March 1, 2008
Caregivers Abuse Patients — and Usually Get Away With It
By Michael Biesecker and David Raynor, The News & Observer, Raleigh, N.C.
Mar. 1--Three employees at a state-run mental hospital beat Dean G. Smith so severely they broke his nose and fractured a rib.
"When I'm manic, I'm not exactly the easiest guy to be around," said Smith, who lives in Roanoke Rapids. "But this happened to me in a mental hospital. They're there to help you, not beat you up."
In the seven years since North Carolina decided to reform its mental-health system, regulators have sanctioned at least 192 state employees for abuse, neglect or stealing from patients. Another 38 employees of state mental hospitals and homes for people with developmental disabilities are under investigation, records show.
They are listed on a state registry available to prospective employers. Though most lost their state jobs, employees blacklisted for abusing and neglecting patients were charged with a crime 13 percent of the time.
Convictions are rarer still, with employees often denying the accusations and the only other available eyewitnesses being victims whose mental illness can be used to undermine their credibility.
At least 19 employees on the blacklist were allowed to keep their positions or were subsequently rehired, according to a review of state personnel records. At least nine others were allowed to transfer to new government jobs as prison guards or law enforcement officers.
The mental-health reforms of 2001 aimed to de-emphasize the use of hospitals and to promote community treatment. But treatment hasn't developed as expected, and the hospitals have become busier while being considered less important.
Each of the 192 employees on the blacklist worked in institutions under increasing strain; the number of patient beds was cut by nearly a third as demand for treatment rose.
Admissions have gone up while the average length of stay has shrunk. Patients are admitted more frequently and often discharged before they are ready.
It's unclear whether abuse in state psychiatric institutions is getting worse, because more than three dozen complaints from the past two years are still being reviewed. But federal investigators have been penalizing the state more severely in recent months for cases of abuse, neglect and wrongful deaths, cutting off federal funds to Broughton Hospital in Morganton and threatening to do the same at John Umstead Hospital in Butner and at Cherry.
While legislators and administrators at the state Department of Health and Human Services have focused on replacing aging hospitals with new buildings, low salaries have driven experienced workers to better-paying jobs at private facilities.
"The inevitable consequence of understaffing, overwork and low wages is poor employee morale," said Vicki Smith, the executive director of Disability Rights North Carolina, a group that investigates abuse in state facilities. "Poor morale results in staff turnover, making it harder to ensure that workers are appropriately trained. Poorly trained workers provide poor services. This translates to poor patient care, meaning increased abuse and neglect."
In an interview this month, the head of the state hospital system said he was unaware so few were charged with a crime.
"I cannot tell you why these were not [prosecuted] in the past," said James Osberg, chief of the state-operated services section of the state Division of Mental Health, Developmental Disabilities and Substance Abuse Services. "But I'm saying at this point that when there is a case of substantiated abuse ... and it is determined that charges are appropriate, we will direct that they take the charges on those individuals."
Dempsey Benton, who became head of the Department of Health and Human Services in September, announced in January that a 5 percent raise would be granted to psychiatrists and other doctors to help retain and attract qualified professionals to the state hospitals. Boosting pay for lower-ranking positions is under review.
With doctors and nurses policed by licensing boards that oversee those professions, it is nurses' aides and health-care technicians, the least-trained and lowest-paid members of the clinical staff, whose names end up on the employee blacklist. They also have the most one-on-one contact with patients.
Becoming a health-care tech requires no special certification beyond a high school diploma or GED. Starting pay is $11.42 an hour.
The reported offenses range in severity from stealing patients' clothes and money to beatings and rape. Cases of abuse confirmed by investigators included:
--Forensic-health technician Daniel Lang repeatedly had sex with a mentally ill woman at Dorothea Dix Hospital in Raleigh. Lang was fired in January 2003. But before he was arrested on six felony rape and sexual offense charges, he slit his wife's throat and dumped her body in woods near the hospital.
--Matthew Allen Rose, a health-care technician at Broughton, performed oral sex on a mentally ill child in August 2002.
--Broughton employee Justin Travis Wood hit a resident in the genitals with his keys while the patient was strapped down in restraints in July 2007.
--Romaine Keith Earnest, a health-care technician at the Caswell Center in Kinston, abused a resident in October 2001 by inserting a broom handle into the patient's rectum, causing severe internal injuries.
