| Problems at state schools bring mounting penalties
By Denise Gamino November 9,1997 |
| In the past 18 months, Medicaid regulators found:
One man choked to death at a fast-food restaurant where workers took him for chicken nuggets even though he was supposed to eat only pureed food. A retarded woman died after falling in a bathtub where she loved to play after aides failed to watch her as closely as ordered. In the same school as those two deaths, aides at various times poured cold water on the vagina of a resident whose ankles and wrists were restrained, forced a restrained woman to bite her tongue until her mouth filled with blood, kicked a resident in the bladder to induce urination and hit residents with shoes, hairbrushes and a braided cord. A woman died at another state school after workers failed to perform cardiopulmonary resuscitation after she stopped breathing. While she was dying, her nurse chatted on the phone and an aide went out for a cigarette break. |
| On the evening of Feb. 28, a dozen mentally retarded men from Abilene State School became trapped in a traveling
chamber of horrors.
An excursion to a city park turned gruesome when a disabled man snapped in the van carrying the men and bit five companions 59 times. One suffered 29 bites on his arms, chest, shoulder and back. Two state workers chaperoning the group said they never saw or heard anything and discovered the injuries when they unloaded the men from the van. "It looked like huge chunks had been taken out of people's arms,'' one worker told state investigators, a point the school denied. The attacker was found in the van, his shirt splashed with blood, his lips bloody and swollen. Safety regulators who investigated the biting brawl halted federal money that Texas depends on to care for the 620 residents of Abilene State School. Their conclusion: More workers should have been watching the men. But the Abilene case may signal larger problems in Texas' 11 retardation institutions. Regulators reviewing deaths and injuries in the state schools have stopped Medicaid payments to Texas more often than ever before. The record number of Medicaid enforcement holds comes as Texas cuts $13.2 million from state schools, forcing institutions to cut workers and services for many of the 5,700 residents. That raises fears that care -- and safety -- may be cut along with the money. "I think it's impossible to take that much money without the quality of care going down,'' said Nancy Ward of Fort Worth, past president of the Parent Association for the Retarded of Texas. Her daughter lives at Denton State School. "The staff are going to be overworked, (and) when a person makes a mistake, it can affect a human,'' Ward said. "I think there will be more (Medicaid) holds, and the clients will end up suffering from this loss of money.'' Regulators detail findings State officials defend the cuts as needed because state school rolls continue to decline. But they insist good care and safety will not decline and say the recent jump in Medicaid actions against Texas retardation schools may not point to a trend. Whatever the cause, Medicaid payments to state schools have been withheld 12 times in the past year and a half -- as many times as in the five previous years. Two state schools were kicked out of the Medicaid program completely this year -- though only for a day -- because regulators found repeated problems. Many of the workers accused of hurting residents have been fired. One aide was indicted for murder after allegedly choking to death a man who lived at Corpus Christi State School, and he has been sued by the dead man's mother. The deaths and injuries in state schools are similar to problems that sometimes occur in Texas nursing homes. But when nursing homes fail to protect residents, they can be -- and often are -- sued by state Attorney General Dan Morales for the very problems Medicaid regulators have found in state retardation institutions. Even as Texas cracks down on nursing home abuses, parents and advocates for mentally retarded people fear that state budget cuts will put more disabled people in harm's way. Half the Medicaid freezes imposed over the past two years were linked to insufficient staffing, inspection reports show. The man in charge of state schools says he cannot explain the increase in federal enforcement against the Texas institutions. "I'm at a loss as to explain why there are more (Medicaid holds),'' said Don Gilbert, Texas commissioner of the mental retardation department. "But I could say that the ones that come forward we pay close attention to, and we have cured every one of the problems to the satisfaction of the (regulators).'' Population changing In a later interview, Gilbert said he saw no statistical significance in the higher number of recent Medicaid payment freezes. "Some years you have more than others, and that's about all the statistical inference that can be drawn,'' he wrote in a follow-up letter. Some officials tie the increase in Medicaid payment freezes to problems with caring for a higher percentage of retarded residents with multiple medical or behavioral problems as higher-functioning residents move out. "I think part of it may have to do with the changing population in state schools,'' said Gerry Brunette, director of mental retardation facilities. "We're progressively serving people with more complex problems (and) behavioral issues.'' Aggressive residents can injure other residents or push workers to a breaking point. The jump in Medicaid sanctions at state schools may be tied to tougher standards used by the Texas Department of Human Services. The investigation staff "has taken a more aggressive approach in the investigation of suspected abuse and neglect,'' said Charline Stowers, a spokeswoman for the human services agency.
Gilbert defended the quality of care in the retardation institutions and said the budgets can be cut without putting residents at risk for harm. "If you consider that one unfortunate, tragic incident can result in a (Medicaid) hold and we serve nearly 6,000 people every day of the year in 11 different locations, I'm convinced that there's not an inadequate resource problem here,'' he said. "I believe we fund our state schools appropriately and adequately.'' Rights advocate eliminated Some institutions must cut more than others because the state wants money divided more equally among the 11 state schools. A few institutions cited for inadequate services in a 1974 federal lawsuit had been given larger budgets, but the suit was dismissed in 1995. The state now wants to equalize budgets. But one mother whose son died in Corpus Christi State School worries that more problems will result from cutbacks. "The staff on now will probably have to work double hours until all this is straightened out,'' said Brenda Epps Richardson of Robstown, whose 26-year-old son, Trake Epps, died last November after being put in a choke hold by an aide. "It will be a morale factor,'' Richardson said. "It can cause another conflict, incident, you name it, out there -- fights breaking out among staff and fights breaking out among staff and client, things of that nature. It will happen if it hasn't already.'' Austin State School must cut $2.4 million and as many as 100 jobs this year. One job targeted for elimination is the residents' rights advocate. That would leave no one assigned full time to make sure civil rights of the 450 residents are not violated. "We're going to be doing everything possible to minimize any negative impact on the clients or staff,'' Superintendent Jim Armstrong said. At Mexia State School, staff shortages already had caused problems before the new $1.6 million budget cut there. Vacant jobs had not been filled for 30 days to save money. But that rule had to be lifted to end a Medicaid freeze imposed in June after a woman died from a bathtub fall. Regulators found too few workers were there to watch her closely. Gilbert, the state commissioner, said state schools have enough workers. But sometimes, he said, "for a variety of reasons -- vacancies, someone going off -- you may not have had enough staff right then, right there, at the time of the incident.'' Medicaid regulators may not be persuaded. When Abilene State School officials tried to overturn the Medicaid freeze imposed after the biting, they argued that the two workers had violated state policy and were fired. School officials also said the bite wounds weren't serious. None of the victims required stitches, and no infections developed. But the Medicaid regulators said the state school remained responsible for the actions of its employees. "The problem was not that we didn't have enough staff,'' Superintendent Bill Waddill said. "The staff didn't do what they were supposed to do and we had absolutely no way to predict that.'' Gilbert said the budget cuts still leave state retardation institutions with more money per resident than they have had in the past because the number of residents is going down. In 1998, each institution will spend an average of $145 per day per resident. "It would not be accurate to conclude that the overall budget reduction for state schools means less money to spend on the people who live in state schools,'' he said. "In fact, the opposite is true.'' |