Appendix — Parham v. JR
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VOLUME Il—Pages 352-717
APPENDIX
IN THE
Supreme Court of the United States
October Term, 1975
NO. 75-1690
T. M. “JIM” PARHAM, Individually and as
Commissioner of the Department of Human Resources,
W. DOUGLAS SKELTON, Individually and as Director
of the Division of Mental Health and W. T. SMITH,
Individually and as Chief Medical Officer of 2
Central State Hospital,
Appellants,
Vv.
J. L. and J. R., Minors, Individually and those
representatives of a class of persons similarly situated,
Appellees.
APPEAL FROM THE JUDGMENT OF THE
UNITED STATES DISTRICT COURT FOR THE
MIDDLE DISTRICT OF GEORGIA
APPEAL DOCKETED MAY 21, 1976
JURISDICTION NOTED MAY 31, 1977
TABLE OF CONTENTS
VOLUME I
Page
Relevant Docket Entries.....................00- Vv
Complaint—October 24, 1975. ...............0005. 1
i rs ee cedeweer. 17
Testimony of Dr. Wayne Hodges, given in hearing
before Judge Wilbur D. Owens, Jr., in Macon,
Georgia, October 30, 1975:
AE ee 20
EE 37
NEE EEE LOOP O CRE POT OO 48
Order Certifying Class Action, November 18, 1975... 49
ee I oe he le hw 50
ci icceccencevێdecdues 59
Revised Statement of Facts............../........ 62
Stipulation of Facts for the District Court Hearing.. 68
Exhibits to Stipulation of Facts................... 76
Deposition of Eli Charles Messinger................ 159
Cn cee esedoucesoes’ 160
SE Ee er 190
Redirect Examination................cccccee: 216
Deposition of Dr. W. Douglas Skelton.............. 217
ns ee ace venees 218
ee en dg ci wcenccececcecetste 225
EE SS TD 239
Deposition of Dr. Donald G. Miles and Dr. William
I eke Ce ee Oe ak 246
Direct Examination of Dr. Miles.............. 247
Direct Examination of Dr. Wieland............ 258
i
TABLE OF CONTENTS—Continued
Page
Direct Examination of Dr. Miles.............. 259
Cross-Examination of Dr. Miles............... 261
Redirect Examination of Dr. Miles............ 269
Exhibit 6—Admission and Evaluation from the
Geographic Service Areas................... 270
Deposition of Dr. John J. Gates and Dr. W. T.
a See OM Cae eek se abcndcedend 276
Neen ne cee buuwe 295
Ee SE 320
BepGIOes TMUMEMOEIOR.... 0. ww ccc ccc ccc ccccves 321
Ne cdeeweweus 321
Exhibit 4—Example of Admission Program and
Responsibility-Action Format............... 322
Exhibit 11—List of Therapeutic Activities
Sponsored by Central Georgia Regional
Sch Gaus ccduubauseeetiewaudeasenu ce 338
Exhibit 12—Minutes of the Utilization Review
Committee and Criteria for Admission to
Regional Mental Hospital.................. 345
VOLUME II
Deposition of Lawson H. Bowling................. 352
aS a 353
ed cuca keceuks Sax 366
Exhibit 2—Policy 2, Part 1, Screening Procedure
—Child and Youth Services................. 384
Deposition of Gladelle Whitaker.................. 390
" BRP ccc enctcceccccdccessens 391
a ee 418
direct Examination.................0..e00. 436
ii
TABLE OF CONTENTS—Continued
Page
Deposition of Dr. Eugene C. Jarrett, III........... 438
Ne ic oc bacenepheeesessees 439
ee cc dace vendeesesns 454
Deposition of Dr. Wladyslaw P. Mazur............ 475
Fed Ldakuadebseeses ets 476
REI Se 488
Exhibit 3—West Central Georgia Regional
Children and Adolescents Unit Policies and
ER ie 513
Deposition of Dr. James B. Craig.................. 519
Ne Ke Ce ices ee eeeseseeses 520
SS 531
Exhibit 2—Georgia Regional Hospital at
Savannah Children and Adolescents Unit
Screening Policy of Children and Adolescents
eee eed eh 6 kee naeeehe es 548
Deposition of Dr. Everett C. Kuglar............... 551
EE ee ee 552
eR, Do als ae See pu ade sv ebe dees 569
