Chicago psychiatric hospital cited for chaotic conditions in report

By DEBORAH L. SHELTON - Chicago Tribune

CHICAGO - In a damning new report, experts from University of Illinois, Chicago paint a grim portrait of conditions at a Chicago psychiatric hospital, describing an environment of chaos, physical attacks and sexual assaults that regularly puts its young patients in harm's way.

The report, released Tuesday by the state Department of Children and Family Services, found that Hartgrove Hospital, on Chicago's West Side, often was understaffed and overcapacity - a dangerous combination that created opportunities for frequent attacks by patients on other patients and hospital staff.

In some cases, hospital employees physically harmed patients.

Reviewers from UIC interviewed children and teens who expressed fear for their safety or that of more vulnerable peers.

After reviewing findings of a preliminary report, DCFS officials in June put an "intake hold" on the facility, meaning they will not authorize the placement of state wards at Hartgrove.

"It's our duty to ensure the safety of children in state care, and we will take whatever action is necessary to keep our kids safe," said Kendall Marlowe, DCFS spokesman.

Experts from UIC's department of psychiatry spent about six months investigating conditions at Hartgrove, a 150-bed private psychiatric hospital that treats adults, children and teens.

The psychiatry department's mental health policy program has been conducting reviews of psychiatric hospitals on behalf of DCFS since 1995 pursuant to a federal court consent decree involving DCFS and the ACLU. The reviewers serve as independent experts.

About 100 violent incidents were documented between December 2010 and mid-June 2011, which included physical attacks, uncontrolled threatening behavior and sexual assaults.

In one case, an "aggressive" male patient, a DCFS ward, who had been discovered receiving oral sex from a female patient a day earlier, was observed "stalking females" on one of the units, according to records.

In another incident, one girl assaulted another, "tearing out her hair and punching her in the face," according to the report. The victim sustained a swollen eye.

The Chicago Tribune previously has reported on violence and sexual assaults at psychiatric facilities for youth, including Hartgrove.

In a statement, officials from Universal Health Services Inc., the Pennsylvania-based parent company of Hartgrove, said: "Despite the findings in the UIC report, Hartgrove is proud of its track record and has many more success stories to its credit than the negative ones highlighted in the report."

The statement said hospital officials are working with the appropriate agencies "towards a resolution which will allow Hartgrove to serve DCFS wards again."

Other hospitals owned by UHS have come under scrutiny in recent years, including facilities in at least eight states.

Among the chilling details in the UIC report on Hartgrove were descriptions of some hospital employees who appeared to be indifferent or too poorly trained to treat seriously mentally ill youth.

One case involved a 16-year-old girl with severe sickle cell anemia who was forced to cope with intense pain for long periods of time. When she became overwhelmed and had emotional outbursts as a result, staff blamed her for not being able to control herself.

A psychiatrist at the facility labeled her behavior as "med-seeking," according to records.

In another case, employees in May reportedly fractured the arm of a 16-year-old boy, who was not a state ward, apparently because they were not properly trained in restraint techniques.

The UIC experts said hospital staff and company officials at times tried to mislead them by attempting to cover up problems or keep reviewers from finding out about them.

"Perhaps most disturbing," the report said, "Hartgrove staff were reportedly told by UHS (parent company) officials that anyone suspected of providing information to the UIC reviewers would be fired."

However the reviewers said they were heartened that a number of employees stepped forward and provided them with much of the data in the report. A section of the report is devoted to comments from employees.

Among the litany of problems detailed were: inadequate training sessions and falsified certification records, psychiatrists spending too little time with patients, extended medication delays and inadequate treatment and discharge plans that frequently were boiler-plate and not individualized to patients' needs.

The report cited "a consistent pattern of unacceptable risks of harm" and "questionable clinical management practices by hospital and corporate officials at all levels of the organization."

The UIC experts found that overcrowding was commonplace, with many young patients regularly forced to sleep on cots in hallways or day rooms.

In many cases, patients were worse off at Hartgrove than they were in the facilities from which they were transferred, which typically had higher staff to patient ratios, the experts said.

"Their opportunity to receive needed mental health treatment in a safe environment suffered as a result of hospital-induced trauma," the report said.

In a letter to DCFS, Steven Airhart, CEO and managing director at Hargrove, denied sleeping kids in hallways, routinely understaffing the hospital and threatening to fire employees who talked to reviewers.

He said the "overwhelming majority" of those involved in training "met the time requirements and competency assessment procedures for the facility."

In its statement to the Tribune, the company said: "While we may not agree with the findings or conclusions of this report, we welcome the input and feedback from the UIC team and will embrace the appropriate recommendations to enhance our services and improve the quality of care we provide."

