CCHR warns of pandemic psychiatric child abuse across the U.S.

By CCHR International
The Mental Health Industry Watchdog
July 5, 2018

Many are outraged by the recent reports of over 11,000 immigrant children being ripped from their families, incarcerated in more than 100 facilities in 17 states, with allegations of them being drugged, beaten, or violently assaulted. According to media reports and child testimonies, migrant children have been dosed with cocktails of psychotropic drugs. A CNN investigation found “Medical records show children were injected with sedatives and antipsychotics and that many of the pills they were given were powerful and sometimes addictive psychotropic drugs.”[1] Mental health watchdog, Citizens Commission on Human Rights International (CCHR) warns that such abuse is not isolated to migrant children but there is a “pandemic of psychiatric child abuse” in private and state psychiatric institutions across the country.

CNN reported that migrant children and teens have also been physically restrained, with some handcuffed to chairs for days for “acting out.”[2]  Multiple Latino teens say they were kept in Shenandoah Valley Juvenile Center in Virginia, for example, for months or even years, where some were beaten or punished by being restrained for hours.[3] Office of Refugee Resettlement (ORR)-contracted facilities have serious records of wrongdoing―including sexual and physical abuse of residents, reported Huffington Post recently.[4]

CCHR says the parallels between what is happening to migrant children in ORR shelters and facilities and those in the for-profit behavioral and foster care systems reveal a serious lack oversight and accountability. Since 2015, the group has filed over 8,000 complaints to state and federal legislators and law enforcement and health officials about the shocking conditions for children in privately owned psychiatric facilities.

The complaints address chains of psychiatric hospitals owned by Universal Health Services (UHS) and Acadia Healthcare—part of a lucrative $26 billion-a-year private psychiatric hospital market.[5] Last year, UHS’s Shadow Mountain Behavioral Health in Oklahoma was investigated by health authorities after children as young as five were separated from their parents and held in dangerous situations. Allegations ranged from medication errors to incidents of sexual misconduct. Internal surveillance videos also showed children being repeatedly physically restrained, including a 9-year-old boy that a mental health technician grabbed by the neck, pushed against a wall, then slammed to the ground.[6]

In 2016, a six-year-old boy who, after having thrown a tantrum, was removed from school by police and taken to UHS’s River Point psychiatric hospital in Florida.[7] He was locked in a “seclusion” room at 3 a.m. and waited more than 24 hours to see a doctor. “It felt like my child had been kidnapped,” his mother said. The boy was released only after a lawyer intervened on his behalf.[8]

The Washington Post reported that a 15 year old had died in November last year after he was restrained at UHS’s North Spring Behavioral Healthcare in Leesburg, North Virginia. Involuntary manslaughter charges were filed against a mental health technician, for which he was convicted.[9]

The previous month, a 13-year-old girl was raped by a patient while under the care of UHS’s Timberlawn Behavioral Hospital in Texas.[10] The father of the raped girl told The Dallas Morning News, “The place needs to be shut down.”[11] In February 2018, Timberlawn closed after state officials found it too dangerous for patients.[12]

In 2015, UHS’s Rock River Academy in Rockford, Illinois was closed following allegations that the facility had restrained youths at a rate eight times the median for all similar Illinois facilities.[13] Rockford Police Department had fielded more than 700 reports “concerning victimization of girls,” including rape, aggravated battery and sodomy during a four-year period.[14]

In July 2017, the mother of a 12-year-old boy alleged her son was sexually assaulted in UHS’s Laurel Heights Hospital, in Atlanta, Georgia.[15] A 16-year-old girl was also raped while under the care of UHS’s Anchor Hospital in Atlanta.[16] Last year, the Massachusetts Department of Mental Health closed UHS’s Westwood Lodge psychiatric hospital due to “issues concerning patient safety and quality of care,” amid a sexual assault investigation.[17] Florida state authorities terminated their contract with UHS’s Okaloosa Youth Development Center over “serious deficiencies that potentially could threaten the health and safety of the youth placed at the program.”[18] In March 2018, UHS reported it had set aside $22 million to settle Federal Department of Justice (DOJ) criminal investigations into 30 of its behavioral hospitals.[19]

Despite a history of abuses, UHS has been allowed to acquire or build even more behavioral facilities.[20]

A Capitol Forum investigation into another behavioral hospital chain, Acadia Healthcare, earlier this year uncovered:

• “A pattern of patient care and safety violations” that “may put the company at risk of federal investigation or losing Medicare or Medicaid funding.”

