Monday, April 27, 2009

Report shows multiple problems at Tennessee center for people with intellectual disabilities

From the Jackson Sun in Tennessee:

The Winfrey Center in Trenton has had at least 13 substantiated complaints of abuse and neglect of its mentally disabled residents since 2006, according to information provided to The Jackson Sun by state agencies.

The facility also has received poor marks for its management, bookkeeping and the medical care of its residents in reviews by a federal court monitor who began surveying the facility in 2007.

The Winfrey Center's managers say they do not think the number of substantiated complaints at the facility is overly high. But a retired administrator from a facility that provides similar care in East Tennessee said the percentage of complaints substantiated at the Winfrey Center according to one state agency's records is troubling.

Managers at the facility also said they think their plans to empty the 84-bed facility into 21 group homes to be built in Gibson and North Madison counties could greatly reduce the situations that create conflict and other problems at the Winfrey Center. The institutional-style facility has operated in Trenton for about 30 years and is designed to care for mentally disabled people with the highest medical and behavioral needs.

The Jackson Sun made public records requests with two state agencies involved in oversight of the Winfrey Center. The Division of Mental Retardation Services provided limited information about investigations that have occurred at the Winfrey Center since June 2008, when Mental Retardation Services became more involved in such oversight. The Department of Mental Health and Developmental Disabilities provided some records on investigations conducted between the beginning of 2006 and spring 2008.

A review of the information and the court monitor's January 2009 report found that:
Much of the Winfrey Center's care was found to be flawed last fall, despite a management overhaul last spring, according to the court monitor's report.

Residents' conditions and personal issues were not correctly tracked in records, and medical issues also were not properly reported, according to the report.

In some instances, medical problems - potential and diagnosed - were not addressed. One resident went five years without glasses needed for an eye condition, and a female resident had no follow-up exam scheduled for her more than two and a half months after a growth was found in her breast, according to the report.

Problems were substantiated in seven of 21 investigations conducted by the Division of Mental Retardation Services between June 1, 2008, and March 23, according to officials with that agency.

Two of the substantiated complaints were for physical abuse, and the remaining five were for neglect in either supervision or treatment.

Two investigations were still pending as of Friday, officials said.

Mental Retardation Services began receiving such complaint reports after March 1, 2008, as part of a transition period to its stepped-up oversight role at the facility, but did not begin investigations until June, said Missy Marshall, a Division of Mental Retardation Services spokeswoman.

Mental Retardation Services officials refused to release records that would provide details of their investigations, saying the records are confidential under state law because they contain identifying information on specific Winfrey Center residents. A lawyer for the state press association disagrees with that interpretation of the law.

Six of 18 investigations conducted by the Department of Mental Health and Developmental Disabilities between 2006 and spring 2008 substantiated reports of verbal and physical abuse at the facility.

That department provided the newspaper with some investigation records, redacting information that could identify residents and their specific conditions to comply with state confidentiality protections on medical and mental health records.

The department later refused to provide further supporting documents that were erroneously omitted from records sent to The Jackson Sun. In refusing to release the documents, department officials cited state law protecting information on the identities and services used by mentally disabled people.

The records the agency released reveal a troubling number of substantiated complaints at the Winfrey Center, said Hal Baker, a former chairman of the Tennessee chapter of the American Association on Intellectual and Developmental Disabilities.

"Reports are healthy. Substantiations are not," said Baker, who retired in February from the Orange Grove disability facilities in Chattanooga.

"A 30 percent substantiation (to) complaint (rate) says you gather your troops around you and say, 'Hey guys, we've got work to do,'" Baker said.

The court monitor's report notes "ongoing concerns" about the facility's incident reporting, though management changes have led to noticeable improvement.

The Winfrey Center is cited in half of the substantiated reports investigated by the Mental Health Department for not properly or quickly reporting complaints of physical or verbal abuse.

For example, Mental Health investigators note that Winfrey Center officials reported a March 2006 incident that led to an employee's firing as "mistreatment and threatening of an individual" but should have reported it as physical and verbal abuse.

Some details of the incident - in which an employee goaded a resident into a fight by shouting, "Come on and get you some!" and pumping his fist in the air - were not reported to the state until three weeks later, a Mental Health Department report says.

In 2007, the Winfrey Center became subject to reviews by a court-appointed monitor that stem from a lawsuit filed in the early 1990s over conditions at Arlington Developmental Center in Memphis. The facility was included in the monitoring because Winfrey Center residents, due to their condition and location, could have been admitted to Arlington, which is operated by the state.

