Investigation Findings

Texas Commission on Alcohol and Drug Abuse
Report of the Investigation of Complaints Against Kids of El Paso County, Inc.

 Complaints Received Against Kids of El Paso and Responses from Kids of El Paso

March 20, 1987. The Commission received a complaint referred from the Texas Department of Human Services in El Paso, which alleged physical and emotional abuse of an 18-year-old male and a 17-year-old female. Specific allegations included holding the adult "against his will," "physical abuse" of clients in the Quiet Room by adults, "emotional abuse by screaming interrogations," having "to make false statements to get privileges," staying in residences where the windows are nailed shut, and nutritional problems with low protein and high carbohydrate diet. The complaint was forwarded to Kids of El Paso for a response, which was received on April 8, 1987. Kids of El Paso denied all allegations.

April 29, 1987. The Commission received a written complaint from the great-grandmother of a client in Kids of El Paso. She alleged that clients were screamed at, called names, pushed, and shoved and were taken into the Quiet Room, where they were beaten and "bounced off the walls" by higher-phase clients. She also alleged that her grandson was not drug dependent, was forced to sign papers admitting to crimes and drug use that were not true, was forced to sleep in locked rooms on the floor in his underwear without blankets in host homes, was never out in daylight, could only use the bathroom and have a drink of water four times a day, and could not go to the bathroom or shower alone. She also stated that she had personally seen marks on one minor client's throat that looked as if he had been scraped or choked. This complaint was not referred to Kids of El Paso for a response due to the fact that the complainant did not reflect first-hand knowledge of many of the allegations.

May 11, 1987. The Commission received a third complaint referred from the Texas Department of Human Services based on a report by the El Paso Police Department. The police report alleged physical abuse of a 15-year-old minor client who reported that higher-level clients had told clients to hurt other clients. He gave the officer the following example: "At times, several of the kids in the program grab him, stretch him by the arms and legs, raise him about 3 or 4 feet, and then drop him to the ground." He then stated, "that the torture that is done in the program is done so as not to leave any visible bruises or marks on subjects so they have no proof of the incidents." He stated to the police officer "that his reason for running away from the program was due to the fact that he could no longer tolerate the torture he was receiving at the program." Because of the severity of the allegations by the minor client, TCADA had the Department of Human Services send a child protective caseworker on May 13, 1987, to interview the client. The worker determined that the client was not in immediate physical danger and did not need to be removed. In addition, on May 13, 1987, TCADA forwarded this complaint to Kids of El Paso for a response, which was due by May 21, 1987.

On September 29, 1987, after a follow-up letter from the Commission on September 24, 1987, Kids of El Paso responded in writing to the May 11, 1987, complaint concerning the minor client. The response denied the allegation and stated that the program would not condone any form of corporal punishment, and included an "amends" from the client dated August 13, 1987, stating he had made misstatements about the program to the police and to the TCADA and Department of Human Services investigators.

 Authority and Methodology of Investigation

Authority for the investigation is found in Article 5561c-2, Sec. 1.13 and Article 5561cc, Section 13, Texas Civil Statutes, Rule 141.71 of the Commission's General Provision Rules, the Board of Inquiry policy of the Commissioners, and Texas Family Code, Chapter 34.

The following methods were used in conducting the investigation of complaints received by the Texas Commission on Alcohol and Drug Abuse, hereinafter referred to as TCADA:

  • Personal and telephone interviews of complainants, clients, former clients, current employees and staff of Kids of El Paso, parents and grandparents of clients and former clients, federal and state law enforcement personnel, and personal or legal representatives of clients.
  • Review of official records on file with the TCADA Licensure Department.
  • Two site visits with investigatory inspections by TCADA Investigators on May 14-16, 1987, and October 26-29, 1987.

Licensure Status of Kids of El Paso, Inc.

Kids of El Paso County, Inc., hereinafter referred to as Kids of El Paso, was licensed by the Commission to deliver intensive outpatient treatment services on March 12, 1986. On May 26 and 27, 1987, the facility was inspected for relicensure by TCADA licensure officers. However, relicensure was delayed, pending the investigation results of complaints, due to their nature and severity and to compliance by the program with licensure standards. On November 24, 1987, the Executive Director of TCADA notified Kids of El Paso of action on variance requests to licensure standards which had been made by Kids of El Paso, and on December 1, 1987, a response was received from Kids of El Paso on the variance issues.

