Clinicare Corp: Governor Orders State to Reform For-Profit Psych Facilities after Aurora Plains Academy Expose

June 13, 2019

South Dakota Governor Kristi Noem has ordered the state Department of Social Services to enact a series of wide-ranging reforms intended to improve the safety of youths sent to privately run treatment facilities across South Dakota.

The governor’s announcement came in response to an investigative report published June 5 by South Dakota News Watch that uncovered a decade-long pattern of physical, sexual and psychological abuse of youths at Aurora Plains Academy, a privately run, government-funded intensive residential treatment facility in Plankinton.

Noem said she has ordered DSS, which has regulatory authority over youth treatment facilities including Aurora Plains, to review and reform licensing and inspection processes of the facilities, to seek ways to improve safety for children, to increase transparency of neglect or abuse complaints and corrective-action plans, and to push state agencies to do more unannounced inspections (only one annual, pre-announced inspection of each facility is done by the state now.)

“In light of the stories of abuse these people have shared, I have asked the Department of Social Services to produce a full analysis on the processes for licensing and inspecting these private facilities and fully evaluate the department’s role in ensuring the well-being and safety of these children,” Noem wrote. “If there are ways to improve our systems – whether that’s through added resources, increased oversight, or legislation – we must act. We must do better.”

The six-month News Watch investigation included a review of public records and independent injury investigations, as well as a dozen on-the-record interviews with former academy residents and employees and the parents of residents. The report showed that 400 child abuse or neglect complaints were filed against Aurora Plains over the past 10 years, but that the state investigated only 39 of those complaints and issued four corrective-action reports during that time. The report further showed that some employees were needlessly rough with residents, that some employees used illegal restraints and holds, that residents were bullied and taunted by some employees, and that a culture of secrecy and protectionism within the facility allowed the abuse to continue unabated. Several residents were left with physical injuries including injured limbs, bruising and rug burns on their faces. Some female residents reported being touched sexually or having their breasts pinched to the point of bruising.

Noem said Aurora Plains was placed under a corrective-action plan by the state from 2012 to 2014 that required improvements in reporting protocols, the proper use of physical restraints on residents, the supervision of youth, the management and training of staff, and emergency procedures. She said the number of complaints filed against the facility fell after those steps were taken.

“Facilities such as Aurora Plains Academy play a critical role to a very vulnerable population,” Noem wrote. “My team and I remain committed to protecting kids in this facility and helping these private facilities administer the best care for youth.”

In an earlier email to News Watch, Noem wrote that improvements were required and have been implemented at the Black Hills Children’s Home, a privately run residential youth treatment facility in Rockerville operated by the Children’s Home Society. That facility in February lost track of nine-year-old resident Serenity Dennard, who ran away and has not been found, and is presumed dead by authorities, who continue to search for her.

The president of Clinicare Corp., the for-profit Wisconsin firm that operates Aurora Plains, said in a statement that the News Watch investigation was incomplete, and “distorted” the role of academy employees in allegations of improper care. “Because of regulatory and legal requirements regarding confidentiality … we are not in a position to publicly address such allegations,” company president David Fritsch wrote in response to a series of questions sent to him by News Watch. “That said, the reporting of several allegations misrepresents the scope of the alleged incidents with incomplete accounts that distort the response by staff members.”

Fritsch noted that Aurora Plains employees were trained in late 2018 on a new form of physical restraint known as Safe Crisis Management, which emphasizes de-escalation and collaborative problem solving.

By state regulation, academy employees are allowed to physically restrain residents only when they are a danger to themselves or others. Former academy residents and employees told News Watch that some employees often used holds or sometimes tackled them to the ground or mashed their faces into walls or the floor. Hard restraints were done for minor violations such as not following orders, talking out of turn or failing to take medications, they said. Some employees would goad residents into acting out so they could restrain them and would then falsify reports to place the blame on residents for causing their own injuries.

Fritsch said the academy houses a difficult population, has successfully treated thousands of youths over the years and works closely with state regulators to ensure resident safety. He said the academy is fully accredited and internally reviews all reports of injuries or claims of abuse, which are also provided to the state. Fritsch pointed out that academy residents can join a student council, participate in theater, take culinary training, attend prom and engage in community service projects.

Aurora Plains is an intensive residential treatment center licensed to house 66 people ages 10 to 20, with 48 beds for males and 18 for females, according to the facility website. The site refers to its clientele as a special population “characterized by high levels of verbal, physical and sexual aggression.”

State Sen. Joshua Klumb, a Republican from Mount Vernon whose district includes Aurora County, where Aurora Plains Academy is located, said he knows and attends church with several academy employees who he said are fine people. “I don’t really believe there is a problem,” said Klumb, who noted that he sits on a community advisory board for Aurora Plains Academy.

