DRUGGED INTO SUBMISSION

THE COLUMBUS DISPATCH

Monday, April 25, 2005

LISA MARIE MILLER

Chelsey Kennedy, 15, of Gahanna, says she ''slept for four days and was
in a drug-induced fog for a week" after being subdued with three shots
of a powerful drug at a Dayton treatment center. Now she's at a
Columbus center, but her mother worries about the number of medications
she takes daily - 14, compared with two when she went into treatment
two years ago.

Nurses Andy Hooks, Debbie McCoy and Melani Scurlock, from left, prepare
to give children at Pomegranate Health Systems their medications. A
state doctor warned the Byesville, Ohio, center about its use of ''drug
cocktails" last summer, but officials there say many of the troubled
kids Pomegranate treats arrive with multiple prescriptions.

CHRIS RUSSELL
Nick Malcuit, 16, endured drugs that made him sleep 18 hours a day,
gain 50 pounds and become hyper before doctors found the one to treat
his bipolar disorder. Behind him in his family's Strasburg, Ohio, home
are his stepfather, Aaron Brown; brothers, Maxwell and Nathaniel Brown;
and mother, Gwen Malcuit.

They are sent away for help. ¶ But when they act out, some troubled
children are controlled with potentially dangerous mind-numbing drugs.
¶ No one knows how often residential centers for hard-to-control kids
use psychiatric drugs to subdue them. Privacy laws shroud the centers
in secrecy. ¶ But a three-month investigation of thousands of state
inspection records as well as more than 80 interviews with
child-welfare workers, doctors, families, lawyers and industry
officials reveal growing concerns that pills and injections, most of
them untested on youths, have become a quick fix to stifle
troublemakers.

''At its worst, it's like a scene from the movie One Flew Over the
Cuckoo's Nest with Nurse Ratched chasing after kids with syringes of
psychiatric drugs," said Gayle Channing Tenenbaum, legislative director
for the Public Children Services Association of Ohio.

At best, it's a rare problem being addressed through better training,
says the Ohio Department of Mental Health.

But an advocacy group says Mental Health is making it easier for
treatment centers to force powerful drugs on kids without reporting it.


Ohio Legal Rights Service, which is leading the charge for change, says
the opposite should be done. Mental Health needs to impose far stricter
rules to limit the use of medications and hold centers accountable for
abuses, it says.

Both sides agree that psychiatric drugs can help kids suffering with
anxiety, depression or a host of other mental illnesses. The question
in these cases is whether medications are being used to treat children
or as a chemical straitjacket.

Legal Rights, an independent state agency, has examined nearly 500
cases involving chemical restraints during the past five years,
including:

. A 5-year-old boy who was so doped up that he couldn't stop batting
the air, complaining about imaginary bugs and smacking his lips. A
doctor ordered him off all medication.

. A 10-year-old boy who was chemically restrained 69 times over 80
days. Doctors prescribed up to six drugs at a time - and never
conducted trials to determine which pills worked for what symptoms or
disorders.

. A 12-year-old girl who was injected six times over nine months with
high doses of Thorazine, a powerful sedative that can knock kids out
and cause muscle spasms and twitches. She also was physically
restrained 31 times by as many as three men, despite a history of being
physically and sexually abused.

''It's scandalous that medications are used to subdue kids for
overworked and underpaid staff or as punishment for bad behavior," said
Carolyn Knight, the group's executive director.

Children already traumatized by abuse, neglect or mental illness can be
hurt further by being forced to take a medication, especially when held
down by adrenaline-pumped adults, said Dr. Ellen Bassuk, an associate
professor of psychiatry at Harvard Medical School who has reviewed Ohio
cases.

''The mental-health system is a mess," she said. ''Not only are these
places giving chemical restraints, but they're prescribing risky
combinations and dosages of drugs that are as dangerous and inhumane."

State officials say Ohio law prohibits chemical restraints except in
emergencies when a child or worker is in danger. Even then, they're
supposed to be used only after lessforceful options fail.

''It's been outlawed," said Thomas Wood, chief of licensure and
certification for the Department of Mental Health.

Critics say the state's 52 private residential centers often skirt the
law by calling the restraints emergency medications or a PRN order -
short for a Latin term for giving drugs as needed.

''No one wants to call it a chemical restraint because it is too
emotionally charged a term," said Curtis Decker, executive director of
the National Association of Protection & Advocacy Systems in
Washington.

Others say the practice is protected by an unspoken rule: ''Don't ask,
don't tell."

''It happens underground all the time," said Steve Eidelman, executive
director of the ARC of the United States, a national advocacy group for
the developmentally and mentally disabled, based in Silver Spring, Md.

