Bad Medicine 

A Nashville youth facility is a nightmare for kids, staffers say, but the state’s licensing body sees no cause for concern

In a smattering of red brick buildings at the bottom of a hill on Eighth Avenue South, a few blocks away from the bustle of Wedgewood Avenue, sits Hermitage Hall—a Nashville treatment program for male sex offenders ages 9 to 17. With nearly 100 sexually abusive boys housed within the seemingly quiet buildings, Hermitage Hall is one of the largest service providers of its kind in the country.

The facility’s brochure outlines this simple mission: “At Hermitage Hall, finding hope for children is what we do every day.” But current and former staffers refer to the facility as a “child jail” where staffers often rough up the kids or drug them into submission—even isolate them in a single room for weeks at a time—all in the name of treatment.

At best, current Hermitage Hall employee Jane Davis—not her real name—describes conditions there as “pretty nasty.” At worst, she calls them a “nightmare.” Davis ducks her head as she describes the facility, which she says does little to treat and reform boys, some of whom are low-functioning and mentally disabled—and many of whom have been abused themselves. Davis decided to share her story after the Scene detailed the deaths of two teens and the abuse of countless others at the Chad Youth Enhancement Center, a residential treatment facility for troubled youth just outside of Clarksville (“Handle With Care,” Nov. 8).

Both facilities are licensed by the state’s Department of Mental Health and Developmental Disabilities (DMHDD) and owned by Universal Health Services Inc., a King of Prussia, Pa., for-profit corporation that owns more than 100 behavioral health facilities across the country. And like Chad, Hermitage Hall uses Handle With Care, a controversial method of physical restraint that teaches staffers to hold residents, theoretically to keep out-of-control children from hurting themselves or others.

In September, the facility’s counselors were having trouble getting a boy in the Eagles group, the facility’s youngest unit, to take a seat. According to staff reports filed with the state, the boy finally sat after numerous directives. But it didn’t stop counselor Byron Keith Brown from grabbing the boy by the back of his shirt and tightening his grip until the boy said he was choking. That complaint prompted Brown to slam the boy against a wall—a confrontation that didn’t end until staff called a “code blue” to break up the fight. A DMHDD investigation found that the unnecessary force constituted abuse. Hermitage officials fired Brown.

But Hermitage employees say it’s not unusual for counselors to get rough with residents. At the hands of “uneducated, unprofessional” counselors, Davis says restraints have almost become a sport to Hermitage counselors, who congregate at night and say things like, “Yeah, I got this kid. I got him good.”

Checo Perryman, a former counselor at the facility who now runs his own business that teaches an alternative method to Handle With Care, says it was so common for Hermitage boys to smack their chins on the floor during restraints that the facility’s staff named the bloody scabs on the boys’ busted chins. They called it the “Hermitage Hall tattoo.”

“What happened behind those walls was very scary and very sad,” he says. But not all restraints end in injury. For some residents, restraint leads to a drug-induced haze that eventually lulls them to sleep—or, as some in the mental health world refer to it, chemical restraint, quite simply because the drugs can be used to restrict residents deemed out of control.

Among incident reports in the DMHDD files, there is tale after tale of restraints that end in some sort of injection. Some of the medications are listed by name—Abilify or Zyprexa, drugs that are used to treat schizophrenia and severe mood disorders. In most of the records, staffers refer to injections with a simple, generic term: PRN, short for a Latin phrase meaning to give drugs as needed.

Davis says that, for Hermitage Hall residents, those unidentified PRN shots usually mean a syringe full of Thorazine—one of the most powerful antipsychotic drugs, which critics liken to a chemical straitjacket.

But DMHDD licensing officials see it differently: They simply say it’s completely legal. Such injections can send children into a sleepy haze that can span hours or days, but Tracey Robinson-Coffee, DMHDD director of licensure, says there is no rule that requires facilities like Hermitage to report the number of times it administers such injections. Robinson-Coffee says her department is only concerned with whether the shots are ordered by a doctor and administered by a nurse, not “the way the medication is actually administered.”

Even though Hermitage Hall doesn’t always include the name of the drugs administered under the PRN umbrella, Robinson-Coffee says the injections aren’t cause for concern. She says her department could check any of the estimated 100 patient records at Hermitage where “all that stuff is documented.”

Do inspectors regularly check those files? “Um, we could,” Robinson-Coffee says. “And we have in the past, yes.”

Officials at Hermitage Hall and UHS, the facility’s parent company, declined requests for an interview. But in a statement, UHS divisional vice president Buddy Turner says that every medicine provided to residents is prescribed by a “qualified physician, many of whom serve on the staffs of Nashville’s premier medical facilities.”

Turner adds that he and his colleagues stand “100 percent behind the treatment protocols at Hermitage Hall and are very proud of the staff that provides an environment of care to help kids get better.”

Janice LeBel, who has worked 20 years in the oversight of residential programs for children with the most severe mental and behavioral disorders, says Hermitage’s use of medication is troubling. She says the intense physical contact found in restraints—especially when exposing a resident’s buttocks to administer an injection—can be traumatic for children with histories of sexual abuse. “It’s unwanted touch,” she says. “Do that out on the sidewalk, and it’s considered assault.”

Hermitage records show just how traumatic this can be. According to an October incident report, a boy became upset when staff wouldn’t allow him to sleep in the facility’s day room. He agreed to move to the “quiet room” to calm down, but refused to take off his belt and shoes upon entering. Staffers then placed him in a hold to forcibly remove the items.