Klumb said it’s likely that people who have alleged abuses at the academy are “disgruntled,” and that he feels state oversight of the facility has been adequate. “I think we’ve got two sides of the story there and I have to go with the people I trust,” Klumb said.

State Rep. Paul Miskimins of Mitchell, whose district includes Aurora County, said he also knows good people who work at Aurora Plains, but added that it is clear mistakes were made and that abuse of some youths did occur. “It’s almost certain from the report; it’s too frequent to not believe it,” Miskimins said. “I don’t think they’re all not telling the truth. That would be sticking your head in the sand and I don’t believe in that.”

Miskimins said he would like standards for resident care and treatment to be reviewed and improved by DSS. He also suggested that new ownership of the facility might be appropriate. Miskimins said. “Whether DSS needs to step up their game to protect these young people or whether ownership needs to change, I’m not in charge of that. But if nothing happens, then I think action needs to be taken.”

Miskimins said greater transparency and oversight of operations and outcomes are needed at Aurora Plains, and he suggested that improved training and screening of employees could help make the facility safer. He also called for more unannounced inspections and more thorough investigations when complaints are made.

“These allegations should be taken seriously and investigated, and probably some changes need to be made in the way things are reviewed and listened to when complaints are made because it doesn’t seem that the complaints were adequately responded to,” he said. “Those that are pinching and sexually and physically abusing, that’s wrong and everyone knows that.”

Jessi Dillon, now 24 and a construction worker in Sioux City, Iowa, said he remains emotionally scarred by the way he and others were treated by employees of the academy. Dillon was sent to Aurora Plains at age 14 in 2009 and spent four years at the facility. Dillon said he saw physical or mental abuse of residents almost daily, and would frequently hear youths cry out in pain or terror either in his residential pod or from others within the campus. He said he was on three medications when he arrived but at one point was put on a dozen medications by academy staff, another frequent complaint of former residents. The medications combined to cloud his thinking and reduce his ability to control his emotions, he said.

One morning, after a restless night where his medications prevented him from sleeping, Dillon said he tried to stay in bed. Suddenly, he said, two therapeutic-support staff members showed up and physically removed him from his bed. “Two of them picked me up and pinned me to the wall and slammed me to the ground and drug me out with my face dragging on the floor,” Dillon said. “They pinned arms so far behind my back it made my chest so tight it was hard to breathe.”

Dillon said residents would behave well and follow rules when treated with kindness and respect, but that many youths did not respond well to bullying, being shouted at in the face or taunted by employees who had bad tempers or seemed to enjoy harming residents. “I understand we were kids with problems, but we still didn’t deserve that disrespect and the ruthlessness the staff displayed to us,” he said.

Lauren Schroeder, the parent of a boy who suffered extensive bruising and rug burns as a result of abuse by employees of the academy in 2015, was cautiously optimistic that the governor’s directives would lead to positive change. “I think it’s a start, and while there’s something behind words, there’s much more behind action, so we really need to see action,” said Schroeder, whose son’s injuries were documented by police in Aberdeen and at Child’s Voice within Sanford Children’s Hospital in Sioux Falls. “The proof is in the pudding; I’m not convinced until I actually see documentation and proof that things have changed. No matter what, these kids shouldn’t be physically, sexually or psychologically abused, they should be getting help,” she said.

Emily Mitchell, whose son Ender Murray, then 10, suffered a black eye, bruising and rug burns during an attack by an academy employee in 2013, said she appreciated the governor’s efforts to reform the youth treatment system. Yet Mitchell remains angry over the mistreatment of her son and said that it shouldn’t have taken state officials so long to listen to and believe the complaints of abuse made against academy employees by residents and their parents.

“It really shouldn’t have gone this far; we should not have had to fight this hard to get the truth out. And they should not have left my son there after they substantiated the abuse,” said Mitchell. Mitchell said her son has post-traumatic stress disorder in addition to physical and emotional scarring from the abuse he endured at Aurora Plains. “They abused him repeatedly over 24 months and stole his shine,” she said. “They left my child a shell of who he was.”

Wisconsin facility closed after injury

Clinicare, a firm launched in 1967, now operates Aurora Plains and similar intensive youth treatment facilities in Victoria, Minn., and in Eau Claire and Milwaukee, Wis. In October 2013, the Wisconsin Department of Children and Families revoked the license of the Wyalusing Academy in Prairie du Chien, Wis., after a boy at the Clinicare-owned facility was left paralyzed due to a damaged spinal cord resulting from three restraints by staff.

State records showed that the boy, who had been at the home less than a week, was taken to the ground during a restraint and lost feeling in his legs. Despite his injuries, the boy was restrained two more times as he was moved to an isolation room and left to sleep without bedding on a hard floor. He was not taken to a hospital for more than 24 hours after the injury.

