Patrick Rose

AUSTIN – More than a year after health officials said that federal civil rights violations inside the Lubbock State School had been addressed, Texas’ own quality rating system gives the institution for the disabled a score of 20 out of a possible 100 – worse than all but two other facilities.

As recently as this summer, a state inspection found critical deficiencies that jeopardized resident health and safety, threatening the school’s certification to care for mentally disabled residents.

The most serious finding was that staff could not prevent the facility’s hundreds of residents from punching, kicking, biting and sexually abusing one another – and that they weren’t always reporting the injuries.

"The state’s most recent quality review clearly shows the system is broken," said Rep. Patrick Rose, the Dripping Springs Democratic chairman of the committee that oversees the state schools. "It underscores the need to pass legislation next session that allows us to provide services to this population in a different and more cost effective way."

The U.S. Justice Department, which recently announced plans to investigate all of Texas’ state schools for the disabled, first reviewed the Lubbock State School in 2005, finding atrocious living conditions, civil-rights violations and 17 deaths over an 18-month period.

As early as March 2007, officials with the Department of Aging and Disability Services, the agency that oversees the state schools, said they had made sweeping changes in Lubbock to fix the problems, which included nursing shortages and a poor management structure. And lawmakers agreed to spend nearly $49 million to hire nearly 1,700 new state school employees, an effort to address staffing ratios and other health and training concerns system-wide.

But recent inspection reports and internal reporting measures obtained by The Dallas Morning News through the state’s open-records laws indicate the Lubbock facility, which remains in negotiations with the Justice Department over the 2005 findings, still faced major shortcomings as recently as June.

The state school’s "Quality Reporting System" score, which is designed to help the public compare different care facilities, is 20 out of 100, meaning the state school failed to meet one or more major conditions of its certification.

Agency spokeswoman Cecilia Fedorov said the scores – which are compiled by pairing a facility’s most recent inspection with its most serious abuse and neglect finding in the past six months – can be misleading. Ms. Fedorov said any facility that is cited for a violation in a major area automatically drops down to a 20, so the number is "not necessarily reflective of everything that’s gone on" to improve the state school.

She said Lubbock’s score was 60 several months ago and could rise again within a matter of months.

"Scores can fluctuate dramatically," she said. "All deficiencies cited in May were corrected within one month of the investigation."

Dennis Borel, executive director of the Coalition of Texans with Disabilities, said the low score is the agency’s admission "that the situation is still dismal."

"This doesn’t sound like improvement to me," said Mr. Borel, who supports moving more state school residents into group homes and independent living. "It sounds like the culture of abuse and neglect is unfortunately continuing at Lubbock."

Among the issues revealed in the May investigation was an incident where two clients were found engaged in sexual activity, one of them covered in feces. The month before, a resident was found dead in his bed, soaked in vomit. In both circumstances, allegations of staff neglect were not substantiated.

Other problems listed in the May inspection include:

•Staff failed to conduct annual vision and hearing tests and left some residents with broken or missing glasses.

•Fire alarms were broken or not functioning properly.

•Underage residents weren’t being moved into age-appropriate settings.

•A lack of personal hygiene, including nurses who applied lotion to several people without switching gloves, and brushed everyone’s hair with the same brush.

Follow-up reports indicate as of June, officials had plans in place to correct the deficiencies, including agreeing to add extra staff and to improve training on how to keep residents from harming each other.

Two other state schools, in Denton and Austin, also scored a 20.

The Denton State School’s spring inspection revealed some undocumented injuries, inappropriate sexual behavior between residents, and lengthy delays to treat some patient health problems. One staffer contributed to a restrained patient’s death by not checking on the patient at the proper times, and then falsified records to show that he had, investigation reports confirm.

The Austin State School was put under a strict monitoring status briefly in late 2007 after investigators learned that a resident had made eight suicide attempts over a six-month period, while supposedly on one-to-one supervision. The attempts included ingesting multiple foreign objects, such as perfume, broken glass, a ring and nail polish remover.

An inspection report indicated that staffers at the facility sometimes failed to give residents personal privacy, left some residents in front of the TV all day, and failed to ensure certain medications were administered properly.

Both state schools have implemented plans to address the problems.

The low scores are not across the board. The El Paso, San Antonio and Brenham state schools all currently have scores of 80 or higher; the state average is 61. Ms. Fedorov said there have been many recent improvements to the state school system, including a statewide reduction in the use of physical restraints, and new procedures for preventing and managing aggressive behavior.

It’s not clear whether the Justice Department has begun its planned review of all of Texas’ state schools.