients at Centers." Hartford Courant, 20 Feb. 2000.
*****
29 kids in 2 1/2 years died in state's care-- 2 stopped breathing while restrained recently
SAN ANTONIO - Two boys who stopped breathing as they were restrained recently in mental hospitals are among at least 29 children who died in the last 2 1/2 years in state-regulated youth institutions and foster homes.
Asphyxiation, suicide, drowning, car accidents and medical problems were some of the causes of death. The children ranged from ages 10 days to 17 years old. Most were teenagers.
The Associated Press obtained child death statistics for residential treatment centers, foster homes and mental retardation homes from the Texas Department of Protective and Regulatory Services under the Texas Public Information Act.
Twenty-nine children died - 10 in fiscal year 1998, 11 in fiscal year 1999 and eight so far in fiscal 2000, according to the protective agency.
The state's fiscal year ends Aug. 31.
Two youths died in institutions of the Texas Department of Mental Health and Mental Retardation. Both were teenage boys who killed themselves at the Austin State Hospital, agency spokeswoman Laurie Lentz said.
The Texas Department of Health, which licenses psychiatric hospitals, would not disclose any child death information. It cited a new law that the agency contends prohibits it from releasing details of hospital complaints to the public.
State Rep. Patricia Gray, D-Galveston, the lawmaker who wrote the bill, said she did not intend for it to keep the public from learning about hospital complaints.
Held to the floor
At least one child - 14-year-old Willie Wright - died at a psychiatric hospital in Texas this year. Willie stopped breathing in March as he was held to the floor by workers at Southwest Mental Health Center in San Antonio.
Willie was banging himself into a wall when three mental health workers restrained the 250-pound boy, said hospital president Fred Hines.
"It [physical restraint] is something we hate to use, but we're dealing with the absolutely sickest kids there are in terms of psychiatric problems," Mr. Hines said. "We get kids that get totally out of control."
A cause of death for Willie has not been determined by the Bexar County medical examiner's office.
The Texas Department of Health completed its investigation and did not find any state violations, Mr. Hines said.
9-year-old's death
Police did not file charges in connection with the youth's death or in the February death of 9-year-old Randy Steele of Nevada, who stopped breathing after he was restrained by workers at Laurel Ridge Hospital's residential treatment center in San Antonio.
As two workers held Randy to the floor, he vomited and stopped breathing, police said. He died the next day at a general hospital.
The Bexar County medical examiner's office ruled Randy had an unusually enlarged heart for his age and size and that he died of "excited delirium" during a struggle.
The Texas Department of Protective and Regulatory Services continues to investigate the death, agency spokeswoman Marla Sheely said.
Another Laurel Ridge Hospital patient, 16-year-old Rochelle Clayborne, died after she was restrained during a scuffle with staff members in August 1997. The state later found the hospital violated some state standards regarding restraint use.
An internal memorandum obtained from the protective services agency cites five other child deaths in Texas dating to 1990 in state-regulated facilities in which the use of restraint played a role.
Of the 29 children who died statewide during the 2 1/2-year period, 15 lived in foster homes while 14 were in residential treatment centers, psychiatric hospitals or mental retardation group homes.
There are approximately 11,000 children in foster care in Texas, including residential treatment centers, Ms. Sheely said.
How some died
A review of the children's deaths in Texas reveal a variety of circumstances:
A 2-year-old boy in Burleson died falling down stairs in May 1999 while in a reputable foster home, said Michael Kregg Phillips, a senior attorney with the protective and regulatory services agency.
In El Paso, three teenagers living at a residential treatment center were killed when their van crashed during a field trip in April 1999.
A 15-year-old boy living with a foster family in Houston was killed in August 1999 after an argument with a neighborhood youth during a basketball game. The other boy's 18-year-old brother returned and shot the foster child in the head, police said.
In Tarrant County, the Jefferson Home for Children, a residence for mentally and physically handicapped youths, closed in February after the state revoked its license following a 13-year-old girl's death. There were no allegations of abuse or foul play, but the death should have been reported, Mr. Phillips said. Other violations also were cited.