Exhibit 2—Children and Adolescent Program,
ES BOE ree 591
Exhibit 4—Georgia Regional Hospital at Augusta
Utilization Review Plan.................... 622
Deposition of Anne Etheridge..................... 631
ioe de cccewedeceennced 632
i ne ne eng seeeebsueactes 680
ccc ci peciatasecnenekes 682
TABLE OF CONTENTS—Continued
Page
Deposition of Dr. Arthur Talek........-...--+-+++- 686
Direct Examination..............csccececeees <
Cronp-Bnmnimatio®. ..... oc ccccscccccssccesuse 702
VOLUME Iii
Deposition of Dr. John Paton Filley............--. 718
Direct Examination... .........ccccccccccccces 719
Croge-Mimamimatio®. ..... 0 sec cccccsccecsccess 757
Deposition of Dr. Luciano L’Abate.........--..--. 795
Direct Examination. ......0ecsccccscccccsseces 796
Crose-Hamimatiom. .....0sesccccesccceusecess 812
Appendix ““B” to Defendants’ Supplemental Brief in
the District Court. .....ccccccccceccccceusseene 822
Attachment “A” to Post-Discovery Brief of Plaintiffs . 888
Attachment “B” to Post-Discovery Memorandum of
the Plaintifls. ......ccccvccenesseees anne 893
Report of the Study Commission on Mental Health
Services for Children and Youth................. 899
Affidavit of Judge Romae Powell. .............++-: 918
Affidavit of Judge Dennis Jones...........-++0++5: 927
Opinion of the District Court..........-----+++-+5 934
Judgment of the District Court............--+++++) 935
Order of the District Court Denying the Defendants’
Motion For a Stay...........ceeeceeecceeceeees 937
Notice of Appeal to the Supreme Court of the
United States... ..ccccccccccessussusesuseeuuen 947
Order of the Supreme Court noting probable
jurisdiction... ......... eee e cece eee tener eeeees 949
iv
IN THE
Supreme Court of the United States
October Term, 1975
NO. 75-1690
T. M. “JIM” PARHAM, Individ
Commissioner of the De Sieger syle
partment of Human Resoure
W. DOUGLAS SKELTON, Individually and as Directo,
of the Division of Mental Health and W. T. SMITH
Individually and as Chief Medical Officer of )
Central State Hospital,
Appellants,
v.
J. L. and J. R., Minors, Individuall
he ; y and those
representatives of a class of persons similarly situated,
Appellees.
352
(1)
IN THE UNITED STATES DISTRICT COURT
MIDDLE DISTRICT OF GEORGIA
MACON DIVISION
(Caption omitted in printing)
eposition of DOCTOR LAWSON H. BOWLING, taken
a 4th day of December, 1975, in Room 534 of the
Georgia Department of Health Building, 47 Trinity
Avenue, S.W., Atlanta, Georgia, before Jean M. Wall,
Court Reporter T-24, 1521 Mercer Way, Decatur, Geor-
fa
APPEARANCES: in
intiffs: GERALD R. TARUTIS, ;
aieeerens DAVID GOREN, ESQ.
STEVE GRANBERG, ESQ.
Georgia Legal Services Programs
Macon Regional Office
653 Second Street
Macon, Georgia 31201
ants: DOROTHY Y. KIRKLEY, ESQ.
a Assistant Attorney General
Department of Law
132 Judicial Building
Atlanta, Georgia 30334
2} *,*
MR. GOREN: The stipulations are all formalities are
waived and objections are reserved until the time of trial .
MS. KIRKLEY: Except as to the form of the question and
the responsiveness of the answer.
; ;, ifically
NOTE: (The signature of the witness was speci
waived by his attorney of record, Ms. Dorothy
Y. Kirkley, Esq.)
353 (3)
LAWSON H. BOWLING, HAVING BEEN DULY
SWORN AS A WITNESS, TESTIFIED AS FOLLOWS:
EXAMINATION BY MS. KIRKLEY:
Q Would you state your name for the record, please?
A Lawson H. Bowling, M.D.
Q And where are you employed, Doctor Bowling?
A I am the superintendent of the Georgia Regional
Hospital at Atlanta.
NOTE: (Defendant’s Exhibit Number One was marked
for purposes of identification.)
