A psychiatric residential treatment center for children in Fayetteville, recently cited for illegal restraint and seclusion practices, also violated state regulations regarding discipline, according to state records.
Piney Ridge Treatment Center failed to comply with four licensing standards related to discipline, including one that bars "physical injury or threat of bodily harm," according to a Corrective Action Agreement between the center and the state Department of Human Services.
The center has promised to refrain from using "physical discipline as a means of correcting a child's behavior," according to the Nov. 26 Corrective Action Agreement, which was provided to the Arkansas Democrat-Gazette under the state Freedom of Information Act.
The Piney Ridge center, which houses and treats youngsters ages 7-17 who have mental illnesses and exhibit inappropriate sexual behavior, also failed to comply with three other rules governing discipline:
• Keeping "a written discipline policy that is consistently followed."
• Using discipline with the goal of "teaching the child acceptable behavior and self-control."
• Choosing discipline "appropriate to the child's age, development and history."
The agreement between the state Department of Human Services (DHS) and the treatment center requires Piney Ridge to "gain and maintain a high degree of compliance" with all those requirements.
It is in effect for six months after signing and could be extended "if the agency experiences any serious non-compliance."
Meanwhile, the state promises "frequent unannounced monitoring visits," according to the agreement.
In an emailed response to Democrat-Gazette questions, a Piney Ridge spokeswoman said the center "takes all incidents and issues very seriously and addresses them immediately. We follow strict protocols and standards to administer proper care. Our residents are very vulnerable children and any allegation of abusive behavior among residents is promptly investigated and reported to law enforcement, state agencies, and guardians.
"We are cooperating fully with the DHS to address their observations. The safety and rights of everyone in Piney Ridge -- our patients and staff -- have been and always will be the hospital's top priorities."
Arkansas law, including the Child Maltreatment Act, A.C.A. 12-2-18, doesn't allow the Human Services Department to release documents related to the discipline violations, department spokeswoman Marci Manley said last week.
That makes it impossible to know exactly what happened to children when discipline rules were broken at the facility that relies largely on funding from public dollars.
In response to the newspaper's questions, Manley said three injuries to children were reported in connection with three events in March and April. The injuries included a lump and abrasion on the head, a two-millimeter (less than an inch-long) scratch on an arm, skin redness and leg pain.
Nurses at the center treated the injuries, Manley said.
Piney Ridge advertises itself as the only residential treatment center in Arkansas that's exclusively for children who have sexual behavior problems, as well as serious mental illness. It's one of six Arkansas facilities owned by the mental health treatment conglomerate Acadia Healthcare of Franklin, Tenn.
Piney Ridge operates as a for-profit business and is approved under Medicaid rules as a psychiatric residential treatment facility for up to 102 children. It is financed largely by federal and state Medicaid money.
About half of its residents are from outside Arkansas, as far away as Alaska and Hawaii, according to state records.
Piney Ridge has been under state investigation and stepped-up monitoring since a watchdog group, Disability Rights Arkansas, on Oct. 2 reported abuse and neglect at the center that included a dirty, damaged building, excessive use of physical and chemical restraints, and poor supervision of children that led to sexual contact, both "forced" and "consensual."
State regulators cited the center that month for improperly using restraints and seclusion simultaneously.
In an Oct. 11 Statement of Deficiencies and Plan of Correction, the state Department of Human Services found that Piney Ridge violated federal restraint and seclusion rules at least 13 times during a 30-day period.
Each time, the center restrained clients with chemical injections while simultaneously placing them in seclusion rooms. That practice violates health and safety regulations, according to the department's findings.
The state has visited at least eight times in the past two months, each time writing reports of one to three pages that primarily focused on conditions of the buildings and grounds, according to inspection reports released to the newspaper.
Several other issues cited in the Disability Rights report, such as a lack of supervision leading to sexual contact between patients, have not been addressed in corrective action plans provided to the newspaper.
The restraint and seclusion findings raised questions about discipline and behavior management at Piney Ridge, according to Manley. There also had been "instances over the past months where behavior management was cited," she said. Those were "corrected immediately through the termination of involved staff."
The Human Services Department decided to focus on behavior management in the Nov. 26 Corrective Action Agreement "in order to help the facility plan ahead to proactively address this issue," Manley wrote in an email.
Though the agreement refers to a "probationary" time frame, Manley said Piney Ridge is not technically on a probationary license.
The language serves to "put the entity on notice that failing to meet a high level of compliance could result in further adverse action," she wrote in an email.
A license can be placed on probationary, suspended or revoked status because of compliance issues.
'OFTEN ACT OUT'
Adrienne Catalina, Piney Ridge's CEO, has described residents as "very vulnerable children [who] often act out because of their psychological and health histories."
Although the state Human Services Department did not release details of discipline violations at Piney Ridge, other records provided to the Democrat-Gazette since October suggest that angry physical encounters happen regularly. Injuries sometimes result.
A Dec. 31 complaint report, for example, found that a resident "was angry because he did not get pizza as a reward for good behavior. He had been on assault precautions the previous week."
The resident hit the staff by "throwing a shoe and hitting the staff in the face, and throwing chairs at staff, threatening to kill staff." Even after he was physically restrained, "he continued to escalate in restraint attempting to hit and kick staff."
In attempting to restrain the boy's arms, "a loud pop was heard and resident verbalized pain." He was transported to a Fayetteville hospital and diagnosed with a broken left upper arm, according to the complaint report.
The Oct. 11 Plan of Correction regarding restraints and seclusion included 13 incidents of residents within a 30-day period becoming angry and violent.
Among them was an Oct. 6 incident involving a resident in a bedroom who "attempted to punch" another resident. When staff members stepped between the two, the resident "proceeded to punch a nurse and two staff members."
After being restrained, the resident "continued physical aggression," kicking doors and a staff member. That resident was then put in seclusion and given a chemical injection, which was later identified as illegal under Medicaid rules.
Sunday on 12/15/2019