Findings of the Investigation

  1. The written complaint dated March 20, 1987, is a valid complaint supported by the findings cited infra.
  1. The written complaint dated May 11, 1987, is a valid complaint supported by the findings cited infra.
  1. Kids of El Paso refused to release adult and emancipated minor clients who were held against their will in the absence of lawful authority or a judicial involuntary commitment to the program, which violates the basic civil rights of those clients guaranteed by the Constitution of the United States in the Fourth Amendment.
  1. Kids of El Paso is not certified under Article 5561c-2, or Article 5561c-1, Texas Civil Statutes, or Commission Rule 151.65, Involuntary Clients, to accept involuntary commitments, and it is not a mental health facility as defined by law.
  1. Kids of El Paso admitted clients who did not meet the program's written admission eligibility requirements in violation of Rule 151.64(a), Admission of Clients.
  1. Clients who were adults at the time of admission were coerced into entering treatment and were held in the program against their will.
  1. Adults who had left the program were subject to harassment by program staff to reenter the program once they had left it.
  1. Kids of El Paso had a procedure by which an adult client could leave but failed to make the requirements or the way it was to be utilized known to clients.
  1. Kids of El Paso continued to refuse to release adult clients even after being warned against this practice by the TCADA Investigator in May 1987.
  1. Kids of El Paso violated Rule 151.66(a)(1) and 151.66(b) relating to a client’s rights to refuse treatment and medication and to be advised of the consequences of such refusal.
  1. Kids of El Paso violated Rule 151.66(a)(3) in that clients did not have individualized treatment plans, nor were these plans periodically reviewed by clinical staff.
  1. Kids of El Paso violated Rule 151.66(a)(3) in that clients did not have the right to meet with professional staff responsible for the clients' care since actual direct supervision of clients was by senior and junior staff and trainees whose only professional qualifications were having been in the program as clients. Treatment contact with professional or clinical staff was usually limited to a weekly therapeutic rap.
  1. Kids of El Paso violated Rule 151.66(a)(4) by failing to provide a humane and safe environment, affording protection from harm and appropriate privacy with regard to personal needs.
  1. Kids of El Paso kept clients in locked facilities without escape routes in case of fire, in violation of Rules 151.203(a) and 151.66(a)(4). This occurred both on the program’s premises and in some host homes.
  1. Kids of El Paso allowed staff and clients to physically restrain other clients, which in many instances led to physical and emotional abuse. Clients were not provided with a humane and safe environment; they were afraid and scared, and in the case of one client, the treatment was both reprehensible and inhumane. The program took no documented steps to discipline or remove the staff who perpetrated the act.
  1. Clients did not have privacy in regard to their personal needs, in violation of Rule 151.66(a)(4) because they were supervised while in the bathroom and had to seek permission to use the bathrooms if they needed relief at times other than those scheduled. When permission was denied, clients soiled themselves and then were harassed for so doing.
  1. Clients did not have a humane environment in which to sleep in some host homes since they slept on floors or on mats without adequate bed coverings and pillows and in overcrowded rooms which were not properly heated or cooled.
  1. Kids of El Paso violated rule 151.66(a)(5) by refusing to let clients on Phase One have the right to communicate with others or to have visitors unless restricted for a good cause by the director of the facility. This prohibition against communication was automatically applied to all clients with no individualized communication as to the need or causes: When clients on Phase One were able to visit with their families, it was under tightly controlled conditions that limited freedom of expression. This restriction on communication prevented clients from reporting instances of abuse to their parents and prevented a potential safeguard from being available to protect both the clients and the program.
  1. Kids of El Paso violated Rule 151.66(a)(6) because clients were mistreated, abused, and neglected.
  1. Kids of El Paso staff knowingly, recklessly, or intentionally condoned and encouraged staff and clients to confront, threaten, and taunt other clients. In addition, the program knowingly or intentionally allowed staff and clients to restrain, hurt, and physically assault other clients.
  1. Kids of El Paso knowingly, recklessly, or intentionally caused or allowed injuries to clients. These injuries include physical injury, mental disorientation, and emotional harm. These injuries were caused by physical action in some cases and by emotional harm in other cases.
  1. Kids of El Paso knowingly, recklessly, or intentionally abused clients through corporal punishment in the form of physical restraints, throwing and dropping clients, and other activities that were designed to be painful and which occurred in the Quiet Room and other parts of the program’s premises.
  1. Kids of El Paso knowingly, recklessly, or intentionally abused clients through the use of unreasonable restraint.
  1. Kids of El Paso knowingly, recklessly, or intentionally abused clients through sleep deprivation.