''It's all about what's easiest for the treatment providers, not what's
good for the kids."

In response to that concern, workers at these centers increasingly are
being taught ways to prevent power struggles instead of how to
physically control children.

''It can be as easy as sitting down with a kid and telling them you
hurt my feelings when you called me a name instead of tackling them to
the ground," said Bob Bowen, chief executive officer of David Mandt and
Associates, a Texas-based training company that Bowen runs from his
Canton office.

Injections as threats

Concerns about overmedicated kids are being heard nationwide.

A children's psychiatric hospital in Louisville, Ky., was chastised in
2003 for giving drugs to children before they could cause problems -
sometimes while still asleep. Kids who refused to take pills were told
they would receive a shot of Thorazine.

In May 2000, a nonprofit group filed a class-action lawsuit on behalf
of 9,000 Tennessee children in large institutions who were given
psychiatric drugs and other restraints without proper legal consent.

''There's no reason to think that Tennessee is an aberration," said
Doug Gray, a lawyer for the New Yorkbased, nonprofit Children's Rights.


Defenders say drugs sometimes are needed to control the increasingly
unruly, violent youths being sent to the centers.

''They bite, hit, kick and spit," said Penny Wyman, executive director
of the Ohio Association of Child Caring Agencies, which represents
residential centers. ''They curse, yell and throw furniture. They're
angry and have a lot of issues to work out."

Many of the children need the kind of intensive care they'd get at a
hospital, but there aren't enough beds, Wyman said. The state closed
most of its mental institutions in the late 1980s and early '90s but
sent little money to community health centers to help with increased
caseloads.

She said Ohio Legal Rights' leaders don't understand the challenges
providers face and are on a ''witch hunt," even though treatment
centers use psychiatric drugs only as a last resort.

Others say they don't understand the fuss.

''It's shocking that we focus so much attention on the residential
treatment centers, which have fewer than 1,000 beds," said Michael
Hogan, executive director of the Ohio Department of Mental Health.

The department licenses the centers, four- to 115-bed facilities that
together can house 919 children. Thousands of kids flow through the
centers in a year, and many more are closed out.

Hogan says the biggest danger facing children is depression. There were
168 youth suicides statewide in 2002, the most-recent figures
available.

''No case of abuse or neglect is good," he said. ''But it would be
wrong for us to ignore the bigger issues, especially as our money gets
tighter and tighter."

Most treatment centers are doing their best, he said. They're adding
psychiatrists, reducing overall restraint use, training staff members
and trying new, positive methods for responding when kids blow up.

Hogan's department thoroughly inspects the centers every two years, or
when concerns arise.

The centers typically charge $100 to more than $1,000 a day. But most
still have few hiring standards and are plagued by high turnover,
Knight said. Workers often are fresh out of college and are paid about
$7 an hour.

The department's assistant medical director agrees that treatmentcenter
workers often are too quick to push drugs because they want calm,
obedient children.

''It's human nature. A lot of adults think children should be seen, not
heard," Dr. Patricia Goetz said. ''It doesn't help that we're a culture
where you can manage everything with a pill."

State intervenes

Last April, the state ''strongly recommended" that Belmont Pines
Hospital, in Youngstown, stop using emergency medications after Goetz
uncovered several troubling trends.

She reviewed 11 cases in which a total of 27 shots of the powerful
drugs Haldol and Thorazine were given to calm angry children.

In a letter, Goetz noted that the medications ''have effects that last
far longer than required for a patient to regain self-control."

Sleepiness can persist for hours or days. And unlike the use of other
restraints, such as padded handcuffs or physical holds, there are no
limits on how long kids can be drugged, said Laurel Stine, director of
federal relations for the Bazelon Center for Mental Health Law in
Washington.

''It's just another way to abuse children who have already been
victimized," Stine said.

Two years earlier, the Department of Mental Health placed Belmont Pines
on probation for five months and barred the 45-bed center from
admitting more children.

The agency took action after Ohio Legal Rights and several Belmont
Pines employees complained that the facility gave too many shots of
Haldol, Thorazine and Vistaril, an antihistamine used for sedation.

One man reported that his son was so drugged up during visits that he
couldn't talk or walk. The boy essentially was being treated as a
''pincushion," said Judy Jackson-Winston, a client-rights officer for
the Cuyahoga County Mental Health Board who spoke with the father.

Belmont Pines officials said they have stopped using emergency
medications and had reduced their use by 86 percent before the state
warning.

''We had already made a decision that we were going to reduce, then
eliminate their use," said Dr. Phillip Maiden, the group's medical
director. ''The Ohio Department of Mental Health just made us do it a
little quicker."