Q Would you identify Exhibit One? Just state what
that is, please, Doctor? Just state what that is.
A This is a curriculum vitae on myself.
@ And how long have you been superintendent at
Atlanta Regional, Doctor?
A Since May of 1968.
NOTE: (Defendant’s Exhibit Number Two was marked
for purposes of identification.)
[3]
Q Now if you would just identify briefly Exhibit
Two and its component parts, then we'll go back into
each of them in some more detail later in your testimony.
A Aili right. This is a looseleaf notebook which con-
tains the following lists by patient number of the children
admitted—-of the persons admitted age seventeen and
under to the Georgia Regional Hospital of Atlanta since
January 1, 1969. It shows the diagnosis made on these
persons and whether they were voluntary or involuntary
patients. It shows the date the person was separated from
(3) 354
the hospital, whether they were on convalescent leave,
and it shows the discharge date and to whom they were
released. It also contains a list by initials of children who
were denied voluntary admissions, including referral to
the Comprehensive Community Mental Health Centers
in the hospital’s service area. It contains written policy
and procedure of the childrens—child and adolescent pro-
gram for periodic review of patient cases. It contains the
written admission policies of the child and adolescent
program, and it contains the hospital’s policies and pro-
cedures for periodic review of patients by the hospital’s
quality review committee, which is a committee of the
medical staff, and this is commonly called a utilization
review in which the committee undertakes to see if the
utilization of the bed is proper, that is if the person oc-
cupying that bed should be occupying it.
Q Okay. Let’s go back for a minute to the first thing,
the itemized list of patients.
[4]
A All right.
Q We were discussing that off the record a minute ago,
and we determined, did we not, these were done manually
and they’re not in any particular order according to date
or patient number?
A That’s correct.
Q Who prepared that summary, Doctor?
A That—that summary was prepared by the staff of
the Patient Affairs and Records section of the Atlanta
Regionai Hospital.
Q Could you describe, please, what your role and
duties are as the superintendent of the hospital?
355 [5]
A Yes, as superintendent of the hospital, I am directly
responsible for the entire operation of the hospital, for its
administration and for the treatment programs and for
establishing policies and procedures for the proper opera-
tion of the hospital.
Q Okay. What counties does Georgia Regional Hos-
pital at Atlanta serve?
A It serves Cobb County, Douglas, Fulton, Clayton,
and the central and south services areas of Dekalb County.
Q Are there also community mental health programs
within this area?
A In that area there are nine established and operating
comprehensive community mental health centers.
Q Do they have satellite offices, also?
A Some of them do.
Q And what is your relationship with the community
mental health centers?
A We have written agreements with each of these
centers as to [5] the function of the center and the function
of the hospital. The basic philosophy of those agreements
is that—which is the basic philosophy of the hospital, is
that persons will be treated in the comprehensive com-
munity mental health centers in every possible instance,
rather than being hospitalized. The hospital’s philosophy
on hospitalization—this applies to all patients, including
the children and adolescent patients, is that hospitaliza-
tion is to be carried out only when the person is, by reason
of mental illness, unable to control his behavior, or con-
stitutes—by that—for that reason, a threat to his and
other person’s physical safety, when all alternatives to
hospitalization have been exhausted, and discharge
[5] 356
planning is begun upon admission. I’d like to add a state-
ment of fact to that, and that is that the hospital has been
critized in the public media for not admitting patients.
We’ve had statements come out in the press that the
patients who are taken to the Atlanta Regional Hospital
often beat the person back home that took them. The
hospital’s philosophy, then, is not to admit unless it is
required for stabilization of out of control behavior and
dangerous behavior. I’m talking about admitting—well,
that is essentially the basic philosophy. We handle volun-
tary or involuntary applicants in a similar manner, and
then relating to the comprehensive mental health centers
—well, the basic policy of the hospital is to either admit
to a bed or find a suitable alternate, and we seek out a
suitable alternate to hospitalization in every possible
instance, and the comprehensive community mental
health centers that I mentioned, are [6] principle places
that we make referrals to—if a person is not requiring
hospitalization.
Q What are you—just in your own words, what are
your policies with regards to admissions, and—with
specific reference to the admission of children and adoles-
cents?
A That they’re admitted only when their behavior is
unstable and out of control and constituting a danger to
themselves or others.
