State center for troubled boys under fire

The state-run Sequoyah Adolescent Treatment Center for mentally ill and violent boys from 13 to 17 years old has been the subject of investigations by the New Mexico Children, Youth and Families Department and the advocacy group, Disability Rights New Mexico, over the use of restraints on residents. (Pat Vasquez-Cunningham/Journal)

A youth at the state’s treatment center for mentally ill and violent boys was physically restrained and forcibly sedated last November, even though he had agreed to be medicated orally.

A week later, a teenager who as a child was locked in a closet for days at a time, was mechanically restrained to a bed at the center for more than two hours without the proper physician’s order.

The use of restraints and other issues at the Sequoyah Adolescent Treatment Center in Albuquerque has spurred investigations by the state Children, Youth and Families Department and the nonprofit Disability Rights New Mexico advocacy group.

Problems for the 36-bed secure treatment facility run by the state Department of Health don’t end there.

The administrator has been temporarily reassigned, the center halted new admissions, and two former employees have filed whistle-blower lawsuits alleging they were retaliated against for having raised concerns about safety of the boys and staff at Sequoyah.

Youths are typically referred to the center through the juvenile justice system or a legal guardian. Those ages 14 years of age and older sign a voluntary consent for treatment.

The goal is to help boys deemed amenable to treatment develop skills necessary to transition back into the community. Residents are expected to complete their treatment in three to six months, according to Sequoyah’s admission criteria.

A state district judge in Alamogordo recommended that Cody Posey, then 16, receive treatment at the 36-bed Sequoyah Adolescent Treatment Center in Albuquerque after Posey was convicted in 2006 of killing his father, stepmother and stepsister on retired newsman Sam Donaldson’s New Mexico ranch. (The Associated Press)

According to news reports, New Mexico judges have in the past recommended stints at Sequoyah for Cody Posey, who was convicted in the 2004 slayings of his father, stepmother and stepsister at a southern New Mexico ranch; Victor Cordova, who was 12 years old when he shot and killed a middle school classmate in Deming in 1999; and more recently, Shalom Katz, a 14-year-old Santa Fe boy who was involved in a baseball bat attack that left two men severely injured.

“This is an opportunity for you to change your life,” state District Judge Michael Vigil told Katz during his 2008 sentencing.

Regulating restraints

A Sequoyah policy first adopted in the 1990s says the use of restraints must be closely regulated because of “the potential to produce serious consequences, such as physical and psychological harm, loss of dignity, violation of an individual’s rights, and even death …”

Restraints, whether chemically-induced, physical or mechanical, are permitted when Sequoyah residents are at risk of harming themselves or others. And documentation is required to show, among other things, the clinical justification for the use.

After an investigation of the November mechanical restraint incident, CYFD ordered immediate corrective action to ensure each treating psychiatrist at Sequoyah is “well-informed and knowledgeable regarding the state and federal regulatory requirements” governing restraints, according to a Jan. 8 letter from a top CYFD official obtained by the Journal.

CYFD wanted to have prior approval of all training curriculum used and planned to verify that the trainings were completed within 30 days.

The agency threatened to impose sanctions if the center didn’t “substantially” comply with the directives, including possible non-renewal or revocation of the center’s certification to treat youths.

CYFD spokesman Henry Varela wouldn’t say last week whether any other investigations are under way at Sequoyah, whether any other incidents have been reported or whether CYFD has taken any action against Sequoyah since the letter was sent in January by deputy CYFD secretary Jennifer Padgett.

Those matters, he said in an email, are confidential by law. But he said both state agencies are working together to resolve the problems.

In a statement responding to Journal questions, Disability Rights New Mexico said last week that it began “a probable cause” investigation at Sequoyah in October 2012 — one month before the November restraint incidents occurred.

“Through monitoring, DRNM found probable cause to believe that residents at the facility may be or may have been subject to abuse or neglect. The allegations we are investigating include allegations of unsafe and improper discharges from the facility; unsafe restraint practices; inadequate restraint training for all staff who need the training,” DRNM officials said in the statement.

The advocacy group, which has federal investigative authority, said it had provided information about some of its findings to the health department, adding, “The Department has responded in a cooperative manner.”

While the health department doesn’t comment on pending litigation, agency officials temporarily reassigned Sequoyah’s administrator, Anita Westbrook, to a health department facility in Roswell.

Health department chief nursing officer, Gayle Nash, a member of the agency’s senior management team, will be interim administrator at Sequoyah.

Sequoyah has also beefed up its training for staff and amended its procedures in response to the CYFD findings, said health department spokesman Kenny C. Vigil in an email.

