SUMMERVILLE -- Staff at a treatment center for troubled teens voiced concerns years ago about community dangers should escaped patients turn to violence to get sex and drugs.
That is just one of many revelations contained in state files on the Summerville center run by Palmetto Behavioral Health and its sister facilities in North Charleston and Florence. The Post and Courier requested the records following two highly publicized escapes from the Summerville center this year. Among other things, the records show:
--The state investigated more than 30 complaints of fights, assaults, unexplained injuries and sexual misdeeds at three Palmetto facilities in South Carolina over the past five years.
--A veteran psychiatrist at the Summerville center complained to the state in 2008 that the facility was placing patients at risk by accepting too many aggressive teens, failing to hire adequate staff and pressuring workers to "knock out" teens with medications to keep them in line.
--Staff members discussed that same year the need for more security to prevent escapes from the Summerville center. They worried that such escapes could place the teens or community residents at risk of "acts of aggression."
--While fire-code violations and record-keeping violations were exhaustively charted, state regulators rarely cited any of the three centers for incidents involving assaults and injuries -- even in cases where arrests were made.
--The problems mirror those experienced at other facilities operated in various states by Palmetto's parent corporation, Pennsylvania-based Universal Health Services.
The Post and Courier filed a Freedom of Information Act request for the Palmetto records with the state Department of Health and Environmental Control in April, but just received the documents this past week, at a cost of $250.
The files contain gaps, heavy redactions and a number of handwritten documents that are difficult to decipher. They also include reports of several investigations by state Department of Social Services caseworkers, who used the same boilerplate language time and again to dismiss allegations of abuse and neglect.
DHEC officials had no response Friday to questions about their records and actions. Palmetto officials said they could not respond to questions they received from the newspaper Thursday afternoon concerning allegations in the state files.
"We are unable to respond to your questions at this time due to the brief time frame we were given prior to the article being published," Palmetto spokeswoman Stacey Lindbergh said. "It is particularly difficult to respond to issues that are several years old with no names or locations provided."
Treating troubled kids
Executives from Palmetto Behavioral Health have worked to downplay community fears about the center's clientele since four Washington, D.C,, teens bolted from the center in April. Summerville residents were stunned to learn that the teens had violent histories and that one of the youths had been charged with attempted murder.
The 60-bed treatment center on Midland Parkway had long operated under the radar of most residents. Few seemed to know it was linked to a chain of for-profit treatment centers that includes an 80-bed psychiatric hospital on North Charleston's Speissegger Drive and a 59-bed treatment facility in Florence.
The centers have been allowed to operate virtually unrestricted in or near residential neighborhoods, treating adolescents for sexual abuse and aggression, substance abuse, post-traumatic stress and mental health issues.
In an age of dwindling state mental health resources, these facilities serve a valuable and profitable niche caring for a difficult and challenging population.
Many clients have histories of psychiatric problems and violent behavior, including fights that required physical intervention by staff to break up.
That has worked against these kids when they complained about abuse at the hands of other clients and staff, state records show. These patients are often seen as unreliable, and their complaints are dismissed as unfounded if corroborating evidence can't be found, these records show.
Investigation after investigation by state Department of Social Services workers came back "unfounded," or unable to produce "a preponderance of evidence," often because the truthfulness of clients making complaints can't be trusted and what they say can't be corroborated.
Allegations of abuse
A 2008 complaint about the North Charleston center, for example, alleges that staff gave a client candy in exchange for a sex act. It was dismissed after the inspector couldn't produce sufficient evidence that the incident took place.
"Victim teen has a clinical history of ODD (oppositional defiant disorder), PTSD (post-traumatic stress disorder), Personality Disorder, a history of self mutilation and suicide," the investigation report reads.
"Victim Teen's credibility regarding these allegations is questionable. Victim Teen's past trauma and clinical diagnosis was considered in determining the likelihood of these allegations having merit."
In another incident, this time at the Florence center, a child reported in November 2007 that a staff member struck him with a stick on the legs. The worker told a DSS investigator that he picked up a stick "to scare the children," but he denied striking the child.
