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Report finds problems at Brown Schools
By JIM ROSS © St. Petersburg Times, published December 27, 2000 LECANTO -- The Brown Schools has received its first state report card, and the marks are not good. Regulators chastised Brown for maintaining inadequate staffing levels, following slipshod admission practices and inappropriately using seclusion as a behavior management tool for unruly residents. Brown has responded with vigor, dramatically improving its staff-to-resident ratio and quickly flying company experts to Florida for emergency response work. Those tasks were accomplished during the pre-Christmas weekend. "It is our intention to meet and/or exceed any regulation, any standard, whatever they need for us to do," Brown spokeswoman Donna Burtanger said Tuesday. "Where we fell in our responsibility was not getting clarification of (state) expectations prior to it getting to the monitoring report. We clearly have not managed expectations very well," she said. "It's a matter of learning how everyone wants to work together." The state doesn't seem as willing to dismiss the major problems as the product of miscommunication. It has demanded changes and has promised close monitoring to ensure compliance. As a sign of how seriously the state is taking the report, the state has set an admissions moratorium at the center. And contract cancellation -- the ultimate sanction -- is not out of the question. "Your staff may expect frequent and unannounced visits," wrote Patrick Howard, top administrator for the Department of Children and Families in this region, in a blunt letter to Brown management. Brown Schools is a private, Texas-based company. Its local base is the former Heritage Hospital building off County Road 491 north of County Road 486. Since late June, Brown has operated a residential facility in the Heritage building. The company treats adolescents who suffer from severe emotional problems. Residents also include children whom the juvenile criminal courts have deemed incompetent to proceed to trial and need treatment to regain competency. As the state's primary social service agency, Children and Families must serve both ofthose populations as best it can. The agency hired Brown to do the job and closely monitors the company's performance. The children come from all over Florida. Brown received a warm welcome from the Economic Development Council, which helped bring the company here and touted it as a business engine. But the company encountered immediate resistance from Black Diamond and other nearby communities, whose residents feared Brown clients would escape and run amok. Some residents have mounted legal challenges to the county's zoning decision that allowed Brown to occupy the Heritage campus. Brown officials have urged compassion and have promised to run a safe, honorable operation. Bowing to community pressure, they altered admission standards and agreed they wouldn't accept "incompetent to proceed" clients unless they also needed other mental health services. Burtanger, the Brown spokeswoman, said miscommunication is among the top culprits. She said Brown has not compromised resident or community safety and has tried its best to comply with requirements. She predicted that Brown, as it has done at other Florida facilities in the past, will respond well, explain any questions of interpretation and correct any problems. The report reveals, in striking detail, Children and Families' persistent concern about Brown's performance. Regulators took pains in their report to note the assistance they provided Brown staff and the unheeded warnings Brown received from a variety of sources, including the news media. Troubled startCitrus County is part of District 13 in Children and Families' organizational structure. When Brown expressed interest in setting up shop in Lecanto, staff at District 13 headquarters in Wildwood negotiated the contract. By reviewing reports from their counterparts statewide, District 13 staff knew Brown facilities had experienced serious problems in South Florida. The problems attracted attention from Children and Families and the media, specifically the Sun-Sentinel of Fort Lauderdale. Local staff also knew that Black Diamond and Beverly Hills residents were concerned about Brown. Brown accepted its first residents June 30, and problems started immediately. The girls called the state's abuse hot line. The fire alarm was activated. Law enforcement was called to break up disturbances, both resident-on-resident and resident-on-staff, the report showed. Some of that activity is to be expected, state regulators acknowledged, considering the residents' emotional problems and tendency to act out. Still, even in Brown's earliest days, Children and Families suspected that the facility would function better if it had more people working with kids. "Lack of adequate supervision became a concern," regulators wrote. On Sept. 29, regulators from Children and Families' office in Orlando paid a visit. Eleven children from their district were living at Brown and regulators wanted to have a look, records showed. Their findings, gleaned after reviewing files, observing staff and residents in action and interviewing Brown leaders, would be repeated again and again in coming