Sunday, September 7, 2008

Shackling of mentally ill foster kids in Dade, Broward courts in question


Last month, a 16-year-old Broward County girl was brought into Circuit Judge John A. Frusciante's courtroom for a hearing. She was handcuffed, her legs shackled with cloth restraints, with two armed deputies leading her by the arm.

Her offense? She's never been charged with one. A mentally ill foster child who was neglected by her mother and wound up in a psychiatric center, the teen was being restrained to keep her from running away, her attorney said.

The girl, who is not being identified to protect her privacy, is among roughly 2,200 foster children in psychiatric centers in Florida recovering from abuse and neglect.

Now, the practice of restraining mentally ill foster children in court is prompting questions in both Broward and Miami-Dade counties.

In Fort Lauderdale, Walter Honaman, the 16-year-old's lawyer and an advocate for foster kids, is working with Frusciante and court officials to develop a voluntary policy to discourage deputies from handcuffing mentally ill foster kids who come to court.

And in Miami, a nurse practitioner who worked briefly as a director of patient care at Jackson Memorial Hospital's mental health center filed complaints with state regulators seeking to end the practice of restraining children who leave the hospital's residential treatment center.

''We bring these kids into the courtroom in handcuffs with armed deputies,'' said Honaman, who works for Legal Aid Service of Broward County. 'We don't maintain these kids' dignity, and we send the message that they are being punished. They are being treated like criminals. These are kids that need serious help.''

Real leg shackles -- the metal kind -- routinely have been used for delinquent children who appear in court, though several public defender offices mounted a statewide campaign two years ago to end the practice. In most counties, shackling continues, said Miami-Dade Public Defender-Elect Carlos Martinez, but The Florida Bar is lobbying for a new rule requiring hearings before restraints can be used.


Other states have questioned the practice of indiscriminately restraining children in court.

More than a decade ago, appeals courts in Oregon and Illinois ruled that children have a right to be free of shackles in court, lacking a specific danger.

Last year, the North Dakota Supreme Court ruled that a trial judge erred by not independently verifying a child, identified as R.W.S., was a danger when the judge refused to remove the boy's handcuffs in court, records show.

Also last year, two California appeals courts struck down the practice of shackling all youths who appear in court. And the North Carolina legislature recently passed a law requiring a hearing before restraints can be used.

Administrators at Jackson have defended the use of ''walking restraints'' when children from their treatment center leave the facility, arguing many kids run away, which can endanger them.


The treatment center ''uses walking restraints for safety and prevention of elopement when clients are sent to an urgent medical appointment or court hearings that they can't miss early in their admission,'' Helga Mayrgundter, a program director for one of Jackson's children's psychiatric units, wrote in an April e-mail.

Lorraine N. Nelson, a Jackson spokeswoman, said the children's psychiatric unit uses walking restraints on less than 1 percent of its patients when they are being transported outside the facility and follows all regulatory agency guidelines.

''The fabric restraints are only used when a patient is determined to be a flight risk and are removed immediately after a patient has returned safely to the facility,'' Nelson said. ``A board-certified psychiatrist with extensive experience in childhood trauma and behavioral management must write an order for the use of restraints.''

Jackson's use of foot restraints came under scrutiny beginning in April, when a new nurse administrator questioned the practice. The nurse, Lisa Burton, later filed complaints, including one to the Miami-Dade County Commission on Ethics and Public Trust.

The ethics commission ''conducted a thorough investigation of the allegations and ultimately dismissed the complaint,'' said Nelson. The commission findings, ''speak for themselves,'' she said.

In an April e-mail with other hospital administrators, risk manager Tish Batchelder wondered whether halting the restraints would lead to more escapes and put patients in danger. But she also acknowledged: ``I hate the idea that we do it.''


Some judges say there is even less justification for restraining mentally ill foster kids who have not been accused of delinquency.

''It's a horrible stigma,'' said Miami-Dade Circuit Judge Cindy Lederman, who heads Miami's juvenile courts. ``These kids already have mental health problems. I would imagine this would exacerbate them . . . . These are not bad children, and they have not done anything wrong. They are just ill.''

Frusciante said he has been asking questions of treatment center and courthouse staff members who bring children to court in restraints.

Among them: Do we have to do this?

''It was very disturbing,'' said Frusciante, who oversees child welfare cases in Broward. He said he wasn't disturbed enough to outright ban the practice at the courthouse, but he is working with Honaman to find ways to limit the use of restraints.

Most treatment centers elsewhere in the state have abandoned the use of restraints, according to internal hospital e-mails obtained by The Miami Herald.

''We do not use them here when we transport children,'' said Robyn Baskin, a children's program director at Personal Enrichment Through Mental Health Services in Pinellas County.

If a child is too great a risk, Baskin said, travel will be postponed or additional staff is provided to ensure safety.

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