An advocacy group in Idaho has released a 114-page report that says the Southwest Idaho Treatment Center in Nampa for people with disabilities has again shown failures and neglect in its care for clients.
In some cases, people with disabilities were reportedly told they could not talk to their guardians about the abuse, according to DisAbility Rights Idaho, an advocacy group for people with disabilities.
The nonprofit made its announcement about the yearlong investigation into reported abuse and neglect during a Monday press conference. The advocacy group reviewed 70 investigations that occurred from Jan. 1, 2017, to Jan. 31 this year. The group said it found 49 substantiated cases of abuse or neglect.
DisAbility Rights Idaho titled its report on SWITC “No Safe Place to Call Home.” The group’s executive director, Jim Baugh, said that because the group has federal authority to do secondary investigations of abuse or neglect involving people with disabilities at an institution, they made the report findings public.
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The Idaho Statesman previously requested copies of the SWITC investigations through a public records request, but it was denied those documents.
The nonprofit reviewed 20,000 pages of investigations at the treatment center to identify problems and make recommendations to the Idaho Department of Health and Welfare, the agency that runs SWITC. The group found that at least 14 residents were victims of confirmed abuse or neglect.
“In a facility with only about 23 residents, these are appalling numbers. In our opinion, these point to systemic failures,” Baugh said.
DisAbility Rights Idaho provided a copy of its report to Health and Welfare on Oct. 1, and the department did respond, saying many of the problems the group outlined were outdated and have since been changed.
Health and Welfare disputed some of the claims in the report, and said the department has already changed policy on some of the recommendations from DisAbility Rights Idaho. Health and Welfare’s response stated the report has “methodological flaws” and “while some of the report’s recommendations are worth considering, others suffer from the limited investigation and lack of expertise.”
DisAbility Rights Idaho did make the department’s full written response public in its report.
“Contrary to what the report says, we first notified media and the public in August 2017 when we identified inappropriate and abusive employee behavior that was not meeting our standards,” the Department of Health and Welfare said in a press release Monday in response to the report. “We launched an extensive internal investigation into the allegations. As a result, six employees were terminated. However, the Canyon County Prosecuting Attorney’s Office declined to file criminal charges based on the Nampa Police Department investigation.”
What is SWITC?
The Nampa facility is home to about two dozen clients who have developmental disabilities or mental illnesses. The facility is supposed to prepare them for care in the community, but many clients end up cycling in and out or staying for long periods of time.
SWITC has faced whistle-blower lawsuit threats from former employees or patients’ families because of neglect. In 2018, inspectors threatened three times in six months to take away SWITC’s ability to treat Medicaid patients because of failed inspections.
In its press release, the Department of Health and Welfare said a survey team reviewed many of the abuse investigation reports from 2017 and 2018.
“It was a full survey that looked at SWITC’s compliance with more than 470 federal regulations,” Health and Welfare stated. “The surveyors also conducted a complaint investigation, addressing some of the same allegations (DisAbility Rights Idaho) makes in its report.”
Baugh said the Department of Health and Welfare made it seem like a small group of individuals who work for SWITC were committing the abuse. But on Monday, he said the abuse was more widespread than that, and inadequacies in SWITC’s system allowed for the conditions for abuse to occur.
“Because many of the residents of SWITC are not able to report abuse, there are likely to be incidents that were never reported,” Baugh said. “We have no way of investigating or reporting those.”
Lack of staffing, inadequate training and the failure to provide individualized treatment plans were all factors that contributed to abuse, he said.
“Residents were slapped, headbutted, thrown to the ground, (and) threatened with physical violence if they didn’t comply with staff’s orders,” Baugh said of the reports the group reviewed. “Staff ignored residents when they called for help after collapsing to the floor. They allowed residents to harm themselves by repeatedly hitting their head on a hard surface while staff stood by and watched.“
In the headbutting incident, Health and Welfare said, a resident at the center had “attacked and was on top of” an employee and was holding that employee down. That staff member was scared for his safety and headbutted the resident. Health and Welfare said that employee was terminated.