  1. Although allegations were made that Kids of El Paso abused clients through nutritional deprivation, the Board of Inquiry could not document whether these allegations were valid for substance abuse clients fed at 6500 K Boeing, although the allegations may have occurred in the host homes. The menus and allegations raise significant concerns regarding the nutritional requirements of the clients who were suffering from anorexia and bulimia.
  1. Kids of El Paso abused clients knowingly, recklessly, or intentionally through systematic provocation to fear and the use of verbal and other forms of communication to curse, shame, or degrade the value or self-worth of a client.
  1. Kids of El Paso knowingly, recklessly, or intentionally abused clients by threatening them with physical or emotional harm.
  1. Kids of El Paso neglected clients through their inattention, disregard, carelessness, ignoring, and omission of reasonable consideration of and appropriate responses to physical or emotional injury to clients.
  1. Kids of El Paso neglected clients by failing to provide adequate health care for clients.
  1. Kids of El Paso recklessly and intentionally neglected clients with anorexia and bulimia by not considering the possibility of physical injury to these clients and by not providing adequate nutrition or health care by medical personnel trained and licensed to treat eating disorders.
  1. Kids of El Paso neglected clients by failing to provide a safe environment free of client abuse.
  1. Kids of El Paso violated Rule 151.66(a)(8) by failing to inform clients of their rights as required by the Commission's rules.
  1. Kids of El Paso violated the intent of Rule 151.66(b) in that clients who refused treatment or medication against medical advice were not given an option of leaving the program but instead were subjected to harsh and punitive repercussions.
  1. Kids of El Paso violated Rule 151.66 (c) by unreasonably restricting visitation or communication on grounds pertaining to the welfare of the individual client or other clients. The restrictions were placed on all clients in Phases One, Two, and Three without individualized justification for the need for measures of this severity for each client.
  1. Kids of El Paso violated Rule 151.66(e) by restricting a client's ability to initiate communications with his or her attorney or with the Texas Commission on Alcohol and Drug Abuse, the licensing authority charged by law with the responsibility of enforcing minimum standards and investigating allegations of abuse and neglect.
  1. Kids of El Paso violated Rule 151.66(f) by failing to fulfill its duty to investigate the allegations of violations of staff conduct on March 20, 1987, and May 11, 1987. These allegations were valid, but no evidence was found that any disciplinary action was taken against the staff members who perpetrated the abuse.
  1. Kids of El Paso violated Rule 151.66(g) by not displaying a written statement of its policies and practice regarding client grievances at a location accessible to clients, thereby avoiding the intent of the regulation that all clients must be made aware of dispute resolution options of the program and the State.
  1. Kids of El Paso violated Rule 151.66(g) in that it did not investigate complaints adequately. The complaints as of March 20, 1987, were denied, and the complaints as of May 11, 1987, were not investigated and reported to the Commission as requested. Instead, the program secured an “amends" from the complainant.
  1. Kids of El Paso violated Rule 151.69(a) by using physical restraint and seclusion in cases that were not shown to be necessary to protect the client from injuring themselves or others. Physical restraint was commonly used, and no other alternatives were tried prior to the use of restraint.
  1. Kids of El Paso violated Rule 151.69(c) by failing to investigate incidents of abuse or neglect of clients by program staff members as required by Article 5561cc, Texas Civil Statutes, when the incidents were known or should have been known to have occurred.
  1. Kids of El Paso violated Rule 151.69(c) in that Incident Reports were not followed up administratively. The Incident Reports documented the actions of staff and other clients. The Executive Director did not take appropriate action in response to a consistent pattern of client provocation, which led to unreasonable restraint and physical abuse of clients.
  1. Kids of El Paso violated Rule 151.101(a) in that the identified problems resulting from the intake assessment did not serve as the basis for the development of the client's treatment plan. In some cases, information was contradictory, yet no revisions to the assessment were made when other information was gained. In some instances, clients were coerced to admit to exaggerated drug use and abuse, with the result that persons who were not drug dependent were needlessly placed in the program.
  1. Kids of El Paso violated Rule 151.101(b) in that treatment plans were not individualized and not developed in conjunction with the individual client. Clinical staff did not monitor the progress of the clients toward treatment goals and objectives and instead treated all clients. as having identical problems and needs and left the progress of these clients in the hands of senior and junior staff and trainees who had neither the skills nor the expertise to develop, modify, and monitor treatment plans.
