Mental Health Officials Could be Held in Contempt

Mental health officials could be held in contempt
Sunday, Mar. 23, 2008 3:00 am
Lawyers for a Lexington boy who was abused by his mental health providers are trying a novel approach: They want individual administrators held in contempt of court — a finding that could carry fines or jail time.
Last June, the case of Daniel Woody, 11, revealed gaping pitfalls in mental health reform, the state plan to privatize the system. Now Daniel's case could set legal precedent.
The child's lawyers will ask a judge to hold in contempt officials at Piedmont Behavioral Health, the local agency that covers Davidson County. Last June, the court ordered treatment for the mentally disabled boy and gave PBH 120 days to arrange it. Nine months later, but for a brief period last fall, the boy is still without services.
Attorneys for the five-county regional agency, the state's largest, argue that PBH worked "long and hard" to find treatment but failed.
"The efforts of PBH have been thwarted, through no fault of its own," agency lawyers wrote in a response filed March 13, "by great difficulties in finding and contracting with providers."
Amid mounting evidence that HMO-type reform fails clients across the state, the boy's lawyers called PBH's admission "remarkable."
"What they're saying is that they're not able to comply" with previous court orders, said Ann-Marie Dooley of Legal Aid. "For the state to make such an admission is astounding."
But in Daniel's case, not surprising. Prior to last June's court order, Daniel was found to have been physically abused by workers for a private agency whose contract with PBH was terminated after complaints involving multiple clients.
Among the complaints: Clients were made to walk barefoot on gravel, so they could not run away.
Next, Daniel was served by a contractor who operated out of her home and employed a relative to baby-sit and transport the clients — even though he had no driver's license.
When the Davidson County Sheriff's Office began investigating why Daniel returned home with bruises on his face, arms and neck, the relative was let go, but the provider still has a contract with PBH, a spokesman said last week.
The agency, which declined to comment on the contempt motion, is considered a "demonstration model" for North Carolina's reform program.
The goal of the massive 2001 initiative was to give people with mental disabilities more "choice" in treatment providers and to keep them close to home rather than institutionalized in a far-flung state hospital.
But the journey through the system has been just the reverse for Daniel, a friendly, towheaded boy whose grandparents adopted him as a baby and have cared for him since.
When Daniel's behavior turned angry and impulsive in 2006 — the same period of time he was abused — he was hospitalized at Wake Forest University Baptist Medical Center. There, his medical file shows, he was given medication that caused an allergic reaction and breathing problems.
From there, his behavior worsened, and he was sent on an emergency commitment to Butner's John Umstead Hospital, which is designed to treat psychiatric patients, not clients with developmental disabilities such as Daniel, who has received a diagnosis of retardation and severe hyperactivity.
And even though Daniel's doctor had determined that he could be safely cared for at home — assuming there were a treatment plan and qualified, competent providers to give respite care and community services — Umstead sought for the boy to be placed in a group home in Florida.
When his grandparents refused, the state cut off the boy's "innovations waiver" that would pay for community services through Medicaid. The family was meanwhile reported to the Department of Social Services to be investigated for medical neglect.
Instead, a DSS worker advised the family to call Legal Aid. The boy's grandmother, Barbara Woody of Lexington, said last week that she believed the family angered mental health officials by demanding that the private providers be shut down.
"That doesn't look good, does it?" Woody said. "But it's not right. You don't abuse children. You don't make money on abuse."
A spokesman for PBH, Stephan Tomlinson, said the agency cannot comment on the Woody lawsuit, which names the three PBH administrators who signed off on Daniel's plan: Dr. Craig Hummel, medical director; Dr. Kristin Baker, assistant medical director; and Andrea Misenheimer, clinical care director.
In part, the contempt motion to be heard April 11 in Raleigh Superior Court is a recognition that the state is immune to being sued. On the other hand, suing individual officers at PBH could be a particularly salient test.
Unlike other regional mental health agencies such as the Guilford Center, PBH contracts directly with private providers and, in turn, sends the bill to Medicaid. The agency's position that it now is unable to provide the child the safety net guaranteed by law is a sobering statement on reform.
For children's advocates, it suggests that not everything works better in the private sector.
"This whole reform was about 'choice,' but they're now saying there's nobody who will serve this child," said Legal Aid's Dooley. "Whenever you privatize services, providers get to cherry-pick who they want."
That was part of the problem highlighted in a series of stories last year by News & Record staff writer Mark Binker. Audits found private providers using unqualified workers who hadn't undergone criminal background checks, falsified billing records and long delays for mentally ill people seeking services.
Those reports found cases in which patients were mistreated, beaten with belts and hangers, exposed to drugs and alcohol or allowed to wander off. In one case, a 16-year-old bipolar girl who was allowed to walk in the park unsupervised was picked up in a car and raped.
Since then, the news has only gotten worse. Carmen Hooker-Odom, former Secretary of Health and Human Services, resigned. The state in January put off plans to close Umstead and Dorothea Dix hospitals, in light of reports of patient abuse at the state's newest mental hospital.And following a series this month in the Raleigh News & Observer showing that some $400 million had been squandered and at least 83 mental hospital patients had died under questionable circumstances since 2000, Gov. Mike Easley argued that he had opposed the mental health reform plan in the first place.
So compared to all the money and all the politics, what's one little boy?
To his grandparents, everything.
When Daniel was at Umstead, Barbara Woody and her husband, Dale, would visit as often as they were allowed, when he wasn't in "seclusion." They would take him clean clothes, she said, and he would clutch them to his face because they smelled of home.
Realizing they were going home and he was staying in the hospital, he then began to tear the clothes.
"Daniel will never understand what happened to him. They can never give it back," his grandmother said.
"To them, Daniel was a burden. To us, he's our life. It doesn't matter that it's hard. That makes us love him even more. And how many other children are out there like Daniel? Their stories are never told."
Contact Lorraine Ahearn at 373-7334 or lorraine.ahearn@news-record.com