Youth center faces scrutiny
Activist calls for Chad closing, sheriff's report still to come
By CHRIS SMITH
and NATE KARLIN
The Leaf-Chronicle
As local officials await results of a state toxicology report on the death of a troubled teen at Chad Youth Enhancement Center, a community activist group is calling for the center to be closed.
"Chad definitely needs to be shut down," said Terry McMoore, director of the Urban Resource Center. "Chad is a big corporation and has a corporate mentality when it comes to business, and you can't have that with kids."
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County and state agencies have been looking into Chad since the death of Omega Leach, 17, who had been placed at the center by the Philadelphia Department of Human Services.
Leach died June 3 after being restrained by Chad staff on June 2 at the center on Oak Plains Road in Ashland City.
According to a report to the state from Mike Wallace, risk manager at Chad, Leach attacked staff member Randell Dale Rae Jr. following an argument over leaving his dorm room.
"The staff member and the resident struggled until the staff member was able to place the resident into a neutral protective hold," Wallace reported.
State officials have said Leach was pinned to the floor, held down by staff members.
Rae and staff member Milton Gerald Francis, 31, kept Leach in the hold for seven to eight minutes until he became calm — and unresponsive. Staff members immediately tried to resuscitate Leach, Wallace wrote.
Leach was pronounced dead the next day at Vanderbilt Children's Hospital, where doctors reported he had suffered "significant" internal bleeding, a state report says.
Both Rae and Francis have been put on administrative leave from Chad, according to state officials.
Criminal investigation
The Montgomery County Sheriff's Office is investigating Leach's death, and that investigation is awaiting the release of a state toxicology report.
The State Medical Examiner's Office said Friday the report is not yet finished, and such reports take an average of eight to 14 weeks. That would put the report out as early as next week or as late as mid-September.
Sheriff's Sgt. Brian Prentice, lead investigator in the criminal case, said Friday such reports sometimes take even longer.
Prentice declined to comment until his final report is released, but he spoke about the case with the Philadelphia Inquirer earlier this month.
At the time Prentice said one of the staff members, though not sitting on Leach, appeared to have put his weight across him, while bowing his arms back, which could have crushed Leach's diaphragm.
Restraint procedures
The state Department of Health has already conducted an investigation into Chad and found the the center "failed to ensure that restraint or seclusion must not result in harm or injury to the residents."
The report also says Chad "failed to ensure that the mental health associates were trained in emergency safety interventions as required on a semi-annual basis."
Leach was restrained using a "neutral protective hold," which is part of a set of "Handle With Care" procedures recommended nationwide, according to Tracy Robinson-Coffee, director of licensure for the state Department of Mental Health.
The procedures outline a system of escalating actions based on the circumstances. This would involve different points of contact that might include restraining the resident's limbs in a standing hold. The final step — a step used in the Leach case — would be a take down, forcing the resident to the floor and securing his arms, similar to procedures used by police, Robinson-Coffee said.
"If the procedure was conducted properly then nothing illegal was done. The question is whether it was conducted properly," she said.
The Department of Health report found that Chad had been under a "plan of correction" as of May 5 that stated, "Effective immediately, mental health associate staff are not to place a resident in a neutral protective hold without nurse recommendation and approval."
Any time a hold is used, a nurse should be contacted immediately, Robinson-Coffee said, and when the nurse arrives, the nurse is to be in charge of the procedure.
The person using the hold was apparently not compliant with this part of the procedure, she said.
These "emergency safety interventions" resulted in Leach's death, the report states.
Complaints of abuse
Sgt. Prentice said this is far from the first time the Sheriff's Office has had to deal with Chad, which is a privately owned 90-bed residential facility that specializes in rehabilitating mentally disturbed youth between the ages of 8 and 18.
"There are reports all the time," Prentice told the Inquirer. "There's a lot of runaways, stories (from children) that 'We're being abused out there.' We've had some broken arms, some separated shoulders."
The Department of Health's investigation found two recent cases of injuries to other residents at the hands of staff members who were not properly trained in restraint procedures.
In January, a resident attacked staff members who then put the resident in a hold that broke the resident's arm, the state report says.
In another case a resident who took a swing at a staff member was "taken to the floor," busting the resident's lip.
Because of these incidents, the Department of Health has directed Chad to improve its training, documentation and reporting procedures.
What next?
For now, Chad is under a 120-day freeze on all new admissions by the Department of Mental Health. The freeze was enacted June 19.
"We're going to keep that in place until we're sure the new processes we put in place are being carried out," said Jill Hudson, department spokeswoman.
Chad has been directed to improve its restraint procedures and to retrain the staff on:
# Restraint procedures.
# CPR.
# Suicide prevention.
# Risk management, which involves identifying and resolving trouble situations before they escalate.
The Mental Health Department is making weekly unannounced visits to Chad to check on progress, Hudson said, and officials at the facility have been cooperative.
"Each time our investigators have gone out there, they've been training the staff and enforcing procedures."
If Chad is unable to satisfactorily implement the changes, its license could be revoked by the Mental Health Department commissioner, Virginia Trotter Betts.
Community complaints
That couldn't come soon enough for McMoore, leader of the Urban Resource Center.
McMoore had arranged a tour of Chad for Wednesday morning.
The Urban Resource Center is conducting its own investigation into Leach's death and McMoore said his group wanted to "get a visual" of the inside of the facility, which is described in the reports.
But on Tuesday he was told the tour was off.
"They informed me they got a call from the regional director, who felt this wasn't an appropriate time to conduct the tour," McMoore said.
"I thought we deserved a better answer. It made me feel like they had something to hide."
McMoore said he wanted to see the center for himself, after having talked about it with parents who have complained about the treatment of their children at Chad.
"They described Chad as more like a prison than a treatment center. The place is set up so that if a kid says one word they're (the staff) already in attack position."
A spokesman for Chad in Nashville did not return messages left Wednesday, Thursday and Friday.
Robinson-Coffee said while the Mental Health Department is thoroughly investigating the Omega Leach case and other complaints about Chad, she noted complaints about centers such as this are not unusual.
"There are a lot of complaints," she said. "You're dealing with a difficult population. These are not model children."
She said Chad's record of founded and unfounded complaints, with the exception of the Leach and Harris deaths, does not stand out as being worse than other similar facilities in the state.Business connection
McMoore was particularly bothered by Chad's status as a for-profit facility, arguing that businesses focused on making profits should not be entrusted with the care of children.
Robinson-Coffee said Chad's for-profit status is nothing unusual. Tennessee has a mix of for-profit and not-for-profit mental health treatment facilities, "probably more not-for-profit," she said.
And she said there are no large gaps in quality of care between the two facility models.
Chad is owned by Universal Health Services Inc. of King of Prussia, Pa., which owns more than two dozen hospitals and 110 behavioral-health facilities in 33 states. It bought Chad and 29 other facilities the month after the Harris death in 2005, the Philadelphia Inquirer reported. That deal was worth $210 million.
The corporation is traded as UHS on the New York Stock Exchange. At the close of business Friday, UHS was trading at $57.85, down 1.38 percent, on a volume of 538,400 shares.
Chris Smith is managing editor for local news and can be reached at 245-0282 or by e-mail at
natekarlin@theleafchronicle.com.
It's time to put the fire to the ass of Tennessee's Department of Mental Health and Developmental Disabilities 