The Winfrey Center has not fared well in the court monitor's reviews. Out of a possible score of 36, it received a grade of 8 in a 2008 review report released in January. The facility also had done "extremely poor" on an ungraded review from the year before, the report says.

The more recent review found poor bookkeeping, with some important documents containing incorrect identifying information and wrong or contradictory details on specific residents' conditions. Some nursing records made it appear that some residents had not been given several doses of important medication, the report says.

The report also noted flawed management. No plans had been made to address one resident's tendency to sexually force himself on other disabled people with limited functional ability. His three roommates seemed to fit that description, the report says.

The Winfrey Center went through a management change about a year ago, bringing in a new administrator who the report says seems to be working to resolve many of the facility's problems.

Kathy Boone, who was a Winfrey Center administrator until 2006, blamed many of the problems on "very raw" employees who did not have enough supervisors making sure they were following regulations and adhering to training.

Boone is now director of operations for Developmental Disability Management Services, the Collierville company that manages the Winfrey Center. She said several additional supervisors and other care staff have been added to the center in the past year. Boosted payouts from the state have helped cover additional costs, she said.

"The very, very basics were met, and the basics could have been better," Boone said. "And they are better now."

Winfrey Center managers say they do not tolerate abuse committed by employees. They say they quickly punish offenders and try to train often-inexperienced new hires to avoid situations in which they might lose their composure.

But they say gauging how many substantiated complaints are a sign of trouble is too subjective. The number and sensitivity of abuse regulations and other rules meant to protect their residents can drive up the number of complaints, they say.

"In our world, there's 700 citations we can be cited for every time we walk in our door," said Terry Swatley, president of the company that manages the Winfrey Center.

Baker, the former state disability association chairman, agreed that stricter regulations enacted in the four decades he worked in disability care likely have caused an increase in the number of complaints reported each year. "The things we used to do in the '60s are now considered abuse you can be prosecuted for," he said.

Still, he said the rate of substantiated complaints at the Winfrey Center sounded too high and likely should have resulted in a review by management of the facility's employees and how they operate.

Turnover is a persistent issue at the Winfrey Center and similar facilities, Swatley said. He said many of the workers hired at the facility are largely unskilled and inexperienced, either because of youth or lack of familiarity with the needs and conditions of the mentally disabled.

"Let's face it: The direct care worker is not the person who is going to build rockets," Swatley said. "They're under educated. They're generally going to be poor, and this is a skill and a job they can grow into."

Boone estimated that one-third of the employees at the facility have worked there less than five years.

Many hires are inexperienced people who supervisors think can be trained to be effective caretakers, Boone said.

"People become overwhelmed, and they resort with something they might do with one of their own children or a family member," Boone said. "I don't approve of spanking children, either, but people do it and it's socially acceptable ... But it's not in this business."

To minimize that kind of response, Winfrey Center employees have 10-day orientation periods and undergo regular training meant to prepare them for managing groups of disabled residents, as well as unruly residents who might curse and become physically abusive.

"Sometimes )employees) get angry, and they may lash out," Boone said. "That's why we try to set up an environment where people don't become angry."

That training does not always work.

In a 2006 incident detailed in the Mental Health Department records, an employee was attacked while trying to break up a fight between two Winfrey Center residents.

Riled, the employee complained, "I am not going to keep getting beat on every day." An upset resident told him, "Don't say that. You don't need to say that."

According to statements by witnesses, the employee became more incensed, pumping his fist in the air and screaming, "Come on and get you some!" The resident lunged at the employee. A witness told investigators that, after the short fight that followed, a nurse had to restrain the employee but not the resident.

Witnesses said the employee screamed, "These people aren't mentally retarded; they're (expletive) crazy."

When questioned by investigators, the employee could give no reason why he thought the resident was trying to attack him. He was soon fired.

During interviews, Winfrey Center managers ask potential hires how they would react in extreme situations, Boone said.

But, "Really there's no test to say that this person is going to go off in this situation," she said. "We train folks, but we can't predict."

Half of the six substantiated complaints in the records provided by Mental Health cite Winfrey Center managers for not properly reporting incidents, including a January 2008 incident in which a program supervisor was fired for hurting a resident's hand.

