TX Medical Care at TYC Falls Short


Date: Mon, 09 Apr 2007 12:59:55 -0500


Medical care at TYC falls short

Exclusive: Slow treatment, ignored ailments, lost records among hundreds of
complaints


12:28 AM CDT on Sunday, April 8, 2007
By EMILY RAMSHAW and HOLLY BECKA / The Dallas Morning News
eramshaw@dallasnews.com and hbecka@dallasnews.com

The rashes sprang up in April 2004, followed by open sores that covered John
Rodriguez's body.


MICHAEL AINSWORTH/DMN
Inmates line up to enter their dormitory at the Marlin Orientation and
Assessment Unit, a Texas Youth Commission facility in Marlin. By the next
month, the 17-year-old inmate at the Texas Youth Commission's Coke County
Juvenile Justice Center had spiking fevers and spent two weeks in the
hospital under observation.

In June, after being transported 10 hours by van to a TYC facility closer to
an urban medical center, John had swollen joints and debilitating chest
pain. He sobbed to nurses that he wanted to go home.

By July 4, the San Antonio teenager was vomiting on himself and lying
unresponsive on the prison infirmary floor. He was brain dead when
paramedics got him to the hospital.

"I was in shock. I didn't want to leave his side," said Cynthia Cavazos, who
removed her son from life support when it was clear he wouldn't recover. "I
said, 'That's my kid. That's my boy, my baby boy right there.' I don't
understand why this happened to him."

John's death, which his family blames on inattentive medical care, was a
rarity at TYC. Of more than 20,000 youths who have filed through the agency
since 2002, six have died while in custody.

But it is representative of a juvenile correctional health-care system that
agency officials admit remains woefully inadequate. Inmates rarely receive
the treatment they need as soon as they need it, and they say small, nagging
problems aren't taken seriously until they turn dangerous or
life-threatening.

A Dallas Morning News review of nearly 2,000 TYC medical mistreatment
allegations and investigations since 2005 shows youths often must wait weeks
or months for X-rays, prescriptions and referrals to specialists at the
University of Texas Medical Branch or the Texas Tech Health Science Center.
Those two health care providers manage all but psychiatric care, which TYC
outsources to local doctors.

Also Online
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Health records and prescriptions are frequently misplaced or left behind
when youths switch prisons, leading to gaps in treatment. Inmates with
mental health problems often are not on consistent drug plans. The result
can be bad drug interactions, wrong or missed dosages, deep mood swings or
suicidal tendencies.

"I'm not prepared to say whose fault it is, but I know a lot of things ain't
right, and it causes me great concern," said Jay Kimbrough. In his role as
conservator of the embattled agency, Mr. Kimbrough hopes to overhaul the
medical system.

"It's not functioning on the level it should," he said. "And if even one
person is not getting the care they need, that's one too many."

Multiple complaints
The medical reports are yet another sign of dysfunction within TYC, which
still reels from a sexual abuse scandal and subsequent cover-up at the West
Texas State School in Pyote.

The 43 medical mistreatment investigations and 1,730 youth medical
complaints reported in the last two years include:

A youth at the Sheffield Boot Camp who complained about headaches,
dizziness and vomiting for close to five months without being sent to a
specialist. A medical exam eventually showed he had a brain tumor. Even
then, it took two more weeks to discharge him.

An inmate at the Corsicana Residential Treatment Facility who suffered a
severe concussion after being assaulted by several youths in his dorm. After
seven days of headaches and vomiting blood, he blacked out in a classroom.
Only then was he transported to an emergency room.

An epileptic inmate at the Marlin Orientation and Assessment Unit who
wasn't given his medication for three straight days and suffered a
five-minute seizure. He collapsed face first, splitting his eyebrow and
requiring stitches.

A youth at Sheffield who suffered chest pain and complained he couldn't
breathe, only to be ignored by staff and threatened with write-ups for his
behavior. Later that day, the youth was taken to a hospital and pneumonia
was diagnosed. He was evacuated to San Antonio for treatment.

The records obtained by The News also include allegations of faulty
treatment for TYC inmates' mental conditions. Among them:

A young man in a deteriorating mental state was moved from the McLennan
County juvenile facility in Mart to the Crockett State School, where he lost
25 pounds during fall 2005. He rarely ate, didn't shower, was agitated and
talked with slurred speech. Four times, the youth was taken to an emergency
room for rehydration. He was eventually admitted to Austin State Hospital
for psychiatric stabilization. "The failure of ... facility staff to notify
the infirmary and/or refer the youth for psychiatric evaluation in a timely
manner violated the standard of care and caused substantial harm to the
youth," TYC investigators concluded.