Virtually all of the UIC findings on Hartgrove were confirmed by surveyors from the Center for Medicare and Medicaid Services. A CMS spokesman said that the federal agency had threatened to pull funding from the hospital but has accepted the hospital's plan of corrections to fix the problems.

The Joint Commission, an independent, not-for-profit organization, that accredits and certifies health care facilities and programs, said it found significant violations when it conducted an unannounced survey for cause earlier this month.

A spokeswoman said the group is working with the company to bring the hospital up to standards in two areas: its processes for assessing patients and its processes for providing care and services. "Our goal is to make sure the organization fixes what they need to do," she said.

No one at the Illinois Department of Public Health, which licenses Hartgrove Hospital, was available to comment on the report.

Ben Wolf, an ACLU attorney, said he was deeply troubled by the situation. The ACLU oversees the services provided to the state's estimated 15,000 foster children as part of the consent decree.

"The scope of the problem and some of the issues of violence and inadequate training were even more troubling than expected," Wolf said. "These are kids who come to a psychiatric hospital in a very vulnerable situation. We need to make sure, either that Hartgrove improves or we stop using it for our clients."

Source http://www.bellinghamherald.com/2011/09/27/2205071/chicago-psychiatric-hospital-cited.html

State report finds Casey Anthony 'responsible' for daughter's death

By the CNN Wire Staff
August 12, 2011 5:45 a.m. EDT

(CNN) -- Casey Anthony is responsible for the 2008 death of her 2-year-old daughter Caylee, a report released Thursday by Florida's Department of Children and Families concludes.

A month after a jury acquitted Anthony on murder and child neglect charges, the state agency found that Anthony "is the caregiver responsible for the verified maltreatments of death, threatened harm and failure to protect" in her daughter's death.

Carrie Hoeppner, a spokeswoman for the Department of Children and Families, said the report was issued this week as a "professional courtesy" after the sheriff's office and prosecutors finished their work on the case.

She added that the state agency is mandated to conduct reviews when there are allegations that a child dies as a result of abuse, abandonment or neglect. The agency had no contact with the Anthonys prior to the girl's disappearance in the summer of 2008, Hoeppner added.

The Orange County Sheriff's Office will not take any further action as a result of the report, Capt. Angelo Nieves said Thursday.

"This closes out the DCF case, and it does not create additional follow-up on our part," he said.

The report said: "The Department of Children and Families concludes that the actions or the lack of actions by the alleged perpetrator ultimately resulted or contributed in the death of the child." The report was signed by officials in the department Wednesday.

Anthony is now free. While she was cleared on murder and aggravated child abuse charges, the 25-year-old Orlando woman was convicted on four counts related to misleading law enforcement authorities. She was sentenced to four years in jail on those convictions, but was given credit for the time she had already served between her arrest and the end of the seven-week trial and was released from jail in mid-July. Prosecutors cannot appeal the acquittals.

The report does not address, or substitute for, judgments regarding the guilt or innocence of the caregiver -- in this case, Casey Anthony -- DCF spokeswoman Hoeppner said.

The state report found that Anthony's "failure to act" in the 31 days between the time the girl was last seen and when police were alerted about the case "delayed and interfered with a law enforcement investigation and best efforts to safely recover the child."

The agency report noted there were "no indicators" that Caylee's death was caused by physical injury, and it was "not substantiated" that she died of asphyxiation -- both points of great contention during the trial.

An autopsy performed in December 2008 by the local medical examiner determined "that the exact cause of death cannot be determined with certainty." Prosecutors tried, unsuccessfully, to convince jurors that Anthony used chloroform to render her daughter unconscious and then duct-taped her mouth and nose to suffocate her.

In its recommendations section, the report said that "the maternal grandfather" -- in this case, George Anthony -- "should have been interviewed for the missing person report." Casey Anthony's defense lawyer had claimed, in the opening argument of the murder trial, that George Anthony knew Caylee had died accidentally and helped cover up her death.

Casey Anthony had been investigated by the agency, when state child welfare investigators determined on September 14, 2008, that there were "verified findings" indicating that Anthony was responsible for "inadequate supervision and threatened harm" of her child, although it found "no indicators of physical injury."

Exactly a month later, a grand jury indicted Anthony on murder and other charges, and the case was eventually reopened by the Department of Children and Families. No further detail was immediately offered as to why or exactly when the department chose to review the case, or why it came out this week.

The report released Thursday officially closes the department's investigation in the case.

Source Article http://www.cnn.com/2011/CRIME/08/11/florida.casey.anthony/index.html?iref=allsearch