Although he regrets that the center was placed on probation, Chief
Executive Officer George Perry said, ''There's no question, we're
better for it."

Multidrug cocktails

Last summer, Goetz warned about the use of ''drug cocktails" at
Pomegranate Health Systems, which runs a center in Byesville in
Guernsey County and plans to open a $5 million, 60-bed facility in
Franklinton next year.

She questioned why five drugs were needed for a 15-year-old with
posttraumatic stress disorder and intermittent explosive disorder,
which leads to sudden outbursts of violence.

''It is very concerning that this child is on three mood stabilizers -
Depakote, Topamax and Trileptal - and two antipsychotic medications -
Haldol and Seroquel," Goetz wrote. ''There is no evidence that Topamax
or Trileptal decreases aggressive behavior."

Few scientific studies have explored the risks associated with using
multiple psychiatric drugs.

However, experts and researchers agree that drug cocktails increase the
likelihood of death or bad side effects. Also, many behaviorial-health
drugs agitate children, so workers respond by giving them more
medication.

Goetz also criticized Pomegranate for using Haldol too often and in
high doses, even though the drug can cause potentially fatal side
effects, including involuntary muscle contractions, low blood pressure
and rapid heartbeat.

Pomegranate officials defend their medication practices, saying they
treat the most difficult, disturbed children, including those who are
victims of violence or attempt suicide.

On average, the kids they see have been through 20 foster, group and
residential homes, administrator Bob Hall said. Some have had as many
as 33 placements.

Most have been to a different physician or psychiatrist with each move,
and each doctor has prescribed multiple drugs. Complicating matters,
the children's medical records often don't keep pace with their moves.

Pomegranate deals with the problem by creating medical and mentalhealth
work-ups within 30 to 45 days of each child's arrival, Hall said.

''We just received a 71-page package on a kid, and there wasn't one
fact about the kid's medications in all that paper," Hall said.

This type of slip-up proves the system is broken, said Yvette McGee
Brown, a former juvenile court judge who is now president of the Center
for Child and Family Advocacy at Columbus Children's Hospital.

But it doesn't take residential centers off the hook.

''They should get those files," she said. ''Anything less is
malpractice."

While on the bench, McGee Brown frequently called the doctors of
children she thought were overmedicated.

''I had a 10-year-old who was so doped up he was walking around like a
zombie," she said. ''Sure, he wasn't creating any problems. But he was
barely conscious."

Problems with staff members

Chelsey Kennedy, 15, of Gahanna, never will forget the effect of being
given three shots of Haldol one afternoon at Kettering Hospital Youth
Services in Dayton.

''I slept for four days and was in a drug-induced fog for a week after
finally waking up," she said. ''That's just wrong!"

Chelsey, who has bipolar disorder, admits being combative and mouthy at
times. But she said residential staff members often egg on patients.

State records reflect that.

For instance, the Mental Health Department reprimanded a southern Ohio
center in January for creating a ''culture of fear and intimidation."
State inspectors said the children at Oak Ridge Treatment Center, near
Ironton, complained about being cursed at, called names and insulted by
staff members.

They also reported being choked, kneed, ''slammed" and put into a
''sleeper" wrestling hold that temporarily cuts off their breathing.

Wendy Kennedy, 40, said teens are ''manhandled" at Residential
Treatment Centers of Ohio, a South Side facility where her daughter has
lived since early March.

''When I went to visit Chelsey recently, one of the girls had a black
eye, bloodied nose, busted lip and she couldn't move her shoulder - all
because of a restraint," Kennedy said. ''Using brute force is so
wrong."

Residential Treatment officials denied using excessive force and said
no children have been hurt. ''Franklin County Children Services has
found nothing to substantiate any abuse," Chief Executive Officer Jeff
Beasley said.

But in March 2003, Children Services pulled 11 teens from the center
after a worker bruised a girl's wrist during a restraint. The state
also placed Residential Treatment Centers on probation for failing to
meet rules.

Beasley said the center doesn't use any emergency medication - ''only
drugs ordered by the doctor."

However, state mental-health officials cited the facility in August for
using a ''medication as a restraint to control behavior."

Kennedy is concerned that Chelsey might be on too many and maybe even
the wrong medications.

Before entering residential care a year ago, Chelsey was on two drugs.
She's now prescribed 14 - 11 psychiatric and three for diabetes.

''The side effects are terrible," said Kennedy, who turned over custody
of her daughter to Franklin County Children Services in 2004 to get her
mental-health help. ''She has joint pain, reflux and no hormone levels,
which have baffled doctors."