In June, a youth at the Al Price unit in Beaumont said he was given the
wrong medication. "The infirmary worker insisted it was my meds, until after
I took it, [and] then just said I would sleep good," the inmate wrote in a
complaint. "I passed out in the cafeteria." TYC classified the incident as a
medication error.

A young man who was taken off his psychotropic medication reported that
every time he got chocolate chip cookies, "they start talking to him and
they say their names are chip, chocolate and cook. [Youth] feels he needs to
be put back on his medication," a TYC report said. A psychiatrist agreed,
records show.

Officials alerted
Some parents, frustrated by TYC's lack of response to their concerns about
psychiatric care, have written Gov. Rick Perry to seek help, according to
records released to The News. The governor's office sent the parents'
correspondence directly to TYC.

In one September letter, a mother of an inmate from Pearland noted that this
was the second time she had contacted state officials because TYC had taken
her son off medication for bipolar disorder.

"My son is now in suicide watch due to the fact of being taken off his
medications," the woman wrote. "As stated previously, these medications are
more damaging than ... helpful to him when not taken properly."

The mother also alleged that her son twice had been physically assaulted at
TYC.

"I have advised my son to try and stay calm but by no means just take
whatever medication TYC tries to provide him without me being able to
research it first since we obviously can't trust their word," she wrote.

In response, Dwight Harris, then TYC's executive director, explained that
the woman's son had indeed been hurt in what investigators deemed to be a
case of excessive force. The guard in the case resigned in lieu of
discipline.

The boy also was injured when another inmate reached through a food slot
into his cell and cut his neck. The guard in that case was found to have
provided inadequate supervision, and he resigned after the incident.

Mr. Harris, who stepped down shortly after the TYC scandal broke, said the
problem was the inmate's refusal to take his medication. "We welcome any
help you can offer in encouraging your son to take his medication," he
wrote. "Like you, we want [your son] to progress in his rehabilitation so he
can return home."

In February, more than 50 percent of TYC inmates were taking some sort of
psychotropic medication, according to UTMB. At Corsicana, TYC's mental
health unit, about 94 percent of the inmates take psychotropic drugs.

Many of the complaints recorded by TYC indicate that health care
professionals often accuse youth of faking or exaggerating ailments to get
attention. Their solution to almost every generic problem: Tylenol or a
glass of water.

It's a system LaDonna Davis believes led to her son's death.

Dwight Davis had open-heart surgery twice as an infant and wasn't supposed
to play contact sports. When he was sentenced to TYC at 16 for assaulting
his grandmother, Ms. Davis made sure officials knew of his condition, she
said.

But in fall 2003, when Dwight was transferred from a Harris County juvenile
facility to the TYC's Marlin intake unit and then to the Al Price facility,
his medical records somehow didn't make the trip. He had been participating
in physical education classes for nearly a month when he suffered a heart
attack and collapsed on the basketball court.

"They told me he had just shot a three-point and was on his way back to the
bleachers," Ms. Davis said. "He never should've been out there. It was all
in his file. They never did revive him."

Ms. Davis said TYC officials came to her home in Houston and told her Dwight
"had an accident." She said they didn't tell her he was dead until she
started packing her bags to go see him.

"I was livid. I'm still livid to this day," said Ms. Davis, who is suing the
agency. "I haven't gotten past it, haven't gotten over it. I never planned
on burying my child for something so minute as this. They knew he was sick,
and it's like they didn't care."

Tense relations
TYC officials have become increasingly unhappy with their medical
contractors, both of which provide doctors, nurses and prescription drugs
for the state's 22 juvenile facilities. Last year, agency insiders said
TYC's relationship with UTMB had gotten so bad that both parties considered
canceling the contract.

The agency has accused the health care providers of keeping incomplete
medical records and of failing to notify prisons that incoming inmates had
life-threatening conditions. It's a problem providers have worked hard to
solve, said Dr. Ben Raimer, a pediatrician and chief executive for UTMB's
correctional health care. This effort, he said, has occurred despite
operating in a fractured, decentralized environment where all mental-health
care is outsourced to local psychiatrists.

TYC also has taken issue with the providers' definition of medical
necessity.

The agency, for example, believes hernias ought to be surgically repaired;
the providers say if the youth isn't in pain, it's generally not medically
necessary.

Agency officials say they feel trapped by a system in which UTMB and Texas
Tech medical directors must approve everything from routine X-rays to
appointments with specialists, which require arduous van rides to and from
teaching hospitals in Galveston or Lubbock.

"We have difficulty getting the type of treatment we feel is necessary,"
said Jim Hurley, spokesman for the TYC. "It's a long-standing problem."

In the outside world, Dr. Raimer said, most juveniles with sprained ankles
ice them and watch them for a few days; they don't get $2,000 MRIs. If UTMB
ran every medical test parents demand for their children, he said, the
entire system would be broke.

