By August, when Octavious had been in CATS for nine months, Howell was getting frustrated. He was still on level A. "You're on the medication — no progress. You're doing your therapy and your treatment — no progress. You haven't made any progress since December 19, 2012, so what's the purpose of being in the program?"
She thought perhaps it was time to take him out of the program. But she would never get the chance.
Responsibility for what happens at CATS is spread among a bureaucratic maze of government agencies.
CATS is accredited every three years by the Joint Commission, a nonprofit organization that greenlights health-care facilities across the country. AHCA issues the facility its license and is supposed to ensure compliance with rules regarding facilities, staffing, and operating procedures. The agency does annual reviews and also investigates when complaints are filed online or via phone. Florida's Department of Children and Families also fields complaints about treatment of children via phone and the internet. In Broward, DCF investigates each complaint through the Broward Sheriff's Office.
Records show that between 2008 and today, AHCA found multiple deficiencies in 11 investigations at CATS. (Citrus Health Network's program in Hialeah had three in the same period.)
AHCA found that the center failed to provide blinds in resident rooms for privacy and that kitchen staff did not follow menu protocol as required. (They just "prepare foods that the residents like," a CATS staffer reported.) In 2010, AHCA found three incidents of residents who claimed to have been injured by staff. One claimed he was tackled, another was punched in the face, and the third claimed a staff member tripped him with a bench. In July 2011, surveyors discovered that a resident had escaped from a Citrus van idling at a red light on the way from the dentist. The program had failed to follow required ratios of staff to residents, and its van was not equipped with childproof locks.
Deficiencies in training and record-keeping were recurring problems. AHCA found instances when staff members were not current on their required CPR or physical-restraint training. In 2013, an employee had worked at the facility for eight months without once receiving the required restraint training.
At least twice, AHCA discovered that patients were given high-powered medications without prior consent of their legal guardians. A nurse told investigators medication was provided when children "asked for something to calm down or help them sleep." In one incident, the nurse handed over a dose of Zyprexa Zydis, a heavy-duty antipsychotic.
Last September, AHCA interviewed two Citrus residents who were in their second trimester of pregnancy. The girls complained they weren't getting extra food for their growing stomachs. The patients' charts made no mention of extra nutrition.
A 2013 review found at least one incident in which a resident claimed she was tied down and given a chemical restraint, but the nurse made no mention of the restraint in the patient's file. AHCA found numerous occasions in which there was no documentation that follow-up steps like parental notification and debriefs were ever executed.
DCF had its own litany of incoming complaints: Between 2010 and July 2013, more than 80 reports about CATS were registered via abuse hotlines.
Among the allegations:
• The staff asked a patient "uncomfortable questions" about the patient's "sexual experience" such as "is you fucking?" and "you ain't fucking nothing big."
• "The facility is dirty... the staff is not allowing" the patient and others "to bathe when they are on their menstrual cycle. It is unknown why."
• While getting restrained, a child was choked. "The child could not breathe and had an asthma attack. The child also sustained bruises."
• A patient described "being bullied by other children in the facility" to the point of not being able to sleep at night for fear of injury. The "staff and teachers have done nothing about" the bullying, so much so that the child constantly walks in front of the facility's security cameras in case the child "was to get beat up it would be caught on camera."
• "At the facility there are bed bugs that are biting the residents. The food has had hair in it."
• A staff member had been "soliciting" a patient "for sex." The staff member gave the patient his or her "contact information because [the patient] is leaving the facility at the end of the week" and the staffer said he or she "wants to make contact."
• "There was a spider in the tuna," one report claims. "The children that ate this tuna got a fever and were vomiting. Staff treated the children for this illness... A child from the program died on 8/8/13."
DCF would not release details of the investigations except to rule them "no indicator" (no proof), "not substantiated" (some evidence, but not proven), or "validated."