He said the child accidentally ran into the stick after throwing a tantrum. A center nurse found no marks or bruises on the child, the report notes.
The DSS caseworker stated in her report that concerns remained that the worker struck the child, but "it does not rise to the level of physical abuse and the group home has addressed this with staff by termination."
Despite the worker's firing, the caseworker concluded that the complaint was unfounded and no further action was taken.
DSS officials said they were unable to comment on specific cases, but defended the thoroughness of the investigative process, which includes conducting interviews and reviewing evidence. "We are always looking out for the children in our cases and we want to do the best investigation we can," DSS spokeswoman Marilyn Matheus said.
Keeping them sedated
The teens weren't the only ones raising red flags. A veteran psychiatrist at the Summerville facility, then known as The Pines Residential Treatment Center, wrote to the DHEC in March 2008 about center practices that "are dangerous and place child patients at risk."
The psychiatrist, whose name is redacted from the documents, alleged that center officials were taking in too many aggressive patients in an effort to fill beds, placing other patients and the undermanned staff at unnecessary risk.
He and other staff were then pressured to "knock out" teens with medications to keep them in line, his letter stated.
"I am most concerned about the repeated attempts by nonmedical administrative personnel to pressure me and nurses to use medication in improper ways to sedate and control patients that they deem are potentially disruptive or may be agitated in the milieu (environment)," the letter reads.
The DHEC waited more than a year before responding to the psychiatrist's complaint. In a July 2009 letter, the agency apologized to him for the delay in looking into his concerns. No violations were found.
Around the same time the psychiatrist was writing his letter to the state, staff members of the facility met to discuss safety issues at the Summerville center.
The discussion, following the escape of two teens, centered on requesting permission from the DHEC to seal windows in the facility to prevent patients from getting out and contraband from getting in, meeting minutes show.
The committee noted that five staff members had been injured during the previous month, but only one incident-- involving a worker whose hand was injured trying to stop an escape -- required reporting to the state.
"Non reportable" incidents included scratches, a punch to the face and a twisted arm that occurred during encounters with patients.
In June 2008, the DHEC gave the center conditional approval to seal the windows, but it is unclear from the records whether that was done. In any event, the escapes continued.
The following year, in October 2009, a 15-year-old boy escaped from the center and reportedly attacked a 64-year-old woman as she was climbing from her car. The woman told police the teen hit her, knocked her to the ground, then continued to pummel her while she was down.
The DHEC files make no mention of the attack, and it is unclear from the records whether the agency was even informed of the incident.
Parents cry foul
Just as unsettling are complaints from some parents, including a handwritten 2007 missive about a child's treatment at Palmetto's Pee Dee center in Florence. Among other things, the complaint alleges the child:
--Was found severely scratched and bruised,
--Was dressed in another client's clothes and missing eyeglasses.
--Missed "life saving" cancer treatments.
--Had a sinus infection untreated for three months.
--Lost reading skills and lost the ability to write.
The DHEC's response, issued nearly two years later, stated that a review of the matter indicated no violations had occurred.
In 2006, a 25-page, handwritten letter from the mother of a teenage girl at the North Charleston center detailed incidents of her daughter not getting prescribed medicine to treat an infection and repeated brush-offs by staff in her efforts to obtain attention to the problems.
"The last few days have been a nightmare," the letter begins. It goes on to charge how her adolescent daughter was housed with adult clients because of renovations, among a long list of concerns.
"The room these children are stuck in is smaller than (redacted) bedroom -- and there are 10 of them. (Redacted) was distraught and told me this place was going to make her crazier. (Redacted) was exposed to adult patients -- which is unlike anything (redacted) has ever seen," the letter reads.
Among other allegations, the mother details repeated, rebuffed or ignored requests and calls to speak with her daughter's doctor and the facility's chief executive officer.
She finally received a meeting with staffers, including one person who claimed to be the chief executive officer, the letter reads. But the mother found out afterward the CEO has a different name.
Again, state investigators found no violations had occurred.