Saturday, November 04, 2006

Arkansas fires firm running youth lockup

We have this report from Arkansas

Arkansas terminated its contract with Cornell Cos. Inc. to run the troubled Alexander Youth Services Center on Friday after learning that employees were drugging youths to control unruly behavior — in many cases without doctors ’ orders, in violation of facility policy and against the children’s wills.

A preliminary investigation found that from Sept. 1 to Oct. 15, nurses at the center gave 63 injections ofanti-psychotic drugs that have a sedative effect, including Thorazine, to 25 children in the center’s custody.

“There is an appropriate circumstance under which you can give a chemical restraint,” said Julie Munsell, spokesman for the state Department of Health and Human Services. “Our concern is that in many of these cases, they appear not to have been appropriate.”

The internal investigation into the use of chemical restraints triggered a series of events: The Health and Human Services Department placed three Alexander employees on administrative leave, the state Board of Nursing was notified, and Gov. Mike Huckabee ordered a review of Cornell’s policies as well as an Arkansas State Police investigation into what happened.

State police investigators are working through the weekend so that they can give Huckabee a preliminary report Monday.

Munsell said her agency gave state police its investigative file, which is a foot thick.

Some state officials have complained that Alexander is unfit for children and are using this latest incident as a call to discuss alternative housing for 140 of the state’s worst juvenile offenders.

But for now, at least, the Health and Human Services Department is once again running the largest juvenile detention center in the state after having the private company in charge for five years at an annual cost of about $ 10 million. And the agency issued a moratorium on the use of chemical restraints.

Division of Youth Service Deputy Director Sid Thompson is overseeing the center and Cornell officials have agreed to help with the transition.

“Although we hired a nationally reputable contractor to provide services, this appears to be a second major breakdown in the facility’s medical system, and we are no longer confident in the management at the Alexander campus,” Health and Human Services Director John Selig said Friday afternoon. Last year, investigators with the Health and Human Services Department uncovered widespread problems with the medical system at Alexander after 17-year-old inmate Keisha Brown died from blood clots to her lungs. Brown had repeatedly complained that she was ill but some nurses and supervisors at the center did not believe her — even in the last minutes of her life.

“Some of us have had concerns with the contract ever since the incident of Keisha Brown’s death,” said Sen. Sue Madison, D-Fayetteville. “We were concerned that her medical care was not what it should have been.” After Keisha’s death, Sen. Terry Smith, D-Hot Springs, urged the Health and Human Services Department to end its contract with Cornell and blasted state officials for not better monitoring the for-profit company. Upon learning about the state’s decision Friday night, Smith said, “I told you so.

“ Apparently this company is not on top of things, and the state employees [who ] are over this are not on top of things. No one is checking on anybody, and this is what happened. It’s just terrible.”

A spokesman for Houston, Texas-based Cornell, which runs 79 correctional-type facilities in 17 states, said that the company was surprised by the state’s decision and investigative findings.

“The allegations in their announcement are inconsistent with the way we try to run our business,” said Cornell’s Christine Parker. “We will investigate [the allegations ]. Unfortunately, it appears that we will not have the opportunity to respond.”

As a matter of routine, the Health and Human Services Department reviews all incidents at Alexander that are considered “use of force,” whether that force be physical or chemical, Munsell said. As part of the review, agency officials watch any surveillance video of the incident.

“In one particular case [from September ], when we pulled the video, we were a little concerned with the administration of the chemical restraint,” she said. “Based on that one tape, we decided to do a 45-day review.”

Munsell would not give a detailed account of what happened on that video, but said that it involved one of three youths who were given forced injections without a doctor’s order. Because there were no doctor’s orders, the Health and Human Services Department reported those three cases to the Child Abuse Hotline on Thursday, and a separate investigation was under way. The youngest inmate at the center is age 12.

In a five-page summary, Health and Human Services Department internal investigators outlined several policy violations and other findings from the 45-day review: Evidence of “falsifying” doctors’ orders on at least two occasions to show that the child should receive injections “as needed.” The original orders did not include that option. Evidence from video surveillance tapes and interviews with the children that some of the inmates were given the injections against their will. Policy allows youths to refuse the injections so long as it is not an emergency situation in which the child may endanger himself or others. Physician order sheets for some of the children that did not include orders for the injections.

Eleven incidents during which the doctor gave a verbal order to use the medication but never signed any documents, which is required.

No evidence that orders for use of “PRN medications,” which means give as needed, were reviewed annually as required. No evidence that a second physician reviewed orders for forced injections as required. No evidence that an independent psychiatrist reviewed the orders for forced injections, as required to ensure the children’s right to due process. Evidence that employees did not properly document the use of the injections.

The lack of documentation made it harder for investigators to piece together exactly what happened during those 45 days, Munsell said.

Investigators interviewed six nurses, including the medical unit supervisor, and later wrote, “it appeared none had an adequate knowledge of the policies concerning the use of forced psychotropic medications or the requirements of follow-up visits, documentation and signature requirements.”

After learning about the results of the investigation, Huckabee said in a news release, “The decision to make this change has been carefully weighed and I believe immediate action is in the best interest of those children entrusted to our care.”

Over the years, the inmates at Alexander have complained that employees kicked, slapped and even threatened them with death. Others killed themselves while there.

One boy, known for days to be suicidal, was able to hang himself with a bed sheet because his guard didn’t check on him. Another boy hanged himself in the same cell just a few months later — just as the state hired Cornell Cos. Inc. to take over the facility and fix problems there.

In 2002, the U. S. Department of Justice found that dozens of problems remained. Most have since been resolved. The center also is used as an intake facility for all children who come into the state detention system.

But there are many other problems, said two state senators and Scott Tanner, a juvenile ombudsman for the state. The facility, which opened in 1918 as a girl’s juvenile lockup, would never be accredited because the buildings and design do not meet current guidelines, said Sen. Shane Broadway, DBryant.

Sen. Madison described the facility this way: “It’s terrible. It is really embarrassing. That’s where we’ve put children with problems and hope they would get better,” she said sarcastically.

“It’s really not a good facility. It’s very hard to supervise children there, really hard.”

Tanner said it is “very run down,” and that it does not have the capacity to meet the needs of all the children who go through there. Because of the campus, Tanner said that any entity running Alexander, whether it be the state or another private company, would have major problems.

“They really need to take this opportunity to dismantle the campus.”

Tanner suggests establishing several facilities in different parts of the state so that juvenile offenders can be closer to their families and communities. But that costs money and would take time to plan — as well as require approval of the Legislature.

For now, Munsell said the state plans to continue operating Alexander because there is no other facility in Arkansas that can handle that many children. “The issue of what to do with the campus itself is obviously something we have to address,” she said. “That needs to be carefully considered. The question is if not Alexander, ‘Where ? When ? Who ?’ “ Those are questions that frankly, we need a little time to answer.”

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