John Hult From Argus Leader

EDITOR’S NOTE: This Cayman Court has nothing to do with the Cayman Islands. Cayman Court is an assisted-living centre for the mentally ill in Sioux Falls in South Dakota, USA. The story is disturbing.

State report faulted assisted-living center for mentally ill after sexual assault

But Cayman Court touts changes it has made since August findings

PHOTO: Yvonne Wilde says ‘I love it here’ at Cayman Court, an assisted-living facility for people with severe mental illness. But three psychiatrists who quit last summer and a former chief financial officer are critical of management. Joe Ahlquist / Argus Leader

A 29-year-old schizophrenic with severe diabetes was found unresponsive in a Sioux Falls motel room last summer.

He was hospitalized and put on an insulin drip.

Doctors soon learned the patient had been removed less than two days before from Cayman Court, an assisted-living facility for people with severe mental illness. He was caught in a compromising position with a female resident who had the mental capacity of a 5-year-old.

Administrators at Southeastern Behavioral Healthcare, which runs the facility in northwestern Sioux Falls, had called police to report a sexual assault that afternoon, but officers concluded that proof of a crime was insufficient.

So Cayman staffers took money from the petty cash drawer, gave the man a week’s worth of medications and discharged him without physician approval.

None of it should have happened.

That was the conclusion of state health department inspectors after an August investigation. The man’s mental illness and history of aggression should have kept him out of the facility. The department’s 62-page report, obtained this month by the Argus Leader, also found Cayman wasn’t properly licensed to deal with developmentally disabled adults. It forced an overhaul of discharge procedures, training and oversight at the little-known home for those with persistent mental health problems.

The 24-bed facility, just west of the intersection of Benson Road and Interstate 29, is one of only a handful in South Dakota to serve as a permanent residence for a population with a specific and unique set of needs. Many of Cayman’s residents would be homeless or committed to the Human Services Center in Yankton but for the availability of the home, said Steve Lindquist, president of Southeastern’s board of directors.

The incident last summer arose from a desire to provide that service, he said.

“Unfortunately, the individual who was there had needs that were probably beyond what Cayman could provide,” Lindquist said. “There was a complaint that surfaced, and the issues have been addressed.”

Some former employees, however, said the incident raises larger questions about the management at Southeastern Behavioral Healthcare under CEO Kris Graham.

Three contracted psychiatrists quit Southeastern last summer, and a former chief financial officer said the administration has created a culture in which experienced professionals are purged from the organization for questioning authority.

“Over time, they’ve systematically gotten rid of the most qualified people and replaced them with people who wouldn’t challenge them,” said Chris Campbell, an accountant who was fired in October after questioning the agency’s ethical climate. “The people who suffer are the clients.”

A former University of South Dakota psychiatry professor was so upset with Southeastern’s leadership last year that he wrote a letter to Lt. Gov. Matt Michels warning that a loss of qualified counselors could put clients at risk.

Dr. K-Lynn Paul, who now lives in Tucson, Ariz., said he’s received calls from former colleagues about Southeastern for years.

“There’s a risk in the suppression of new ideas,” Paul said. “You don’t want people to be fearful of bringing things up.”

Began as help for homeless

Cayman Court was built in a partnership with Citibank, using federal tax credits, and opened in 2006. Cayman replaced Southeastern’s transition house, a temporary home for the mentally ill on Minnesota Avenue, which helped move patients from psychiatric units to life in the community.

There was a need for permanent housing, Graham said. Some clients, with diagnoses range from schizophrenia to bipolar disorder, severe depression and a host of other issues, are unable to function on their own.

Many had tried other living arrangements without success, winding up couch-surfing from place to place between hospitalizations.

“Initially, part of the criteria was that the person had been homeless,” Graham said.

Seven of Cayman’s residents have been there since it opened, current administrator Christine Luth said.

“We feel like this is a safe, positive environment for them,” Luth said.

Most residents pay for their services at Cayman with the help of Medicaid, the federal insurance program for low-income citizens. The facility offers apartment-style living, three meals a day, group therapy sessions and at least two staffers on site 24 hours a day.

Residents can come and go as they please and have visitors through the day, but no residents drive, Luth said. The center’s assistants take residents shopping in groups.

Therapists from Southeastern’s Fifth Street Connection lead group sessions, and Case Manager Clinton Johnson is on site to intervene when residents have issues. That could mean anything from distracting an upset resident with calming music, walking the halls, talking, playing cards or sitting down with them in front of a fish tank.

“Each day is different,” Johnson said. “Every client is different.”

Yvonne Wilde has lived at Cayman for two years. Before that, she lived at a Ward Enterprises home that didn’t specialize in mental illness.

The walls of Wilde’s apartment are adorned with photos of her children and extended family. An electric keyboard sits on a table in her living room, the sheet music and set list for Cayman’s upcoming Christmas program alongside it.

“I love it here,” Wilde said. “I would recommend it to anyone who needs a nice place to stay. It’s an excellent place.”

Several other residents, who spoke Thursday with the Argus Leader but declined to speak on the record, said they are grateful to have a home at Cayman.

There is a waiting list for the facility with 19 names on it.

Trouble with a resident

Cayman is among a small number of assisted-living facilities in South Dakota to specialize in the mentally ill, as opposed to the aging or elderly.

All assisted-living facilities in South Dakota are surveyed by the state Department of Health about once a year, said Tom Martinec, the department’s deputy secretary.

Cayman’s initial survey in March wasn’t perfect, but it wasn’t particularly problematic, Martinec said. “My staff informed me that it was a relatively uneventful report,” he said.

