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Tuesday, August 20, 2002
Out-of-state care takes its toll
Copyright © 2002 Blethen Maine Newspapers Inc. | ||||||||||
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Also on this page: CASTAWAY CHILDREN: Maine's Most Vulnerable Kids | |||||||||
Jan. 29, 2002/ Devereux Cleo Wallace, Westminster, Colo. — A youth placed at Devereux , a program for emotionally and mentally ill youths, ran from the facility on a November evening, according to Maine records. She called police from a pay phone and later told Devereux staff she was picked up by an older man and had sex with him. The girl was checked medically and appeared to be OK. April 8, 2002/Pines Treatment Center, Va. — A Maine boy sent to the hospital for sexual offending was to be on 24-hour watch. Instead, according to Maine records, he and another boy were caught having sex . "There have been other incidents where he was able to become sexually involved with other students, as well as being involved in fights,..." wrote his Maine caseworker. "I am concerned about the level of supervision Pines is providing." April 17, 2002/Devereux Hospital, Fla. — An emotionally troubled Maine girl, sent to the hospital for treatment, says she has had sex three times with a male staffer and believes she is pregnant. According to Maine records, hospital workers test the girl for pregnancy and find out she is not. The staffer who had sex with her was fired. Florida police are investigating the case. They are Maine's most vulnerable and troubled children. Kids who have been abused and neglected, youths diagnosed with mental illnesses. They need intense psychiatric treatment, and because that help often is not available in Maine, these children are sent away to hospitals and programs around the country. A total of 737 Maine children have been sent away in the past five years. Eighty-nine remain out of state today. Their average age is 15. Some are as young as 6 and 8 years old. Their treatment sometimes costs as much as $1,000 a day. Yet the expensive care does not guarantee that these children will get quality treatment. Every year, Maine receives complaints of children who are restrained too roughly, sexually assaulted, allowed to live in unclean and unsafe hospitals. The state has no legal authority to investigate these claims, and because many children are hundreds and sometimes thousands of miles from home, it's difficult to know if they're safe or receiving proper care. Up until a year and a half ago, Maine didn't have rules on how often caseworkers should check up on them. And even if these children and teen-agers receive good care, experts say they suffer because they're torn from their families and communities, where they often must return and learn to cope with their illnesses. "It's absolutely devastating for these children to be shipped out," says Wanda Mohr, a Rutgers University professor who has researched children's mental health facilities nationwide for the past 10 years. "It's like you're being thrown away." During a six-month investigation, the Portland Press Herald/Maine Sunday Telegram analyzed databases and reports detailing how many children have been sent away for treatment since 1997, how much their treatment has cost and how well the children have been treated. The review was part of a comprehensive look at Maine's mental health care system for children. The newspaper found that Maine's tendency to send children with severe psychiatric illnesses elsewhere for treatment is one of the top reasons why this state's system is so costly and ineffective. Payouts to other states In the past four years, Maine has spent close to $84 million in state and federal money on out-of-state psychiatric hospitals and facilities. New Hampshire hospitals garnered the most, at $43 million. Pennsylvania, the corporate headquarters for Devereux, which has facilities nationwide, collected $15 million; followed by Massachusetts, at $13 million; Georgia, $3 million; and Rhode Island, $2 million. Some children Maine sends away for treatment are gone for six months. Others are away for years. Since 1997, at least 53 children stayed out of state for two years or longer. At least 195 were away a year or more for psychiatric treatment. Children who were wards of the state tend to stay away for longer periods of time. Of the 100 children gone for 18 months or more between 1997 and 2001, 73 were kids whose parents either gave them up because they couldn't afford treatment or who were taken away because of neglect or abuse. Of the 15 children out of state for three years or longer, all but one were wards of the state.