The health care providers are being forced to do more with less, in a time
of nursing shortages and skyrocketing health care costs. TYC paid $12.7
million for its health care in the last fiscal year. The agency's medical
budget for fiscal year 2008 was about $100,000 less, officials say, though
that may change now that lawmakers have gotten a whiff of the problems.

Dr. Raimer said TYC has repeatedly gone over UTMB's head to order
unnecessary tests and procedures and then has stuck the health care
provider with the bill. Many of these medical problems are the result of
injuries that he says never would have occurred if not for poor guard
supervision at TYC units.

"We've beat this horse to death," Dr. Raimer said. "We've said [to TYC
officials], if you want to do the testing ... you do it, but you pay for it.
It's not an appropriate use of taxpayer funds."

The health care conflict is so tense that Mr. Kimbrough has asked both
providers and some private contractors to submit new health care proposals
for the agency, which must renew its contract by September.

"There's definitely a tension there," Mr. Hurley said.

No sense of urgency
In the battle over health care budgets, Ms. Cavazos said, some youths are
getting caught in the crossfire.

She and her attorney want to know why doctors released her son John from the
hospital when his symptoms were so severe. They both believe it was to save
money.

And they're horrified that officials forced John on a 525-mile van trip from
West Texas to the Al Price facility in Beaumont when he was in such fragile
condition. Despite the so-called "medical" move, they say, John never saw a
specialist or got consistent treatment there.

"There was never any sense of urgency he was endlessly sick and just kept
getting stuck on a cot in a room," said James Myart Jr., Ms. Cavazos'
attorney. "And the fact that no one caught it, that's not just indifference.
It's a direct violation of their legal duty."

TYC officials absolved themselves of any responsibility for John's death in
the agency's official death report.

An internal investigation into John's death indicates that doctors and
nurses, with a few minor exceptions, met the standard of care during his
illness. They said that the 10-hour journey, joined by a nurse, included
frequent rest stops and that John never complained. And they said the Al
Price facility was the appropriate place for him because it was close to a
good hospital and had 24-hour nursing care.

Ms. Cavazos, who has been in and out of jail and halfway houses with drug
and alcohol addiction and has another child in TYC, isn't convinced. If
agency officials had paid closer attention, she said, her son would be alive
today.

"The last time we spoke he told me, 'Mommy, I'm OK. I know you're worried,
but don't worry about me.' He told me that he never wanted to go back again
to prison, that he was going to have a job and support me and take care of
me," Ms. Cavazos said. "Never again did I speak to my son."

Staff writer Amy Rosen contributed to this report.

AN AILING SYSTEM

TYC deaths since 2002

2002
A male youth commits suicide after being transferred to an adult jail. He
was listed as a TYC inmate at the McLennan County State Juvenile
Correctional Complex because he hadn't yet faced adult charges.

2003
A male youth dies of a heart condition on the basketball court at Al Price
State Juvenile Correctional Facility.

2004
A female youth dies in a hospital of a medical condition that causes her
bone marrow to fail. She was released on a medical necessity from the
Giddings State School two weeks before her death.

A male youth dies at a hospital after suffering from an undiagnosed viral
condition at the Al Price State Juvenile Correctional Facility. His family
removes life support when he is declared brain dead.

A male youth commits suicide at the Gainesville State School by hanging
himself with a bed sheet.

2005
No deaths are reported.

2006
A male youth commits suicide at the Coke County Juvenile Justice Center by
hanging himself with his jumpsuit.

TYC youth medical complaints since January 2005: 1,730

Categories of complaints:
Type of medical treatment received: 44 percent
Problem getting access to care: 26 percent
Medication timeliness or wrong medication: 10 percent
Special youth medical needs: 8 percent
Conduct of medical personnel: 4 percent
Dental care: 3 percent
Other: 5 percent

TYC medical mistreatment investigations since January 2005: 43

Allegations confirmed: 21 percent
Allegations unconfirmed: 79 percent

TYC youth medical complaints/investigations of alleged mistreatment since
January 2005, top facilities by number:

Marlin Orientation and Assessment Unit: 401
Ron Jackson State Juvenile Correctional Complex: 306
Corsicana Residential Treatment Center: 253
Gainesville State School: 117
John Shero State Juvenile Correctional Facility: 96
Coke County Juvenile Justice Center: 95
McLennan County State Juvenile Correctional Complex: 93
Giddings State School: 92
Al Price State Juvenile Correctional Facility: 77

Number of youths on psychotropic medications, February: 2,751

Annual cost of all TYC prescription drugs: $1,656,182

SOURCES: Texas Youth Commission and University of Texas Medical Branch
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