Children who live in foster homes, group homes or residential treatment centers often have serious emotional or behavioral problems, Ms. Sheely said. Some also have severe medical troubles.
"It's a real different kind of population. These are difficult kids," Ms. Sheely said, but she added that any child's death in an institution or foster home is seriously scrutinized by the state.
"One child death is too many," she said.
Shannon, Kelley. "29 Kids in 2 1/2 Years Died in State's Care-- 2 Stopped Breathing While Restrained Recently." Dallas Morning News, 18 Apr. 2000.
*****
Teen died after banned restraint used
Moments before a 17-year-old died in their care last week, employees at a Mason County wilderness program held the youth in a restraint outlawed a year ago because of its lethal potential, officials at the camp said Tuesday.
Charles Chase Moody is at least the fifth youth to die in Texas since 1988 after being restrained in a facility or program run by the Brown Schools. Officials for the Nashville-based company acknowledged the deaths and the fact that Moody had been placed facedown in a prone position.
"Our staff was not trying to take this man into a prone position, but they ended up falling to the ground in the course of things," said Diane Huggins, a Brown Schools spokeswoman. The company offers youth behavioral treatment services at 21 facilities nationwide, seven of which are in Texas, including the San Marcos Treatment Center and the Oaks Treatment Center in Austin.
"When they went to the ground, they did fall forward," Huggins said of the three staff members who restrained Moody. "This young man was a pretty big fellow: He's 6'1" and weighed 180 pounds. From our own looking into things and knowing how our staff responded, we know that they did the best job that they could to respond appropriately."
Moody, who investigators say was having difficulty breathing when sheriff's deputies arrived at the camp, died before paramedics arrived.
Authorities have not released an autopsy or commented on the cause of death, pending a toxicology report.
However, Moody's father said investigators told him that his son died from asphyxiation.
"He vomited and nobody even knew it," said Charles Moody, a Dallas defense lawyer who once represented the Brown Schools in a case involving a restraint-related death. "I cannot imagine how somebody could vomit and be unconscious and nobody knew it until the sheriff arrived. That doesn't happen. There are many, many unanswered questions."
Moody, who is divorced, said he did not know that his son, who was taking medication for anger issues and had been in a treatment facility before for drug and anger problems, had been sent to the On Track wilderness program in Mason.
The Mason County sheriff's office, the Texas Rangers and the Texas Department of Protective and Regulatory Services, which oversees such programs, are still investigating. Huggins said the staff members involved in the incident, whom she would not identify, have been placed on administrative leave with pay.
The state's rules on use of restraints on youth, dated August 2001, do not allow staff members to place a patient facedown and apply pressure to his back, the so-called prone restraint. Other forbidden restraints include any that keep the staff member from seeing the youth's face, restrict the person's ability to communicate or impair the ability to breathe.
Officials at the Department of Protective and Regulatory Services said they don't know how many people have died in the facilities they oversee, in part because their electronic database goes back to only 1998.
The Brown Schools is the oldest and largest youth behavioral program in the state, Huggins said, and each year treats thousands of troubled children and adults in its Texas facilities.
The other four Texas deaths associated with restraints at Brown Schools programs occurred not in the wilderness program but at facilities where "young people with more serious behavioral and psychological issues are treated," Huggins said.
The first death occurred in 1988 at South Austin's Healthcare Rehabilitation Center, which has since been renamed. An 18-year-old, Brandon Hadden of East Texas, died after being restrained in a straitjacket and held facedown on a bed, according to Michael Slack of Austin, who represented Hadden's mother.
"He started to vomit in their presence . . . and choked to death with two staff members continuing to hold him down," Slack said.
Charles Moody, who was the defense lawyer for the Brown Schools in that case, settled it during trial in 1997 for an undisclosed amount.
"I don't know exactly what I can tell you based on attorney-client privilege," Moody said. "But there wouldn't have been a settlement unless there was some question of liability."
In 1990, 17-year-old Diane Harris died in the Brown Schools' Seguin Community Treatment Center after five staff members placed her into a "basket hold," in which a person's arms are crossed in front of the chest. The center has since closed.
A grand jury did not issue any indictments, but it blasted the center in a report for "the inadequate training of the staff administering the hold."
