Sunday, October 23, 2011

Texas Tribune: Gov. Perry and his staff downplayed abuse allegations at Texas institutions for disabled people

From The Texas Tribune:

MEXIA, Texas — At the Mexia State Supported Living Center, on the sun-bleached site of a former World War II prisoner of war camp an hour east of Waco, residents with profound disabilities and behavioral problems spend their days doing repetitive chores: sticking paper into shredders, folding towels, sorting nuts from bolts. And, in some cases, being physically abused, despite a sweeping federal settlement signed in 2009 to prevent it.

In the last two years, a Mexia worker was caught on video pushing down a disabled resident and stepping on his throat while other employees looked on. A staff member goaded one resident into hitting another with a belt, causing bloody wounds and resulting in a trip to the emergency room. A direct-care worker showed residents pornographic pictures and tried to get them to perform oral sex on him. Another sexually abused two residents.

This pattern of abuse appears pronounced in Mexia, where roughly half of the disabled residents are alleged criminal offenders and nearly a third are under 21.

But two and a half years after Texas officials signed an agreement with the United States attorney general’s office aimed at improving conditions in the state’s 13 institutions — following a Justice Department investigation that found avoidable deaths, civil rights violations and systemic abuse — a Texas Tribune review of facility monitoring reports and employee disciplinary records shows that mistreatment is still relatively common.

Although there is some evidence of improvement, the state’s federally designated disability watchdog group, Disability Rights, said that halfway into the five-year settlement agreement, not even a quarter of its requirements have been met.

“It’s all just as bad,” said Beth Mitchell, Disability Rights’ supervising attorney. “The numbers suggest less physical abuse, but we still see a lot of really significant cases. I can’t tell you that there’s one shining example of a wonderful facility, because there’s not.”

Officials with the Department of Aging and Disability Services, which oversees the state-supported living centers, point to evidence of compliance, from advances in security to improvements in staffing.

Nearly 3,500 security cameras have been installed in Texas’ institutions for the disabled. Each facility has an independent investigator to monitor abuse. Potential employees are now fingerprinted and run through background checks before they are hired, and existing employees are subject to random drug tests.

Today, 94 percent of facility jobs are filled, a marked improvement over past years, even with the influx of more than 1,000 new positions established under the settlement agreement. Staff turnover has dropped. And there are now more than three employees for every resident, in part because the census at the state-supported living centers has dropped by nearly 800 residents since late 2008.

But despite more consistent staffing and annual spending that has grown by nearly 50 percent since 2006, abuse allegations have continued to rise steadily, with confirmed allegations hovering at 9 percent. The agency attributes this to better investigations: in the last fiscal year, 375 workers were fired or forced to resign because they abused or neglected disabled residents, more than in any of the previous three years.

Justice Department officials declined to comment on Texas’ efforts thus far. But Cecilia Fedorov, a spokeswoman for the Department of Aging and Disability Services, said that meeting the terms of the agreement is intended to be a long-term process and that “milestone dates” laid out in the agreement are guidelines, not deadlines.

“While progress toward and achievement of substantial compliance has been slower than anticipated by the state, efforts continue to be sustained in every facility,” Ms. Fedorov said in a statement.

Federal investigators have a lengthy history with Texas’ state-supported living centers, formerly known as state schools. The Justice Department sent a team into a Lubbock facility in 2005 and released a highly critical report in 2006 that cited more than 17 deaths at the institution in the previous 18 months.

Despite some improvements made by state leaders, in 2008 the Justice Department announced that it would examine conditions in all 13 Texas institutions. Four months later, investigators published a scathing rebuke, saying residents’ constitutional rights had been violated, and threatened legal action if Texas did not resolve the problems.

In May 2009, four years after the initial investigation in Lubbock, state leaders signed a five-year, $112 million settlement agreement with the United States attorney general’s office, pledging to improve standards of care, increase oversight and monitoring, and enhance staffing.

On a recent visit to the 500-acre Mexia facility, many of these efforts were visible, from paper signs listing the telephone number of an abuse-and-neglect hot line to strategically placed surveillance cameras to the nondescript dormitory office that is home to a state abuse investigator. A sign at the entrance to the property read “Now hiring!”

The workers on duty that morning — many of them veterans with decades of experience — helped residents with their daily tasks, from planting carrots in a garden to removing staples from paper for shredding. They showed off squeaky-clean cement- and linoleum-floored dormitories, an on-site hair salon, a cafe with a jukebox and old movie posters. They shuttled residents between bedrooms and bathrooms and therapy sessions, interacting with a familial warmth that made the facility’s confirmed abuse allegations seem hard to fathom.

Yet records show that awful abuse continues, and not just at Mexia. In the years since the settlement agreement was signed, a staff member at the Lubbock State Supported Living Center beat a resident he was trying to shave and slammed his head into a cabinet. An employee at the Richmond State Supported Living Center was captured on video kicking a resident in the legs, punching him in the neck and chest, and striking him on the head. And a staff member at an Abilene center kicked a resident in the head eight times.

At Mexia, an employee started a romantic liaison with a resident, sending the resident nude photos and calling the resident’s cellphone 452 times. Another worker there failed to supervise a resident, who attempted to construct a Molotov cocktail.

In late spring, seven staff members at a Corpus Christi center were fired for undisclosed abuse allegations. That is the same center where dozens of employees were fired in 2009 for forcing disabled residents into staged fights. Five were convicted of crimes.

Ms. Fedorov, the Aging and Disability Services spokeswoman, said the agency had zero tolerance for abuse and neglect. She said that for the most part, the workers at these facilities are amazing — but that with any public entity, from a school district to a hospital system, there will be some bad apples.

“You have good days and bad days anywhere,” she said. “No matter what you do, from fingerprints to employment history, bad things sometimes happen.”

But watchdogs say that is not an acceptable explanation. Whether the Justice Department will acknowledge it, they say, Texas is not living up to its end of the bargain — as evidenced by the results of frequent status reports released on each center by independent monitors.

Ms. Mitchell said the federal settlement directed facilities to come into compliance with 171 provisions by the end of the agreement in 2014 — and that they should have made substantial progress on at least 150 of them so far. On average, she said, the state-supported living centers have met only 20 percent of those 150 provisions, according to a Disability Rights analysis of facility monitoring reports. The Richmond and Corpus Christi centers have not even broken 13 percent, Ms. Mitchell said.

Ms. Mitchell said that despite reductions in staff turnover, keeping qualified people in their direct-care or nursing jobs is still a major problem. She said that breakdowns in communication still prevent residents from getting the proper therapy and treatment they need. And while security cameras have reduced abuse, it still happens outside their view. In some cases, Ms. Mitchell said, facilities will come into compliance with certain standards — and then fall back out again.

“As much as the department wants to continue to say they have fixed their problems, we don’t see that, and I don’t think the monitors see that,” Ms. Mitchell said. “The fact that we’re still seeing a lot of abuse cases that are pretty significant — the only lucky thing is that now they’re being caught on camera.”