In that case, the resident was not taken to the hospital for the "sore and swollen" hand until the day after the resident first reported being hurt, according to a Mental Health report. Doctors found no serious injury.

The state report says the supervisor and the resident were the incident's only witnesses and that there was a lack of corroborating evidence on the circumstances of what happened. An internal investigation reported that "evidence taken as a whole paints a picture of 'He said, she said.'"

But the state's report says investigators concluded the incident did happen and chides Winfrey Center employees for not following the facility's abuse reporting policy.

Mental Health officials determined the Winfrey Center properly reported an April 2008 incident in which a female employee cursed at an unruly resident, according to a state investigative report. But the employee, who was retained after receiving a verbal reprimand, volunteered to an investigator that sharp tensions between residents and staff had provoked a subversive culture of abuse by employees.

"I won't name names," she said, "but there are employees who talk real bad and curse clients. If I felt like the clients would be physically harmed, I'd report it, but this is not the case."

She added: "I have heard (employees) say to patients (that) if they hit them, they would get them back, and many more threats. But none of this would ever happen if y'all didn't leave them to think it was OK for them to hurt us because we can't defend ourselves or we'll go to jail."

The employee said residents regularly mocked employees, bragging that they could attack employees knowing the employees could not fight back.

Swatley and Boone both painted that employee's comments as likely a defensive reaction to being investigated.

Baker said that, given the intensity and sensitivity of rules in facilities such as the Winfrey Center, complaints by upset employees probably can skew the volume and perception of problems at a facility.

"I think there's been kind of a false sense of occurrences because of the sort of 'get-back-at-you' accusations, and it's really hard to know how many of those" are among the total incidents reported, he said.

Owners and managers of the Winfrey Center plan to eventually move the facility's operation into 21 group homes that will be built in mostly residential areas of Gibson and Madison counties.

Construction is expected to begin as soon as next month on homes in Gibson County, said Swatley, president of the company that manages Winfrey. Two of 14 facilities planned for Gibson County did not receive certification from the state Health Services and Development Agency, which the company is appealing, Swatley said.

Seven facilities that will be built in North Jackson, Oakfield and Three Way in North Madison County were approved on Wednesday, a development agency official said. Construction likely will begin on those facilities in late summer, Swatley said.

The overall project is expected to take 16 months to complete, he said.

Winfrey managers say their move to group homes likely will reduce the chances of more problems like those cited in the complaint reports provided by the state - mainly by shrinking the number of disabled residents whom employees must monitor and care for each day.

Winfrey Center managers say legal protections and state and federal pushes to move the Trenton facility's population into new facilities make it unlikely the group home project will be stopped. Residents in Gibson County and North Madison County communities have protested the project, accusing builders of trying to sneak the homes into their neighborhoods without the input and permission of surrounding

Although Winfrey Center operators say research has shown group homes do not degrade property values, residents have refused to believe that. Some also have confused mental disabilities with potentially dangerous mental illnesses, saying they are worried about the threat group homes pose to themselves and their children.

Ron Barger, 61, lives near a home planned to be built on Windale Drive in North Jackson. He said he was not overly bothered by the complaints alleged and substantiated against the Winfrey Center.

"It's understandable that you're going to have those sort of activities" at a facility such as the Winfrey Center, he said.

He had questions about how freely those cared for in the facility will be allowed to move around his neighborhood but said he was most concerned that the group home would be too large and would not fit in with surrounding homes.

"That's going to stand out like a sore thumb in the neighborhood," he said. "... It destroys the whole concept of a single-family residential neighborhood, and when you do that, the property values go down in a like manner."

State officials and group-home builders have maintained the key reason for the move is that people with mental disabilities are more likely to thrive in a safe, residential environment. The Winfrey Center and any similar institutional facilities are a few decades out of date, said Baker, the former state disability association chairman.

"Folks with this level of difficulty can flail out, throw something and be difficult if someone else gets in the way," Baker said. "You've kind of got to think of it as your own family ... You got eight kids? Whoa! And if you have got 84 people, it becomes very hard to comply with contemporary standards in a facility that large."

Swatley agreed.

"One or two people having a bad day is easier to handle than several people having a bad day," he said.

In her January report, court monitor Nancy Ray says there is "considerable promise" in the group home plans of the Winfrey Center's managers. "It will fill a significant gap in services for persons with profound disabilities in this area of West Tennessee," Ray writes.

But she also notes that the care will have to be far better than it has been in the past couple of years to fulfill that promise.