Each employee in these cases pleaded guilty or was convicted of a criminal offense. But many employees who abuse patients are never charged.
An example is nurse's aide Bettie Ruth Mercer. While she was an employee of the Longleaf Neuro-Medical Treatment Center in Wilson in September 2003, a state investigation concluded Mercer abused a patient "by holding a razor at his throat and threatening to cut him, by pulling on the resident's penis, threatening to pull it off and by hitting the resident with her fists."
She was fired but not charged with a crime.
Many of those who abused patients have faced criminal charges before. Michael Eugene Dalton of Marion was fired from the Alzheimer's unit at the Black Mountain Center for hitting a resident in the head, pulling the chair out from under a resident and pushing a resident, causing a stumble. Before he was hired, Dalton had a lengthy record that included multiple DWIs and an assault conviction.
A review of conditions in North Carolina's mental hospitals by the U.S. Department of Justice in 2004 concluded that staff members routinely violated patients' civil rights. The inappropriate use of physical restraints and seclusion was specifically cited. So was failure to "ensure the reasonable safety of patients."
Attack in a quiet ward
Dean Smith, who has bipolar disorder, was involuntarily committed in October 2006 to Cherry Hospital, a sprawling campus of brick buildings in Goldsboro originally founded in 1880 as an institution for African-Americans.
Desegregated in 1965, Cherry is now the designated state psychiatric hospital for a region that includes 33 Eastern North Carolina counties. Though it once housed more than 3,500 patients, the hospital now has 274 patient beds.
Smith admits he wasn't well-behaved during his stay on Ward U-2, No. 3 East, making fun of the health-care technicians and complaining when they refused to give him requested medicine.
Shortly after he was involved in an argument, Smith remembers that nurses took many of the other patients on the ward outside for a smoke break.
Smith stayed behind inside the nearly empty ward and was walking to the bathroom when he says he was struck from behind and knocked to the floor. He was then "swooped up" by three staffers.
He kicked one of them, James A. Smith, in the groin -- a reflex that he says sparked a severe beating, with staff members repeatedly punching and kicking him.
"I'd seen what they did to other patients," said Dean Smith, who believes the attack was premeditated to occur when supervisors were out smoking. "I thought the best thing to do was resist, because somebody might hear something. I thought they were going to kill me."
The assault continued as he was dragged down a hall and into a secluded room. As he sat on the floor bleeding, Dean Smith says, he was coached to say he had injured himself in a fall and was threatened with further violence if he reported what happened.
He was then forced to take off his blood-soaked clothes, clean up pools of his own blood and take a shower before he was allowed to get medical treatment from a nurse for injuries that included a broken nose and rib.
The hospital's internal police department was asked to find out what happened. Dean Smith, still bleeding and with dark bruises emerging on his body, was photographed by an officer. The report describes his face as looking like "hamburger meat."
In a police lineup, he identified health-care technicians James Smith, Eric Jerrod Isler and Billy Gerald Wynn Jr. as the employees who had beaten him. Investigators matched the tread on Isler's shoes to purple bruises left on Dean Smith's flesh.
James Smith and Isler both said Wynn was the one who hit Dean Smith. Wynn told investigators that he was not present when the patient was injured but that he later walked in on the other two employees while they had Smith in the back room.
'Too many to count'
In an interview, Wynn said his co-workers were coerced by hospital police officers and administrators to lie about his hitting Dean Smith.
Asked how many abuse complaints were filed against him during his 13 years at Cherry Hospital, Wynn said he didn't know.
"Too many to count," he said. "There isn't a person working at Cherry who hasn't had some allegations."
Some of those incidents are outlined in Wynn's personnel file, part of which is disclosed in an investigative report. In the months before Smith was beaten, Wynn received written warnings for placing a pillow six inches from a restrained patient's face and for improperly grabbing a patient and putting his hands on his chest.
Though all those accusations were lies, he said, the "therapeutic hold" techniques taught for safely restraining mental patients were sometimes impractical during a physical altercation.
Some of the patients at Cherry, which serves an area that includes several military bases, are former soldiers and Marines with training in hand-to-hand combat. If a patient starts acting aggressively, Wynn said, in his experience it was best to go ahead and "put him down."
"I'm not the sort of person I'm out there to abuse patients," Wynn said. "You get backhanded in the mouth, who knows? You might react."