“The hope is to get a fresh set of eyes at SATC. Her (Nash’s) focus will be to work closely with CYFD to implement their recommendations,” Vigil stated.

In addition, the health department “independently made the decision to cease new admissions at this time,” Vigil stated.

But he said the health department has found no reason to discontinue its use of the private firm that has assumed the mental health treatment at Sequoyah at a cost of more than $60,000 a month.

The owner of the New Mexico Psychiatric Services, Dr. Babak Mirin, ordered the two restraints in question. He has been serving as interim medical director at Sequoyah since July.

An attorney for Mirin declined comment on Friday.

Meanwhile, the health department in February extended the original $167,000 contract of Mirin’s Roswell-based psychiatric services company to a maximum $520,000 a year, records show. “NMPS is a local group of physicians; they have a good reputation in other healthcare facilities and are knowledgeable of New Mexico clientele,” Vigil said in his email.

Lawsuits

A 14-year supervisor contends that she lost her job at Sequoyah in part because she reported to CYFD safety threats involving residents, including an Aug. 20 incident in which a resident began punching himself in the face.

Lea Zukowski alleged in her lawsuit that the psychiatrist in charge refused to allow staff to intervene and she reported the incident to CYFD.

Another whistle-blower lawsuit was filed last week by Amy Chapman, a manager of one of the four Sequoyah lodges, where residents live while attending school and receiving treatment.

Chapman reported the Nov. 3 restraint incident to Disability Rights New Mexico, her lawsuit states. “The resident’s cooperating (with taking the medication orally) indicated that the resident was not an imminent danger to himself or others and did not meet the criteria to be restrained,” the lawsuit added.

Chapman, a 10-year employee who was terminated, effective Jan. 17, alleged that the health department “significantly diminished the quality of care and constitutional safeguards for patients at Sequoyah” by contracting with Mirin’s firm to replace health department physicians providing psychiatric services.

The new contract psychiatrists “instituted unreasonable and unjustified changes to care and intervention services,” the lawsuit alleges.

The lawsuit pointed out that Mirin’s speciality is geriatric psychiatric care and he has little to no expertise in treating adolescents. An attorney for Mirin has previously stated that adolescent care was part of Mirin’s overall medical training.

Chapman’s lawsuit alleges that, when she and other Sequoyah staff raised safety and “other professional concerns with supervisors and watchdog agencies they were harassed, punished and/or terminated.”

The other November restraint, which was investigated by CYFD, involved a 16-year-old with an early childhood history of pervasive neglect, and physical, emotional and sexual abuse from his biological family, according to the CYFD letter from Padgett to then-Sequoyah administrator Westbrook. The letter described the restraint episode as a “serious incident” that affected the boy.

The letter faulted Sequoyah and the physician involved for “non-compliance” with state and federal regulations relating to the use of such restraints, including failing to provide the required documentation. Omissions were discovered in seven additional physician restraint orders signed in October and November, the letter added.

CYFD also found no consideration in the boy’s treatment plan that related to how restraints were to be used, given the youth’s “extensive history of physical and sexual abuse,” the letter stated.

CYFD ordered immediate corrective action, Padgett’s letter stated, “due to the recurrent nature of some of the findings.”

After an inspection and annual survey by CYFD last August and September, Sequoyah was supposed to start complying with state and federal regulations regarding restraints, among other issues. But the letter states that the subsequent November incidents “demonstrate continued non-compliance.”

Safety top priority

“The safety of the boys is our number one priority,” health department spokesman Vigil told the Journal in an email.

While declining to comment on the Nov. 3 forced sedation incident noted in the lawsuit, Vigil called the subsequent Nov. 10 restraint episode an “aberrancy.”

He said Sequoyah hasn’t used a mechanical restraint since last November.

“These restraints are used to keep the boy from kicking and hitting himself and others until he is calm and has regained control,” Vigil said.

Federal law sets a maximum of two hours for restraining youths between 9 and 17 years old. After that time, a renewal order must be obtained.

But the boy involved wasn’t ready to be released after two hours, Vigil said, and a supervisor didn’t keep track of the time the restraint had been employed.

While prolonged use of restraints is allowed, Vigil said, “we are required to initiate a physician assessment at the two-hour point, which did not occur.”

Mirin’s firm “was not central to the root cause of the delay in relieving the restraint,” he added.

“The cause of the November restraint exceeding the two-hour time frame was timing, lack of assessment and lack of communication.”

— This article appeared on page A1 of the Albuquerque Journal