"We have taken the unusual step of developing an official record . . . into the bizarre way (Harris died) so that this tragedy will not have to be repeated," the report said. "Even though the hold was not authorized under the center's own policies, apparently it was routinely used with the knowledge and consent of the center's management."
Slack's firm, Slack & Davis LLP, also represented the family of 16-year-old Roshelle Clayborne, who died in 1997 at the Brown Schools' Laurel Ridge facility in San Antonio. According to a state report, Clayborne died of an irregular heartbeat after a violent struggle with hospital staff, during which they put her in a restraint.
During the altercation, Clayborne said she couldn't breathe, according to the report, which was obtained through the Citizens Commission on Human Rights, an international watchdog group that focuses in part on institutional health care.
The treatment center was placed on probation for a year in 1997. The lawsuit was settled out of court in 1999 for an undisclosed amount.
A year later, 9-year-old Randy Steele died of suffocation at the same facility after a violent outburst. Two hospital workers held the boy down, during which he vomited and began having trouble breathing, state officials said at the time. He later died.
What happened to Chase Moody is less clear.
According to Brown Schools officials, the Richardson teenager and two other boys became aggressive toward staff members about 8:30 p.m. Oct. 14. Moody was the only one placed in the restraint hold.
Huggins said every employee receives training in proper crisis prevention techniques, and in this case the fall to the ground was unavoidable.
"When situations like this happen, it is very devastating," Huggins said. "The young people we serve come to us with emotional, behavioral and psychological problems. We do everything that we can to keep them safe, and these are some unfortunate cases."
But critics such as Jerry Boswell, president of the Austin chapter of the Citizens Commission on Human Rights, say these cases are occurring too frequently.
"The more you look at a situation like this, the more incensed you get," Boswell said. "How many children have to die . . . before you lose a license in this state?"
And Slack, whose firm reviews "hundreds" of cases involving care facilities each year, said more such cases are inevitable unless lawmakers address the issue.
"We're talking about very fundamental errors in judgment that were committed," Slack said.
But caring for troubled youth with such problems is an evolving process, Huggins said.
"It behooves all of us in our industry to continue to look at safer ways to handle patients," she said. "Obviously we need to continue to re-examine the way that we're handling situations and try to find safer ways to deal with them."
Osborne, Jonathan. "Teen Died After Banned Restraint Used." American Statesman, 23 Oct. 2002.
Randy Steele was out of control, a 9-year-old whirlwind in a furniture- throwing rage, when two orderlies at the San Antonio treatment center stepped in Feb. 6 to calm him down.
They did a lot more than quiet him.
After Randy was forced face down on the floor, he started vomiting. Then he stopped breathing.
Officials at Laurel Ridge Residential Treatment Centersaid this week that preliminary investigations into Randy's death show that the aides followed proper procedures for restraining patients -- some of the same procedures, apparently, that resulted in the death of 16-year-old Roshelle Clayborne at the same Texas facility just 2 1/2 years ago.
They are also some of the same procedures that continue to kill people in institutions across the United States.
Although federal regulations have been adopted to curb the misuse of restraints in psychiatric hospitals, the government has not yet moved on similar rules for residential treatment centers such as Laurel Ridge.
And, despite fervent talk in Congress last year about passing stronger measures to prevent the abuse of restraints, legislation that would strictly regulate the use of these potentially deadly methods in hospitals and treatment centers has not made it through the U.S. House of Representatives.
*
The victims keep piling up.
There's Randy Steele, who had been a resident at the San Antonio center for one month before he died.
There's Sabrina Elizabeth Day, a 15-year-old North Carolina girl who died Feb. 10 after being held down by three workers at a group home in Charlotte.
There's 17-year-old Joshua Sharpe, who tried to run away from a Milwaukee residential treatment center Dec. 28 because he lost a Monopoly game. He ended up losing his life during the restraint that followed.
And there's Macy Stafford, a 51- year-old who died Dec. 10 following an argument with hospital staff in Dallas over keeping his light on past curfew. Like Roshelle Clayborne, Stafford was restrained and shot with drugs before he died, his family's attorney says.
