Advocates and state officials say they are concerned about the treatment last year of a disturbed, disabled teenager who was handcuffed by private security guards on a commercial flight from Juneau to Anchorage for admission to Alaska Psychiatric Institute.
The teenager's mother was trying to get him more intensive help than is available in Juneau. The teenager's troublesome behaviors had been escalating: fights at school, aggression at home including throwing furniture and brandishing a knife, public masturbation and smearing feces on the walls, according to the Disability Law Center.
A new investigative report by the law center says that the mistreatment began when the teenager, then 16, and his mother showed up on Feb. 20, 2009, at Bartlett Regional Hospital in Juneau to get medical clearance for him to fly to Anchorage.
The teenager's experience at the hospital and with the security company amounted to neglect, the law center concluded. The center is a private advocacy and investigatory agency.
"It is (the law center's) determination that this experience, which (the center) believes could have been avoided, placed the adolescent at risk for emotional injury and/or trauma and as such constituted neglect," said its report, released last month.
Things didn't go as planned, the Disability Law Center found. Instead of a smooth checkup before the flight, the situation was handled like a mental health crisis. The teen was held overnight with one-on-one supervision. He was repeatedly asked invasive questions by strangers, and had to listen to his mother describe his problematic behaviors over and over, the report said. Though his mother had planned to be the one to fly with him, he ended up with two escorts from a private security company, Securitas USA, who put him in handcuffs for the Alaska Airlines flight.
"Your report reflects serious concerns about the lack of a dignified and therapeutic response to an individual in crisis," Melissa Stone, director of the state Division of Behavioral Health, wrote to the law center. "We see this as an opportunity to reshape and improve our policies to ensure the safe and respectful transportation of patients to our safe hospital."
TEEN IS 'MORE HOSTILE'
The mother and son aren't identified in the report and they didn't want to be interviewed directly. The mother relayed through the Disability Law Center that the child is still angry, "perhaps even more angry now," as a result of the experience. Law center attorney Meg Allison Zaletel said the mother believes her son may have "more hostility toward authority."
Bartlett Regional says the law center didn't properly evaluate the situation and that its staff provided good care for the teenager.
Even if he wasn't in crisis when he got to Bartlett, his behaviors leading up to that day had been escalating, Bartlett's lawyers said in a written response to the report. He was safely transported to API, which was what his mother wanted, the response by attorney Michael Lessmeier said. Hospital nurses, an emergency room doctor and a psychiatrist were all involved, and it was appropriate to keep him overnight, the response said. At any rate, Bartlett didn't handcuff him.
"The truth is that Bartlett had no control whatsoever over the use of restraints and in fact objected to the use of restraints," the hospital said.
WHO GETS HANDCUFFED
State officials say the case appears to be isolated, but they don't track how often mental patients are handcuffed during flights to treatment hospitals.
A Securitas representative told the law center that they all are handcuffed.
That shouldn't be happening, Stacy Toner, operations manager for the behavioral health division, said in an interview.
Securitas officials didn't participate in interviews with the Disability Law Center. After a draft report was circulated, someone with Securitas provided some information, the law center said.
The law center said a Securitas representative explained that "escorts use handcuffs with each transport so that they cannot be accused of 'handcuffing based on race, religion, gender, etc.' The representative further reported Securitas escorts do not carry such things as pepper spray, do not have body armor and are not trained in defensive tactics," the final law center report said.
The state has agreements with Securitas USA and a Juneau Native corporation, Goldbelt Inc., to transport patients from outlying areas to Anchorage, Juneau and Fairbanks to be committed for treatment. The escorts are supposed to be trained in a system that relies on the "least restrictive" means necessary. State health officials want to evaluate whether that's being done.
"We don't really want this kind of thing happening again," Toner said. "If we don't need to impinge on people's civil rights and handcuff them, we don't want to."
CHALLENGE OF RURAL PATIENTS
Last year, there were 294 such trips in which mental patients were escorted by Securitas or Goldbelt at a cost to the state of $447,000, according to state figures.
It's a serious challenge to provide mental health care for people in crisis in far-flung Alaska communities. State health officials have been trying for years to improve how psychiatric emergencies are dealt with in rural Alaska, said Kate Burkhart, executive director of the Alaska Mental Health Board. But problems remain -- including holding people in crisis in jail until troopers or private escorts arrive.
"So many communities don't have adequate facilities or staffing to provide a safe place for someone to stay pending transport," Burkhart said. "And so sometimes they end up in the jail. Of course Mental Health Board members want to prevent any kind of criminalization of mental illness, ever."
One fix is for hospitals in bigger communities to operate mental health units so that everyone doesn't have to be flown to Anchorage for treatment at API. But that didn't prevent the breakdown in this case. Both Bartlett and Fairbanks Memorial Hospital have mental health units, but are limited in the services they provide for adolescents. Neither has a special adolescent unit, Toner said.
Burkhart said she's been on flights with Securitas escorts and that they don't handcuff every patient, no matter what the company told the law center. But she knows it happens.
Escorts and health officials must balance the safety of the patient and other passengers with the need to treat the patient with dignity and humanity, Burkhart said.
"You should not be treated like a criminal just because you have a mental health disability and you require treatment for it," she said.
Find Lisa Demer online at adn.com/contact/ldemer or call 257-4390.
By LISA DEMER
ldemer@adn.com