Health and Welfare said employee injuries are not uncommon at the facility, and that 30 percent of employees have had at least one medical claim while working at SWITC.
“In 2017, an average of over 70 assaults on staff per month occurred at SWITC from clients,” Health and Welfare stated. “Client-to-client assaults averaged a little over 26 per month. This means we regularly have staff out on medical leave and high turnover in our direct care staff.”
Baugh claimed staff allowed residents to sit in soiled clothing, and it was “reasonable to assume there are other incidents.”
The nonprofit believes there were 40 other acts of abuse and neglect referred to by witnesses in the reports that were never investigated. It believes the investigations were not thorough, and that the staff was allowed to change records after investigators questioned them.
“Investigators routinely tell residents that they cannot talk to anyone about the abuse,” Baugh said. “Investigators actually had residents sign nondisclosure agreements saying that they would not talk to anyone, including their guardians or advocacy agencies.”
When asked about the legality of having residents sign non-disclosure agreements, Baugh said he could not offer individual names, but he confirmed that some of those that signed the documents have legal guardians, designated by the court.
“Some were unable or unwilling to sign, and investigators actually signed the document on their behalf,” Baugh said.
In spite of the frequency of the abuse, internal investigations focused on direct care staff, not supervisors or professional staff, he said.
“We are well aware of the fact that some of the residents at SWITC are people with histories of assaultive behavior, that they pose a challenge for direct care staff, but they are no different from the residents of facilities in other states,” Baugh said. “They are no different than the residents of SWITC five years ago or 10 years ago. This is not a phenomenon that is caused by a change in the initial conditions or diagnoses of residents.
“In our report, we think what has happened is the policies and behavior of SWITC staff actually precipitated many of the violent incidents that resulted in injuries to both the staff and the residents.”
DisAbility Rights Idaho offers recommendations
DisAbility Rights Idaho offered 19 recommendations to the Department of Health and Welfare, starting with discontinuing the policy of telling residents they cannot report abuse or neglect and to stop making them sign nondisclosure agreements.
Other recommendations included improving training and supervision for direct care staff and improving the internal investigations. The group also called on SWITC to seek outside expertise to work with residents who have both a developmental disability and a mental illness.
The group hopes to incorporate “trauma informed practices” and improve abuse and neglect procedures.
A history of problems
Idaho lawmakers called on the Office of Performance Evaluations this year to investigate operations at SWITC, how employees are held accountable for inappropriate care, and staffing workload and qualifications.
Idaho senators asked that OPE look into whether SWITC’s practices align with best treatment standards.
The OPE’s 2018 report to the legislators explained that “From July 2009 to April 2018, the number of residents declined from 95 to 23,” at SWITC because the mission changed, targeting short-term, crisis care. Their budget and staffing numbers also decreased.
Ongoing problems at SWITC date back years. The state settled one lawsuit earlier this year, agreeing to pay $10,000 to the mother of a 24-year-old resident, Moses Rodriguez, who died after being in SWITC’s care.
Rodriguez, who had autism and severe epilepsy, had the mental capacity of a child between the ages of 3 and 4, according to the lawsuit. He died at a hospital, one week after leaving SWITC’s care.
DisAbility Rights Idaho hopes to have a dialogue with the Department of Health and Welfare, Baugh said.
“We hope that policymakers and others will recognize that there is a need for some significant changes,” he said.
The Department of Health and Welfare said it walks a fine line with providing a safe environment where patients can receive care and a safe working environment for its staff.
“The actions of a few former employees do not represent the commitment, compassion, and professionalism demonstrated by the majority of our staff at SWITC who daily turn extremely challenging situations into potentially life-changing moments for residents,” Health and Welfare stated. “As we continue to improve our treatment and care for individuals with intellectual disabilities, we also are working to rebuild the community trust so that SWITC is a good neighbor and a model treatment center.”