"There have been eight deaths that we know of since August, and that's just what we know about," said Curtis Decker, executive director of the National Association of Protection and Advocacy Systems, a federal agency charged with protecting the rights and safety of patients. "I'm very concerned that this keeps happening."
A 1998 investigation by The Courant, later confirmed by the federal government's own investigators, found that the deaths officially reported as restraint-related represent a mere fraction of those that occur.
Because there is no requirement that such deaths be reported, The Courant found that restraints probably account for one to three deaths every week in psychiatric hospitals, treatment centers and group homes across the nation.
Restraints involve a variety of physical holds and mechanical devices to control a patient's movements. They are intended to prevent a dangerous patient from harming himself or others, but The Courant and federal investigators found that restraints are used too frequently and for improper reasons, and that the methods are often dangerously incorrect.
U.S. Sen. Christopher J. Dodd, D- Conn., who sponsored restraint-reform legislation passed by the U.S. Senate last fall, said the continuing deaths underscore the need for lawmakers' efforts to reach fruition.
"Maybe the legislation wouldn't have saved these lives, but it would minimize this from happening again," Dodd said. "It can save some lives and we should get on with it."
The state of Texas has chosen not to act. Just one week before Randy Steele died at Laurel Ridge, the board of directors for the Texas Department of Protective and Regulatory Services voted against more stringent rules.
"I was pleading with them to adopt these rules," said Aaryce Hayes, a program specialist with Advocacy Inc., a private nonprofit organization in Austin. "And then we had another death. I'm just sick. This is a very clear indication of why we need something to happen on the federal level."
The federal government has a major stake: It provides billions of dollars in funding to hospitals and treatment centers annually.
Although the Senate passed Dodd's measure last November, the legislation is now stalled in the House Commerce Committee awaiting action. The bill would prohibit use of restraints or seclusion except when needed to protect the patient, staff or other residents of a facility.
Dodd's measure, co-sponsored by Sen. Joseph I. Lieberman, D-Conn., also would require the reporting of any deaths tied to use of restraints or seclusion, and impose new training requirements on mental health workers.
*
Although Dodd doesn't believe there's any reluctance by House members to pass the legislation, advocates for the mentally ill fear that groups representing hospitals, doctors and residential treatment centers will persuade lawmakers to weaken -- or abandon -- the legislation.
These same industry groups already are waging an intense battle to water down some of the key aspects of federal regulations passed last June by the Health Care Financing Administration, advocates say.
"They are very rich and they have a lot of say and they are fighting very hard to pressure HCFA," Decker said.
The HCFA regulations, which for the first time give psychiatric patients in hospitals protections against being restrained for punishment or for the convenience of staff, are still open to final revisions.
A coalition of nine groups representing the mentally ill says the industry groups are now using the nation's largest accreditation organization to influence the HCFA rules before they are finalized this spring.
As proof, the coalition points to a proposal from the Joint Commission on the Accreditation of Healthcare Organizations to substitute its own restraint guidelines in place of the more stringent ones issued by HCFA last June.
While the federal rules require that a physician or a licensed practitioner authorize a restraint and have a face-to-face visit with a patient within the first hour, the joint commission guidelines would allow "competent and trained" staff to begin a restraint, and for an evaluation to be made "promptly."
"Hospitals don't want to have a professional accountable for making those decisions, and oppose public reporting of deaths and injuries," said E. Clarke Ross of the National Alliance for the Mentally Ill.
"Now the hospitals are using the joint commission to undermine what the government of the United States has done to protect people," Ross said. Advocates are quick to point out that the Joint Commission is funded by the health care industry and most of its directors are chosen from the industry's ranks.
Industry groups contend the so- called one-hour rule is impractical. They say they are working with regulators and the joint commission to find reasonable compromises.
"A lot of our members are telling HCFA directly that the regulations are unworkable in real-life, real- time situations," said Rick Wade, a spokesman for the American Hospital Association.
The joint commission also denies the advocates' charges.
"We are not being used as a tool of the provider community," said Margaret Van Amringe, a Joint Commission vice president.
