Solitary confinement, restraints at issue in Iowa boys’ school lawsuit

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Mentally challenged students at Iowa’s State Training School for Boys are ‘exquisitely vulnerable’ to lasting psychological harm from being placed in solitary confinement cells or being tied to a bed with a large Velcro device, a psychiatrist said in federal court this week.

Leaders of the public institution Eldora testified that the measures are only used as a last resort to protect the safety of students and staff members when the boys become agitated and violent. But mental health professionals giving evidence on behalf of teenagers who were subjected to restraints and solitary confinement said that was not true.

Practices are at the heart of a federal trial that began last week in Des Moines. The group Disability Rights Iowa filed a class action lawsuit in 2017 against the Iowa Department of Social Services, alleging the agency is allowing inhumane treatment at the school, which is home to nearly 100 teenagers who have been convicted of having committed crimes.

School staff members often used seclusion or restraint to discipline teenagers, testified Stuart Grassian, a Massachusetts psychiatrist who has written extensively on the psychological effects of solitary confinement.

Grassian, testifying for Disability Rights Iowa, said school records show a boy was isolated for 12.5 hours because he continued to fart in a locker room after staff told him to stop. The unidentified boy claimed he had lactose intolerance and couldn’t stop, Grassian said.

Records show another boy was tied to a bed with a large Velcro and leather contraption, called “the sling,” despite having asthma, severe heart disease and liver problems, Grassian said. The device presses on the chest and abdomen, could have killed the boy, and staff members did not obtain medical clearance before putting him in, the psychiatrist said. “Why would you do that?” asked Grassian. At another point, he called some of the staff’s actions “sadistic”.

Grassian described the wrap as “a 14-point restraint system that crushes both body and mind.” He said he had never seen such a device before.

Andrea Weisman, a Washington, DC psychologist who has studied the use of restraint and seclusion among adolescents, said the wrap is akin to a torture device.

A Boys State Training School building in Eldora.

Restraint, isolation completed elsewhere

Weisman and Grassian testified that many other states have stopped using solitary confinement and restraints in facilities for troubled teens. This made the facilities safer as students were less agitated, mental health professionals testified.

Many adolescents in such facilities have a history of mental illness often caused by childhood abuse and neglect, Weisman and Grassian testified. Being isolated or restrained can trigger the damage caused by such traumas again, causing boys to lose control to the point of violence or hallucinations, they said.

Staff at Eldora Institution do not consider boys’ mental health histories before placing them in segregation or restraint for aggressive behavior, Weisman said. “They need to understand that children can not only misbehave, but they can be sick,” she said.

The case will be decided by U.S. District Judge Stephanie Rose, who is presiding over the trial.

State administrators testified that the facility tries to minimize the use of restraints and seclusion. Jerry Foxhoven, director of the Iowa Department of Social Services, called the school in Eldora “a placement of last resort.” It houses boys who have committed serious crimes and failed to attend less restrictive programs, he said. For many of them, he said, “the alternative to training school is adult prison. … It is their last hope.”

Assistant Attorney General Anagha Dixit, helping to represent the state, made several attempts on Thursday to ask Foxhoven what would happen if the state was forced to close the Eldora Boys’ School. Lawyers for Disability Rights Iowa argued against the issue, noting that their lawsuit did not seek the closure of the facility. Rose confirmed the objections.

The judge questions the legality of the evaluation process

At some point on Wednesday, Rose briefly interrupted the trial while Dixit questioned the school’s director of nursing, Tanya Richmond.

Dixit had asked Richmond to describe how the nursing staff cared for boys admitted to the school. Richmond, who is a registered nurse, replied that she or one of the three licensed practical nurses she supervises gives each boy an initial assessment. The judge stepped in and asked Richmond if the school’s licensed practical nurses, who have less training than registered nurses, had performed initial assessments on the boys. Richmond told the judge yes.

The judge then grimaced and turned to the assistant attorney general. “Does the attorney know this is not legal under Iowa law?” Rose asked Dixit.

The judge, who is a former federal prosecutor, said she knew that State Law prohibits licensed practical nurses from making initial assessments on patients. The judge said it could also be an issue under federal law for licensed practical nurses to dispense medication prescribed by video by an off-campus doctor, as Richmond had previously testified. The judge warned Dixit that she could jeopardize Richmond’s professional license by having her testify about such practices. After a 15-minute break in the trial, the state’s attorney moved on to other matters during her questioning of the state nurse.

In a phone interview Thursday, Iowa’s top nursing regulator confirmed that a licensed practical nurse could be disciplined for performing initial assessments on patients, even if supervised by a licensed nurse. or a doctor. Kathleen Weinberg, executive director of the Iowa Board of Nursing, also said a registered nurse who supervises licensed practical nurses could be disciplined for allowing them to make such assessments. Weinberg, who did not know the details of the Eldora incident, said his agency would normally investigate such a case if it received a complaint about it.

The superintendent speaks with emotion of “my children”

In court on Thursday, school superintendent Mark Day testified to the staff’s dedication to keeping students safe while trying to steer them away from the lives of criminals.

Day, who has run the Eldora institution since 2008, called the students “my children”. He said staff members were trying to make the facility feel more like a campus than a prison and they were trying to help the boys catch up and learn a trade, like carpentry or welding.

Day, who is named as a defendant in the lawsuit, attended several days of testimony on behalf of the plaintiffs. He testified in a pragmatic manner when called by state attorneys Thursday morning. But he became emotional as he described how he, his wife, their son and daughter serve Christmas breakfast every year to school boys who cannot go home for the holidays. He wiped his eyes and his voice became hoarse. He paused for several seconds. “I’m sorry, Your Honor,” he said to Rose. “It’s hard to be reviled when you know what’s really going on.”

Rose assured him that everything was fine, and Day regained his composure and continued to testify.

The trial is expected to continue next week. When this is done, Rose will decide whether to order changes in the way the school handles its students. Plaintiffs do not seek damages.

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