Every Day, a Child is Held Beyond Medical Necessity in Illinois

by Duaa Eldeib, David Eads, Vignesh Ramachandran

June 5, 2018

Hundreds of children in state care are held each year in psychiatric hospitals for weeks or months at a time — even though they have been cleared to leave — because the state Department of Children and Family Services fails to find them a more appropriate place to go.

Doctors in some of these cases said the delays caused the children to deteriorate emotionally and behaviorally. Between 2015 and 2017, 21 percent of the total time DCFS children and teens spent in psychiatric hospitals was not medically necessary.

Doctors admitted 12-year-old Gabriel Brasfield to a psychiatric hospital in 2016 after he caused thousands of dollars of damage at his grandmother’s home.

Six weeks into his stay at Chicago Lakeshore Hospital, staff agreed he could leave. But Brasfield had to wait for DCFS to find him a foster home.

“I had a good view of the road and some dandelions,” he said. “I would look out and think, ‘They’re lucky to be outside there, and I’m stuck in here.’”

Brasfield’s hair, which he liked to wear short, grew long and unkempt. He forgot what it felt like to wear shoes because he was allowed only to wear hospital socks. He missed months of school. He couldn’t go outside.

When he was finally discharged in July, he was disappointed and angry.

He had spent a total of 102 days in the hospital, 58 beyond medical necessity.

Terrence Wardell spoke of his time at Hartgrove Hospital on Chicago’s West Side as if it were a prison sentence.

Then 15, he was cleared for discharge after three months.

DCFS matched him with three facilities, but two of them had six-month waiting lists. A juvenile court judge granted DCFS permission to move Wardell to a facility in Indiana, but that never happened.

In December 2015, Wardell’s lawyer asked DCFS to explain what it had done to find him a placement.

“I was fighting everybody because they wouldn’t let me go home,” he said.

He was released in March 2016, seven months after he had been admitted. Doctors had cleared him for discharge more than four months earlier.

Now 18, Wardell is back in high school and applying for summer jobs at a couple of fast-food restaurants and a grocery store.

James Martin is one of the agency’s most complex and difficult cases.

At 18, he is severely autistic and functions much like a 2-year-old in the body of a 6-foot-2-inch, 223-pound man. He broke doors, hit the people he loved and ran out of the house in the middle of the night.

He was placed in a specialized unit for high-risk DCFS children, but when he was ready for discharge from the hospital in November 2016, DCFS struggled to place him.

Martin’s doctor wanted him placed “as soon as possible.” He sent an email in April to DCFS in which he wrote he was “disheartened” to learn that the agency had not finalized a contract with an out-of-state facility.

Two more months passed before Martin went to a residential facility in Kansas. On his first day there, he rode a bike. Within a month, workers noted a sharp drop in the number of times he was physically aggressive or destroyed property.

“Why did it take so long?” his aunt asked.

Brasfield, Wardell and Martin are among hundreds of children each year who are held in psychiatric hospitals after they have been cleared for release.

Every day since July 2015 through December 2017, at least 9 children were held beyond medical necessity, with an average of 26 children held daily during that time.

Between 2015 and 2017, children across the state languished in psychiatric hospitals for a total of more than 27,000 days.

“It’s a waste of those kids’ lives,” said Dr. Mitchell Glaser, a child psychiatrist in Chicago.

A ProPublica Illinois analysis of DCFS statistics from 2015 to 2017 showed:

14%	of all psychiatric hospital admissions of children in DCFS care — more than 800 — went beyond medical necessity.
29%	of all children in DCFS care who were hospitalized were held beyond medical necessity. Many children were admitted to the hospital more than once.
21%	of all time spent hospitalized, more than 27,000 days, was medically unnecessary.
80%	of admissions that went beyond medical necessity ended with children waiting 10 or more days.
$6.9m	was spent on unnecessary hospitalizations instead of better options.

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