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Paper’s findings spur changes in practices that left mentally disabled children exposed to attacks

By David Jackson | Chicago Tribune reporter
12:42 AM CDT, July 17, 2008

Illinois’ largest psychiatric hospital left sexual predators unguarded despite allegations that at least 10 mentally disabled children were assaulted during the last three years.

The youngest victim was an 8-year-old state ward admitted for evaluation after expressing suicidal thoughts.

Administrators at west suburban Riveredge Hospital and government authorities failed to share basic information as the savage violence left some youth worse off than when they arrived, a Tribune investigation found.

After the newspaper asked about the series of assault reports, the state Department of Children and Family Services last week stopped admitting wards to Riveredge—a punishment imposed on just three other psychiatric hospitals since 2004, records show.

Follow up:

On Wednesday, agency officials announced that the Tribune’s findings had prompted them to immediately impose changes, including new training for child-protection workers and better reporting of assault allegations.

In one incident last year, Riveredge workers noted drops of blood in the bathroom where a psychotic 19-year-old said another teen raped him. But records show hospital officials didn’t send the victim to a local emergency room for a trauma evaluation and didn’t report the allegations to local police.

That young man’s alleged attacker had been admitted with “special precautions” to protect other patients from sexual assault. Yet even after that rape report, inspectors found, Riveredge failed to assign an aide to maintain the required one-on-one observation.

The attacker struck the same victim again the next day, government records show.

Riveredge executives said patient confidentiality laws bar them from discussing specific incidents, but said they protect youth while providing top-notch care to some of Illinois’ most damaged and dangerous patients.

“I can’t speak knowledgeably about incidents from the past, but the current team has a dedication to excellence,” said Carey Carlock, who became the hospital’s new chief executive officer last month.

On a recent tour of Riveredge, paint crews could be seen applying soothing garden murals. Tucked between the Des Plaines River and a Forest Park cemetery, the warren of locked two-story dorms is a flagship facility of Psychiatric Solutions Inc., or PSI, the nation’s largest for-profit behavioral health firm.

Authorities turned to PSI several years ago amid the collapse of big state- and church-run facilities that promised to treat the same daunting population: DCFS wards whose misbehavior and mental disabilities overwhelm foster-care guardians and group-home managers.

State agencies last year paid Riveredge $32.4 million to treat public aid recipients. About 80 of the hospital’s beds go to adults, and the other 130 hold youth, including children placed in DCFS custody after enduring abuse or neglect.

Some of the patients have violent histories while the mental disabilities of others render them vulnerable. Six of the 10 reported victims allegedly were attacked by fellow youth, the other four by adults.

The Tribune pieced together accounts by examining thousands of pages of records from local police, state and federal agencies, and court filings. Some government records were redacted to protect the privacy of hospital patients and workers, so it wasn’t always possible to determine the precise outcome of each case.

An alphabet soup of local, state and federal agencies have piecemeal responsibility for monitoring the facility. But they often don’t cooperate, the Tribune found, and DCFS has cut back on thorough investigations of such hospitals.

The newspaper uncovered instances in which hospital administrators shooed away police. In other cases, police didn’t send their reports to state inspectors. In yet another example, the state Department of Public Health cited River-edge for 22 patient-safety deficiencies last year and Forest Park police were called to the units. But the Tribune found that DCFS did not have records pertaining to many of those incidents.

Until 2003, DCFS conducted broad investigations of the psychiatric hospitals where state wards are shuttled for short stints, sometimes pulling clinical files and interviewing youth and staff during unannounced midnight visits. Today, DCFS spokesman Kendall Marlowe said, the agency focuses on reports of harm to individual wards, but “there are not formal inspections, investigations, evaluations of the facilities as a whole.”

DCFS Director Erwin McEwen said he was surprised to learn from a reporter that his agency no longer conducted the investigations, known as Independent Utilization Reviews.

“I have not been able to find out specifically when and why we discontinued that practice,” McEwen said in a recent interview. “Do you think kids are being hurt?”

Gaps in the law

One reason youth were left vulnerable is the lack of communication among the agencies that are supposed to help protect them.

Like all hospitals, Riveredge is legally obligated to report suspicions of mistreatment to an official DCFS division called the Child Abuse Hotline. Riveredge spokesman John Van Mol said it does so.

“The hospital’s strict policy as mandated reporter is to notify through the DCFS hot line,” he said.

But DCFS, which fielded about 266,000 hot line calls last year, examined only three allegations that a child was harmed at Riveredge in 2007, records show.

The agency marked those three cases “unfounded” and examined none of the serious assault reports documented by the Tribune. It is unclear from available records whether Riveredge didn’t report those incidents or DCFS failed to investigate them.

Gaps in the law exacerbate the problem. While hot line calls are mandated when young patients are assaulted or harmed, state and federal laws do not require hospitals to call police or the state Department of Public Health, which licenses hospitals. “Illinois is currently looking at legislation requiring hospitals to report abuse and neglect,” said Melaney Arnold, spokeswoman for the state Health Department.

Even when authorities independently learn of an incident, they often face roadblocks. Riveredge administrators say they restrict police from the units because their presence can upset patients and disrupt therapy.

For their part, DCFS hot line workers don’t automatically pass along abuse allegations to local police or the state Health Department.

And the hot line doesn’t always share abuse reports with DCFS officials who monitor psychiatric facilities, according to Michael Jones, the DCFS associate deputy director who runs the agency’s psychiatric hospitalization unit.

Jones said his unit sometimes conducts unannounced inspections. But “most times I let hospitals know I am coming.”