Van Amringe said that her agency is focusing on ways to prevent restraints, and that the HCFA regulations were issued without enough input from doctors and hospitals, and were motivated in part by political concerns.
"There were political pressures to solve the problem quickly," she said, referring to the response of Congress and advocacy groups to reports of restraint-related deaths.
*
While there has been some movement to strengthen regulations for hospitals, those housed in residential treatment centers have little protection. HCFA is expected to issue its first draft of restraint regulations for treatment centers later this year.
These centers have been increasingly criticized as expensive, ineffective and staffed with poorly trained workers. In a December report on children and mental health, the U.S. Surgeon General said "there is only weak evidence for their effectiveness," even though 25 percent of all national child mental health spending goes to these facilities.
Tightening rules for these facilities would go a long way toward reducing the use of restraints, experts say.
"The state cannot stop these things from happening, but they can send a clear message to providers that they won't be tolerated," said Hayes, the Texas advocate.
Yet Laurel Ridge has received mixed messages from the state of Texas.
Although state investigators urged that the center's license be revoked following the 1997 death of Roshelle Clayborne, that finding was appealed by Laurel Ridge and eventually overruled by the state's top regulators.
A one-year probation was ordered instead, during which the facility had to abide by a corrective action plan. But since Laurel Ridge was taken off probation in December 1998, records show the state has been summoned numerous times to investigate charges of improper restraint use and other violations.
State officials said Thursday they are still determining the cause of Randy Steele's death and whether the center or its workers bear responsibility.
But a spokeswoman for Laurel Ridge insisted last week that preliminary findings show the facility isn't at fault.
"I can tell you," said Donna Burtanger, "that we followed the proper procedures."
Hamilton, Elizabeth and Eric M. Weiss. "Restraints Still Killing Patients at Centers." Hartford Courant, 20 Feb. 2000.
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29 kids in 2 1/2 years died in state's care-- 2 stopped breathing while restrained recently
SAN ANTONIO - Two boys who stopped breathing as they were restrained recently in mental hospitals are among at least 29 children who died in the last 2 1/2 years in state-regulated youth institutions and foster homes.
Asphyxiation, suicide, drowning, car accidents and medical problems were some of the causes of death. The children ranged from ages 10 days to 17 years old. Most were teenagers.
The Associated Press obtained child death statistics for residential treatment centers, foster homes and mental retardation homes from the Texas Department of Protective and Regulatory Services under the Texas Public Information Act.
Twenty-nine children died - 10 in fiscal year 1998, 11 in fiscal year 1999 and eight so far in fiscal 2000, according to the protective agency.
The state's fiscal year ends Aug. 31.
Two youths died in institutions of the Texas Department of Mental Health and Mental Retardation. Both were teenage boys who killed themselves at the Austin State Hospital, agency spokeswoman Laurie Lentz said.
The Texas Department of Health, which licenses psychiatric hospitals, would not disclose any child death information. It cited a new law that the agency contends prohibits it from releasing details of hospital complaints to the public.
State Rep. Patricia Gray, D-Galveston, the lawmaker who wrote the bill, said she did not intend for it to keep the public from learning about hospital complaints.
Held to the floor
At least one child - 14-year-old Willie Wright - died at a psychiatric hospital in Texas this year. Willie stopped breathing in March as he was held to the floor by workers at Southwest Mental Health Center in San Antonio.
Willie was banging himself into a wall when three mental health workers restrained the 250-pound boy, said hospital president Fred Hines.
"It [physical restraint] is something we hate to use, but we're dealing with the absolutely sickest kids there are in terms of psychiatric problems," Mr. Hines said. "We get kids that get totally out of control."
A cause of death for Willie has not been determined by the Bexar County medical examiner's office.
The Texas Department of Health completed its investigation and did not find any state violations, Mr. Hines said.
9-year-old's death
Police did not file charges in connection with the youth's death or in the February death of 9-year-old Randy Steele of Nevada, who stopped breathing after he was restrained by workers at Laurel Ridge Hospital's residential treatment center in San Antonio.
As two workers held Randy to the floor, he vomited and stopped breathing, police said. He died the next day at a general hospital.