At times, these children live in hospitals and treatment centers where staffing ratios are dangerously low and children are left unmonitored. Dozens of Maine children have been abused at out-of-state hospitals over the past decade. The most egregious case involved a New Hampshire hospital, Charter Brookside, where children were found having sex with each other and living in filthy rooms. After federal investigators shut down the hospital in 1999, Maine developed a policy that caseworkers should visit children at least four times a year when they're sent out of state. Prior to the Charter Brookside scandal, Maine had no rules on supervising children sent away for psychiatric help. Many families and foster parents said their children never saw or heard from anyone in Maine, once they left the state for treatment. "It's like these children disappear when they go out of state," said Ronnie Sprinkle, whose foster child was sent to Charter Brookside. "They have no contact. They have no one coming to see them. It's pretty scary. They're like the last train of misfits. The last train to nowhere." Many states send children away for specialized psychiatric treatment, but mental health advocates say few states have shipped away as many children as Maine. Maine traditionally has spent nearly 72 percent of its mental health care money reacting to children in crisis and placing them in psychiatric hospitals and facilities instead of working with families to keep their kids at home and stable. That's double the proportion that mental health experts say the state should be spending on such services. State faced two lawsuits During the past six years, the state has faced two class-action lawsuits on behalf of more than 1,200 children who could not receive community or in-home services. The children were so disabled they were eligible for Medicaid. Child advocates say Maine broke federal law by not helping these mentally ill children, a charge the state disputes. "For years, Maine's mental health care system for children has been nonexistent," said Cindy Fagan, vice president of Sweetser Family Services, one of the largest state-funded mental health care providers for children. "The state's health care for these kids has been driven by lawsuits." The lack of support contributes to the break-up of families, Fagan said. Maine removes hundreds of children from their homes each year and ranks fifth in the nation when it comes to taking children away from parents. Many children end up needing psychiatric care, overwhelming the state's treatment programs. Without enough in-state care available, hundreds of children with psychiatric problems have been sent to treatment centers in other parts of the country. Several of the mental health directors in neighboring states were astonished that Maine sent 737 children away in the past five years. Though the state has made progress in bringing these children home, the number of out-of-state placements remains far higher than other New England states. As of July, 89 children remained out of state. "Wow," said former New Hampshire's director of Behavorial Health Tom Keane of the 737 Maine children sent out of state. Keane has worked for state mental health care systems for 30 years, including New Hampshire, Massachusetts and Ohio. "That's a lot of children out of state." New Hampshire puts most of its mental health money for children into community programs, Keane said. "We've got programs that identify kids before they end up in crisis and at the emergency room," Keane said. "We try to track these kids, run groups in the community. We do what we can to avoid putting these kids into hospital beds." Vermont shares New Hampshire's philosophy. Its Department of Mental Health seldom sends children away for treatment. "We've had a policy not to send children out for 12 years," said Charles Biss, Vermont's director of Child and Adolescent Mental Health Services. "We're trying to build community services for our kids, and you can't do that if you're spending all your money out of state." Biss says Vermont's child welfare division does send some troubled children away, but there are no more than 45 out of state now. And, he said, previous experience suggests that those children placed out of state often don't come back in "any better shape." Massachusetts' Department of Mental Health also has made an effort over the past 10 years to treat most children in state. "I can count on a couple hands the number of kids out now," said Joan Mikula, assistant commissioner for child and adolescent services in Massachusetts' Department of Mental Health. "We've made the change to keep children here over the past 10 years." Lawmakers outraged Three years ago, Maine lawmakers vowed to bring children home after federal health officials shut down New Hampshire's Charter Brookside for safety and health violations. New Hampshire refused to send its mentally ill children to the hospital even though it was in the southern corner of the state. Almost all of the children at the hospital 36 out of 44 had been placed there by Maine. "We weren't enamored with that program at Charter Brookside," said John Wallace, associate commissioner for New Hampshire's Department of Health and Human Services. "We try to keep our kids out of those places in general." Reports of how Maine children suffered abuse and neglect at Charter Brookside outraged Maine lawmakers. They demanded the state stop sending children away. "At one point we had 250 kids out of state in 1999; now we've got around 100," Maine Commissioner of Human Services Kevin Concannon said. "And in July, we will have placements down below 100 for the first time since the 1990s." In late July, there were 89 Maine children out of state. Though Concannon says the children who are coming back to Maine are receiving community services or help in group homes and residential programs, not everyone is convinced these kids are receiving good care once they return. "We've got kids coming back to Maine, but where are they going?" said state