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DCFS sued over 'inhumane' practice of leaving kids too long in psych hospitals

Chicago Tribune - 12/13/2018

Dec. 13--Cook County's public guardian sued the Illinois Department of Children and Family Services on Thursday, alleging the beleaguered child welfare agency is causing "immense harm" to mentally ill foster children by keeping them in psychiatric hospitals beyond medical discharge dates as it struggles to find them homes with appropriate services.

The federal class-action lawsuit was filed on behalf of more than a dozen Illinois foster youths against DCFS and several employees, including the estates of two deceased past agency directors.

The suit alleges that state officials have known for decades about the lack of suitable placements, and that they worsened the tragic circumstances of the children's lives by repeatedly cutting budgets for appropriate treatment facilities and foster homes. The "inhumane" practice, known as "beyond medical necessity," costs taxpayers more than $125,000 a month, the suit alleges.

The suit states that the problem is so well known that state lawmakers in 2015 directed DCFS to formally track children and teens in foster care who languish after being medically cleared for discharge. In one case cited in the lawsuit, a girl spent her 14th birthday in a psychiatric hospital during a more than four-month hospitalization in 2015. The child was supposed to be placed with her sister, but she was so traumatized by the prolonged hospitalization that the relative's home was deemed inappropriate and the girl ended up in a residential group home and then in specialized foster care, according to the lawsuit.

"Being unnecessarily locked in a psychiatric hospital undermines -- even eliminates -- the precious stability that children formed during their admission," the lawsuit read. "Children in psychiatric hospitals receive no formal schooling. They are locked indoors every day. Their ability to visit with siblings and family members is drastically curtailed. And psychiatric facilities can be dangerous, particularly for vulnerable children, when other patients express psychiatric and behavior disorders."

DCFS spokesman Neil Skene said the agency had no comment on the lawsuit and had yet to see it.

Skene said it's a "very complex challenge" to find placements for youth with severe behavioral or mental health needs. Some of these children may display adverse behaviors, including fire setting and self-harm practices, that get them rejected from private providers, foster homes or their own families.

"The availability of community resources and facilities to handle complex behavioral and physical health needs of children and teenagers is a serious need in Illinois," the statement said. "This is a decades-long problem in Illinois that has now fallen to the current leadership of DCFS. We are at the deep end of a challenge within the health care system....Rebuilding the capacity of the mental health system will require more than a lawsuit."

Acting public guardian Charles Golbert and attorneys from the Loevy & Loevy law firm in Chicago plan a Thursday news conference to discuss the suit.

"The first rule of health care is 'do no harm,' yet the state of Illinois and its child welfare agency have made a mockery of that precept," Golbert said in a news release. "The harm to these youth that DCFS is committing by locking them up long after they've completed their courses of treatment is incalculable. It's an abject moral and human rights failure."

Also Thursday, an Uptown psychiatric hospital that is struggling to survive amid complaints that young patients face unsafe conditions asked a federal judge to intervene in its battle with the federal government over funding.

Chicago Lakeshore Hospital wants a temporary restraining order to stop a Saturday cutoff date for the facility to continue billing Medicare and Medicaid for new patients.

At a hearing, Meredith Duncan, an attorney for the hospital, said an abrupt cut-off federal funding would eliminate a unique facility that "takes the most difficult cases, the youth that other providers cannot and will not take."

Duncan said Chicago Lakeshore has put in place a corrective action plan and substantial changes already have been made to the way it handles allegations of abuse. The hospital presented the changes to the government, but they have refused to even consider it, she said.

"We are at an absolute impasse," Duncan said.

Assistant U.S. Attorney Valerie Raedy, who represents the government, said "there is damage being done" by having children remain in the hospital's care. She said the facility has repeatedly failed to take corrective action even though after the issues were exposed in the media.

"(The hospital) was unable to keep its patients -- vulnerable young kids -- safe from sexual and physical abuse," Raedy said. "They were aware of the ProPublica (Illinois) and Chicago Tribune reports and still were not in compliance."

U.S. District Judge Sharon Johnson Coleman is expected to make a decision later Thursday on whether to issue a "stay of termination" that would keep federal funding in place while the issues are sorted out. The judge also gave the government until Dec. 21 to respond to the motion for a preliminary injunction. She is expected to rule on Jan. 2.

DCFS stopped admitting children in its care to Chicago Lakeshore several weeks ago amid an increased number of calls to the state's child abuse hotline this year. The final DCFS teen was transferred out of the hospital Nov. 30.

The child welfare agency has launched at least 20 hotline investigations in 2018. Many of the complaints alleged inadequate supervision by staff as young patients fought or engaged in sexual activity. In some investigations, staff members were accused of being physically or sexually abusive. A Nov. 19 complaint involved a 9-year-old patient who accused a staff member of choking her while trying to restrain the child.

Most of the hospital's inspection violations this year related to regulatory issues such as the length of telephone cords or improperly secured doors. But a Nov. 21 inspection cited the child abuse investigations and found hospital policies and procedures were inadequate and constituted an "immediate threat to patient health and safety."

Chicago Lakeshore is one of the largest hospitals for psychiatric services in Illinois, serving more than 5,000 patients a year in two buildings, including one for children and teens. An estimated one-quarter of DCFS children who need inpatient psychiatric services are treated there, with many languishing beyond their scheduled discharge date as the state agency struggles to find them homes.

This is the second time in recent months that the hospital has asked a federal judge to intervene. After an earlier threat to cut off government funding, the hospital filed a similar request Sept. 27, then promptly withdrew it when regulators agreed to give the hospital more time.

In their latest legal filing, hospital officials said they have appealed directly to federal officials but cannot get a hearing until February -- weeks after the Dec. 15 deadline. The hospital has another 30 days after this weekend's deadline to bill for current patients.

Several child welfare watchdog groups, including the American Civil Liberties Union of Illinois, pushed for an independent review of the hospital and demanded that DCFS halt future admissions. DCFS agreed, pending the outcome of a review that is on hold given the hospital's unsure future.

The hospital has pledged to work with state and federal agencies to correct problems. Administrators said they installed new security cameras in early November, replacing an old system that at times resulted in inoperable cameras and crippled complaint investigations. They said a new patient safety committee also was formed.

"The expectation of allegation-free acute psychiatric care to traumatized children and adolescents, especially those who are a product of the public system, is unequivocally unrealistic," Dr. Peter Nierman, the hospital's chief medical officer, wrote in an attachment in this week's court filing. "While it is incumbent upon our staff to limit the opportunities for abuse and neglect to occur, an expectation of zero tolerance for allegations constitutes a complete lack of understanding of the psychopathology of what we do as providers in this field."


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