The Bexar County medical examiner's office ruled Randy had an unusually enlarged heart for his age and size and that he died of "excited delirium" during a struggle.
The Texas Department of Protective and Regulatory Services continues to investigate the death, agency spokeswoman Marla Sheely said.
Another Laurel Ridge Hospital patient, 16-year-old Rochelle Clayborne, died after she was restrained during a scuffle with staff members in August 1997. The state later found the hospital violated some state standards regarding restraint use.
An internal memorandum obtained from the protective services agency cites five other child deaths in Texas dating to 1990 in state-regulated facilities in which the use of restraint played a role.
Of the 29 children who died statewide during the 2 1/2-year period, 15 lived in foster homes while 14 were in residential treatment centers, psychiatric hospitals or mental retardation group homes.
There are approximately 11,000 children in foster care in Texas, including residential treatment centers, Ms. Sheely said.
How some died
A review of the children's deaths in Texas reveal a variety of circumstances:
A 2-year-old boy in Burleson died falling down stairs in May 1999 while in a reputable foster home, said Michael Kregg Phillips, a senior attorney with the protective and regulatory services agency.
In El Paso, three teenagers living at a residential treatment center were killed when their van crashed during a field trip in April 1999.
A 15-year-old boy living with a foster family in Houston was killed in August 1999 after an argument with a neighborhood youth during a basketball game. The other boy's 18-year-old brother returned and shot the foster child in the head, police said.
In Tarrant County, the Jefferson Home for Children, a residence for mentally and physically handicapped youths, closed in February after the state revoked its license following a 13-year-old girl's death. There were no allegations of abuse or foul play, but the death should have been reported, Mr. Phillips said. Other violations also were cited.
Children who live in foster homes, group homes or residential treatment centers often have serious emotional or behavioral problems, Ms. Sheely said. Some also have severe medical troubles.
"It's a real different kind of population. These are difficult kids," Ms. Sheely said, but she added that any child's death in an institution or foster home is seriously scrutinized by the state.
"One child death is too many," she said.
Shannon, Kelley. "29 Kids in 2 1/2 Years Died in State's Care-- 2 Stopped Breathing While Restrained Recently." Dallas Morning News, 18 Apr. 2000.
*****
Teen died after banned restraint used
Moments before a 17-year-old died in their care last week, employees at a Mason County wilderness program held the youth in a restraint outlawed a year ago because of its lethal potential, officials at the camp said Tuesday.
Charles Chase Moody is at least the fifth youth to die in Texas since 1988 after being restrained in a facility or program run by the Brown Schools. Officials for the Nashville-based company acknowledged the deaths and the fact that Moody had been placed facedown in a prone position.
"Our staff was not trying to take this man into a prone position, but they ended up falling to the ground in the course of things," said Diane Huggins, a Brown Schools spokeswoman. The company offers youth behavioral treatment services at 21 facilities nationwide, seven of which are in Texas, including the San Marcos Treatment Center and the Oaks Treatment Center in Austin.
"When they went to the ground, they did fall forward," Huggins said of the three staff members who restrained Moody. "This young man was a pretty big fellow: He's 6'1" and weighed 180 pounds. From our own looking into things and knowing how our staff responded, we know that they did the best job that they could to respond appropriately."
Moody, who investigators say was having difficulty breathing when sheriff's deputies arrived at the camp, died before paramedics arrived.
Authorities have not released an autopsy or commented on the cause of death, pending a toxicology report.
However, Moody's father said investigators told him that his son died from asphyxiation.
"He vomited and nobody even knew it," said Charles Moody, a Dallas defense lawyer who once represented the Brown Schools in a case involving a restraint-related death. "I cannot imagine how somebody could vomit and be unconscious and nobody knew it until the sheriff arrived. That doesn't happen. There are many, many unanswered questions."
Moody, who is divorced, said he did not know that his son, who was taking medication for anger issues and had been in a treatment facility before for drug and anger problems, had been sent to the On Track wilderness program in Mason.
The Mason County sheriff's office, the Texas Rangers and the Texas Department of Protective and Regulatory Services, which oversees such programs, are still investigating. Huggins said the staff members involved in the incident, whom she would not identify, have been placed on administrative leave with pay.