The problems that brought inspectors back in August centered on a resident admitted less than a month later. The 29-year-old arrived in mid-April after a long string of failed admissions to previous facilities, the report said.

His behavior toward other residents — including the aggressive pursuit of cigarettes and inappropriate sexual remarks — should have sent up red flags from the start, the report says.

He was taken to the Human Services Center in Yankton for most of May because of uncontrollable behavior, but trouble returned with him. On June 1, for example, he said he was going to shoot other residents with a gun, the report said.

The near-death incident at the hotel that ultimately caught the attention of the Department of Health took place less than two days after that resident’s discharge June 19.

Management faulted

The allegation of a sexual assault in the laundry room was part of a pattern of escalating behaviors that should have been dealt with sooner, the August report concluded.

“They should have been reporting things to us long before they did,” Martinec said.

The report noted failures in managing both his physical and mental conditions, and the decision to move him without instruction was hasty, the report concluded.

“He had high-risk issues related to treatment and discharge planning that had included poor follow-through with after-care services, substance abuse issues, noncompliance with medications, and diabetes issues,” the surveyor wrote.

The staff told surveyors they hadn’t been properly prepared to cope with a client so difficult. One resident assistant described his training to surveyors as subpar for dealing with the mentally ill.

Graham told the Department of Health it was clear that the man “fell through the cracks.”

The facility also hadn’t been licensed to care for those with developmental disabilities.

Staff training, licensing

The Department of Health survey required a plan of action from Cayman, including rules and policy changes.

The new license issued Nov. 5 has Cayman approved to care for the developmentally disabled.

The administrator and case manager working during the summer have resigned, Graham said, and the new training and policy review plan was in place by September.

Luth and Johnson came to Cayman full time this fall.

Graham said having the right staff in place will help ensure that the organization is prepared to handle any future issues.

“I really rely on the administrators of our programs to keep me informed about what’s going on and what the issues are.”

Cayman hasn’t had any complaints since the problem resident left, said Martinec, who called the plan of corrective action appropriate.

Fear of retribution

Graham joined Southeastern in 2006 after earning a master’s degree in counseling, moving into the role of interim CEO in 2009. She’s been CEO since 2010. She was director of the South Dakota State Fair in 2001.

Graham admits mistakes were made by Cayman’s administrators, but she said the problems have been corrected.

“We have a great facility here,” she said Thursday. “This is home for our residents. That’s why we immediately went after the problem.”

Campbell, the one-time chief financial officer, said he’s not so sure. He filed a complaint with the state’s Board of Examiners for Counselors and Marriage and Family Therapists in October after his dismissal.

Confidentiality concerns

Campbell worked seven weeks before he was fired — which he said happened the day he voiced concerns about patient confidentiality.

“I was a CFO, and I was hearing things (about patients) that I had no business hearing in my position,” Campbell said.

The board did not take action against Southeastern, but Campbell said he has reached out to several other former employees and heard similar stories of retribution. Multiple former employees contacted last week by the Argus Leader voiced similar concerns but declined to go on the record about their experience.

Dr. Paul said his information came from friends within the industry. He wrote a letter to Lt. Gov. Michels in 2012 under the heading, “Travesty at Southeastern Behavioral Healthcare,” pointing to Graham’s 2010 appointment as CEO as the catalyst for the departure of experienced staff.

“Knowledge, capability and experience are important in all areas of medical care, but especially for the mentally ill, who need stability in their lives,” Paul wrote.

Michels wrote back, telling Paul that Southeastern was in compliance and in good standing with the Department of Social Services and Department of Health. No further letters were exchanged.

Paul said this week that he wasn’t surprised to hear of a poor report from the Department of Health at a Southeastern facility.

“Things were never perfect at Southeastern, but things used to be a lot better than they are now,” Paul said.

Psychiatrist Dr. William Fuller of Avera was a medical director for Southeastern until July 1. Fuller and two other contracted, part-time psychiatrists quit during the summer.

“Officially, I would just say that I disagreed with some of the management,” Fuller said.

Disagreements, change

Graham said she wasn’t aware of Paul’s letter and wouldn’t speak to specific allegations from a former employee.

In response to questions about turnover, Graham said the notion that her agency is abnormal or that experienced professionals are “pushed out” doesn’t fit with her experience.

She points to the expansion of programs under her tenure — including the creation of a mobile crisis team — as evidence of high-quality work. Turnover at Southeastern is about 20 percent, she said.

“People come and go for various reasons, but we have a lot of people who have been with us for years,” Graham said. “We’re very proud of what we’ve done.”

The new programs have as much to do with turnover as anything else, Lindquist said. New ideas are often met with skepticism by old guard staff, he said, regardless of the organization.

“We on the board recognize that there has been some turnover, but we also know that there have been a lot of changes,” Lindquist said. “Sometimes, people don’t like change, and in a lot of respects, there hadn’t been a lot of change at Southeastern.”

The mobile crisis team, a partnership between Southeastern and Minnehaha County, now responds to emergency mental health calls and has seen “outstanding results,” Lindquist said.

Southeastern also has expanded Behavioral Mental Health Home, a nonresidential program at Fifth Street Connection for people with severe mental illness. That program has helped cut hospital admissions for people with persistent conditions that aren’t serious enough to require assisted living.

Lindquist said the Cayman Court situation was unfortunate, but he pointed out that the staff called police and took steps to keep the residents safe, even if they “missed some steps.”

“As a board, we’re satisfied with the changes that have been made,” he said.

For more on this story go to:

http://www.argusleader.com/article/20131215/NEWS/312150009/State-report-faulted-assisted-living-center-mentally-ill-after-sexual-assault