One of the earlier complaints against Wynn involved Jason DeArellano, who was a patient on the same ward six months before Dean Smith was assaulted.
William O. Mann III, a staff psychiatrist at Cherry in 2006, filed an abuse complaint on DeArellano's behalf after he noticed large bruises on his patient's face, though no report of an injury was included in his medical records, as required.
DeArellano told investigators Wynn beat him after DeArellano used a racial slur. Wynn is black. DeArellano is white.
A former Marine with bipolar disorder, DeArellano says he was tackled by several male employees who put him in restraints and punched him.
"They had me face-down with I don't know how many people on top of me," DeArellano, who now lives in Florida, said in an interview. "I couldn't do anything."
A report shows DeArellano later picked Wynn out of a lineup and said Wynn beat him while taunting him to repeat the derogatory name. DeArellano was left with a bloody nose and bruises on his face, ribs and back.
DeArellano's version of events is backed by another patient interviewed by investigators.
"He didn't make the first move," said Mark Sellers, a former Army medic who lives in Wilmington. "They took him down, and then they were punching him in his back and torso and pushing his face into the floor. He was yelling, 'I'm sorry, I'm sorry, let me up.' It was just brutal force. I couldn't believe what I was seeing. It made me sick to my stomach."
Wynn and other health-care technicians involved claimed DeArellano injured himself falling over a chair, according to their handwritten statements.
The hospital's investigation ended with officials unable to substantiate that DeArellano was abused. The review did conclude that Wynn "inappropriately touched patient on the chest" and suggested that he take a refresher course in the proper techniques for restraining patients, but it recommended no disciplinary action.
Mann said he reported at least 10 similar cases of abuse before quitting his job in disgust. He said he was not told what came of those reports.
"In the 14 months I worked at Cherry Hospital, I saw more cases of patient abuse than I have in the rest of my career," said Mann, whose previous experience included working at two state mental hospitals in Pennsylvania. "The large majority of people there were good staff members, but there was a small group, usually the health-care technicians, whose idea of treatment was hurting the person to teach them a lesson."
In Dean Smith's case, hospital police determined there was sufficient evidence to press criminal charges. An officer cited Wynn, Isler and James Smith with a single count each of patient abuse and neglect, a misdemeanor.
All three health-care technicians were fired in October 2006 and their names added to the state health care worker blacklist.
The case was assigned to Thomas H. Perlungher, an assistant district attorney. In May 2007, Perlungher dropped the misdemeanor counts with the stated intent of refiling more serious charges of aggravated assault on a handicapped person.
Wynn appealed his dismissal to the N.C. Office of Administrative Hearings. At a hearing in October, Wynn's attorney was able to point to contradictions in the accounts of Isler and James Smith.
Special Deputy Attorney General Dorothy Powers agreed to a deal that paid Wynn $9,526 in back pay and attorney's fees in exchange for Wynn ending his effort to get his job back. Wynn's name is to remain on the state blacklist for abusing Dean Smith.
Perlungher, the assistant DA in Wayne County, said that after talking to Powers, he decided not to refile criminal charges against the three health-care technicians.
"There was just not enough evidence to move forward," he said. "For witnesses, we had three charged defendants and a victim who was mentally ill. That's what the case boiled down to. There were a lot of other doctors and nurses on the floor, but they were not willing to come forward."
Mann, the staff psychiatrist, escorted a bleeding Dean Smith to hospital police to report the beating. He said he was never contacted about testifying.
Fear for patients' lives
Mann said that just because someone has a mental illness does not mean the person should be rejected by the legal system as a credible witness. Dean Smith's bipolar disorder would in no way hamper him from accurately remembering or truthfully telling what happened to him, Mann said.
"The reason I left Cherry Hospital is because I was afraid eventually one of my patients was going to end up dead," Mann said. "I thought the system was moving too slow to address these cases of abuse. It was scary."
Dean Smith was not invited to the hearing for Wynn and learned from a reporter that the criminal charges had been dropped.
For more than a year, he maintained faith the state would punish its employees for his beating. He says that trust was misplaced.
"They're not going to do any time," Smith said of his abusers. "No justice has come out of this."
(News researcher Brooke Cain and staff writer Pat Stith contributed to this report.)
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News researcher Brooke Cain and staff writer Pat Stith contributed to this report.
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