Iowa boys school's use of restraints, seclusion could devastate students' psyches, doctors testify

Mentally ill students at Iowa's State Training School for Boys are "exquisitely vulnerable" to long-lasting psychological harm from being placed in isolation cells or being strapped to a bed with a large Velcro device, a psychiatrist testified in federal court this week.

Leaders of the state-run Eldora institution testified that the measures are used only as a last resort to protect the safety of students and staff members when boys become agitated and violent. But mental-health professionals testifying on behalf of teens who were subjected to the restraints and solitary confinement said that's not true.

The practices are at the heart of a federal trial that started last week in Des Moines. The group Disability Rights Iowa filed a class-action lawsuit in 2017 against the Iowa Department of Human Services, alleging the agency allows inhumane treatment at the school, which houses nearly 100 teen boys who have been found legally delinquent for committing crimes.

School staff members have often used isolation or restraints to discipline teens, testified Stuart Grassian, a Massachusetts psychiatrist who has written extensively about the psychological effects of solitary confinement.

Grassian, testifying for Disability Rights Iowa, said school records show one boy was put in isolation 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 strapped to a bed with a large Velcro and leather contraption, called "the wrap," despite having asthma, a severe heart condition 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 it, the psychiatrist testified. "Why would you do that?" asked Grassian. At another point, he described some of the staff's actions as "sadistic."

Grassian described the wrap as "a 14-point restraint system that crushes both body and spirit." He said he'd never seen such a device before.

Andrea Weisman, a Washington, D.C., psychologist who has studied the use of restraints and isolation on adolescents, said the wrap is "akin to a torture device."

Restraints, solitary confinement ended elsewhere

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

Many teens in such facilities have histories of mental illness often caused by childhood abuse and neglect, Weisman and Grassian testified. Being isolated or restrained can re-trigger the damage from such traumas, making boys lose control to the point of violence or hallucinations, they said.

The Eldora institution's staff doesn't take boys' mental health histories into account before placing them in isolation or restraints for aggressive behavior, Weisman testified. "They need to understand that kids may not just be misbehaving — they may 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 isolation. Jerry Foxhoven, director of the Iowa Department of Human Services, called the Eldora school "the placement of last resort." It houses boys who have committed serious crimes and have failed to succeed at less-restrictive programs, he said. For many of them, he said, "the alternative to the training school is adult prison. ... It's their last hope."

Assistant Attorney General Anagha Dixit, helping represent the state, repeatedly tried Thursday to ask Foxhoven what would happen if the state were forced to close the Eldora boys school. Lawyers for Disability Rights Iowa objected to the question, noting their lawsuit doesn't seek closure of the facility. Rose upheld the objections.

Judge questions legality of assessment process

At one point Wednesday, Rose briefly halted the trial while Dixit was questioning the school's nursing director, Tanya Richmond.

Dixit had been asking Richmond to describe how the nursing staff handles boys who are being admitted to the school. Richmond, who is a registered nurse, replied that she or one of the three licensed practical nurses she supervises give each boy an initial assessment. The judge interjected, and asked Richmond whether the school's licensed practical nurses, who have less training than registered nurses, performed initial assessments on the boys. Richmond told the judge they did.

The judge then grimaced, and turned to the assistant attorney general. "Is counsel aware that's not legal under Iowa law?" Rose asked Dixit.

The judge, who is a former federal prosecutor, said she happened to know that state law prohibits licensed practical nurses from doing initial assessments on patients. The judge said it also may be a problem under federal law for licensed practical nurses to dispense medications prescribed via video by an off-campus doctor, as Richmond had previously testified. The judge warned Dixit she might be putting Richmond's professional license in jeopardy by having her testify about such practices. After a 15-minute break in the trial, the state lawyer moved on to other matters in her questioning of the state nurse.

In a telephone interview Thursday, Iowa's top nursing regulator confirmed that a licensed practical nurse could face discipline for performing initial assessments on patients, even if supervised by a registered nurse or a physician. Kathleen Weinberg, the 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 do such assessments. Weinberg, who didn't know the details of the Eldora incident, said her agency normally would investigate such a case if it received a complaint about it.

Superintendent talks emotionally of 'my kids'

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

Day, who has run the Eldora institution since 2008, referred to the students as "my kids." He said that staff members strive to make the facility feel more like a campus than a prison, and that they try to help the boys catch up on classes and learn a trade, such as carpentry or welding.

Day, who is named as a defendant in the lawsuit, sat through several days of testimony on behalf of the plaintiffs. He testified in a matter-of-fact manner when called by state lawyers Thursday morning. But he became emotional as he described how he, his wife and their son and daughter serve Christmas breakfast every year to boys at the school who are unable to go home for the holiday. He wiped his eyes, and his voice became husky. He paused for several seconds. "I'm sorry, Your Honor," he told Rose. "It's hard to be vilified when you know what's really going on."

Rose assured him it was all right, and Day regained his composure and continued to testify.

The trial is expected to continue into next week. When it's done, Rose will decide whether to order changes in the way the school handles its students. The plaintiffs are not seeking monetary damages.