• “Acadia and/or its facilities have been the target of lawsuits over injuries and deaths occurring at the facilities. Park Royal Hospital in Fort Myers, Florida, was sued for alleged negligence that led a patient’s suicide. The same hospital saw one of its employees imprisoned for sexually assaulting several patients, and has been named in several other lawsuits, including one this year alleging it failed to prevent sexual abuse of a female patient undergoing an involuntary mental health evaluation. According to the plaintiffs’ attorney, the lawsuit over the patient’s suicide was settled, and the sexual abuse suit is ongoing.”

• “Acadia’s Sierra Tucson rehab facility was sued over the suicide of a patient in January 2015, the month before Acadia completed its acquisition of the facility. Five patients died at the location in four years, which the complaint described as a ‘suicide cluster.’” In October 2015, the Arizona Daily Star reported that Sierra Tucson had paid $35,000 in penalties related to the two patient deaths. [21]

Substantially all of Acadia facilities’ Medicaid payments relate to the treatment of children and adolescents.[22]

In comparison, the detainment of migrant or unaccompanied immigrant children has led to similar psychiatric abuse. Allegations include:

• Youths housed in shelters report being awakened in the small hours of the morning and soon thereafter finding themselves confined in juvenile halls or psychiatric facilities.”
• Children are routinely prescribed psychotropic drugs that could permanently injure them; they are also put on multiple psychotropic drugs, a deeply disturbing practice known as polypharmacy.
• The ORR neither requires nor asks for a parent’s consent before drugging a child, nor does it seek lawful authority to consent in parents’ stead.
• Youth report being told that if they refuse the drugs they will remain detained, be denied privileges, or be physically forced to take them.[23]

A Houston Chronicle investigation in 2014 found restraint deaths in Shiloh Residential Treatment Center in Houston, Texas, where migrant children are held.[24] In its sister facility, Daystar Residential Center, between 1993 and 2002, three children died of asphyxiation from restraint procedures. A fourth death, 16-year-old Michael Keith Owens, due to asphyxiation, occurred in November 2010.[25] The teen was physically restrained in a bedroom closet after he had refused to show a staff member what he was holding in his hand, which turned out to be merely the cap of a pen.[26] In two of the deaths, homicide was ruled.[27] Daystar was found criminally negligent in one of the deaths and eventually closed down.[28]

“Beyond these deaths, there were reports of sexual abuse,” reported the National Center for Youth Law. In January 2010, a 16-year-old was sexually abused by a Daystar staffer. Yet Daystar maintained its license to house more than 140 unaccompanied minors until 2011.[29]

Some children say they were prescribed as many as 10-18 pills a day.[30]  Included among the powerful drugs administered are antidepressants, anti-anxiety drugs such as clonazepam, antipsychotics that include quetiapine, Latuda (lurasidone) and Geodon (ziprasidone), the mood stabilizers divalproex and lithium and an ADHD drug, guanfacine (Intuniv ER).[31]

One affidavit from a child who came to the U.S. in 2014, states: “ln Shiloh they gave me even more medicine. I took nine pills in the morning and seven in the evening. I don’t know what medications I was taking; no one ever told me that. I don’t know what my diagnosis or illness is….Some of the staff at Shiloh would provoke the children there and make us angry intentionally. They made us act violently so then we had to be given shots.”[32]

