Olmstead Decision: Review of Mentally Ill Care Now State-by-State Concern

Article excerpt

State lawyers, citing client confidentiality, turned me down when I asked for files on a sexually aggressive resident of a state-run institution. By the way, one attorney added, the resident had been involved in 1,215 bad-behavior incidents. If ever a red flag were waved in front of a reporter, this was it. Chasing that flag led to the Arkansas Democrat-Gazette publishing a five-part series, "My Brother's Keeper."

It began with the story of Anthony, who had spent at least 10 years sexually preying on male and female residents of the Conway Human Development Center in Conway, Ark.

The human development center, about 30 miles east of Little Rock, is home to 560 developmentally disabled residents. That means the residents are cognitively impaired - they are mentally retarded, autistic or epileptic. They might have cerebral palsy or Down syndrome, be mentally ill or suffer from a combination of these problems.

At the Conway center, residents are between age 10 and 64. Many are in wheelchairs or cannot walk without help. Anthony lived among them. The 42-year-old resident had been diagnosed with a sexual disorder and mental retardation and had lived at the center since 1975.

He climbed in bed while other residents slept, cornered them in bathrooms, jumped on them as they watched television, forcing his penis into their mouths, according to reports. Residents cried and fought with him.

Conway superintendent Bob Clark did not segregate Anthony from those he had attacked, did not put him on medicine to inhibit the behavior, and did not provide the full-time supervision Anthony required.

An internal Conway committee had warned Clark for years that Anthony was violating the civil rights of other residents. Those warnings languished in his files.

Clark insisted that Anthony's actions were simply "inappropriate" and "not abusive."

How did we finally get Anthony's files? State attorneys had initially turned us down because we knew Anthony's full name and releasing records would violate his privacy. So Deputy Editor Frank Fellone and I met with state attorneys and modified our Freedom of Information Act request. We asked for files on all sexually aggressive residents for a three-year period. We suggested the files be labeled Client A, B, and C, and that the names of the living units be added.

Humiliating and demeaning

The fact that names are redacted from records is not necessarily a bad thing. Since client confidentiality has been protected, you should be able to argue for all incident reports, investigations, medical and mental evaluations, treatment, therapy and educational records.

By expanding the request, we were able to show that there were 14 residents who acted out sexually against others. We examined what, if anything, was being done for them - and for those they preyed upon.

Other types of records we requested involved the use of restraints and documents on fired employees. They showed:

* A mentally retarded man was routinely forced to get on his knees, put his hands behind his back and place his nose on the ground for as long as 25 minutes "to calm him." Responded the staff member: "It's humiliating and demeaning, but it works."

* A mentally retarded woman in a wheelchair was placed in a headlock and had milk poured down her throat until she choked while the staff member yelled, "You're going to drink or drown." The staff member was fired for "discourteous treatment," not abuse. That meant she was not placed on the state registry that would prohibit her from working with vulnerable clients in other state institutions.

The Arkansas Democrat-Gazette informed the state Department of Human Services of its findings on Anthony as well as other abuses at the Conway center. Clark, the politically powerful superintendent for 22 years, was forced to resign several weeks later.

The U.S. Department of Justice Civil Rights Division is investigating the Conway center, and the federal Centers for Medicare and Medicaid Services in Dallas gave the Conway center two immediate jeopardy notices, meaning it could lose federal funding if conditions did not improve quickly. …