Of the 60 or so serious complaints for which New Times asked the disposition, not one was validated.
After attorney Gordon Weekes wrote his letter, two investigations were opened into CATS, one led by the Broward Sheriff's Office's Child Protective Investigations Section, the other by SFBHN.
These substantiated many of the teenagers' complaints.
The latter report supported all of Weekes' allegations — that kids are routinely tied down and shot up without first using less-restrictive techniques — and concluded that "patterns have been developed by individual staff as well as the program at large that are not conducive to the population served."
The BSO interviewed all 52 current residents at CATS and analyzed the facility's records. CATS was found to use timeout, but never seclusion, before resorting to restraints. The agency found that in just seven and a half months — between January 1 and August 13 of last year — the facility had restrained girls 81 times and boys 32 times for a total of 113 ETOs, an average of once every other day.
When kids were restrained, monitoring staff sometimes chatted on their personal cell phones. And the staff were hardly more educated than the patients: "The front line personnel, Mental Health Technicians (MHT)s," were equipped "primarily with high school education... The majority of patient care and interventions are with the MHTs." Many patients "felt when admitted they were not explained restraints, time-out, etc. when signing orientation papers."
The other report noted that over two days in June 2013, just two staff members initiated 21 ETOs. "Thirty-one percent of the time, the consumers stayed in physical restraints the full two-hour" period. Overall, the program "has shown an increase in the use of ETOs" each year since 2011.
That frequency is "not normal," says Michael Dale, a former litigator and professor at Nova Southeastern University's law school who has sued institutions on behalf of neglected children.
In fact, the use of restraint is being phased out of many institutions, according to Dr. Wanda Mohr, a former professor of adolescent psychiatric nursing at Rutgers University who has studied restraint and its effects on mentally ill children. "At most of your places where people are professional, where they care about the patients more than the bottom line, they are going to have a very low use of restraint," she says. "They don't work. You might temporarily contain some explosive behavior, but you haven't really taught anybody anything." In fact, Mohr opines that the entire level-based program is completely useless. "You create this punitive environment where the staff is picking up on these stupid issues," she says. "So he used the f word? What are his bigger issues? Why can't he modulate his emotional responses?" The misbehavior continues, and "the kids develop a hopelessness because their symptoms mean they can't negotiate the program."
Mohr estimates that facilities similar to CATS might see one or two legitimate uses of restraint per week. "At many facilities, if anybody sees the use of restraints creeping up, there's usually a meeting to see what the heck is going on." Restraint is particularly wrong when dealing with abused kids, Mohr says. "When someone is manhandling you, especially when you're having male-on-female restraint, it piles trauma upon trauma."
And who knows whether Citrus' records are even accurate? The SFBHN report found multiple occasions when Citrus staff administered psychotropic medications but failed to report them as ETOs — 40 times with 19 patients in 2013 alone. While Kate told investigators she had been restrained and shot up with booty juice 14 times, records from CATS tracked only eight instances. The BSO found that after Kate was arrested, a CATS report noted her arrest but left out the fact that an officer had punched her in the face.
None of the reports give the medical name for "booty juice." They refer to the substances at CATS only as "psychotropic medications," a large category of medicines that alter brain functions like mood, consciousness, or cognition. One grandmother of a CATS patient told New Times that the staff told her that her granddaughter had been injected with Haldol, an antipsychotic, to calm her.
Despite the reports' findings, there's little accountability for Citrus.
Broward Sheriff and SFBHN reports only offer "suggestions" — that Citrus "reconsider" using the prone position, try less-restrictive techniques before reaching for the needle, and keep better track of restraint.
John Dow, head of SFBHN, would tell New Times only, "We continue to pursue corrective action when needed."
Sheriff's investigators redirected inquiries about their investigation to DCF.
DCF redirected inquiries about the facility's contract and license to SFBHN and AHCA. ("The issues and deficiencies identified were addressed, and action was taken," said a DCF spokesperson.)
AHCA typically gives facilities 30 days to correct the issues or to put together a "plan for correction" within ten days. Whenever Citrus has been found with deficiencies, records show the nonprofit has addressed the issues.