Chelsey also hasn't been herself.

''She can be normal one minute and like a small child another," Kennedy
said. ''I just don't understand why they give her so many drugs but no
meaningful counseling. It kills me."

Gwen Malcuit, 33, of Strasburg in Tuscarawas County, understands
Kennedy's pain. Her 16-year-old son, Nick, was misdiagnosed four times
and given more than a dozen medications before doctors concluded he has
bipolar disorder.

One drug made him sleep 18 hours a day. Another caused him to gain 50
pounds. A third made him fidgety and hyper.

''I really believe the medications impaired his learning," Malcuit
said. ''He was angry, out-of-control and thought I had betrayed him."

Today, Nick is on one medication and enjoys life as a 10 th-grader. He
is doing well in school, has a girlfriend and is looking for a
part-time job.

''Look at what happens when you give a child what he really needs:
appropriate services in his own home," Malcuit said.

She lays part of the blame on the confusing system.

For example, four state agencies license residential centers: the
departments of Health; Job and Family Services; Mental Health; and
Mental Retardation and Developmental Disabilities. Each has different
licensing standards. The Ohio Department of Alcohol and Drug Addiction
Services also certifies some programs.

''It's a maze that leaves families feeling left out," Malcuit said.

It doesn't help that families often relinquish custody of their
children to county child-welfare agencies because mental-health care is
so expensive. And when they do, they frequently lose the power to make
decisions about medications. They're also afraid to challenge decisions
out of fear their children won't be returned.

Fewer reports

Finding out how often treatment centers use drugs to restrain children
has become more difficult.

In January 2004, the Department of Mental Health stopped requiring
treatment centers to fill out incident reports for restraints unless
they involved abuse or neglect, or resulted in an attempted suicide,
injury or death, Knight said.

As a result, the number of reported restraints - both emergency
medications and physical holds - dropped from 6,815 in 2003 to 113 last
year. Reports of emergency drugs declined from 118 in 2003 to 10 last
year.

Mental Health officials say providers now have to log the use of
restraints daily. The department regularly reviews them and compiles
totals every six months.

But advocates say the centers aren't required to note the use of
emergency drugs.

Meanwhile, state developmental disability officials have toughened
their reporting requirements, causing their figures to spike from 12
reported restraints in 2001 to 542 last year.

The Department of Mental Retardation and Developmental Disabilities
also considers the use of any unapproved psychiatric drug - whether in
an emergency or not - a chemical restraint.

''They're well ahead of the Department of Mental Health on this issue,"
Knight said.

MRDD officials admit they toughened their requirements after a scathing
audit by what is now the federal Centers for Medicare & Medicaid
Services in Washington.

''It's tough asking the painful questions, but if you don't you'll
never know if a provider is doping a client up with a powerful
psychotropic medication just for convenience," Director Kenneth Ritchey
said.

Since 2000, the department has added 14 people to its investigative
unit, created an online registry of caregivers who have abused people
with disabilities, and developed a Webbased reporting system for
incidents.

Ohio Legal Rights would like the Department of Mental Health to be
equally vigilant, particularly in requiring treatment centers to report
the use of all restraints.

Legal Rights points to an incident at Kettering Hospital in Dayton last
July in which a 14-year-old girl was restrained - with drugs,
handcuffs, other devices and physical force. Eight staff members, a
guard and two police officers were involved in the episode, which
stretched over ''eight horrendous hours," according to Legal Rights.

Details remain sketchy, but the agency's investigation found:

. The teen became agitated and was put in a seclusion room. State
officials say she was spitting and threatening staff members.

. While in the room, she managed to pull a mattress cover off a bed and
zip herself inside. Police were called and put her into handcuffs until
she calmed down. Staff members replaced the cuffs with other restraints
and kept her tied up for more than seven hours, against state rules.

. The girl was given three shots each of Haldol and Cogentin, a
medication used to offset potential side effects from the Haldol,
including stiffness and tremors. The child-welfare agency responsible
for the teen had never consented to the use of Haldol.

In the end, the guard filed charges against the girl because he had
thrown out his back during the restraint, and she was discharged to
another facility.

Executive Director David Drawbaugh said Kettering is now committed to a
zero-tolerance policy for restraints and seclusion.

State mental-health officials said the incident ''raised a lot of
concerns" but was not reportable as a ''major unusual incident" under
the department's standards.

''This is the kind of human-rights abuse that occurred in the back
wards of psychiatric hospitals 25 years ago," said Laura Wissler, a
parent advocate for the Mental Health Association of Summit County.

''If this isn't reportable, what is?"

Copyright © 2005, The Columbus Dispatch