Dallas / Fort Worth Local News

DALLAS (AP) ― At least 53 mentally disabled patients in Texas' large residential facilities died in the last year from preventable conditions "that are often the result of lapses in care," a federal investigation revealed Tuesday.

Those deaths, which accounted for nearly half of all patient deaths, were detailed in a Department of Justice letter sent to Gov. Rick Perry. The report concluded that the Texas facilities violate residents' rights and called the number of injuries to patients "disturbingly high."

The facilities, known as state schools, fail to provide adequate mental health services or treat patients in integrated community settings, according to the 62-page letter. It also detailed investigations into abuse and mistreatment, including an alleged rape of a 17-year-old female by a staff member.

The findings mark the third time in three years that the Justice Department has investigated the Texas facilities. Similar findings of mistreatment at the Lubbock State School came out in 2006. The latest letter details deficiencies in Texas' 12 other state schools.

"We have concluded that numerous conditions and practices at the Facilities violate the constitutional and federal statutory rights of their residents," wrote Grace Chung Becker, an acting assistant attorney general in the civil rights division of the Justice Department.

In the one-year period ending in September, at least 114 residents died, with one facility averaging two deaths per month. Although many residents are considered medically fragile, at least 53 deaths were from possibly avoidable conditions such as pneumonia, bowel obstructions or sepsis, according to the letter.

Many residents "do not receive routine adequate preventive health care," the letter stated.

Laura Albrecht, a spokeswoman with the Texas agency that oversees the institutions, said state officials are reviewing the investigation's findings.

"We will continue our ... good-faith negotiations with the Department of Justice to reach a detailed and comprehensive agreement ... ," Albrecht said. "And we will continue our ongoing improvements in the quality of care at the state schools."

In an e-mail, Albrecht said the schools are adding 1,690 positions, improving staff training, reducing the use of restraints and expanding community-based services for state school residents.

"The governor expects the Department of Aging and Disability Services to continue to ensure that corrective actions and improvements are implemented to provide appropriate and quality care for state school residents," said Perry spokeswoman Allison Castle.

Jeff Garrison-Tate, an advocate who wants the state schools closed, called the report "devastating and horrifying." He said he is concerned the Legislature will give the facilities more money for staffing, instead of increasing resources for community-based group homes.

"These places are not fixable," Garrison-Tate said. "It scares the heck out of me that the Legislature might dump more money into these toilets."

The federal review said the Texas facilities are out of step with accepted professional standards in four main areas: providing adequate health care; protecting residents from harm; providing adequate behavioral services, such as freedom from inappropriate restraints; and providing services in settings integrated into the community.

Investigators singled out the frequent and "disconcerting" use of physical restraints as an injury factor.

In January 2007, a teenage resident died while being held in six-point restraints, the letter said. At a different facility four months later, "staff reportedly broke a resident's shin bone as they slammed him to the ground during a restraint."

Other findings include:

-- A 17-year-old female resident with mild mental retardation said she was raped by a male staff member. Another staffer witnessed his colleague in a compromising position with the girl, but did not report the incident for two days. A rape test was not performed for two or three days, and the results were negative. The facility physician noted that such a time lapse would likely mean there would be no evidence of sexual activity.

-- One resident on three occasions swallowed latex gloves, but the mental disorder causing the behavior was not listed on his charts.

-- From July through September, the state has investigated at least 500 allegations of abuse, neglect and other mistreatment of residents.

-- At least eight of the facilities were recently in danger of losing Medicaid funding because of "significant care and safety deficiencies."

The letter also notes that more than 800 employees from the 13 facilities were suspended or fired for mistreating patients since fiscal year 2004, as first reported by The Associated Press in April.

Investigators conclude that staff turnover and unfilled positions are to blame for most of the problems. It praised the facilities' "many dedicated medical professionals" but said staffers are overwhelmed by large caseloads.

"Until the facilities can successfully retain, train, and supervise their staff, they will face enormous difficulties in addressing the identified deficiencies," the letter stated.

(© 2009 The Associated Press. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed.)

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