UIC study alleges an overuse of drugs on juveniles at understaffed Streamwood psychiatric hospital

By David Jackson Tribune reporter

December 10, 2009

One of Illinois' largest psychiatric hospitals dosed foster children with dangerous combinations of mood-altering drugs, sometimes using the medicines as "chemical restraints" to control youth who needed counseling, according to a sharply worded new report by the University of Illinois at Chicago's department of psychiatry.

The northwest suburban Streamwood Behavioral Health Center, which has treated roughly 475 Department of Children and Family Services wards since 2007, is "so understaffed as to be counter-therapeutic," the UIC report said. Amid violent outbursts by young patients, hospital staff resorted to extraordinarily high rates of emergency psychiatric medications, physical restraints and seclusion, the report said.

DCFS Director Erwin McEwen reacted to the findings by angrily criticizing Streamwood owner Psychiatric Solutions Inc., the nation's largest for-profit behavioral health firm.

"Profiteering at the expense of the mental health of vulnerable children will not be tolerated in Illinois," McEwen's statement said. "PSI needs to develop a different business model if they want to continue caring for our children. Unless and until this corporation pays attention to children with the same fervor that they devote to the bottom line, we will seek alternatives to reduce and eventually eliminate our dependence on this provider."

McEwen added that DCFS intends "to fully implement the report's recommendations." He said DCFS will seek probes from the state auditor general to determine whether PSI overcharged the state, and from the inspector general of the U.S. Department of Health and Human Services in instances of alleged harm to youth.

The Streamwood facility said it will give a detailed response in the coming weeks. But in a written statement, it called the UIC report biased and said "many of the 'findings' in the report, including allegations of understaffing and overuse of medications, are exaggerated and misleading." The facility said "all medications provided to our patients are at the direction of our physicians," and the hospital fulfills "its mission of providing quality, compassionate care."

DCFS commissioned the UIC team to examine conditions at state psychiatric hospitals following a July 2008 Tribune investigation that documented a series of sexual assault allegations at a sister PSI facility, west suburban Riveredge Hospital. The U.S. Justice Department also opened an investigation into Riveredge.

PSI, which operates 95 behavioral health care facilities nationwide, dominates Illinois' youth treatment market. At Streamwood, the UIC report said, treatment became "undermined or sidetracked by the over-reliance on chemical restraints as the primary behavior management tool."

Although Illinois law requires hospitals and doctors to secure DCFS consent when prescribing psychotropic medicine to foster children, Streamwood hospital last year stopped reporting prescriptions of emergency medications to juvenile state wards to DCFS, the UIC report said.

At PSI's adjacent residential facility, known as the John Costigan Residential Center, emergency medication use was more than 30 times higher than in other psychiatric residential programs serving a similar population of troubled DCFS wards, the report said.

There were numerous medication errors at both the hospital and treatment center, the UIC report said. In one incident, hospital staff called a Code Blue after a 6-year-old boy was given twice the dose of an anti-psychotic medicine recommended for his body weight, the UIC report said. The child was rushed to an emergency room where he was kept overnight and then released, the report said.

The Tribune reported last year that DCFS paid PSI at least $650,000 to hold empty beds at the Costigan center for 38 wards who were being treated next door at the company's Streamwood hospital. The UIC team harshly criticized this "pattern of revolving-door hospitalizations from the residential program," saying it put children through chaotic therapeutic regimes.

dyjackson@tribune.com