  1. Kids of El Paso violated Rule 151.101(c) in that clinical staff did not document the delivery of their limited services in the individual client records and did not review, evaluate, or update treatment plans as changes occurred in the client's condition. All charting was done by unnamed “peer group" staff who apparently had no qualifications nor training to perform this task.
  1. Kids of El Paso violated Rule 151.62(f) in that all staff did not receive an annual orientation of the operating policy and procedures manual. Failure to have the manual readily available to all staff may have contributed to the instances of abuse and neglect, and the program's refusal to provide TCADA with a copy of this manual hampered the investigation.
  1. Kids of El Paso violated Rule 151.62(h) in that the plan to provide training and educational opportunities for staff was superficial and not designed to give the in-depth training needed by the clinical staff and recent program graduate staff who had no previous training or expertise in delivering substance abuse treatment services. The failure to provide quality training may be one of the contributing causes to the client abuse and neglect found to have occurred.
  1. Kids of El Paso violated Rule 151.63(e) by failing to have an alcoholism and drug abuse counselor on clinical staff. XXX, Executive Director, is a Certified alcoholism and drug abuse counselor, but he did not function as a clinician providing therapy. The lack of an adequate number of trained and certified adult staff to provide clinical supervision in the meeting room and the quiet room whenever clients were present contributed to the client abuse and neglect found to have occurred.
  1. Kids of El Paso violated Rule 151.63(f) in that some annual employee evaluations were not signed by the supervisor, and two were signed by the employee's spouse.
  1. Kids of El Paso violated Rule 151.63(h) in that clinical supervision did not occur on a consistent basis to ensure quality care. Kids of El Paso had little direct clinical supervision by a person with the appropriate training of skills. The presence of a qualified clinical supervisor could have prevented some of the instances of abuse and neglect that have been found.
  1. Kids of El Paso violated Rule 151.64(b) in that while a general physical examination was given to each client, medical histories and medical examinations in client files did not document alcohol or drug use or abuse. A thorough examination for substance abuse disorders could have prevented non-dependent clients from being admitted to the program.
  1. Kids-of El Paso violated Rule 151.64(b) by not providing clients with timely and appropriate medical care since clients who needed referral for treatment of medical needs had to go through a cumbersome chain of command in which minor and adult clients with no medical expertise would determine whether or not a client was in need of medical care.
  1. Kids of El Paso violated Rule 151.64(b) by stating that a psychiatric consultant was used to review all admissions and certify clients as appropriate for treatment when, in fact, there was no evidence of such review in client files. Failure to use this consultant caused some clients not to receive needed psychiatric services and others to be admitted to the program when they should have been in treatment elsewhere for other conditions.
  1. Kids of El Paso violated Rule 151.64(b) by not referring persons suffering from eating disorders to treatment for their medical needs but instead actively accepting clients with this potentially life-threatening disorder.
  1. Kids of El Paso violated Rules 151.21 in that the program provides a 24-hour supervised living environment for some clients and hence should be licensed as a primary care facility. Kids of El Paso is not an outpatient program with respect to First Phase clients.
  1. While Kids of El Paso cooperated fully in the May investigation, it was not fully cooperative during the October investigation. The program expressed concern and displeasure at the interruption of therapy caused by the interviews with clients by the investigator, allowed parents to harass the investigator, and would not provide TCADA with a copy of its Policy Manual upon request by the Investigator.
  1. On September 16, 1987, XXX gave sworn testimony before the 210th District Court. He was asked, "So it's your testimony, Mr. XXX, that the Commission on Alcohol and Drug Abuse came out here and found no problems, gave you guys a seal of approval, and went back to Austin. Is that correct?" Mr. XXX answered, "Yes." The Commission's Investigator did find problems that were orally brought to Mr. XXX's attention, and this report contains the only written findings which have been prepared or transmitted to Kids of El Paso.

Decision of the Executive. Director

The Intensive Outpatient License of Kids of El Paso, Inc., will be revoked on April 12, 1988, for non-compliance with standards unless the cited licensure violations are cured and the program comes into compliance with all standards within sixty days from the date of this report.

The Texas Commission on Alcohol and Drug Abuse (TCADA) will provide technical assistance in identifying appropriate curative measures or consultative resources upon specific request by Kids of El Paso. Compliance efforts within the sixty-day period will be monitored by TCADA by one or more unannounced site visits, as well as by consultation visits upon Kids of El Paso's request during the sixty-day period. Compliance is the responsibility of the Program.

Signed and dated this_________________________ day of January, 1988.

______________________________, Executive Director

 

 

 

 

 

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