Lax oversight and biased investigations by Texas state officials have placed vulnerable psychiatric patients at risk for abuse and neglect for two decades, according to a sharply critical investigative report released Monday.
The report, prepared by Disability Rights Texas, recommends reforms to the state psychiatric hospital system. Its findings spread blame for the oversight failures widely, identifying multiple missed opportunities to protect patients from a handful of doctors whose behavior raised numerous red flags over the years:
- The Department of State Health Services, which oversees the state’s 10 psychiatric hospitals, hired and then failed to adequately supervise five physicians with histories of sexually inappropriate behavior, even though hospital officials knew about the doctors’ troubled pasts.
- The Department of Family and Protective Services, charged with investigating allegations of abuse at the hospitals, dismissed numerous allegations of child sexual abuse levied against former Austin State Hospital psychiatrist Charles Fischer over 20 years because, in part, the agency believed that patients’ mental disabilities made them unreliable.
- Prior to 2011, hospital administrators failed to act as the allegations against Fischer piled up, even when Family and Protective Services raised concerns about his behavior.
Taken together, these breakdowns permitted the physicians to continue practicing despite repeated allegations of patient rights violations, abuse and neglect, the report concludes.
While a State Health Services spokeswoman says the report does not acknowledge fixes that have been made to the system over the past year, attorneys for Disability Rights say the report’s findings point to problems that continue to put people in harm’s way.
The report is Disability Rights’ first comprehensive assessment about what systemic failures may have contributed to the situation with Fischer, who was fired in November 2011 amid allegations he sexually abused adolescent patients at Austin State Hospital. Fischer was indicted last June on 23 sex crime charges involving five adolescent patients.
The document has been distributed to Family and Protective Services, State Health Services and the Health and Human Services Commission. Disability Rights also intends to make copies of the paper available to legislators.
“We would like to see legislative and policy changes to address the issues,” said Beth Mitchell, an attorney with Disability Rights.
State Health Services Spokeswoman Carrie Williams said the report “doesn’t seem current and doesn’t seem to take into account the improvements we’ve made.”
The agency allowed Fischer to continue working as a hospital psychiatrist for two decades because Family and Protective Services did not confirm any allegations of abuse until October 2011, she said. Since then, Williams said, State Health Services has made more than a dozen changes to improve patient safety.
For example, Williams said, officials now analyze quarterly reports detailing the most serious abuse and neglect allegations. Employees accused more than twice within a one-year-period are being scrutinized more closely. More than 500 surveillance cameras have been purchased and are being installed at nine of the 10 state hospitals. State Health Services has worked closely with Family and Protective Services to start tracking abuse and neglect complaints to identify patterns. The director overseeing all state-run psychiatric hospitals now has final approval before any psychiatrist is hired.
“We’ve made major improvements, especially in the last year while this report was being written, and we’ll continue to make more to protect our patients,” Williams said.
Mitchell acknowledges that State Health Services has enacted policy changes over the past year. The Disability Rights paper builds on those and proposes a series of additional reforms that would create an even safer environment, she said.
“We’re hoping they’ll work with us,” Mitchell said.
Meanwhile, Family and Protective Services disputes the contention that it conducts biased investigations.
“Our investigators are trained on how to assess the credibility of each witness interviewed, including the alleged victim, and including the alleged perpetrator,” said spokesman Patrick Crimmins.
Disability Rights — which is designated by the federal government to protect people with disabilities — launched its investigation about a year ago, after the American-Statesman published a series of stories about problems at the state-run hospitals that treat people with profound mental illnesses. Because of its status, Disability Rights has access to confidential patient records and agency files that are not available to the general public.
The report’s conclusions identify many of the same lapses in oversight documented over the past year by the American-Statesman.
But the report also uncovered some new details. For example, the paper reported that Dr. Larry Hawkins, a former Austin State Hospital psychiatrist now working at Rusk State Hospital, pleaded no contest to a charge of indecency with a child and was sentenced to eight years of probation. But Disability Rights stated that less than three years after he was sentenced, the Austin hospital administrators successfully advocated to get him off probation early and he soon entered the hospital’s psychiatric residency program.
Disability Rights also stated that State Health Services failed to hold doctors accountable for unprofessional, ethical or criminal conduct, did not appropriately monitor physician performance and did not consistently alert the Texas Medical Board of misconduct.
Since the winter of 2011, when many of the changes were enacted, seven doctors have been reassigned or put on restrictions while complaints were investigated, Williams said. In total, 65 allegations have been made against 40 doctors over that time. None of those allegations were confirmed by Family and Protective Services, she said.
In its report, Disability Rights recommended reforms to prevent future incidents. For example, when investigators are checking out a patient’s complaint of abuse, they should routinely review the personnel and credentialing files of the accused caregiver — something that has not always been done in the past.
Crimmins, spokesman for Family and Protective Services, says the agency is considering that idea, as well as whether to routinely review past complaints against someone accused of abuse or neglect.
The report also recommends that State Health Services change its employment practices, saying that physicians with a history of Texas Medical Board or other disciplinary action for abuse, neglect or exploitation should not be eligible for hire or continued employment at any state psychiatric hospital.
Disability Rights suggested the agency conduct more honest job evaluations as well, including documenting physicians’ practice problems in their performance reviews.