Q What process would they go through to get ad-
mitted?
A When any contact is made with the hospital to
admit a child, and this is true, also, with most adolescents,
they are referred to their comprehensive community
mental health center initially. The purpose of that is to
357 [7]
try all non-hospital alternatives first. The primary source
of such patients is the—are the county departments of
family and children services, and we have established
relationships with them in such a way that when they
have a potential—when they have a disturbed child
before them, they—the Departments of Family and
Children Services contact the comprehensive community
mental health centers first, before calling us. We have that
understanding with them. The purpose of that is to try to
ensure inappropriate hospitalization does not occur.
Q Are there ever situations where a child would not go
first to the community mental health clinic?
A Yes. Yes. I would like to add first before I answer
that, that not all comprehensive community mental
health center referrals are admitted, because the hospital
has a screening procedure, even after they are referred to
us from the mental [7] health centers, and the estimate as
to how many of those are turned back is approximate]
twenty-five percent.
Q Excuse me, that’s even from the community mental
health clinics?
A Even from the community mental health centers.
We do have direct calls, and when that call comes to the
hospital—I do have a document here that gives a run-
down or those kinds of contacts as from January the 22nd,
’75 up until the present time. It just covers that one-time
period.
NOTE: (Defendant’s Exhibit Three was marked for
purposes of identification.)
A Then the hospital’s childrens programs screening
procedure is carried out, of which there is a copy of that
written procedure in this looseleaf notebook under the tab
{7] 358
that’s called admission policies and procedures. That pro-
cedure is carried out—the purpose of that is to make
doubly sure that inappropriate hospitalization does not
occur.
Q Who would be involved in that screening process at
the hospital?
A The staff of the childrens unit. Then the kinds of
persons that are involved in that are called screening
coordinators, who are appointed by the program director
of the child—of the children’s service, and it includes
these kinds of personnel, social workers, psychologists, an
assistant director of education and a psychiatrist.
Q And this procedure is done after a referral is made
but before the hospital—the child is admitted to the
hospital?
A That’s done before the child is ever admitted to the
hospital.
Q You stated a minute ago what your philosophy was
and what some of the criteria were for admitting people to
the hospital, [8] that is if they were dangerous to them-
selves or others. Do you use that standard for children?
A Yes, we do. Dangerous to themselves or others, or
behavior that is out of control.
Q Do you have any policies with regard to the joint
treatment of a family while a child is in the hospital?
A It’s standard procedure in the children’s program to
immediately involve the available—the parents in the
treatment process.
Q Are you »ware in any percentage of cases, of reluc-
tance of parents to become involved in the treatment
program?
a
359 [9]
A I don’t know a percentage. There are a certain
number, that it is difficult for us to get them and keep
them involved.
Q Would you say that that would be—in ballpark, say
a quarter of the time, ten percent of the time . . .
A No, I’d just guess that it would be ten percent.
Twenty-five percent or less. The majority of the parents
cooperate on that. , i
Q And that treatment program would be carried out for
the family by the community mental health centers?
A Not necessarily. It’s—I would say primarily, on the
hospitalized children, it’s done by our own staff, but it
may be done by the community mental health centers.
Q Once a child is in the hospital, are there any pro-
cedures for reviewing his case? |
A Yes, and these are set forth in this looseleaf note-
book in the form of copies of those standing official hos-
pital and children’s program policies and procedures. One
is entitled “Rounds”, which is a regular meeting of the
staff which takes [9] place once each week, in which they
take a reading on the situation, the progress, and what is
known as the “Staffing procedure”, which involves—
which involves a number of things. It involves an initial
assessment of the problem, the formulation of the treat-
ment plan, and—that is carried out—that is followed up
by the regular rounds at which that is reviewed.
Q How often does one of these reviews occur, is there
a stated time?
A There’s a review of each case once a week.
Q By the—this policy on staffing procedures?
(9] 360
A Staffing procedure is done on the initial admission
primarily to formulate a treatment plan for the patient,
and there’s a third part of that policy which is called
“Termination conference’, which takes place about the
time the staff is of the opinion that the person—the child
should be discharged.
Q Do you know how many in-patients you currently
have on the children’s unit?
A Yes, there are fourteen.
Q Does that include adolescents?
A No, it does not include adolescents.
Q Do you have a separate adolescent unit?
