|
At Elmcrest, Positive Change
Is Born Of Andrew McClain's Death
By DWIGHT F. BLINT
This story ran in The Courant on October 15,
1998
PORTLAND
 It
is too late to help 11-year-old Andrew McClain.
But thanks to the bitter lessons of his death,
one life has been saved and another has been improved.
Andrew, a state foster child, died in restraint
in March at Elmcrest psychiatric hospital. Two months later,
staffers who had just undergone state-ordered CPR training saved an
adult patient whose heart was failing.
And because of improved record-keeping and
monitoring required in a state consent order, workers noticed a
child was at risk of dehydration and were prepared to treat the
condition.
The incidents are described in reports filed by
a state monitor. The monitor was assigned to oversee improvements at
Elmcrest, a subsidiary of Hartford-based St. Francis Care, after
state investigators found numerous license violations.
The monitor's records reflect major staffing
and policy changes at Elmcrest in the six months since Andrew's
death.
"None of this is going to bring him back,"
points out Andrew's mother, Lucinda McClain of Bridgeport.
Nonetheless, McClain said, she is glad to hear changes might save
other lives.
Unlike many similar cases, Andrew's death was
extensively investigated by police and child welfare officials,
whose findings were widely distributed.
The question now is whether Andrew's legacy
will have a lasting impact. Will it improve the level of care not
only at Elmcrest, but at every Connecticut facility that treats
children?
Few comprehensive, statewide reforms have been
put in place yet and even at Elmcrest, where state scrutiny remains
intensive, questionable practices have persisted.
Linda Pearce Prestley, the state's child
advocate, who harshly criticized Andrew's care in two reports this
year, expects the improvements undertaken at Elmcrest to spread
across Connecticut.
Records show Elmcrest has cut back on its use
of restraint holds, workers now use a nationally recognized
restraint technique, and regular, specialized restraint training has
been put in place.
The hospital has increased the number of
workers in each unit, while reducing the number of patients. It also
has established a policy to call 911 immediately in an emergency,
among other measures requested by Pearce Prestley and the state
Child Fatality Review Board.
Yet no other facility in the state has been
asked to ensure the same level of care, and at least two other
comprehensive reforms have yet to come to fruition.
Department of Children and Families
Commissioner Kristine D. Ragaglia recommended last spring that the
state standardize restraint practices. A proposal has been drafted,
but is still being reviewed by a variety of state agencies.
DCF has prohibited facilities from using
face-down restraint holds -- the type that killed Andrew -- on all
children who are in state custody. But a plan to broaden the ban to
encompass all children in all state-licensed child-care facilities
has yet to be put in place.
Despite the lack of progress on those fronts,
DCF has intensified its oversight of psychiatric hospitals and other
service providers.
Dr. Gary Blau, director of DCF's bureau of
quality management, said the agency reviewed 25 programs in the
first six months of this year compared to five over the same period
last year.
DCF learned the hard way from the Andrew
McClain case not to trust the existing system of oversight.
"To hear that a facility is licensed by the
Department of Public Health, the federal government and [the Joint
Commission on the Accreditation of Healthcare Organizations], I
thought there was no reason for me to worry about the quality of
programming," Ragaglia said.
"But I guess I was proven wrong."
After investigating Natchaug Hospital in
Mansfield and Hall-Brooke Foundation in Westport last summer, for
instance, DCF asked the facilities to stop accepting state foster
children. Both programs were reinstated after making improvements.
"We're certainly showing much greater
visibility in the psychiatric community than we ever had before,"
Blau said.
But DCF may be alone on that front.
Cynthia Denne, director of the division of
health systems regulations for the Department of Public Health, said
the circumstances surrounding Andrew's death have resulted in no
policy changes at her agency.
The department now inspects psychiatric
hospitals once every four years, and plans to maintain the status
quo.
Currently, the health department is overseeing
the state monitor stationed at Elmcrest. But state regulators will
pull the monitor this fall if they determine the hospital is on the
road to compliance.
At that point, Elmcrest will be forced to stay
on track by its own "commitment to quality care," Denne said. She
conceded that Elmcrest's changes, while significant, are not
necessarily permanent.
And over time, strategies and philosophies can
change.
After Andrew's death, Elmcrest and St. Francis
Care kicked their public relations and legal teams into high gear.
Company officials held press conferences and placed full-page
newspaper advertisments promising to set "benchmarks for
excellence."
But in recent weeks hospital officials declined
requests for interviews and for a tour of Elmcrest, and they did not
respond to a series of written questions submitted by The Courant.
St. Francis issued a six-paragraph statement pointing out some of
the changes it has made, and the appointment of Ronald LaPensee as
Elmcrest's chief administrative officer.
St. Francis has cited potential litigation for
its reluctance to comment. The potential became real this week when
the estate of Andrew McClain served hospital officials with a
lawsuit charging negligence and recklessness.
As this watershed case enters the court system,
the care of thousands of other children will remain an issue. And
for all the efforts made after Andrew's death, state records show
the job of ensuring quality care is a continuing one.
On June 21, the monitor's records show, an
Elmcrest staff member covered an 8-year-old boy's mouth with a glove
during a restraint -- a practice condemned by experts. In the same
incident, staffers delayed calling for help.
Afterward, the state monitor who had witnessed
the event met with hospital administrators to devise new policies.
Bettering the care of troubled children has
historically been a slow process, said Martha Stone, an attorney who
helped lead a landmark 1989 lawsuit against the state on behalf of
neglected children.
But Stone, director of the Center for
Children's Advocacy at the University of Connecticut School of Law,
is optimistic that Andrew did not die in vain. People are growing
more aware, momentum is growing.
"I think," she said, "there is going to be some
kind of legacy."
http://www.pcma.com/crisis_intervention_news/deadly_restraint/day5sid2.stm
|
