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Judge rules restraint process must be changed at Woodside



VtDigger
Monday, August 12, 2019

COLCHESTER, Vt. — A federal judge has issued a preliminary injunction against the state, requiring changes to the physical restraint and seclusion policies and practices at Vermont’s only juvenile detention facility.

Judge Geoffrey Crawford called a video he reviewed as part of reaching his decision involving the restraint of a girl — appearing to be about 16 years old, at the Woodside Juvenile Rehabilitation Center in which she is naked and streaked with feces — “horrific,” and “entirely inappropriate.”

The judge added that it “demonstrates in the space of a few minutes Woodside’s limited ability to care for a child who is experiencing symptoms of serious mental illness.”

The video was filed under seal as part of the case and is not accessible to the public.

Disability Rights Vermont, the organization that filed a lawsuit against the state Department for Children and Families in June seeking the injunction, had termed the physical restraint and seclusion policies and practices at the Woodside facility in Colchester as “dangerous” and “excessive.”

By seeking the injunction, the nonprofit organization that advocates for people with disabilities and mental health issues, sought to stop those practices at Woodside.

Crawford, in a ruling issued Friday, wrote that the organization had met its “burden of demonstrating irreparable harm and a likelihood of success on the merits.”

The case now continues as the organization works to make that preliminary injunction a permanent one.

According to the ruling Friday, the preliminary injunction concerns three areas of concern at the Woodside facility — the use of physical restraints, seclusion and the treatment of youth in mental health crisis.

Crawford set deadlines for the state Department for Children and Families, which oversees Woodside, to address each of those areas.

Regarding the use of restraints, the judge wrote that the parties have already “stipulated” the current restraint manual and practices will be replaced with a “nationally recognized” model agreeable to both sides.

“The court orders that this replacement with the requisite training occur as quickly as reasonably feasible,” the judge wrote.

Crawford also wrote that within six weeks of his ruling the state “shall” create a seclusion policy limiting the current practice of isolating youth in a unit for weeks at a time.

The new policy, according to the ruling, will be developed in consultation with Disability Rights Vermont and “consistent” with national standards, the judge wrote.

Also within six weeks, according to the ruling, the state will develop a “detailed policy for treating youth experiencing severe mental health symptoms.”

That policy, Crawford wrote, should take into account Woodside’s “capacity” to provide such care as well as its “limitations” in carrying it out.

“The policy shall clearly identify the point at which Woodside lacks the ability to provide psychiatric care to a youth and discharge to a higher level of care is necessary,” the judge wrote.

“The court,” Crawford added, “recognizes that these judgments are complex and will require coordination with other agencies with overlapping responsibility.”

A hearing in the case took place last month, and Crawford took the matter under advisement before issuing his order Friday.

Disability Rights Vermont had two experts who testified that Woodside wasn’t meeting “modern standards of care” at the facility.

“They also disagreed strongly with the practice of isolating young people from their peers for days and weeks on end,” the judge wrote.

“In their view, “ Crawford added, “disruptive behavior and violence were best met with a brief time-out and a return to normal, shared life as quickly as possible.”

In response, the judge wrote, Woodside director Jay Simons described the dedication of the staff at the facility to their therapeutic mission.

“He defended the restraint technique as non-harmful and noted that no youth had ever required medical care following an episode of restraint,” Crawford wrote. “He described the success in school achieved by many residents, often for the first time.”

Simons also “expressed frustration” that the University of Vermont Medical Center has declined to accept Woodside youth who are experiencing mental health crises, the judge wrote.

DCF Commissioner Ken Schatz could not be reached Sunday afternoon but his office submitted the following statement on Monday, after the initial story had been published:

“The Department for Children and Families appreciates the Court’s decision and is supportive of making changes to policy and practice that are reflective of current best practices for youth. DCF has already begun this work earlier this year when it engaged a consultant to make recommendations for a nationally recognized model for de-escalation, restraint and seclusion. DCF is in the process of adopting its consultant’s recommendations.

“DCF has also been working with the Agency of Human Services and Department of Mental Health on the process and placement options for youth at Woodside experiencing a mental health crisis and/or exhibiting extreme and harmful behaviors. DCF is committed to ensuring that youth receive quality care in the most appropriate setting, acknowledging that Woodside cannot meet the needs of all youth referred to its program. The Court’s order on this topic will require continued collaboration with other mental health agencies and professionals to successfully implement.”

