Dozens of Maryland children who have been removed from their families have languished in hospitals instead of settling in with foster parents or at group homes.
These children have been in medical hospitals or on psychiatric units, often for weeks at a time, even though they are not sick, injured or mentally ill. One such child was kept in a hospital for 636 days, according to a report from the Maryland Department of Human Services, which is charged with ensuring the well-being of the children.
The situation has drawn the attention of state lawmakers, who are concerned state officials aren’t doing enough to resolve it and that vulnerable children could be traumatized by being left at hospitals. They’re considering legislation that would limit nonmedical hospital stays for children who are in the social services system, in hopes of ending the practice.
“We are destroying these kids,” said Del. Kirill Reznik, a Montgomery County Democrat who is drafting the bill. “We are taking kids who are otherwise mentally healthy and we’re sticking them in psych wards. We are destroying them.”
Sen. Clarence Lam said it’s disturbing that children are stuck in “bureaucratic limbo.”
In a recent report to lawmakers, Department of Human Services officials wrote some foster children stayed in hospitals while they waited for spaces to open up in specialized settings, such as therapeutic group homes. The children may have complex needs such as being victims of sex trafficking, exhibiting “aggressive and or assaultive behaviors” or have a combination of low intelligence and behavior challenges, officials wrote in the report.
The report was the first time the state quantified the number of foster children who have been held as “overstays” in hospitals and psychiatric units. In the first 11 months of 2019, an average of 36 children per month were held in hospitals when not medically necessary — 19 in medical hospitals, 17 in psychiatric units — according to the report. July was the peak month during that period, with 53 children in hospital or psychiatric settings.
The children in hospital medical units were there for 23 days, on average, and those in psychiatric units were there for an average of 13 days.
“It is a shameful situation that some of our children who are in the most amount of need are in these situations with the least amount of help, and the state is turning its back for a long amount of time,” said Lam, a Democrat who represents parts of Baltimore and Howard counties.
Officials with Republican Gov. Larry Hogan’s administration responded Monday to request for interviews with a written statement, in which a Department of Human Services spokeswoman said officials face challenges finding places to send children with “complex needs” after they are examined or treated at hospitals.
“Finding appropriate placements for youth in DHS’s care is very complex, as each placement needs to be evaluated based on an individual youth’s specific needs and challenges, and every child is unique,” spokeswoman Katherine A. Morris wrote. “The more complicated a child’s behavioral health issues, the harder it is to secure individualized services.”
Morris wrote the state government has “multi-disciplinary work groups” addressing the issue.
She also wrote that the Department of Human Services staff is starting to work on post-discharge plans for youth from the time they’re admitted to a hospital, in hopes of reducing overstays.
Representatives from the Department of Human Services did not attend a briefing on the issue held last week by a House of Delegates subcommittee that Reznik chairs. Morris wrote that the department was invited to testify only an hour before, and that officials have offered to answer any questions from the subcommittee.
Reznik acknowledged the department was given short notice, but he said he hasn’t heard from officials since the hearing and hopes they will agree to appear before lawmakers.
The foster children go to hospitals for emergency psychiatric evaluations after acting out or suffering a crisis, according to advocates.
If doctors find a child is not a danger and doesn’t need psychiatric care, the child is supposed to be released. Other times, a child initially may need psychiatric care, but stabilizes after a few days, said Carroll McCabe, chief of the mental health unit of the Maryland Office of the Public Defender.
In such instances, however, case workers often won’t pick up children or they collect them and take them to another hospital, McCabe said.
McCabe and her team have represented dozens of children in involuntary commitment hearings before administrative judges to get them released from hospitals and psychiatric units. She said such orders are often ignored by the state, however.
“To be stuck on one of these units for a long period of time, I can’t imagine it,” McCabe said. “It’s just really sad. And the kids get sad.”
State officials previously said the overstays were a “rare situation,” said Lam, who also is looking into the issue.
Concerned that they weren’t getting a full answer, lawmakers withheld $250,000 from the Department of Human Services’ budget this year until the department compiled the report.
Advocates say the state is still lowballing the number of foster children in hospitals. For example, the state reported that no children were being kept in hospitals or psychiatric facilities in November. But McCabe said her team represented 38 children that month who were in hospitals.
Since her office began tracking these cases in October 2018, McCabe said they’ve counted 90 children who were kept in hospitals despite not meeting medical criteria for inpatient care.
McCabe said vulnerable children may be further traumatized by living in such places.
“A child’s life can become very small, because their whole world is the psychiatric unit," she said. “It might be one hallway with a day room and a TV. There is no school setup ... They’re cut off from their families and friends, they are not socializing.”
Mitchell Mirviss, an attorney with the Venable law firm in Baltimore, has been representing children in the social services and foster care system for 35 years. He’s involved in a long-running lawsuit over the quality of services provided to foster children in Baltimore.
“For me, this is the worst,” he said of the hospital overstays.
“I wish the decision-makers would understand just how destructive and traumatic this practice is to the children,” Mirviss said. “These children already have been traumatized very badly and we should be doing everything we can to provide them the best care we can — and instead, we are warehousing them in hospitals.”
Mirviss said it is unconstitutional and in violation of numerous federal and state laws to hold children in hospitals against their will and in violation of a judge’s order. Also, hospitals aren’t licensed to serve as a foster care facility, he said.
“You are forcing someone to stay in a psychiatric setting, receiving treatment that they don’t need involuntarily in a semi-incarceration-type environment,” he said. “They have no freedom.”
Mirviss said the state lacks enough places to care for these children, who may have challenging behavioral and social needs. He said state officials can fix that if they recognize the problem’s scope and figure out how much money they need to open more group homes and provide more support for foster parents.
“This is a problem that is solvable,” he said.
Reznik, Lam and other lawmakers are considering legislation they hope will spur state agencies to act. One idea is to limit nonmedically necessary hospital stays to no longer than a week. While Reznik doesn’t like the idea of children staying in a hospital even that long, he hopes the restriction would be enough to force change.
“It is my hope that this legislation forces them to come up with a plan for what we do with these kids,” he said.