According to Reveal News, Dr. Javier Ruíz-Nazario, the psychiatrist at Shiloh prescribing psychotropic drugs to immigrant children, reported on the Texas Medical Board’s website that he had specialized certification for treating children and adolescents. However, according to the website, he has not yet updated the board on the status of this board certification as required by its rules.[33]

Ruíz-Nazario’s name appears on various court documents that allege troubling practices, including affidavits in which children claim they were tackled and injected and forced to take pills identified as vitamins that made them dizzy and drowsy. Many of the records specifically name Ruíz-Nazario as the doctor who prescribed the drugs.[34]

The psychiatrist has received payments from drug companies that manufacture psychotropic drugs being given to children at Shiloh.[35] Between 2012 and 2015, he billed Medicare Part D, a total of $1.5 million for psychotropic drugs. Among his top drugs prescribed, duloxetine HCL, the sedative-hypnotic clonazepam, the antipsychotics Invega Sustenna (Janssen Pharmaceuticals, the manufacturer of Risperdal) and quetiapine (generic of Seroquel). [36]

Yet, in a response to the allegations of inappropriate drugging at Shiloh, officials said “psychiatrists strive to use no more than four psychotropic medications at once.”[37] However, such cocktails are potentially dangerous, CCHR says. A 2013 study, “Polypharmacy in Psychiatry: A Review,” reported not only are there “possibilities of cumulative toxicity” with polypharmacy but also “increased vulnerability to adverse events.”[38]

CCHR says no child should be restrained and subjected to cocktails of mind-altering drugs. They say restraint abuse and deaths should have stopped after the 1998 ground-breaking Hartford Courant series that uncovered at least 142 psychiatric restraint deaths that had occurred over previous 10 years, many of them children. An analysis done for the Courant estimated that between 50 and 150 such deaths occurred every year across the country.[39] Federal regulations enacted in 2000 under the Children’s Health Act were supposed to restrict the use of restraints and seclusion in psychiatric facilities and “nonmedical community-based facilities for children and youth” that receive federal funds.[40] A “national reporting system” was to be implemented and government funding cut to any facility that did not comply.[41]

Yet, restraint deaths have continued to be exposed at UHS behavioral centers and migrant children that are traumatized by an uncaring system of separating them from their parents and detaining them involuntarily in centers, are being drugged, restrained and harmed without any protections. It doesn’t appear funding has been cut when a pattern of restraint abuse occurs.

The US government provides around $1 billion to nonprofits and local government agencies each year to house and provide services for detained migrant children, in facilities, including psychiatric and juvenile detention centers.[42] Billions of dollars in Medicaid and Medicare are also paid to for-profit behavioral facilities each year that also treat children and youths. UHS and Acadia Healthcare accounted for a combined 8.3 percent share of the $17.2 billion mental health and substance abuse clinics industry in 2015.[43] UHS gets a third of its revenue from Medicare and Medicaid.[44] Substantially all of Acadia facilities’ Medicaid payments relate to the treatment of children and adolescents. [45]

Jan Eastgate, President of CCHR International, says, “A lack of effective action is rampant in the treatment of children in behavioral/psychiatric facilities, and now migrant children in detainment centers. It’s been ongoing for years. There needs to be an overhaul of the system, with federal and state funds cut if a facility is found to have put children at risk and a ‘three-strike rule’—after three sanctions and correction plans, if the abuses continue, the facility must be shut down. If abuses are seriously negligent resulting in deaths, one incident should be sufficient to order a closure.”

References:

[1] Blake Ellis, Melanie Hicken, and Bob Ortega, “Handcuffs, assaults, and drugs called ‘vitamins’: Children allege grave abuse at migrant detention facilities,” CNN investigation, 21 June 2018, https://www.cnn.com/2018/06/21/us/undocumented-migrant-children-detention-facilities-abuse-invs/index.html.

[2] Ibid.

[3] Emily Stewart, “The places the government sends migrant children face allegations of abuse,” Vox, 21 June 2018, https://www.vox.com/2018/6/21/17488130/family-separation-facilities-migrant-children-abuse.

