EFE Calls for Closure of Choate

Time and again, large institutional settings have lacked appropriate care and fostered abuse and neglect.

Equip for Equality called on the state to close the nonforensic units of the Clyde L. Choate Developmental Center (Choate), Illinois' southernmost state-run institution. Choate is located in Anna, Ill., and currently houses approximately 200 people with disabilities. Equip for Equality's Abuse Investigation Unit conducted an extensive investigation of the facility, which included more than 200 hours of on-site observations throughout the facility on different days and various times from April through December of 2004, and the examination of hundreds of pages of relevant material, including medical and treatment records, restraint records and state agency investigative reports.

Choate was originally constructed in the late 1800s as the Anna State Hospital. While picturesque in its rural setting, the serious problems at Choate depict an institution that is in sharp contrast with its setting. The Investigation Unit documented a long-standing pattern of significant failures and mistreatment of residents.

The Investigation Unit's examination found that Choate repeatedly failed to monitor medication, to closely supervise individuals at risk of harming themselves, to implement plans to ensure safety, and to maintain a functioning emergency call system. For example, in April of last year, an individual started choking on a meatball. Responding to the crisis, individuals attempted to activate Choate's Code Blue emergency response system, which malfunctioned. The doctor, who was in an office only 30 feet away, did not receive the page. By the time he arrived, it was too late, and the individual had died.

The investigation also revealed extraordinarily excessive use of restraints and a practice of using restraints as punishment or for the convenience of staff, in violation of state and federal law. Choate had the highest number of physical restraints of any state- operated developmental center in Illinois in 2003.

The Investigation Unit’s review also revealed that Choate has failed to address the needs and safety of residents with pica (the ingestion of inedible objects) behavior. In March 2003, one individual told a nurse that he had swallowed batteries at his workshop. After X-rays confirmed his assertion, he underwent surgery to remove four double-A batteries and a ring. In May 2003, the same individual required medical intervention after having ingested soda tabs. In light of these incidents, the individual was placed on one-on-one supervision, requiring one staff person to supervise only that one individual. Nonetheless, in November 2003, he swallowed two triple-A batteries and again required surgery.

The Investigation Unit, as well as the Illinois Department of Public Health, has routinely observed Choate's failure to provide appropriate programming or meet the basic needs of the individuals living there. Often residents were observed simply sitting around or roaming the unit hallways with no staff present and with no available materials designed for meaningful programming or activities.

During a 2004 site visit, Investigation Unit staff observed one individual seated in the corner of a common room masturbating and placing her hands in her mouth. The two staff present did not intervene until they noticed Investigation Unit staff observing this behavior. An Illinois Department of Public Health monitor noted an individual masturbating and rectally penetrating himself for over 15 minutes before staff intervened.

Many individuals living at Choate have been denied their basic right to personal dignity. Individuals have been seen in torn clothing that exposes their breasts and undergarments, or wearing clothing that is so large they are compelled to walk around holding their pants up.

People living at Choate describe an environment of fear and retaliation, where exercising basic rights results in abuse or being put in restraints, which is described as being "tied up." Some residents referred to incidents in which staff curse at them and call them degrading names. One individual repeated a statement said to her by a staff person: "You'd better not tell on me! I have kids to feed!" On more than one occasion, individuals living at Choate have said to Investigation Unit staff, "Get me out of here."

In response to the serious concerns identified by Equip for Equality, the Department of Human Services, Division of Developmental Disabilities, and Choate's director have begun to take action to address the problems. The Department of Public Health has placed independent monitors in the institution and has brought in the Illinois Foundation for Quality Health Care to encourage a culture change at Choate in an effort to better meet the needs of the residents.

While Equip for Equality appreciates the Departments' and the facility director's prompt response to the problems, it strongly urges the state to shift its focus from saving the institution to developing and facilitating a wellplanned and orderly transition of residents to less restrictive settings in the community or to other facilities, based upon individual preferences.

The history of this institution, like the history of large institutions generally, raises significant concerns regarding the sustainability of such improvements. Time and time again, large institutional settings for individuals with disabilities have resulted in environments that lack appropriate care or treatment and foster abuse and neglect.

The national trend over the last several decades has been to decrease the number of individuals residing in state-operated developmental facilities and to close institutions. Illinois is one of only a few states that continue to reject that trend and remain heavily institutionalized.

Equip for Equality has released a report detailing the Abuse Investigation Unit's extensive investigation of the institution and its mistreatment of people with developmental disabilities, and this report also includes responses from the Illinois Departments of Human Services and Public Health. The entire report can be found the Abuse Investigation Unit Reports page on Equip for Equality's website.

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