Wednesday, May 02, 2007

Healthcare poor for kids in TYC, committee told

The Texas Youth Commission has very little oversight over youth medical care, a consultant told a legislative committee this morning, and misdiagnoses by undertrained staff have led to poor care for students in TYC youth lockups.

The Joint Legislative Committee on Operations at the Texas Youth Commission heard testimony this morning from Michelle Staples Horn, a pediatrician working with the American Corrections Association who is conducting an audit of TYC medical care.

Dr. Horn criticized a "lack of clinical oversight" at TYC where people with the "lowest level of training" made assessments of youth and often did not make correct diagnoses, particularly regarding infections. As a result, she described several individual examples where misdiagnoses causes ailments to worsen, putting youth at risk and costing the agency much more to treat in the long run.

After reporting a sexual assault in February, she said, a student whose file she examined did not receive a complete rape examination and people upstream in the medical system weren't notified. Dr. Horn only examined 10 specific students' medical records - randomly chosen - and found three or four, she said, where the medical care provided was of questionable quality. She said TYC does not use rape kits nor outsource such examinations to local emergency rooms, which she said would be the preferred method to avoid appearance of conflicts of interest. With other kids, an ear infection and a case of ringworm were misdiagnosed.

Dr. Horn recommended that TYC needed to create new oversight positions, including a medical director, director of nursing, director of pharmacy, etc., and beefing up staffing to let higher level practitioners play a bigger role in student care. TYC does not currently have a medical director, said Chairman Madden, and is searching for one. Chairman Whitmire mentioned that most TYC facilities are in such remote places that it would be impossible to find registered nurses, for example, to staff the facilities full-time. They could make more money, he rightly said, working at the nearest hospital.

TYC does a "great job," she said, evaluating kids on the front end and preparing for kids' continuity of care when they're released, but care is poor while the kids are actually there.

She also said the Marlin orientation units physical facility was inappropriate to its purpose and selected swapping it out to put intake at another facility. (Legislators have already proposed turning the Marlin unit into an adult facility and shifting orientation functions to another, as yet unnamed facility.)

Dr. Horn said both medical and non-medical staff need to be trained under new federal mandates in the Prison Rape Elimination Act. Medical staff need better protocols for sexual assault allegations, she said, and should outsource post-sexual assault exams instead of performing them in house.

Rep. McReynolds pointed out that it isn't TYC but two universities that provide medical care - the University of Texas Medical Branch and Texas Tech University. Chairman Whitmire said the committee needed to speak to those agency leaders and find out why they didn't bring these problems to the Legislature's attention earlier.


Anonymous said...

Mart will most likely take over intake responsibiities when Marlin is transitioned to TDCJ.

Some units have working systems in place for alledged sexual assault which includes taking youth to hospitals who coordinate SANE exams, have law enforcement officials on site, and can coordinate forensic aftercare with advocacy centers.

The synopsis provided by the medical director is an example of the trouble with this agency wide assessment from the beginning. A subject matter expert looks at 10 files out of 4700 and comes up with this type of summary. That could possibly be a valid sample.

Anonymous said...

If they pick 10 random files and find that many problems that makes you think looking at more would be better?

Anonymous said...

then they should have done so!

Gritsforbreakfast said...

They're going to, actually. The ACA accreditation team was asked to do a preliminary assessment, which is why only ten files were vetted. Supposedly they're going to audit all of them, she told the committee. And the Doc caveated herself that ten files wasn't a representative sample, just to have mentioned it. best,

Anonymous said...

After watching Fridays joint committee meeting archive, I think we all need to hang on. Whitmire has decided to start all over from scratch..whatever that means. The medical people from UTMB and Tech could only lay blame on ALL the facilities being in such remote areas that they can't get nurses..not that there is a nation wide shortage of nurses..Exactly what Whitmire wants to hear...Move all the TYC facilities to his county so all his parents can visit their kids and to hell with the rest of the parents in Texas.