‘The state has chosen to warehouse children’: Feds say ‘over-hospitalization’ of nearly 600 kids violated disability laws

Screen shot of video tour from Bradley Hospital in Rhode Island from Lifespan Healthy System YouTube channel.

Nearly 600 children and young adults with developmental disabilities or acute mental health issues were left to languish in a Rhode Island hospital for months — and in several instances for over a year — rather than being placed in community-based or in-home programs, according to the findings of a multiyear probe led by the Department of Justice.

A statement released by U.S. Attorney Zachary Cunha and U.S. Department of Health and Human Services director Melanie Ranier claims that the Emma Pendleton Bradley Hospital in Providence, Rhode Island, failed to meet its legal obligations to hundreds of special needs children.

The state’s governor Dan McKee and the Rhode Island Department of Children, Youth and Families, or DCYF, received an 18-page “letter of finding” from federal prosecutors on Monday.

It notes that while Bradley Hospital’s inpatient admissions are only meant to last one to two weeks, federal investigators repeatedly discovered that children were forced to stay at the hospital for weeks and months or longer, “despite being ready for discharge and despite the fact that these children would be better served in a family home.”

The hospital is meant to stabilize children and adolescents who are in crisis and it has three inpatient units: 17 beds in the Children’s Services Unit for children ages 3 to 12 years; 34 beds in the Adolescent Inpatient Services Unit for children ages 13 to 18 years; and 19 beds in the Center for Autism and Developmental Disabilities Unit (CADD) for children between the ages of 4 and 21 years who present with serious behavioral/psychiatric disorders in additional to a developmental disability, such as autism, or intellectual disability.

This “over-hospitalization” is considered a civil rights violation under the Americans with Disabilities Act as well as Section 504 of the Rehabilitation Act. The leader of the DOJ’s civil rights division, Kristen Clarke called the department’s findings “nothing short of appalling.”

Rhode Island “has chosen to warehouse children in a psychiatric institution, rather than stepping up to provide the community care, support and services that these kids need,” Cunha said, adding that he is hopeful Rhode Island officials will take swift steps to rectify the alleged violations.

A representative for Bradley Hospital did not immediately respond to a request for comment on Monday. Nor did the governor or DCYF. The latter have 10 days to respond to the government’s findings.

If they fail to respond, the Justice Department has vowed to sue.

Federal investigators say that from January 2017 through September 2022, some 527 children who were either in the care of DCYF or were voluntarily receiving services there, were admitted and of them, 116 were hospitalized for over 100 consecutive days.

The report notes that 42 children were hospitalized for over 180 days and at least seven children were hospitalized for more than one year.

“Keeping a child hospitalized for an extended period when their needs could be served in a less restrictive setting only serves to exacerbate the child’s acute needs. Indeed, the investigation found that extended hospitalization often traumatizes the children as well as their families,” the Justice Department said.

The hospital’s slipshod discharge practices included failing to place children in an appropriate home setting — often leading to re-hospitalizations. Referrals to Bradley from DCYF were often “rapid-fire” and “haphazard” and didn’t drill down on the specific needs of the patient.

“Many of the children languishing at Bradley and ready for discharge remained there because the referral agency declined the DCYF’s referral for services because the agency’s services were not appropriate for the level of care that the child needed,” the government’s letter states.

The Americans with Disabilities Act and Section 504 are meant to guarantee that state and local governments provide disabled people with the services they require, regardless of age or type of disability.

Per the government’s letter of finding:

Nearly 40%, or 197 of the 527 children, were hospitalized at Bradley more than one time during the relevant period.

And 129 of those children were rehospitalized at Bradley fewer than 30 days after being discharged. Because many children had multiple admissions within that time frame, the average total time spent admitted to Bradley Hospital was 92 days per child.

One child who was first admitted at nine years old spent a total of 826 days admitted across five admissions within the time frame.

Another child who was first admitted at fourteen years old had eleven separate admissions totaling 706 days within the time frame.

There were also five patients who were only four years old at the time of their first admission, one of whom spent 126 days hospitalized across four admissions within the five-year time frame.

The children’s medical records, according to the Justice Department, made it abundantly clear what happens to kids who are kept at the hospital.

“The longer children stay at Bradley, the more their behavior deteriorates,” the report states.

One adolescent who was stuck at Bradley for seven months said their mental health started to backslide during their extended hospitalization. Being around other adolescents who exhibited suicidal ideation gave the patient “additional ideas about how to harm themselves.”

A DCYF caseworker allegedly ignored this patient’s pleas that they be allowed to leave the hospital. Instead, the teen was sent “for an additional thirteen months” to an out of state facility. [Emphasis original]

Read the complete letter of finding here.

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‘The state has chosen to warehouse children’: Feds say ‘over-hospitalization’ of nearly 600 kids violated disability laws

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