The boy began yelling, “I feel so violated. You are raping me!” The employees held the boy in a horizontal position on the floor, where he told staff, “I don’t like people standing between my legs.” The employees, unmoving, held the boy in the restraint for more than 20 minutes.

Davis says she sees as many as 100 incidents of restraint and injury in one month—a number she attributes to the type of employees the facility hires. “They hire the cheapest staff they can possibly get,” she says.

In the world of mental health, “cheap staff” translates to employees who are often untrained and uneducated. Robinson-Coffee concedes that with some employees “being paid $20,000 [a year], I challenge you to find a college graduate that’s going to take that job.”

But staffers such as Davis can hardly stomach the trickle-down effect that inadequate staffing has on kids. “We don’t have the capacity or the training to deal with kids [with mental problems], and it shows,” she says.

She talks about the case of one particular resident: an autistic boy who she says is struggling because of frequent turnover and lack of staff understanding. “A kid with autism, they need the same thing every day,” she says. “We have different staff dealing with him every day. When they come, the kid freaks out and has a total meltdown. Every single day, he’s in a restraint or facing the wall...and he’s been there for over two years now. The program’s just not doing him any good.”

But she speculates that treatment isn’t exactly the facility’s top priority. On average, Hermitage Hall makes $300 to $600 a day for housing a resident, she says. UHS officials declined to verify or refute those numbers. “That’s a multimillion-dollar industry,” Davis says. “If there’s not enough kids in the building, if they’re not making enough money, the CEO gets on our admissions person to pull some more kids in. He doesn’t care where they come from—just get the beds filled.” While those kids come from all over the country, few come from the state’s Department of Children Services (DCS). DCS spokesman Rob Johnson says the facility stopped serving most DCS children some time in 2006. Hermitage now accepts only a few DCS kids under a “unique care” contract, which comes at a higher rate. DCS has only one child there now.

Davis says there are still a handful of Tennessee kids in the facility, though, and most are placed through the juvenile justice system. But business is good at Hermitage Hall—so good, in fact, that Davis and a former staffer, who also wishes to remain anonymous, say it’s not uncommon for boys to sleep on mattresses in the building’s hallways, an arm’s length away from other boys who are known to have molested other children, when the facility is overbooked. Other residents sleep in a cold basement that reeks of urine, both Perryman and Davis say.

Staffers are also concerned about how the boys are divided and housed. The most severe cases, some who have had more than 20 victims in their short lives, are grouped together, Davis says. But others find their way into the unit as well.

Davis says it’s not uncommon for Hermitage officials to make boys who “are just too hard to handle with their [mental retardation] issues” sleep with the most serious sex offenders. “It’s just a dangerous situation,” Davis says. “It kind of shows that they don’t have the child’s best interest at heart.”

At times, when a resident breaks the facility’s rules, he is isolated in a small “redirect room,” where kids are forced to live for days or weeks—sometimes months—on end. Residents can leave the room only for bathroom breaks and calisthenics, Davis says. No books, no playtime—only a bed.

If necessary, staffers double-book the room. Two boys have been living in the redirect room together for nearly a month and, at press time, Davis says the boys were still there. “Two beds can’t even fit in there, and you’ve got two sex offender kids that are acting out...stuck in there all day long, looking at each other,” she says. “To me, I think that’s child abuse.”

It seems that staffers would report such incidents if they did, indeed, suspect abuse. But when asked if she had ever heard of residents sleeping in Hermitage’s hallways or staying in the redirect room for months at a time, Robinson-Coffee says that “we probably would’ve known about that.”

Her office is required to visit the facility annually for inspection. Robinson-Coffee could not provide the Scene with an exact estimate of how many times her staffers have visited the campus but says that it could be “20, 30 or 40 times a year,” depending on how many serious incident reports her office receives. Those reports, however, are filed by Hermitage Hall itself and submitted to her office. And, while not all visits are announced, Robinson-Coffee says, “once we get the complaint, they’re going to know we’re coming out.” Hermitage Hall, after all, has to submit the reports.

While DCS has its own hotline for employees to report abuse anonymously, few Hermitage Hall staffers know that it exists. Davis says that employees are told to submit claims of abuse to Hermitage’s human resources department—and many claims die there. When Davis spoke out about residents sleeping on the floor, she says Hermitage officials did nothing. “They would investigate it internally and...it pretty much disappears,” she says.

In October 2005, at a time when both DCS and DMHDD licensed Hermitage, a DCS investigator interviewed the facility’s staff and reported that, when asked what they would do if they felt a resident was mistreated, “all staff reported that they would tell a senior staff person or administrator. No one seemed to know the child abuse reporting hotline number or knew that they would be obligated to call [Child Protective Services].”

Robinson-Coffee says she wasn’t aware that there seemed to be a misunderstanding about how to report abuse, saying she finds it odd because “no one has complained to our office about this.” In fact, aside from knowing that Hermitage administered injections during restraints, Robinson-Coffee says these claims are news to her. “So there’s no way to address it,” she says. “You know, it’s great that they’re telling the media about these things, but what are you guys going to do other than raise awareness?”

For DMHDD to investigate these incidents, someone would have to file a formal complaint—preferably an employee or someone inside the facility, Robinson-Coffee says. “Unless you have something you want to share with us,” Robinson-Coffee tells the Scene.“We’re the licensing body and we don’t know about [these alleged incidents],” she says. “But if we don’t know, how are we going to do anything about it?”

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