Health and Human Services has temporarily suspended a practice of sending some of its youngest mentally ill patients to a ward with disturbed teenage and adult patients.
State officials are investigating why a 6 and 12 year old spent parts of Monday through Wednesday on that unit.
Advocates for children have questioned whether the policy has psychologically harmed the two boys.
New Hampshire Public Radio’s Dan Gorenstein reports.
The Department of Health and Human Services says there’s nothing unusual about periodically sending 4.5 -15 year old mentally ill patients from the Philbrook Center overnight to wings for teenagers and adults in the New Hampshire Hospital.
HHS Deputy Commissioner Mary Ann Cooney.
“I think that what we need to be aware of is that number one, this policy is not something that was an aberration. 3 or 4 years ago and when the census dips this low it is not uncommon for us to want to move the children from the Philbrook Center to the main hospital. So, it’s not an uncommon thing. They have done that in the past.”
Philbrook is a facility where disturbed children can be assessed, get counseling and take classes.
It houses up to 24 patients at a time.
This month, admission, either voluntary or court-ordered has dropped.
A memo released to New Hampshire Hospital staff dated December 14th instructs staff to move children to F unit if the number of patients at Philbrook drops below four.
Right now, HHS, which includes the New Hampshire Hospital and Philbrook, must cut $38 million dollars from its budget over the next two years.
According to an article in the Concord Monitor earlier this week a staff member said the plan to relocate the children was not done to save money.
But the article and Deputy Commissioner Cooney say there are savings.
“I don’t think you can get around that, there is staff efficiency. Especially if we can deploy those other staff, particularly if it’s on a weekend, or nighttime, evening shifts that you can deploy the other staff and float them to other units.”
“Whether it’s the pressure of the budget cuts, or just bad judgment, it’s hard to believe that professionals would put 6 and 12 year olds in an adult psychiatric ward. The particular F unit doesn’t even allow children on the ward as visitors.”
That’s Dick Cohen, head of the Disabilities Rights Center.
“The F unit has people, some of who are actively psychotic, and you don’t want to expose children to that...and you certainly don’t want to expose children who are emotionally ill.”
Cohen says he received an anonymous complaint this week that alerted him of the action.
Under federal law, the Center has the authority to enter any facility that houses people with mental illness with or without notice.
On Tuesday and Wednesday he sent two staff attorneys to investigate.
The Monitor reported, according to staff that the 6 and 12 year olds were spending evenings and nights away from the older patients at the far end of one wing.
Cohen says that’s not true.
“The six year old was sleeping in the wing with the women. And it wasn’t at the end, it was probably three-quarters of the way down...he wasn’t in some kind of separated, segregated place. That was totally false. And then the 12 year old was in the sort of the middle of the men’s section.”
HHS says discrepancies between what the Center reported and what New Hampshire Hospital staff said, is what prompted the Department to open an investigation.
Cooney says they suspended the practice Wednesday afternoon, after a call from Cohen and the governor.
“We are going to be going through a thorough review to make sure everything that was done appropriately and the children were taken care of. But it’s up to us as administrators and caretakers of these kids that we want to make certain that everything was ok. And if not then take the proper actions to correct it.”
Top HHS officials, along with the Governor say they understand this type of action has taken place for years.
A senior staff member at the hospital confirmed there is no written policy, but more of an understood practice.
The official underscored that at least one staff member was present with a child at all times.
When asked how frequently such transfers have taken place, the staff member said as often as needed.
And while Cohen and others have raised concerns the two children were potentially harmed through their exposure to very disturbed teenagers and adults, Deputy Commissioner Cooney says she’s not convinced.
“They were there all of an hour and a half maybe before they went into bed. That was the first night, on the second night they were brought over even later. So the exposure to the adults, and it was more adolescents, and the exposure was very limited. And I feel confident about that.”
Psychiatry Chief Dr. Craig Donnelly, who oversees the physicians on the units in question, says he too is confident the children were well cared for.
In an email, speaking on behalf of the psychiatrists, Dr. Donnelly wrote “they would do nothing to compromise the quality of care that children are receiving. They are committed physicians who are dedicated to the care of their patients and to making New Hampshire Hospital one of the finest state institutions in the country.”
But opinions on the care the two boys received differ.
NHPR has obtained internal correspondence from clinical staff which lists numerous health and safety concerns.
It says one child’s admission was delayed from Sunday to Monday due to dangerous conditions present on F unit.
Over the weekend, before the children arrived, there were eight so-called personal safety emergencies.
That means when staff put their hands on patients, either to break up a fight, prevent a patient from harming themselves, or to put them in restraints.
Over those 48 hours, staff retrained people six times, meaning their wrists and ankles were bound to their beds with leather cuffs.
One morning this week, the correspondence goes on, an adult psychotic patient chased one of the children because that patient didn’t like the noises the child was making.
At another point, the six year old ran into an adult woman’s room, which upset the woman because of concerns she has about her own child.
One of the children overheard a patient screaming, and swearing and threatening to burn down the hospital.
A weapon was found on the unit.
And the correspondence raises a concern that one teenage patient may have viewed sexually explicit pictures of children.
HHS says its investigation is on-going.
It’s being conducted by staff who are called the Quality Assurance Team.
For NHPR News, I’m DG.