LITTLE ROCK — Government attorneys, state and federal alike, got a taste of their own acronymladen medicine Friday when Chief U.S. District Judge Leon Holmes closed another week’s worth of testimony on the state of the Conway Human Development Center by jokingly imitating much of the language used during the trial.
“I wanted to see if I’m understanding what you all presented this week correctly,” he said solemnly. “I’ve written this down here. You can tell me if this sounds right.”
Attorneys on both sides of Holmes’ Little Rock courtroom leaned in to listen closely, but soon broke into grinsand laughter, as did spectators in the gallery, as Holmes read from his notes:
“CHDC is an ICFMR, not an LEA, regulated by CMS, DDS and ADE, required to provide FAPE in the LRE, and using IEPs in addition to IPPs to comply with the IDEA in addition to the ADA through the use of IDTs, IRCs and LPEs, and which has now been suedby the USDOJ and is defended by the Arkansas AG.”
He then paused. “Did I get all that right?”
“You missed CRIPA, your honor,” offered attorney Christopher Cheng of the Department of Justice.
“I needed that,” Holmes replied.
It was a moment of levity as the third week of serious and complicated testimony wound down in a nonjury trial in which the Justice Department is asking Holmes to order the state to better comply with federal regulations at its state-run center for about 500 developmentally disabled people in Conway.
Some parents and guardians of the residents fear tha ta lawsuit the Justice Department filed in 2009, leading to the trial, could result in the center being permanently closed. They say their loved ones, some of whom have lived there for decades, are well cared-for, and that uprooting them would be difficult, if not dangerous.
On Friday, the judge heard from a Maryland clinical psychologist with a background in eating disorders who was one of a group of experts the Department of Justice sent in to the center in 2009 to assess its treatment of residents. The team also attempted to determine whether the residents are being cared for in the “least restrictive environment” (LRE), as the law requires, rather than being needlessly institutionalized.
Ramasamy Manikan discussed written plans, including treatment schedules and goals, for several residents.
Throughout the trial, the residents have been referred to by initials only, to protect their privacy. Their full names, however, are available to the attorneys and the judge in sealed documents that they keep in front of them without projecting them onto courtroom screens that normally display exhibits to spectators as well.
Manikan’s observations focused on what he considered the center’s too-frequent use of restraints, such as papoose boards, to control undesirable behavior; spotty data collection; and a general lack of consistency, accuracy and accountability among reports contained within patient files.
Papoose boards are long wooden boards to which patients are strapped. Some federal government witnesses say they are outdated.
The files contain records of residents’ treatment and responses, as well as progress or lack thereof toward set goals. They document incidents and provide guidance for an array of specialists, such as physical therapists or nutritionists, who tend to the patient at different times.
Conflicting documentation about, for example, aggressive incidents, and whether certain actions alleviate the problem or make it worse, create confusion for caregivers who are supposed to consult the resident’s chart for direction, Manikan said.
Some staff members’ ways of dealing with problems don’t make sense, Manikan said, and are inconsistent with those used by other staff members, which hampers the resident’s ability to understand what is expected and make positive changes. He noted that in several cases, the staff’s response to a problem appears to aggravate the problem.
Manikan testified about documents he reviewed for a 12-year-old girl, saying she demonstrated through clever interactions with a doctor that she has a higher functioning level than her chart indicates.
“Assessing her proper level of functioning would be useful in establishing her plan,” Manikan said under questioning by Cheng. The psychologist also noted that the girl was subjected to punitive measures as a way of learning, but “that would not be the best way to motivate her to improve.”
Records for a 45-year-old male resident who has a tendency to smear and eat feces indicate that he is often kept - day and night - in a onepiece jumpsuit that restricts his hands, instead of being given an opportunity to change his behavior, Manikan said.
“I think that at nighttime, the way it’s stated, it’s primarily for staff convenience,” Manikan testified. “That shouldn’t be the purpose of addressing the individual’s behavior.”
The residents’ plans often aren’t aimed at ensuring continual progress, Manikan observed. He noted that after one male resident met certain goals, his plan was never revised.
In his opinion, Manikan said, assessments at the center aren’t meaningful and constitute a departure from professional psychological standards.
He will face cross-examination when the trial resumes at 9 a.m. Monday.
Arkansas, Pages 9 on 09/25/2010