Records: Child site violated U.S. rules

Letter faults treatment center’s use of injections, isolation to control kids

Piney Ridge Treatment Center in Fayetteville violated federal rules at least 13 times during a 30-day period by restraining its young clients with chemical injections while placing them in seclusion rooms, state records show.

Medicaid rules prohibit simultaneous restraint and seclusion because it violates health and safety requirements for patients, according to an Oct. 11 Statement of Deficiencies and Plan of Correction report that detailed each incident.

The Arkansas Democrat-Gazette learned of the chemical restraint/seclusion violations after obtaining the report through a Freedom of Information Act request to the state Department of Human Services.

An Oct. 23 letter to Piney Ridge’s administrator noted that an Oct. 11 complaint survey was conducted to “determine if your facility was in compliance with federal requirements.”

“This survey found that your facility had deficiencies requiring correction/ substantial correction,” the letter said.

Piney Ridge administrators submitted their plans for correcting the infractions Nov. 6, records show.

Corrections include more training for nurses, updates to written policies and eight weeks of monitoring to make sure the bad practices aren’t used again.

Piney Ridge, the state’s only treatment center exclusively for children with sexual behavior problems and mental illness, is an inpatient facility largely funded with Medicaid money.

The center has been under state investigation since early October, after a watchdog group — Disability Rights Arkansas — alleged that the facility was dirty and in disrepair, used restraints excessively and lacked enough supervision to prevent sexual contact among children there.

Young Piney Ridge residents talked about use of restraints and other allegations in interviews with state-provided inspectors last month.

“They restrain people left and right … grab them and take them in the time-out room and give them shots,” one unnamed patient said, according to inspectors.

The newspaper was unable to reach representatives from Piney Ridge or the Human Services Department late last week for interviews about the restraint and seclusion violations.

Licensed to treat 102 boys and girls, Piney Ridge is designated by Medicaid as a psychiatric residential treatment facility. State and federal dollars pay for children’s treatment there.

The center serves children from Arkansas and states as far away as Alaska and Wyoming.

‘SECLUDED FOR SAFETY’

Disability Rights Arkansas, a nonprofit that monitors such facilities, told state officials in an Oct. 2 letter about 14 allegations of abuse and neglect at Piney Ridge.

The group’s letter didn’t specify simultaneous use of chemical restraints and seclusion, but the staff say that practice is dangerous.

Reagan Stanford, an attorney with Disability Rights Arkansas, said federal rules against simultaneous restraint and seclusion exist to ensure that children who are injected with “potent drugs” are consistently monitored afterward.

“Sometimes the drugs completely knock them out,” Stanford said.

Records show chemical restraints used on Piney Ridge residents included antipsychotics Zyprexa or Thorazine given with the antihistamine Benadryl.

Piney Ridge’s seclusion room has a small, plastic-glass window in the door. The window is often dirty and hard to see through for monitoring children, added Stanford, whose group inspected the center Sept. 19-20.

Nine Piney Ridge children received simultaneous chemical restraints and seclusion on a total of 13 occasions between Sept. 6 and Oct. 6, according to the Statement of Deficiencies and Plan of Correction report.

A child identified as “Resident #1” was involved in two incidents dated Sept. 10 and Sept. 15.

The unnamed child was put in a seclusion room at 12:25 p.m. Sept. 10 “for safety, until calm” after “screaming, cussing, kicking staff and banging” on room windows. A chemical restraint — the specific drugs weren’t named — was administered at 12:35 p.m.

Five days later, the child, whose age was not provided, “started punching staff about 2 p.m. as they were redirecting and trying to guide resident from the fence outside.”

The first restraint was physical, without an injection, but the resident “was jerking his body around in attempt to throw staff off balance. Resident bit staff and attempted to kick staff.” The resident was “secluded for safety,” according to the report.

“While in seclusion resident behavior continued to escalate. Resident screaming, slams head against wall, kicks seclusion room door multiple times, punches wall. Chemical restraint administered for safety.”

A nurse administered an injection of Zyprexa and Benadryl at 2:25 p.m., the report shows.

‘VERY VULNERABLE’

Though Adrienne Catalina, Piney Ridge’s chief executive officer, did not respond late last week to requests for comment about the simultaneous restraint and seclusion violations, she did address restraint questions in earlier communication with the newspaper.

In a Nov. 7 email responding to Disability Rights’ allegations, Catalina told the Democrat-Gazette that restraints and chemical injections were used in accordance with state and federal regulations.

Children treated at Piney Ridge are “at-risk” youths, Catalina said. “They are very vulnerable children and often act out because of their psychological and health histories.”

A state inspection on Oct. 10 found 110 instances of restraints or seclusions at Piney Ridge in a 30-day period.

Of the 110 incidents, 52% were physical restraints, 37% were seclusions and 11% were chemical restraints, according to the report by the Arkansas Foundation for Medical Care, a nonprofit that performed the inspection under contract for the state.

Foundation inspectors also interviewed 20 patients and 10 staff members. Eleven children said they had received physical or chemical restraints. All said they had witnessed other children being restrained.

“Start you out wit [sic] 2 shots when you get there … can get up to 10 shots at one time,” a patient told investigators.

Disability Rights’ Stanford said some states outlaw use of restraints on children because other de-escalation tactics should be sufficient.

“The fact that that’s kind of [Piney Ridge’s] pattern shows that they’re not effectively de-escalating situations,” Stanford said of the restraints.

‘WORK TO DO’

In addition to restraint and seclusion violations, the Statement of Deficiences and Plan of Correction obtained by the newspaper detailed two instances of incomplete reporting of child injuries.

“Based on record review and interview, the facility failed to ensure a serious occurrence report was maintained in the clinical record for easy reference,” according to the document.

One involved a resident who was playing outside Aug. 9 and started climbing a fence. When staff members asked him to get down, his “left arm started to connect or catch on the fence link.” When he jumped down, he landed on his left arm. He was taken by ambulance to a hospital and diagnosed with an effusion, or fracture, according to the report.

Piney Ridge officials notified the state and Disability Rights Arkansas of the injury on Aug. 12 but failed to include a report in the child’s medical record.

Another resident playing outside on Sept. 10 was injured climbing a fence and received a 1-inch cut that was treated by a doctor. Piney Ridge on Sept. 12 notified the state and Disability Rights but kept no record in the child’s chart.

Human Services Department officials have acknowledged the investigation into Piney Ridge. A spokesman said the treatment center has “work it needs to do to improve its facility.”

The state has several options after an investigation, from a corrective action plan to license revocation.

Piney Ridge is operated by Acadia Healthcare Inc, a for-profit, publicly held corporation with 595 facilities in 40 states, the United Kingdom and Puerto Rico, according to the company’s website.

Headquartered in Franklin, Tenn., Acadia operates six mental health treatment centers in Arkansas.