Despite Reforms, Abuse Continues at Texas Institutions for Disabled
MEXIA — At the Mexia State Supported Living Center, on the sun-bleached site of a former World War II prisoner-of-war camp an hour east of Waco, residents with profound disabilities and behavioral problems spend their days doing repetitive chores: sticking paper into shredders, folding towels, sorting nuts from bolts. And, in some cases, being physically abused, despite a sweeping federal settlement signed in 2009 to prevent it.
In the last two years, a Mexia worker was caught on video pushing a disabled resident down and stepping on his throat while other employees looked on. A staffer goaded one resident into hitting another with a belt, causing bloody wounds and a trip to the emergency room. A direct care worker showed residents pornographic pictures and tried to get them to perform oral sex on him; another sexually abused two residents.
This pattern of abuse appears pronounced in Mexia, where roughly half of the disabled residents are alleged criminal offenders and nearly a third are under age 21. But two-and-a-half years after Texas officials signed an agreement with the U.S. Attorney General’s office aimed at improving conditions in the state’s 13 institutions — following a U.S. Justice Department investigation that found avoidable deaths, civil rights violations and systemic abuse — a Texas Tribune review of facility monitoring reports and employee disciplinary records shows mistreatment is still relatively commonplace. And though there’s been some evidence of improvement, the state’s federally designated disability watchdog group Disability Rights says that halfway into the five-year settlement agreement, not even a quarter of its requirements have been met.
“It’s all just as bad,” said Beth Mitchell, Disability Rights’ supervising attorney. “The numbers suggest less physical abuse, but we still see a lot of really significant cases. I can’t tell you that there’s one shining example of a wonderful facility, because there’s not.”
Officials with the Department of Aging and Disability Services, which oversees the state supported living centers, point to evidence of compliance, from advances in security to improvements in staffing. Nearly 3,500 security cameras have been installed across Texas’ institutions for the disabled. Each facility has an independent investigator to monitor abuse. New employees are now fingerprinted and run through background checks before they’re hired, and existing employees are subject to random drug tests.
Today, 94 percent of facility jobs are filled, a marked improvement over past years, even with the influx of more than a thousand new positions established under the settlement agreement. Staff turnover has dropped. And there are now more than three employees for every resident, in part because the census at the state supported living centers has dropped by nearly 800 residents since late 2008.
But despite this falling population, more consistent staffing and annual spending that has grown by nearly 50 percent since 2006, abuse allegations have continued to rise steadily, with the percent of confirmed allegations hovering at 9 percent. The agency attributes this to better investigations: In the last fiscal year, 375 workers were fired or forced to resign because they abused or neglected disabled residents, more than in any of the previous three years.
Justice Department officials declined to comment on Texas’ efforts thus far. But Aging and Disability Services spokeswoman Cecilia Fedorov said meeting the terms of the agreement is intended to be a “long-term” process and that “milestone dates” laid out in the agreement are guidelines, not deadlines.
“While progress toward and achievement of substantial compliance has been slower than anticipated by the state,” she said in a statement, “efforts continue to be sustained in every facility.”
Federal investigators have a lengthy history with Texas’ state-supported living centers, formerly known as state schools. The Justice Department sent a team into a Lubbock facility in 2005, releasing a highly critical report in 2006 that cited more than 17 deaths at the institution in the previous 18 months.
Clearly not swayed by the improvements state leaders had made, in 2008, the Justice Department announced it would investigate conditions in all 13 Texas institutions. Four months later, investigators published a scathing rebuke, saying residents’ constitutional rights had been violated, and threatened legal action if Texas didn’t resolve the problems.
In May 2009, four years after the initial investigation in Lubbock, state leaders signed a five-year, $112 million settlement agreement with the U.S. Attorney General’s office, pledging to improve standards of care, increase oversight and monitoring, and enhance staffing.
On a recent visit to the 500-acre Mexia State Supported Living Center, many of these efforts were visible, from paper signs listing the phone number of an abuse and neglect hotline to strategically placed surveillance cameras to the nondescript dormitory office that’s home to a state abuse investigator. A sign at the entrance to the property advertised: “Now hiring!”
The workers on duty that morning — many of them veterans with decades of experience — helped residents with their daily tasks, from planting carrots in a garden to removing staples from paper for shredding. They showed off squeaky clean cement and linoleum-floored dormitories, an on-site hair salon, a café with a juke box and old movie posters. They shuttled residents between bedrooms and bathrooms and therapy sessions, interacting with a familial warmth that made the facility’s confirmed abuse allegations seem hard to fathom.
Yet firing records show awful abuse continues, and not just at Mexia. In the years since the settlement agreement was signed, a staffer at the Lubbock State Supported Living Center beat a resident he was trying to shave and slammed his head into a cabinet. An employee at the Richmond State Supported Living Center was captured on video kicking a resident in the legs, punching him in the neck and chest and striking him on the head. And a staffer at the Abilene facility kicked a resident in the head eight times. At Mexia, an employee started a romantic liaison with a resident, sending the resident nude photos and calling the resident’s cell phone 452 times. Another worker there failed to supervise a resident, who was able to construct a Molotov Cocktail.
In late spring, seven staffers at the Corpus Christi State Supported Living Center were fired for abuse allegations that still haven’t been disclosed. That’s the same facility where dozens of employees were fired in 2009 for forcing disabled residents into staged fights. Five were convicted of crimes.
Fedorov, the Aging and Disability Services spokeswoman, said the agency has zero tolerance for any abuse or neglect whatsoever. She said for the most part, the workers at these facilities are amazing — but that with any public entity, from a school district to a hospital system, there will at times be bad apples.
“You have good days and bad days anywhere,” she said. “No matter what you do, from fingerprints to employment history, bad things sometimes happen.”
But watchdogs say that’s not an acceptable explanation. Whether the Justice Department will acknowledge it, they say, Texas is not living up to its end of the bargain — as evidenced by the results of frequent status reports released on each facility by independent monitors.
Mitchell said the federal settlement requires facilities to come into compliance with 171 provisions by the end of the agreement — and that they should have made “substantial” progress on at least 150 of them so far. On average, she said, the state supported living centers have only met 20 percent of those 150 provisions, according to Disability Rights’ analysis of facility monitoring reports. The Richmond and Corpus Christi state supported living centers haven’t even broken 13 percent, Mitchell said.
Mitchell said despite reductions in staff turnover, keeping qualified people in their direct care or nursing jobs is still a major problem. She said breakdowns in communication still prevent residents from getting the proper therapy and treatment they need. And while security cameras have reduced abuse, it still happens outside their view. In some cases, Mitchell said, facilities will come into compliance with certain standards — and then fall back out of it again.
“As much as the department wants to continue to say they have fixed their problems, we don’t see that, and I don’t think the monitors see that,” Mitchell said. “The fact that we’re still seeing a lot of abuse cases that are pretty significant — the only lucky thing is that now they’re being caught on camera.”