Rep. Julie O'Brien, who represents the Augusta area and sits on Maine's Children's Mental Health Oversight Committee. "We've asked the state for specifics on where these children are going, and we often were frustrated with the lack of statistics. Concannon says he's happy the number of kids going out of state is going down. That's a victory for them or it very well may not be." Still, the children who remain out of state are complaining of abuse and neglect in facilities and hospitals entrusted to care for them and make them better. Complaints of abuse The state has recently received reports on 12 complaints of abuse and neglect involving Maine children sent away for psychiatric treatment. The complaints were made during a six-month period from November 2001 through April 2002. They include children at facilities and hospitals in New Hampshire, Florida, Colorado and Virginia. One Maine girl sent to Hamsptead Hospital in Hampstead, N.H., complained of being restrained by staff so roughly she couldn't breathe. She said staff held her hands so tightly they turned tingly and blue. Another Maine boy at the same hospital had his face pushed to the floor during a restraint. His face, limbs and knees were bruised. A third girl from Maine sent to Hampstead Hospital said she had to fend off inappropriate sexual touches by a hospital worker. Hamsptead Hospital officials say the complaints were investigated by New Hamsphire's child welfare authorities, who determined they had no merit. This spring, at Devereux, a Florida facility for emotionally and mentally ill children, a Maine girl reported having sex with a staff member three times. The male staff member was fired and Florida authorities are investigating the case. A Devereux spokesperson said the facility deals with cases of inappropriate sexual behavior quickly and allows children to call the Florida abuse hotline whenever they feel they need to make a complaint. Last fall, at a Devereux residential program in Colorado, a Maine girl receiving treatment ran from the facility. She said she had sex with a man, who picked her up on the street after she left the hospital grounds. The program is not locked, and a Devereux spokesman said although the staff monitors children closely, there are some youths who run from the campus. A Maine boy sent to a Virginia hospital for psychiatric and sexual-offender treatment repeatedly had sex with other patients. The child was supposed to be on constant watch. "I'm concerned about the level of supervision" at the hospital, the boy's Maine caseworker wrote in an April report. Last November another boy said he was sexually assaulted by his roommate at Lakeview Neurorehabilition Center, a hospital in Effingham Falls, N.H. The hospital said it could not comment on any specific case but that New Hamsphire officials had not recently cited them for any abuse or neglect cases. Windham foster mother Pam Charette is skeptical that Maine children receive good care when they're sent away. "We shouldn't even be putting our children in these places to begin with," said Charette, who has formed a group to stop Maine from shipping children away for psychiatric treatment. "Maine needs to create more programs to keep these children in state. These poor kids get lost in the shuffle, and they're neglected, unwanted and abandoned." Over the past five years, Maine has made improvements in its mental health care system for children. They've added several new services and programs. Mental health managers helped 4,000 children in 2001, compared with 500 in 1998. Close to 2,000 children received in-home help last year, while only 155 got those services in 1998. In the past three years, the state has created 425 more residential treatment beds for troubled children. "Some of these beds are at locked facilities, which Maine didn't have before," Concannon said. "We spend millions on group homes, residential treatment centers every year. We are not a state that ducks its responsibility to these special needs children." Needing special services Many of the children sent out of state today are severely troubled and need specialty services that Maine cannot provide, Concannon said. "These are kids with histories of fire-setting or sexually predatory behaviors. Most of your typical group homes in Maine say, 'We can't handle that kid.' These are kids with serious problems with serious needs and there aren't any easy answers." Still, Maine spends nearly $20 million a year on out-of-state psychiatric hospitals and programs. Seventy-two percent of the $232 million in federal and state money spent on Maine's emotionally and mentally ill kids is used to place children in hospitals and treatment facilities, both in-state and out of state. National mental health experts say states should spend at least 60 percent of their money on keeping mentally ill or emotionally troubled children healthy and stable in their homes. Maine spends less than half that 28 percent on community care. Though it's expensive to place children in hospitals, it is less demanding on the state budget. "In some ways, it's cheaper for Maine to send these children out of state," Fagan said. "You only get a portion of Medicaid money for in-state programs. But if you're sending a kid to a hospital, you get most of it reimbursed through Medicaid." But hospital care is not an effective way to treat these children. Psychiatric experts believe children treated in their community have the best chance of making progress. "If you want these children to make a permanent change, it has to take place in the environment that has all of the stimulus the child has to deal with on a day-to-day basis," said Mohr, the Rutgers psychiatric nursing professor. "It makes no sense for that child to be treated in an artificial setting hundreds of miles from home." Children feel abandoned Many children feel abandoned when they are sent far from their homes, Mohr said. "Nobody says these are pleasant, easy children, but they are children nonetheless." Mohr also is skeptical of