[4] Roque Planas, “Migrant Children Drugged Without Consent At Government Centers, Court Documents Show,” Huffington Post, 20 June 2018, https://www.huffingtonpost.com/entry/migrant-children-drugged-without-parental-consent-at-government-institutions-court-documents-show_us_5b2a9e87e4b0321a01cd4dd3

[5]  “Psychiatric Hospitals – US Market Research Report,” IBIS World, April 2018, https://www.ibisworld.com/industry-trends/market-research-reports/healthcare-social-assistance/hospitals/psychiatric-hospitals.html

[6] Roslind Adams, “Videos Show The Dark Side Of Shadow Mountain Youth Psych Facility,” Buzz Feed News, 11 April 2017, https://www.buzzfeed.com/rosalindadams/shadow-mountain?utm_term=.ynvnN5okY#.kwyRK1wNE.

[7] Kendra Parris, Esq., “Dept. of Children and Family Services Task Force to Release Report on Involuntary Commitments of Children in FL,” The Mental Health Industry Watchdog, 20 Nov 2017, http://news.cchrint.org/2017/11/20/task-force-to-release-report-on-involuntary-commitments-of-children/

[8] Rosalind Adams, “How a 6 Year Old Got Locked On A Psych Ward,” Buzz Feed News, 30 Dec 2016, https://www.buzzfeed.com/rosalindadams/how-a-6-year-old-got-locked-on-a-psych-ward?utm_term=.noaQPZwAm#.axwpgQlyk.

[9] Ellie Silverman, “Behavioral healthcare worker charged in teen patient’s death,” The Washington Post, 16 Jan. 2018,  https://www.washingtonpost.com/local/public-safety/behavioral-health-care-worker-charged-in-teen-patients-death/2018/01/16/7a80c07e-fb13-11e7-a46b-a3614530bd87_story.html?utm_term=.f4dfb6f6b073

[10]“Dallas’ Timberlawn psychiatric hospital has run out of second chances,”  Dallas Morning News, 24 Oct. 2017,  https://www.dallasnews.com/opinion/editorials/2017/10/24/dallas-timberlawn-psychiatric-hospital-run-second-chances/.

[11]Sue Ambrose, “FATHER OF GIRL, 13, SAYS SHE WAS RAPED AT TIMBERLAWN BY TEEN MALE PATIENT,” Dallas Morning News, 18 Oct. 2017, https://www.dallasnews.com/news/crime/2017/10/13/father-girl-13-says-raped-timberlawn-teenmale-patient.

[12] Sue Ambrose, Sarah Mervosh and Miles Moffeit, “Timberlawn psychiatric hospital to close Feb. 16 after safety Violations,” Dallas News, 31 Jan 2018, https://www.dallasnews.com/news/investigations/2018/01/18/dmn-investigates-troubled-timberlawn-psychiatric-hospital-closing-before-state-can-shut.

[13] “Center for troubled girls will close, cites decision by DCFS,” Chicago Tribune, 28 Jan. 2015, http://www.chicagotribune.com/news/watchdog/rtc/chi-youth-treatment-rock-river-20150128-story.html.

[14] Lorraine Bailey, “Severe Abuse Alleged at Illinois Home for Girls,” Courthouse News.com, 10 Sept. 2015, http://www.courthousenews.com/2015/09/10/severe-abuse-alleged-at-illinois-home-for-girls.htm; https://www.courthousenews.com/severe-abuse-alleged-at-illinois-home-for-girls/.

[15] “Joshua Sharpe, “Lawsuit: Boy, 12, sexually assaulted at DeKalb hospital,” Atlanta Journal-Constitution, July 11, 2017, https://www.ajc.com/news/local/lawsuit-boy-sexually-assaulted-dekalb-hospital/18rQCaixRqyqjfJrrKNKwO/.