A We do not. The adolescent patients are admitted to
the adult units, which are based on a geographic service
area. They—there is an in-hospital day treatment pro-
gram for adolescents.
Q How many adolescents are there currently in the
hospital?
A Idon’t have that number. Yes, I’m sorry, I do have
it. [10] The current in-patients, adolescents, twenty-two,
and I gave the wrong number earlier for children. I said
fourteen, it’s seventeen, so that there are a total of thirty-
nine adolescents and children combined.
Q What is the day treatment that you spoke of for
adolescents?
A That is a treatment of activities, group therapy,
which takes place during the hours of approximately
eight A.M. until four-thirty P.M.
Q Is part of that a school program for the adolescents?
A Part of that is school, yes it is.
361 [11]
Q You spoke about geographic units. You mean like
each county in your area is represented in your hospital
by a ward?
A Yes, it is. There are one or more buildings in the
hospital whose staff in that building are designated for
paticnts from the—from these several counties that we
mentioned earlier.
Q Is there a separate unit for each county th
mentioned? eames
A Some counties have one unit, there is one—and
others have two. That has to do with the numbers of the
patients that are admitted from the different areas be-
cause there are more people in some counties than others.
Q Okay. And the adolescents would be disbursed
among those different units?
A They are, as far as their—as to where their treat-
ments plans are formulated, they are formulated by the
staffs of those geographic units, and the patients—and the
adolescent patients live in those units, that geographic
area.
Q But during the day they’re all brought together?
A They are all brought together during the day in that
day program.
(11)
Q Do you have any idea what the current average
length of stay is for the children and the adolescents?
A I’m sorry, I don’t.
, ” mr be = spoke about a utilization review
, and that’s different, is it not, from the staffin
the rounds conducted .. . —
[11] 362
A Yes, it is. That is outlined in the looseleaf notebook.
That is a overall hospital policy and procedure which is
part of the proceedings of the quality review committee of
the medical staff, which—which committee is appointed
by the president of the medical staff, who is appointed by
me.
Q And how often would this utilization review occur?
A It occurs—they meet monthly to review utilization
of beds in the entire hospital, including children and ado-
lescents.
Q Would they review each case every month?
A No, they do not. They review a representative
sample of cases. They would not review every case in the
hospital every month.
NOTE: (Defendant’s Exhibit Number Four was marked
for purposes of identification.)
Q Would you identify that Exhibit, please?
A These are the admission documents and admission
instruments on all patients who are currently resident
patients at the Atlanta Regional Hospital, and it includes
data regarding their social history. That’s what it is.
Q And that’s for each child who is presently a
patient...
A That’s for each child and adolescent who is presently
a patient in the hospital.
[12]
Q Does this include social summaries?
A It’s supposed to include the social data that we
have. We do not collect a specific document that is called
bition eviews
363 [13]
social history. That—we have a data base that’s collected
on every patient and that includes social information,
plus additional notes that may be made by social workers
who are working on a particular case, and in instances
where that was the case, that was attached to these
individual admission instruments.
Q Would this include information gathered by the
community mental health program if someone had been
through a community program?
A It would include—yes, it would, although it would
not be in the form of a document submitted from the
center. It would include information that they may have
obtained prior to the person’s admission.
Q You were talking a bit ago about a screening com-
mittee even after a referral had been made by a mental
heaith clinic, is that right?
A Yes, the screening procedure that’s outlined in this
written policy and procedure in this booklet is carried out,
even on those patients who are referred by the community
mental health centers before a final decision is made to
actually admit the person.
Q Well, when...
A I’m talking about pre-adolescent children. I’m not
talking about adolescents. They’re handled by—in the
same manner that adults are in those adult units.
Q Okay. In this screening process, does the screening
committee [13] have additional information from the
community mental health clinics like prior treatments
and psychological examinations and psychiatric inter-
views?
[13] 364
A They do have additional information, and some of
which may—some of which may be in writing, and some
of which may have been obtained by them directly over
the phone.
Q So the information in Exhibit Three would not
necessarily be all the information upon which an admis-
sion decision was made?
A Wouldn’t necessarily be all of it, that’s right.
Q In this screening process, is another psychiatric
interview conducted by the admitting physician?