the treatment Maine children receive in psychiatric hospitals or residential facilities, where much of the staff is poorly trained and paid. Many of them are hired for jobs that require little more than a high school diploma. "There are typically lots of turnover at these places and a lot of corners cut," Mohr said. "You have untrained staff that doesn't know how to deal with these kids. "What you end up with is the sickest, most vulnerable children receiving the lousiest care." The staff at many psychiatric hospitals and facilities often aren't well trained on how to safely restrain children, Mohr said. That can lead to injuries and, in some cases nationally, even death. Federal health care officials tightened regulations on how hospitals train and use restraints after a Connecticut newspaper, The Hartford Courant, reported that 142 adults and children died between 1988 and 1998 in psychiatric institutions after being improperly restrained. For every complaint that is investigated, dozens go unreported, Mohr says. When children do say they've been abused or neglected, they're rarely believed, Mohr said. "Hospitals dismiss these complaints saying, 'These kids are mentally ill, we have to take what they say with a grain of salt,' "Mohr said. Little is done to make sure children aren't further abused Mohr said. "Typically, no one wants to look at these cases of abuse," Mohr said. "Unfortunately, children's mental health care across the country is characterized by these scandals. But mentally ill children tend to be unattractive. It's easy to turn your head and forget about these kids." Until 2001, Maine had no policy on how often they checked up on children sent out of state. How often caseworkers visited kids depended on how close they were geographically to Maine and whether there were allegations of mistreatment. "We had caseworkers go see them, but it depended on the youngsters," said Human Services Director Concannon. "A year ago, kids were to be assessed at least quarterly. But before that, there weren't any time requirements." Maine also has no authority to force another state to investigate abuse or neglect complaints involving Maine children placed in psychiatric hospitals or facilities. "If a Maine caseworker learns about potential abuse of a child, they make a note of it in a child's record," said DHS spokesman Newell Auger. "The caseworker reports it to the facility and the state's Department of Human Services, but if that state doesn't want to do an investigation, we can't force them." Historically, Maine has not kept track of complaints. Nor has it kept statistics on how often children are harmed in out-of-state facilities. Logging complaints The state's Institutional Abuse Unit only began logging abuse and neglect incidents in a computer database last year. It investigates cases of mistreatment in Maine facilities. It also contacts other state facilities when it learns about an incident involving a child who is a ward of the state. "To tell you how many complaints have come in involving out-of-state placements, I'd have to go through hundreds of individual files by hand," Auger said. "It could be done, but it would take a long time." The lack of record-keeping and the difficulty of keeping an eye on Maine children when they're out of state has led to problems. New Hampshire state police and officers from four towns quelled a riot at Beech Hill hospital's adolescent unit in 1997. Two years later, Maine began sending some children to Beech Hill from the troubled Charter Brookside hospital. Beech Hill had chronic staffing problems. Nurses told New Hampshire investigators that the "staffing ratio is dangerous." Professional care at the hospital failed to meet state and federal standards. There was no psychiatrist on staff or contracted to diagnose and evaluate the children. The hospital's admission director treated patients despite having fabricated her degrees in psychology and nursing. New Hampshire health officials shut down the hospital in June 2001 for "engaging in practices detrimental to the health, well-being and safety of its patients." During the hospital's last two tumultuous years, Maine sent 11 children there for psychiatric treatment. Today, still more reports of abuse at another New Hampshire hospital continue to provoke concern about Maine children. Sharon Kyle received a phone call in early November 2001 about her son, who was a patient at Lakeview, in New Hampshire. "The social worker told me not to panic, but there was an incident involving my son," Kyle said. "He told me he was sexually assaulted, but at the time, the hospital was looking at it just as a sexual fondling." Kyle drove to the hospital that night. When she spoke to her 15-year-old son, he said the hospital staff told him not to talk about the incident. "I told him he needed to tell me," Kyle said. "He said another boy came into his room and they got into a fight and the boy raped him. He hollered and screamed. And then when he reported it, no one believed him." Kyle said the hospital social worker told her that it was best if she didn't speak to her child about the incident because the youth "didn't know what was going on." "I told him, 'Oh yes he does,' "Kyle said. "My son is not feeble." Kyle says her son's caseworker from Maine later called the hospital and asked if there was an investigation into the alleged Oct. 21 sexual assault. "The hospital said they were doing their own in-house investigation first and the caseworker told them they legally had to report it to the state of New Hampshire," Kyle said. "She told them she was going to report it herself. And when she called New Hampshire, they said, 'Isn't that funny, the hospital just called this in, too.' " Maine's Department of Behavioral and Developmental Services also received a report on the sexual abuse complaint. Officials declined to talk about the case, citing patient confidentiality. Lakeview's clinical director, Tina Trudel, said she cannot discuss any patient who was or is at the hospital. But she added