[16] Christian Boone, “Lawsuit: College Park hospital’s neglect led to patient’s rape,” Atlanta Journal-Constitution, Sept. 15, 2017, http://www.myajc.com/news/local/lawsuit-college-park-hospital-neglect-led-patient-rape/a6f57hOLFHFyy5X6TaM8EN/ .

[17] Alex Newman, “Sexual Assault Investigation At Now-Shuttered Westwood Psychiatric Hospital: Westwood police are investigating an alleged sexual assault at Westwood Lodge, which state officials permanently closed Friday,”  The Westwood Patch, 30 Aug. 2017, https://patch.com/massachusetts/westwood/sexual-assault-investigation-now-shuttered-westwood-psychiatric-hospital.

[18] Annie Blanks, “State shuts down youth detention center in Crestview,”  Daily News, 24 June 2017, http://www.nwfdailynews.com/news/20170624/state-shuts-down-youth-detention-center-in-crestview.

[19] Harold Brubaker, “Universal Health Services sets reserve for fraud Settlement,” Philly.com, 1 March 2018,  http://www.philly.com/philly/business/universal-health-services-sets-reserve-for-fraud-settlement-20180301.html.

[20] Heather Stauffer, “Aerial video shows progress of Lancaster Behavioral Health,” LancasterOnline.com, 27 June 2018, https://lancasteronline.com/news/local/aerial-video-shows-progress-of-lancaster-behavioral-health-hospital-june/article_b77dc958-7a08-11e8-9f0b-9f5aed6ab0e8.html.

[21] “Acadia Healthcare: A Close Look at Alleged Abuses and Violations at Acadia Facilities; Use of PSI Playbook May Expose Company to Legal and Regulatory Risk,” Capitol Forum, Vol. 5., No. 400; 28 Nov. 2017.

[22] “United States Securities And Exchange Commission,” https://www.sec.gov/Archives/edgar/data/1520697/000119312515069793/d854534d10k.htm.

[23] Flores v. Sessions, Attorney General, United States District Court, Central District Of California – Western Division, 2018, https://www.documentcloud.org/documents/4525121-ORR-MTE2-Brief-Dkt409-1-041618.html.

[24] Roque Planas, “Migrant Children Drugged Without Consent At Government Centers, Court Documents Show,” Huffington Post, 21 June, 2018, https://www.huffingtonpost.com/entry/migrant-children-drugged-without-parental-consent-at-government-institutions-court-documents-show_us_5b2a9e87e4b0321a01cd4dd3.

[25] “Immigrant detention crisis could yield profit for some providers and payers,” Modern Healthcare, 21 June 2018, http://www.modernhealthcare.com/article/20180621/NEWS/180629984; Annabelle Timsit, “Cruel And Unusual, The most shocking abuse allegations against shelters for immigrant children,” Quartz, 20 Jun. 2018, https://qz.com/1310544/the-shiloh-treatment-center-has-been-accused-of-child-abuse/.

[26] “Closure of center for troubled kids follows years of woes: Texas shuts down treatment center for kids Daystar loses license after teen’s death is ruled a homicide,” Houston Chronicle, 7 Jan. 2011, https://www.chron.com/news/houston-texas/article/Closure-of-center-for-troubled-kids-follows-years-1687768.php.

[27] Ibid. “Closure of center for troubled kids follows years of woes….,” “Daystar home’s troubles were years in the making,” Houston Chronicle, 9 Nov. 2010,  https://www.chron.com/news/houston-texas/article/Daystar-home-s-troubles-were-years-in-the-making-1695191.php; “Mother sues facility in death of teen girl,” Houston Chronicle, 28 Sept. 2002, https://www.chron.com/news/houston-texas/article/Mother-sues-facility-in-death-of-teen-girl-2083509.php.

[28] Ibid., “Mother sues facility in death of teen girl,” Houston Chronicle, “Closure of center for troubled kids follows years of woes….”

[29] “Immigrant detention crisis could yield profit for some providers and payers,” Modern Healthcare, 21 June 2018, http://www.modernhealthcare.com/article/20180621/NEWS/180629984.

