Virginia's largest and oldest institution for mentally retarded people does not have the staff or the safeguards to protect patients from harm, according to a confidential report by the state's watchdog agency for people with disabilities.
As a result, the Central Virginia Training Center in Lynchburg relies too heavily on mechanical restraints and powerful medications to control its patients, who have the highest rate of injuries of any mental institution in the state, said the report by the Virginia Office for Protection and Advocacy.
"The nature and frequency of injuries sustained due to challenging behaviors supports the conclusion that behavior support services are inadequate, placing individuals at significant risk of bodily harm," states V. Colleen Miller, executive director of the watchdog agency, in a five-page letter delivered last month to the state commissioner of mental health,mental retardation and substance abuse services.
The letter catalogues a series of problems at the training center that, if confirmed, would represent the biggest challenge to Virginia's institutions for the mentally ill and retarded since 2003, when the U.S. Department of Justice ended 13 years of investigations into dangerous conditions at five facilities. Central Virginia was not among them.
The report by the advocacy agency appears to contradict the findings of the state's inspector general for mental health and retardation services. The last report on the training center by Inspector General James W. Stewart was based on a two-day visit in 2004. It gave the training center high marks in all of the areas found lacking by the Virginia Office for Protection and Agency. Stewart has toured the center recently but not issued any findings.
Virginia officials say they have not seen the report on which Miller's letter is based. "We definitely want to know what they've found, and what they're basing these things on," said Dr. James S. Reinhard, the state commissioner responsible for the institution.
Reinhard has written to Miller to open a dialogue with the agency about its report on the training center. He said he hopes to hold the initial meeting with the agency this month.
The commissioner and other mental-health officials also say that many of the training center's problems stem from its size and age, which is why Gov. Mark R. Warner is proposing to replace the institution with a smaller facility.
Central Virginia Training Center is among the oldest and largest institutions for mentally retarded people in the United States. Established in 1910 as an institution for epileptics, the center now houses about 500 people, almost all of them severely or profoundly retarded. Officials estimate that at least 350 of the current patients rely on wheelchairs and many have serious medical problems in addition to their mental disabilities.
Warner wants to build a new training center to house about 300 patients, which would improve the ratio of staff, especially professionals such as nurses and psychologists, to patients.
The training center's director denied Miller's assertion that restraints and psychotropic medications were used excessively "for staff convenience."
"That I would say is absolutely incorrect," said Denise D. Micheletti, who has been director of the training center since mid-2004.
Micheletti said the injury rate cited by Miller in the letter could be misleading because those injuries could be as slight as scratches that have been reported by the on-site doctor at the center. "Since I've been here, we've seen significant improvement in the injury rate," she said.
She said restraints could include helmets, bed siderails, and seat belts used to protect physically fragile patients. She said the center's use of powerful psychotropic medications is higher than average for such a facility, but she said their use is tightly controlled and monitored.
Staffing and supervision is an underlying concern throughout Miller's summary of the report's findings. Central Virginia "is understaffed," she writes.
"The lack of a sufficient number of competent and qualified direct care and professional staff inhibit the provision of adequate care, treatment, and training programs," Miller states.
Micheletti acknowledged yesterday that there are too few professional staff members to serve the patient population, according to U.S. Department of Justice standards. However, the center does employ the correct number of direct-care staff to patients meet the federal benchmarks. "I need to understand what data they're looking at," she said.
Miller, reached yesterday, said she could not comment on the report because the investigation is both confidential and ongoing.
The report appears to be based on a four-day visit by a team from the Miller's agency in April, according to Micheletti. The team made rounds of the center, inspected the charts of a number of patients, and gathered "a variety of data," she said.
News of the report was not well-received by parent advocates for the center. "Are they biased in their agenda?" asked Atul Gupta, president of Parents and Associates of the Institutionalized Retarded of Virginia, known as PAIR.
Gupta fought to get his daughter, Alisha, now 5, into Central Virginia Training Center two years ago because the services she needed were not available in Lynchburg, where the family lives.
He has nothing but praise for the center. "My experience has been wonderful," he said.
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