“I’m not out to come with a heavy hammer or stop admissions,” he added. “My goal is to work with you.”

Profitable business

Children placed in state custody develop mental disabilities more frequently than those from intact families, largely because they are more likely to have endured abuse and neglect or have been exposed in utero to alcohol and drugs.

Last year, 1,284 Illinois wards were admitted to psychiatric hospitals, nearly 8 percent of DCFS’ total caseload. These mentally disabled young people represent one of the largest and fastest-growing line items on DCFS’s budget: The agency last year spent more than a half-billion dollars to treat and house youngsters at psychiatric hospitals, residential centers and specialized foster homes. That was more than a third of the agency’s budget.

PSI, which operates 90 facilities nationwide and 10 in Illinois, has found a steady market in treating such kids. The firm’s profits surged from $5 million in 2003 to $76 million in 2007.

With a spurt of recent acquisitions and construction, the company now dominates Illinois’ youth treatment market, serving roughly 700 youth a day at Riveredge, five other juvenile psychiatric hospitals, a residential treatment center and three special-education schools. Last year, PSI facilities accounted for roughly 45 percent of the $51 million the state Department of Healthcare and Family Services spent on psychiatric treatment for wards at the hospitals most used by DCFS, records show.

Public aid programs cover more than 90 percent of Riveredge patients, according to PSI. The state allows such firms to maximize their government reimbursements.

Last year, for example, DCFS paid PSI at least $650,000 to hold empty beds at PSI’s Streamwood residential treatment center for 38 wards who were being treated next door at the company’s youth psychiatric hospital, a Tribune analysis of government records found.

Those records show some wards were shuttled repeatedly between the Streamwood center and the adjacent hospital. One boy was transferred seven times between the two facilities last year, and DCFS paid PSI about $35,000 to hold his residential bed for the 91 days he spent at the company’s hospital.

Riveredge said the transfers were made in consultation with social service agencies hired by the state.

McEwen, the director of DCFS, said his agency pays such residential centers to hold empty beds so wards will have someplace to go after they’re discharged by psychiatric hospitals. But DCFS officials are working to end such serial short-term psychiatric hospitalizations because they drain tax funds and put children through chaotic therapeutic regimes.

“I know it appears like they’re getting paid twice for the same kid,” McEwen said. “I understand why you find that disturbing.”

Lax monitoring

While Riveredge last year treated 341 wards—more than any psychiatric hospital in Illinois—allegations of harm mounted amid haphazard monitoring.

State Health Department surveyors last year cited the hospital 22 times for deficiencies that threatened the safety or legal rights of patients, a Tribune analysis found. (Some deficiencies cover several incidents, and some incidents prompt several citations.)

By comparison, during the same period the department cited a total of 31 such deficiencies at the dozen other private psychiatric hospitals or hospital units frequently serving DCFS wards. Riveredge had the highest rate of deficiencies per patient day, the Tribune found.

In March 2007, after the 19-year-old patient allegedly was raped twice, federal regulators placed Riveredge under “immediate jeopardy” of losing Medicaid and Medicare funding, saying the hospital hadn’t ensured “the protection of patients from sexual abuse.”

That sort of “immediate jeopardy” watch is put in place when a facility’s failure to comply with Medicaid requirements has caused, or is likely to cause, serious injury or death to a patient.

Riveredge’s owners say the company quickly corrected the deficiencies.

“We deal with a very acute population, and there are instances in all facilities where something will happen,” said Jeff Bergren, PSI’s Midwest division president.

Bergren said PSI tries to be open “and to say, ‘You know what, this happened, this is what we’re doing about it, these are the corrective action plans.’ ” In the case of that rape allegation, “we did just that,” he added. “They came out and investigated, and we responded to their findings with a corrective action plan that was fully accepted.”

But the hospital slid in and out of compliance with Medicaid requirements until Dec. 17, 2007, records show.

And in a sign of continued problems, DCFS said this week that Riveredge had failed to promptly notify the agency of a July 5 fight in the adolescent boys unit.

Such fights were not uncommon. Between 2005 and 2007, police and state surveyors investigated reports that eight young patients were injured in non-sexual assaults.

Riveredge staff or contract employees were accused in four of those alleged attacks.

Six youth escaped from Riveredge during those three years. Three were found, state and police records show.

And in at least four cases since 2006, government inspectors cited Riveredge for improperly sedating children with powerful psychotropic drugs.

In 2006 Riveredge administered forced medication to a bipolar 12-year-old three times without notifying a guardian actively involved in his care, an Illinois Human Rights Authority report stated.

Fates unclear

The hospital’s new management team said it is improving such conditions.

“There have been issues, but they’ve got new leadership and have beefed up psychiatric staff and are still making changes to try and get better,” said Van Mol, the Riveredge spokesman.

In incidents large and small, incomplete government and hospital investigations make it impossible to determine what actually happened when children were harmed.

In the case of the youngest victim, the 8-year-old ward’s foster mother visited two days after his 2005 admission.

When she did, a nurse told her the child had been sodomized and sexually assaulted by his 9-year-old roommate.

The foster mother went straight to Forest Park police, who opened an investigation.

A Riveredge worker told police he was doing rounds, chanced upon two half-naked boys, separated them and called in a counselor.

Police telephoned a third Riveredge employee who revealed “a past incident involving sexual activity” by one of the two boys but said “she could not go into detail about the incident because she was driving children in her auto.”

With that, the police file ends.

Police did not interview either child but concluded that no criminal complaints would be filed because “there was no penetration and the sex was consensual.”

According to reports released to the Tribune under the Freedom of Information Act, the state Health Department did not investigate the assault allegations.