[30] Ibid.,  Blake Ellis, Melanie Hicken, and Bob Ortega, CNN investigation; “Migrant children describe abuse, being forcibly medicated at youth shelters: lawsuit,” AzCentral, 22 June 2018, https://www.azcentral.com/story/news/politics/2018/06/21/lawsuit-alleges-abuse-migrant-children/723476002/.

[31] “Migrant children describe abuse, being forcibly medicated at youth shelters: lawsuit,” AzCentral, 22 June 2018, https://www.azcentral.com/story/news/politics/2018/06/21/lawsuit-alleges-abuse-migrant-children/723476002/; Matt Smith And Aura Bogado, “Immigrant children forcibly injected with drugs at Texas shelter, lawsuit claims,” The Texas Tribune, 20 Jun. 2018, https://www.texastribune.org/2018/06/20/immigrant-children-forcibly-injected-drugs-lawsuit-claims/; James Kosur, “The Shocking Abuses Of Children Held Within Trump’s Detention Centers,” Hill Reporter, 21 Jun. 2018, https://hillreporter.com/the-shocking-abuses-of-children-held-within-trumps-detention-centers-2917.

[32] “Doctor giving migrant kids psychotropic drugs lost certification years ago,” Reveal, 25 June 2018, https://www.revealnews.org/blog/exclusive-shiloh-doctor-lost-board-certification-to-treat-children-years-ago/.

[33] Ibid.

[34] Ibid.

[35] Ibid.

[36] “Javier Ruiz-Nazario, M.D.,” Prescriber Checkup, Propublica, http://projects.propublica.org/checkup/providers/1972569721.

[37] Op. cit., CNN investigation, “Handcuffs, assaults, and drugs called ‘vitamins’: Children allege grave abuse at migrant detention facilities.”

[38] Sanjay Kukreja, M.B.B.S., F.C.L.R, et al., “Polypharmacy In Psychiatry: A Review,” Mens Sana Monogr. 2013 Jan-Dec; 11(1): 82–99, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3653237/.

[39] “Medicare and Medicaid Programs; Hospital Conditions of Participation: Patients’ Rights; Interim Final Rule,” Federal Register, Department of Health and Human Services, 2 July 1999, https://www.gpo.gov/fdsys/pkg/FR-1999-07-02/html/99-16543.htm; Michael Remez, “Use of improper restraints widespread, group says,” Hartford Courant, 16 Dec. 1998, http://www.charlydmiller.com/LIB05/1998hartfordcourant16.html.

[40] “Seclusion and Restraints: A Failure, Not a Treatment: Protecting Mental Health Patients from Abuses,” California Senate Office of Research, Mar. 2002, http://sor.senate.ca.gov/sites/sor.senate.ca.gov/files/Seclusion%20and%20Restraints.pdf.

[41] “Medicare and Medicaid Programs; Hospital Conditions of Participation: Patients’ Rights; Interim Final Rule,” Federal Register, Department of Health and Human Services, 2 July 1999.

[42] Op. cit., CNN investigation, “Handcuffs, assaults, and drugs called ‘vitamins’: Children allege grave abuse at migrant detention facilities.”

[43] “Aurora Behavioral Health Auction Attracts Interest from Acadia Healthcare,” The Wall Street Journal, 13 May 2016, http://www.wsj.com/articles/aurora-behavioral-health-auction-attracts-interest-from-acadia-healthcare-1463163933.

[44] Beth Mole, “Feds probing psychiatric hospitals for locking in patients to boost profits,” Ars Technica, 24 May 2017, https://arstechnica.com/science/2017/05/top-us-psychiatric-hospital-chain-investigated-for-keeping-patients-too-long/.

[45] “Acadia Healthcare Company, Inc.,” Form 10-K, U.S. Securities and Exchange Commission, https://www.sec.gov/Archives/edgar/data/1520697/000119312515069793/d854534d10k.htm.