that the hospital reports any abuse or neglect cases immediately to New Hampshire child welfare investigators. Boy allegedly beaten Concerned about her son's safety, Kyle removed him from Lakeview last November. "I couldn't let him stay there," she said. But once Kyle brought her son back to Maine she could not find help for him. She remained on a waiting list for in-home help for nearly eight months. She finally got help this past June. Last summer, Kyle said she had no choice but to put her son in the New Hamsphire hospital because there was little help for him in Maine. Kyle had waited over six months to find treatment for her son so she could keep him in their Monmouth home. She was placed on waiting lists for a case manager, waiting lists for an in-home mental health worker who would help keep her son calm. "There was a six-month period, he just pounded on me," Kyle said. "He made death threats to assassinate me. For weeks, I called the police nearly every day." As spring 2001 approached, her son worsened. Kyle said her son's caseworker told her: Walk away from it. Just wash your hands of it. Give him up to the state. "I said, 'My God, he's my son. If I turn my back on him, who's going to help him?' '' That spring, her son was twice rushed to the local hospital and later placed in St. Mary's psychiatric unit in Lewiston. One of the emergency trips occurred after Kyle found a knife under her son's pillow. "He stayed at St. Mary's for four weeks while they tried to find him another program," Kyle said. "But there were no beds anywhere in Maine." Unable to find him treatment in state, her son's caseworker suggested Lakeview. Kyle looked over a brochure and thought, "The place sounded real nice." "I thought it would benefit him," Kyle said. Long waiting lists Her son's caseworker said he'd only be there a few months while she searched for a treatment program in Maine. The summer passed and Kyle learned she couldn't get her son help here because of the long waiting lists. "I needed in-home help, counseling, a psychiatrist, and I couldn't get any of it for him," Kyle said. "So he was stuck in Lakeview." In October, five months after the boy had been placed in Lakeview, he repeatedly called his mother, Kyle said. "He sounded scared and said, 'If you don't get me out of here, I'm going to get seriously hurt.' '' "I should have gotten him out of there before the assault happened, but there was nothing for him in Maine," Kyle said. Not all parents are unhappy with the care their children receive out of state. But even these families are saddened by the hundreds of miles that separate them from their sons and daughters. Rick Ramsey's son receives treatment at Bradley Hospital in Rhode Island, one of the few hospitals in the country that provide treatment for children who are mentally disabled and have emotional or psychiatric troubles. Ramsey's son Jamie was placed at the Providence hospital two years ago. Doctors have diagnosed the boy with autism and emotional problems. While Ramsey is pleased with the care his 15-year-old son is receiving, he is frustrated with having to travel five hours every weekend to see Jamie. "It's a great hospital, but Maine's paying $1,100 a day," Ramsey said. "My son's treatment has got to be approaching a million dollars by now. It's crazy. With all that money being pumped into the Rhode Island economy, why can't Maine do something with that money in-state for my son?" Like many families, Ramsey's medical care is paid for with a combination of federal and state money. His son is eligible for Medicaid because he is considered disabled by his mental illnesses. "Jamie is a sweet kid, a heartbreaker," Ramsey said. "But he can get aggressive. At school, he attacked the staff. He will bite. Pull hair." For five years, Ramsey struggled unsuccessfully to find in-home support to keep his son stable. After Jamie worsened and was hospitalized three times at Bradley, Ramsey quit his job to stay home and take care of his son. "I had to go on welfare to do it," Ramsey said. "I stayed home with him until he got too aggressive and we had to put him in back in the hospital." Jamie was admitted to Bradley again in September last year. Over the past two years, Ramsey has driven the 300 miles from his Bangor home to Providence every weekend but one. When he first began visiting his son, Ramsey wept when he had to leave his boy behind at the hospital. "He's my son, and I love him," Ramsey said. "He's got big blue eyes. He likes to be held and hugged. He'd much rather be home with dad. It's tough." Recently, Ramsey believed there was hope for his son to be placed in a Portland program called Support Solutions. The agency helps place mentally disabled and emotionally troubled children in group homes. But this spring, Ramsey received a letter from the agency, saying Maine's Department of Behavioral and Developmental Services, which oversees and funds his son's treatment, couldn't pay for the program. The bed, which was being reserved for Jamie in the group home, will instead be taken by a child in state custody, the agency said. Because that child is a ward of the state, Maine can receive federal money to pay for room and board, and most of his treatment. Ramsey's son received Medicaid funding, but it only covers two-thirds of his psychiatric treatment. Maine must pay for the boy's remaining medical costs and his entire room and board. "Basically, it means if I gave up custody of my child, he could come back to the state of Maine," Ramsey said. "Why do I have to give up my kid to get services here?" For now, Ramsey has resigned himself to the weekly five-hour drive to see his son. Jamie smiles when he glimpses his dad coming through the door. His dad always asks the boy the same question each visit: "What do you want to do?" "The first thing he communicates to me is hold," Ramsey said. "It comes out like 'old' but it means: 'I want to be held.' "So, I wrap my arms around him and we hug for a long time." |
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