A The pre-adolescent children—the pre-adolescent
childrens unit has a psychiatrist who participates in the
admission procedure, and he—he interviews—he at least
sees personally—I’m sorry, that’s not correct. He does not
necessarily see the patient in person each time before he
is admitted, but he makes the decision as to whether a
person shall be admitted or not. That’s done by the phy-
sician—by the psychiatrist. And the same is true of the
adolescents in those adult units. All patients are admitted
to the hospital on the decision of the hospitai physician.
Q But you're saying it wouldn’t necessarily be on the
basis of a psychiatric interview by the admitting psy-
chiatrist?
A Not necessarily.
Would admission be preceded by a psychiatric
wae by a psychiatrist at the mental health clinic?
A I don’t specifically have that knowledge.
Okay. Do you know of any problem with regard to
ain who [14] are reluctant to take their children back
home when your staff recommends discharge?
365 [15]
A I can’t quantify that, but there are—there are
problems in a certain number of cases.
Q Have you got an estimate as to what percentage of
cases that might be?
A Twenty-five percent would be an estimate of that.
Q And how do you handle that reluctance, or that
problem?
A The staff works intensively with those parents on a
continuing basis, and where that’s a problem, they address
that as a problem, and if they’re absolutely unable to
place the parent—the child with the parents, or if it is
determined by the psychiatrist that it would be undesir-
able for that child to be—in the interest of his mental
health, that he be placed with those parents, then we seek
an alternate foster home type placement in collaboration
with the county Departments of Family and Childrens
Services. I might say that on occasion our staff has—has
sought out a foster home themselves, gotten the county
Family and Childrens Services to certify that home as
being proper to receive a child, and that was done in one
instance just recently, a child in Fulton County, who had
been in the hospital for two years. The staff sought out
a foster home and that child was placed in that home just
before Thanksgiving of this year.
Q But the resource you would use primarily for that
would be the county Department of Family and Childrens
Services?
A That’s the primary resource we use to place those
children.
Q And then sometimes—do they go into juvenile
court to remove [15] custody from the parents?
[15] 366
happens in some instances, yes. By the way,
a Pete > ae that child I mentioned, but a certain
number of these children have no natural parental figures,
so that we—we seek out surrogate parental figures, and
family—home settings.
Q One of the contentions in this case, Doctor, is that
there is a necessity for judicial proceedings in juvenile
court prior to the admission of children to the hospital. As
superintendent, do you believe that such proceedings are
necessary?
A I happen to be of the opinion that they are not
necessary, that there are many mechanisms to protect a
child from, shall we say, just being thrown into a mental
hospital. I’ve described a number of a we do
it at Atlanta Regional Hospital, how we un ke to do
it. I—it’s my opinion that where mental illness exists, that
physicians and staffs of community mental health centers
are trained and experienced in recognizing those condi-
tions, and that the subjecting of a mentally ill child toa
courtroom procedure, could be detrimental to his—could
cause him anxieties and tensions, fears, thet in my
opinion would not be necessary.
Q That’s all the questions I have.
EXAMINATION BY MR. GOREN:
' — — eas
Doctor Bowling, I’d like to ask you, initially, a
Pn relationship with community health centers. Could
you describe how they might get a referral and how that
would lead someone to coming to your institution?
; k directly
A Yes, I—you understand that I do not work
with [16] them in those centers, but the—they might get a
referral from an adolescent either presenting himself at
that center with a problem, a parent presenting an adoles-
367 [17]
cent with a problem, or a parent presenting a child with a
problem. They might get a referral from a family phy-
sician, pediatrician, they might get a referral from the
department—county Department of Family and Chil-
drens Services. I guess those are the principle ways that
people might approach them wanting a service.
Q Do you know what criteria the community mental
health centers use in deciding whether or not to refer kids
to your hospital?
A As far as I know, because of the relationships that
Mr. Baeszler, who is the director of the hospital’s program
has developed with these centers, it is essentially persons
whose behavior is out of control and constitutes a physi-
cal danger to themselves and others, that’s the primary
criteria.
Q Is that the same criteria that your hospital uses?
A Yes.
Q Do you know on what basis the community mental
health clinics arrive at that decision?
A Ido not. I don’t know how they reach that decision,
other than, I presume, overt behaviors on the part of the
child or adolescent.
Q Do you know how they get that information about
that overt behavior?