Ed Paquin, executive director of Disability Rights Vermont, said Sunday that he was pleased with the judge’s ruling.

“(Crawford) recognized that there is damage being done in the way the youth are treated and that it’s necessary for DCF to take a new look at how they are doing business at Woodside,” Paquin said.

Paquin said his organization had been raising its concerns about Woodside with DCF since last fall.

He added that through the lawsuit, Disability Rights Vermont is not seeking monetary damages but changes in policies.

“I think it opens a difficult process ahead for the state and a big challenge for us,” Paquin said, “to communicate openly and clearly with DCF and try to see if we can come to some good sense of what really is the best policy for helping troubled youth who have serious disabilities and who in some cases do in fact represent a safety concern.”

The 30-bed Woodside facility is for youths ages 10 to 18, typically housing six to 16 youths at one time.

Disabilities Rights Vermont, in its lawsuits, cited 11 reports issued by DCF’s Residential Licensing and Special Investigations Unit in October 2018 finding violations of state regulations at Woodside.

The reports found cases of unnecessary use of restraints and seclusion on youth at the facility, and inadequate mental health treatment for children actively suicidal.

In one case from June 2018, according to the filing, one female resident who refused to return to her room was physically restrained with handcuffs and leg irons.

In addition, the report stated, a video of the incident shows staff putting their knees into the resident’s back while she was still being restrained, leaving her “clearly in pain.”

Disability Rights Vermont filed its lawsuit shortly after Washington County Superior Court Judge Mary Miles Teachout threw out another lawsuit alleging the inappropriate use of physical restraints at Woodside.

That lawsuit, brought in April by the Vermont Defender’s General’s Office, was dismissed after the teen alleging the dangerous use of restraints had been released from the Woodside facility.

Crawford, in his ruling Friday, wrote that one of the practices of restraining youth at the facility was called “Dangerous Behavior Control Techniques” developed by Simons, Woodside’s director.

“This system of physical restraint directs staff in how to impose physical control on a recalcitrant youth,” Crawford wrote. “The handbook provided to the court displays a variety of ways to block, parry, and take down a youth. It includes advice on handcuffing, team restraint, and room extrication.”

The judge added, “It includes a warning about the dangers of positional asphyxia. It is strongly directed towards physical confrontation and use of force.”

The maneuvers, Crawford wrote, culminate in forcing the youth to the floor, held face-down by staff members with one staff member seeking to cross the youth’s legs at the ankles and forcing the legs back up to the buttocks.

“At the same time, other staff members pull on both arms in an effort to raise them towards the ceiling at right angles from the body,” the judge wrote.

“In the examples shown to the court, four large male staff members struggled for many minutes to achieve this positioning,” Crawford added. “The end result is that the wrists are hand-cuffed and the youth raised to his feet and led to a bedroom to be locked in.”

The judge also discussed in his rulings a video of an incident introduced as an exhibit in the case he termed “horrific.” Crawford wrote it involved a girl he described as about 16 years old.

“The girl is completely naked. The girl is streaked with excrement,” he wrote. “She is agitated and has moments of angry accusation followed by wild laughter. She is obviously in the midst of an acute mental crisis.”

During the video, Crawford wrote, the girl is moved a few feet from a cell or anteroom into a white tiled space.

The staff who move the girl are dressed in “haz-haz” suits and hoods, and are all men except for a woman who can be heard in the background, the judge wrote.

“They push a concave plastic shield against the girl’s body and push her from the anteroom into the tiled space where the door is locked,’ Crawford wrote. “A female staff member can then be heard talking to the girl, who is occupied in pushing a wire into her right forearm. The girl is asked why she is doing that. No one interrupts this action on the video.”

As this case has been working its way through the court, the fate of Woodside remains in doubt.

Lawmakers last session discussed a proposed that would have replaced the facility at a cost of $23.3 million.

Also, last fall, the state decided to no longer pursue a two-year effort to secure federal funding to help cover the costs of running the facility, with the federal government saying the facility didn’t meet its criteria for a psychiatric residential treatment facility provider.

Paquin of Disability Rights Vermont said: “(Crawford) recognized that there is damage being done in the way the youth are treated and that’s it’s necessary for DCF to take a new look at how they are doing business at Woodside.”

Paquin said his organization had been raising its concerns about Woodside with DCF since last fall.