months. The monitors found incomplete admission paperwork, improper documentation of children placed in seclusion and poor quality of treatment plans. A closer lookAfter receiving a copy of that report, as well as reviewing Children and Families' report concerning the problems in South Florida, District 13 staff scheduled a Nov. 21 site visit of their own. They reviewed client files and found a striking number that did not comply with state administrative code, their report showed. It's unclear whether residents had not undergone the appropriate examinations and received diagnoses needed for placement or whether everything except the paperwork was in order. Either way, contract monitors must cite that as a contract violation. That was also the case with residents who were part of the "incompetent to proceed program." Brown had promised that such residents wouldn't be admitted unless they also needed other mental health services, but many of the relevant files showed no documentation of any such need. Burtanger said that was a procedural and paperwork issue, not one of substance: All residents at Brown need, and are receiving, treatment, she said. The District 13 monitors, like their counterparts from Orlando, also found problems with Brown's seclusion practices, especially the record keeping. Burtanger said residents at risk of harming themselves or others can be placed in seclusion for a limited time. No mechanical restraints are used and the door is not locked. Seclusion, she explained, is sort of a clinical version of "timeout." State law requires staff to check a resident in seclusion every 15 minutes and note that check in the resident's chart. "The documentation, if present, was sloppy and inconsistent," District 13 monitors wrote. Children and Families officials spoke during a conference call Nov. 29 and agreed that more thorough investigation was necessary. They decided to visit Brown on Dec. 6. Brown had been warned several times that it was failing to comply with contract requirements. Still, Children and Families found some of the same problems during the Dec. 6 visit. Burtanger said the apparently recurring staff problem was the result of miscommunication. Brown was following what it thought were the correct guidelines, while Children and Families was citing different standards. "There was definite confusion about what staffing levels they wanted us to comply with," Burtanger said. Children and Families failed to see the confusion: Brown was failing to maintain staffing levels called for in its own contract and program explanations. The agency said the overnight shift regularly featured three employees overseeing 43 residents. Proper staffing levels require twice that many workers. Seclusion practices once again became an issue. But this time, documentation wasn't the only problem. "Seclusion appeared to be used as a first resort rather than a last; the frequency and duration was much higher than expected and completely unacceptable," monitors wrote. Burtanger said use of seclusion might be more likely in a new facility where residents and staff are interacting for the first time. Still, she said Brown is looking at ways to reduce use of seclusion and possibly eliminate it from the program altogether. On Dec. 8, two Brown residents pushed out a window, frame and all, and escaped. Authorities say they stole a car from a nearby nursing home and made their way to Lee County before being captured. The escape didn't precipitate the state review, which obviously was well under way. However, because of the timing, regulators said the escape served to reinforce their findings. "It is felt that (a) poor staffing pattern has contributed to the number of significant events reported," regulators wrote. To make matters worse, Brown workers didn't discover the escape until law officers investigating the car theft asked them whether any residents were missing. "The children would have needed a significant amount of unsupervised time in order to leave the facility in the manner they used and remain undetected," regulators wrote. Burtanger said that part of the report confused her. "We were actually overstaffed that night. I need to check into the conclusion that they drew from that," she said. A bad monthWhile most people were preparing for the holidays and debating the end of the presidential election, state regulators were putting serious heat on Brown. The Dec. 6 visit was followed by visits on Dec. 15 and 18, the report said. On Dec. 19, Howard, the Children and Families administrator, met with Laura Schuck, Brown's top officer in Florida. Children and Families staff visited Brown again on Dec. 21 and made clear that certainstaffing levels -- one staffer for every four residents during waking hours, one staffer for every six residents at night -- were required. Regulators were back on Friday to deliver their final report. By Tuesday, they were encouraged to learn that Brown had spent the holiday weekend beefing up staff numbers and working on its corrective action plan, which is due to the state soon. PREVIOUS COVERAGE:Incidents at facility increase concerns Officers catch Brown Schools' boys Facility zoning faces challenge Police visit new youth home often Brown Schools await zoning review
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