The license-revocation notice from the state said, “The agency staff implemented a physical hold with a resident when there was not any imminent danger.” Clinicare initially fought the license revocation but later agreed to close the facility, according to press reports at the time.

In a separate case, an employee of the Clinicare-owned Milwaukee Academy youth facility in Wauwatosa, Wis., was arrested in August 2017 after police say he helped a 15-year-old girl run away from the facility, then gave her alcohol and marijuana before having sex with her multiple times.

In 1980, Clinicare agreed to settle a class-action lawsuit filed on behalf of residents of its youth academy in Eau Claire, Wis. While denying any wrongdoing, Clinicare agreed to settle the suit by adopting and enforcing new policies regarding treatment of residents. The company agreed to new disciplinary policies that focused on treatment “instead of punishment.” The settlement “specifically prohibited physical and verbal abuse, withholding meals, mail and family visits as discipline, allowing children to punish one another and other inappropriate discipline.” Clinicare also agreed to stop using psychotropic drugs to control behavior, except in emergencies.

Clinicare remains involved in an ongoing lawsuit filed against it by the Wisconsin Department of Children and Families regarding the use of strip searches of residents at the academy.

Fritsch, the president of Clinicare, said in an email to News Watch that the firm learned lessons from the closure of the Wyalusing Academy. “In the past, Clinicare, in consultation with state authorities, did voluntarily close a treatment facility in another state, after which we conducted a review of policies and procedures,” Fritsch wrote. “As an organization, we learned from that experience and have moved forward, committed to providing high-level services at all our institutions, including Aurora Plains Academy.”

Concerns raised over private, for-profit operators

Youth treatment centers across the country have seen thousands of abuse cases, some involving deaths, owing to poor employee training and inadequate management of facilities, according to a 2017 federal Government Accountability Office report sent to Congress. Negligent operating practices and poor training and oversight of staff heightened the chances for abuse of residents in youth residential-treatment programs, the report concluded.

In a separate GAO report, the improper use of restraints was highlighted as a factor in deaths at several treatment facilities. A 1998 report by the Hartford Courant newspaper tallied 142 deaths across the country in a 10-year period caused by improper restraining of patients at residential treatment centers and group homes.

All 20 youth treatment facilities in South Dakota are privately operated, either by nonprofits or for-profit entities, said Tia Kafka, spokesperson for DSS.

Privatization of correctional and treatment centers for both youths and adults is on the rise in the U.S., with about half of youth facilities now run by private non-profit agencies or for-profit companies, according to the U.S. Department of Justice.

Some national studies and reports have shown that compared with state-run facilities, privately operated juvenile facilities see higher employee turnover rates, less employee training, decreased facility maintenance and increased injuries for both staff and residents.

Melissa Goemann, senior policy counsel for the non-profit National Juvenile Justice Network, said treatment outcomes and resident safety are lower at institutions run by for-profit, private firms than those that are publicly owned and overseen. Government oversight of private facilities tends to be lower as well, she said.

“There’s so many negative consequences that we’ve seen in private, for-profit facilities,” said Goemann, who researched studies and reports on privately run facilities for a 2015 position paper for the network. “The private, for-profit facilities in general have a much worse track record in terms of resident and employee safety and positive treatment outcomes.”

Goemann said for-profit firms need to maintain a strong, steady population of residents in order to maximize profits, sometimes taking in residents who don’t really need to be there. They also try to limit spending on employee training, resident programming and other overhead expenses in order to maintain cash flow, she said.

Aurora Plains is mainly funded through the Medicaid program, with a combination of state and federal funds. In fiscal year 2018, Kafka said, the facility was paid $7.34 million in government funds, with $4.1 million in federal funds and $3.2 million in state funds.

“The incentive as a for-profit company is to run the place as cheaply as possible, and that’s not in keeping with providing what children need for positive youth development, which isn’t always cheap,” said Goemann. “Because they tend to be doing things on the cheap in terms of lower-quality employees and less training for staff, they cut programming for kids, and it all leads to a bad cycle where you have higher levels of violence and abuse situations.”

Goemann also said her research showed that states where privatization is dominant, such as South Dakota, operate under a false premise that privately run facilities save taxpayers money.

“It’s really a myth that these governments are saving money, but they seem to keep buying into that idea,” she said. “It’s our position that the government shouldn’t be trying to save money off the backs of children. It should be about creating a safe space for a young person to thrive and come out better than when they went in.”

Source: “Governor to enact reform of youth treatment facilities,” South Dakota News Watch, June 12, 2019. URL: https://www.capjournal.com/news/governor-to-enact-reform-of-youth-treatment-facilities/article_8c98b7da-8d66-11e9-b279-6f2085b09b3e.html