The state's rules on use of restraints on youth, dated August 2001, do not allow staff members to place a patient facedown and apply pressure to his back, the so-called prone restraint. Other forbidden restraints include any that keep the staff member from seeing the youth's face, restrict the person's ability to communicate or impair the ability to breathe.
Officials at the Department of Protective and Regulatory Services said they don't know how many people have died in the facilities they oversee, in part because their electronic database goes back to only 1998.
The Brown Schools is the oldest and largest youth behavioral program in the state, Huggins said, and each year treats thousands of troubled children and adults in its Texas facilities.
The other four Texas deaths associated with restraints at Brown Schools programs occurred not in the wilderness program but at facilities where "young people with more serious behavioral and psychological issues are treated," Huggins said.
The first death occurred in 1988 at South Austin's Healthcare Rehabilitation Center, which has since been renamed. An 18-year-old, Brandon Hadden of East Texas, died after being restrained in a straitjacket and held facedown on a bed, according to Michael Slack of Austin, who represented Hadden's mother.
"He started to vomit in their presence . . . and choked to death with two staff members continuing to hold him down," Slack said.
Charles Moody, who was the defense lawyer for the Brown Schools in that case, settled it during trial in 1997 for an undisclosed amount.
"I don't know exactly what I can tell you based on attorney-client privilege," Moody said. "But there wouldn't have been a settlement unless there was some question of liability."
In 1990, 17-year-old Diane Harris died in the Brown Schools' Seguin Community Treatment Center after five staff members placed her into a "basket hold," in which a person's arms are crossed in front of the chest. The center has since closed.
A grand jury did not issue any indictments, but it blasted the center in a report for "the inadequate training of the staff administering the hold."
"We have taken the unusual step of developing an official record . . . into the bizarre way (Harris died) so that this tragedy will not have to be repeated," the report said. "Even though the hold was not authorized under the center's own policies, apparently it was routinely used with the knowledge and consent of the center's management."
Slack's firm, Slack & Davis LLP, also represented the family of 16-year-old Roshelle Clayborne, who died in 1997 at the Brown Schools' Laurel Ridge facility in San Antonio. According to a state report, Clayborne died of an irregular heartbeat after a violent struggle with hospital staff, during which they put her in a restraint.
During the altercation, Clayborne said she couldn't breathe, according to the report, which was obtained through the Citizens Commission on Human Rights, an international watchdog group that focuses in part on institutional health care.
The treatment center was placed on probation for a year in 1997. The lawsuit was settled out of court in 1999 for an undisclosed amount.
A year later, 9-year-old Randy Steele died of suffocation at the same facility after a violent outburst. Two hospital workers held the boy down, during which he vomited and began having trouble breathing, state officials said at the time. He later died.
What happened to Chase Moody is less clear.
According to Brown Schools officials, the Richardson teenager and two other boys became aggressive toward staff members about 8:30 p.m. Oct. 14. Moody was the only one placed in the restraint hold.
Huggins said every employee receives training in proper crisis prevention techniques, and in this case the fall to the ground was unavoidable.
"When situations like this happen, it is very devastating," Huggins said. "The young people we serve come to us with emotional, behavioral and psychological problems. We do everything that we can to keep them safe, and these are some unfortunate cases."
But critics such as Jerry Boswell, president of the Austin chapter of the Citizens Commission on Human Rights, say these cases are occurring too frequently.
"The more you look at a situation like this, the more incensed you get," Boswell said. "How many children have to die . . . before you lose a license in this state?"
And Slack, whose firm reviews "hundreds" of cases involving care facilities each year, said more such cases are inevitable unless lawmakers address the issue.
"We're talking about very fundamental errors in judgment that were committed," Slack said.
But caring for troubled youth with such problems is an evolving process, Huggins said.
"It behooves all of us in our industry to continue to look at safer ways to handle patients," she said. "Obviously we need to continue to re-examine the way that we're handling situations and try to find safer ways to deal with them."
Osborne, Jonathan. "Teen Died After Banned Restraint Used." American Statesman, 23 Oct. 2002.
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