When public psychiatric hospital patients say they've been abused, neglected or exploited, they turn to the Department of Family and Protective Services for help.
But the agency charged with protecting some of the state's most vulnerable patients routinely declines to investigate complaints that come from the 10 publicly funded hospitals that house people with serious mental illnesses. In fiscal year 2011, Family and Protective Services kicked back 36 percent of the complaints it received to the very facilities accused of wrongdoing in the first place: the hospitals.
Agency officials say those cases involved medical care, patient rights or hospital policies — all areas they don't investigate. Instead, they focus on cases that they believe meet the definition of abuse, neglect or exploitation. But mental health advocates say the department is abdicating its responsibility, miscategorizing cases and punting too many complaints that it should scrutinize.
"I think this is endemic of state agencies, frankly," said Jim Harrington with the Texas Civil Rights Project, a nonprofit foundation that promotes civil rights and economic and racial justice. "I think they just don't deal with the complaints that come in. They don't take it seriously. Part of it is that they're underfunded, but part of it is the culture."
Family and Protective Services spokeswoman Julie Moody says the agency is simply following the law.
"Of course, we care, and it is ridiculous to assert otherwise. Our investigators work extremely hard, and many of them have chosen this very difficult work as a career because they want to help people in need. But we can't do more than the law and our rules allow us to do."
Protecting patients
Advocates are concerned not only about the number of complaints that are being rejected, but also the types.
Last month, Family and Protective Services declined to investigate whether a doctor exploited patients after he videotaped them without permission and then made a DVD that he gave to a for-profit company. It also passed on reviewing allegations that a Rusk State Hospital employee sold drugs to a patient, a decision it reversed after the Austin American-Statesman raised questions about the issue.
When Family and Protective Services rejects a case, other agencies — such as the Health and Human Services Commission's Office of Inspector General and the Texas Medical Board — can investigate.
But often, their roles are specialized. The Office of Inspector General looks for crimes and violations of state work rules. The Texas Medical Board scrutinizes only doctors.
Family and Protective Services plays a broader role in protecting patients. The agency regularly works with law enforcement and reports confirmed allegations to professional licensing boards. It scrutinizes the behavior of all employees, not just licensed professionals.
It also directly influences who can work at the psychiatric hospitals. Staffers found to have abused, neglected or exploited patients can be disciplined or fired. They can also be placed on the state's employee misconduct registry, thus becoming ineligible for future employment with the agency.
And while other agencies can investigate, they often don't. The Texas Medical Board, for example, investigated about one-quarter of the 8,100 complaints it received in fiscal year 2011 about doctors across the state.
When other agencies decline to take a case, the task of investigating falls solely to the hospitals and the Department of State Health Services, which oversees the hospitals.
The agency looks into every rights complaint it receives, said State Health Services spokeswoman Carrie Williams. Hospital doctors review patient complaints about medical care, as does the state medical director over the facilities.
Advocates say that hospitals can't investigate themselves objectively. Williams says staffers are professional and committed to good medical care.
Weighing complaints
Family and Protective Services investigates complaints from a wide range of facilities: psychiatric hospitals, foster care homes, living centers for people with intellectual disabilities. The Statesman is focusing on the hospitals as part of its ongoing coverage of state psychiatric care.
Each year, patients and staffers call in thousands of complaints about hospital care. Family and Protective Services investigates those that meet the agency's definitions of abuse, neglect or exploitation. Examples might include reports of physical or sexual abuse or of leaving suicidal patients unattended. The department, for example, investigated the case of former Austin State Hospital psychiatrist Charles Fischer, who was recently indicted on charges that he sexually abused five boys in his care.
The agency declines to investigate cases they deem to be medical, policy or rights matters, such as patients not being allowed to use the telephone, medication mistakes or staffing problems. Those complaints are referred back to the hospitals for their own review. The referrals are permitted under state policy, which was developed in conjunction with State Health Services and other groups that agreed that Family and Protective Services investigators didn't have the expertise to sort through such issues.
But mental health advocates say they're surprised at how many cases Family and Protective Services is declining to investigate.
Between Sept. 1, 2010, and Aug. 31, 2011, Family and Protective Services received 3,984 complaints from the 10 state hospitals. Of those, 1,434, or 36 percent, were kicked back to the hospitals.
"That seems quite a high number," said Beth Mitchell, a lawyer with the advocacy group Disability Rights Texas. "It would be interesting to try to determine how many of them should have been kept."
By comparison, during that same time period, the agency declined to investigate 22 percent of the approximately 9,000 complaints it received from the 13 state supported living centers. Those institutions house people with intellectual disabilities.
Moody said she did not have information on why Family and Protective Services rejected a higher percentage of allegations from the hospitals.
"We just don't know why the numbers are the way they are," she said.
Revisiting cases
Several recent cases that Family and Protective Services passed over have raised red flags for mental health advocates.
In March, a patient at Rusk State Hospital in East Texas overdosed on 30 Vicodin he said he bought from an employee once found to have drugs and a gun in his car on campus. Family and Protective Services initially declined to investigate, saying it didn't count as abuse, neglect or exploitation. Officials later changed their minds, and the allegation is under review.
Rusk did its own investigation and found no evidence of wrongdoing by the employee.
Staffers at State Health Services determined that the patient's rights had not been violated. The Office of Inspector General investigated and found no criminal violations.
Meanwhile, Family and Protective Services has declined to look into the case of Dr. Allen Childs, a former North Texas State Hospital psychiatrist accused of videorecording patients without permission and then using that footage to make a DVD promoting an electrical device made by a company he later worked for.
The case does not count as exploitation, Moody said, because the doctor is not accused of misusing a patient's financial resources.
Mitchell disagreed with that decision, saying that the state's definition of exploitation includes using a patient for personal gain and that the doctor appeared to have done that.
"That one still seems crazy to me," Mitchell said of the agency's decision not to investigate.
The case is now being reviewed by the hospital and the Department of State Health Services.
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source: Statesman (Ball, 6/30)
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