A No, I don’t. I don’t know whether they get it by
hearsay from other persons, or whether they actually
observe it.
Q But however they arrive at the conclusion that a
child or an [17] adolescent is exhibiting dangerous be-
havior or behavior that’s out of control, they then would
refer the case to your hospital?
[17] 368
A (No audible response.)
Q And specifically how would they do that?
: ‘ : d
A They would call the hospital childrens unit an
state the AP ares whereupon we would have them enter
the child into our screening procedure which I tried to
describe earlier, and which is outlined in this booklet.
Q You don’t know if that child was first examined by
a psychiatrist at the community clinic before the case was
referred to your hospital?
A Ido not specifically know that. I do know that those
centers have psychiatrists. I do not know whether they
specifically have an examination by a psychiatrist in each
instance. I just don’t know that.
Q Do you know if they are psychiatrists who work in
the center, or are they consultant psychiatrists?
A My-—I should think that in most instances they are
consulting psychiatrists on a part-time basis. I don’t know
specifically of any of those centers that have a full-time
child psychiatrist.
Q You also mentioned that you believe that your hos-
pital rejects about twenty-five percent of the referrals
from the community clinics?
A Yes.
Q Do you know what percent the community clinics
themselves reject?
A Ido not.
Q Okay. In the screening review at your hospital after
a, case is referred there, do you know exactly what that
screening review [18] consists of?
ae wth
369 [19]
A Well, it consists of—of everything that’s outlined in
this type of procedure. I don’t know how do give you a
capsule summary of that because the. . .
Q Well, how long would the screening procedure take
before it’s finalized and before a decision is made?
A Those—the decision is made at the—at the screen-
ing appointment, which is referred to in that policy pro-
cedure, and prior to that time there are considerable
amounts of data gathered about the child, which is out-
lined in there, and I would say that the screening appoint-
ment and the actual procedure would consume about two
to three hours on the average.
Q Is it important to gather such data?
A To gather the data prior to that appointment? In
my opinion it is.
Q Why is that?
A To—to obtain as much information as the staff can
as to what has happened to that child in the past and
what may have happened to him prior to him—as to the
reason for referring him for hospitalization. The informa-
tion, of course, is accepted from other persons. It’s not a
direct experience of the staff of the hospital.
Q How is this information verified by your screening
procedure?
A It is accepted on the basis of any verbal information
that’s given, of the staff of the hospital knowing or ac-
cepting the statement of the person that they are talking
to, that they are staff of the centers, and they—members
of our staff spend a certain amount of time in these
centers, so that [19] many times the persons know each
other personally and know that they are on the staff of
these treatment centers, and the written documents
would usually bear the letterhead of the referring center.
Who would you believe would be the primary
Pe of information when a child or adolescent is to be
admitted to your facility?
A Who would be the primary source of information?
Q Yes.
A You mean as to who—as to who would be the person
that would best be interviewed?
Q Right.
hild’s parents or
A I would say that probably the child’
parent surrogates, but not—wouldn’t limit it to that. It
should be—there should be additional information ob-
tained from such persons as a family physician who hav!
have made observations of the child in a professiona
manner.
te parents,
In regard to the parents or the surroga
a mentioned that with a certain percent of the cases,
and I believe you used somewhere between ten percent
and twenty-five percent, you noticed that parents were
reluctant to participate in their responsibilities for their
children, is that correct?
A That’s what I said, yes.
Q Okay. Why do you think this might be?
think there can be a variety of reasons. It can be
| aan as the parents feel guilty about having a arf
turbed child. They may wish to have some —
or other [20] persons to make this child different .
behaviors from what he is. They may feel guilt that t wd
did not—that they did something wrong in rearing be “
child. Those would be the principle reasons that I t '
they might be reluctant. It’s possible that they might no
Pitter cieee his ae ras
371 [23]
want the child. But all of those things would have to be
determined on each individual case, on an individual
basis, and that is what the staff is trained to do in their
professional practice.
Q Sure. You mentioned that one of the keystones is
involving the family itself in treatment?
A That is axiomatic in the treatment of children, is to
treat the parents and the child. It’s considered to be a
constellation of disturbance that exists, that where there
is a mentally or emvtionally disturbed child, that it
relates to the parents.
Q And therefore the parents themselves require
treatment?
A Yes, they do, they require—the parents and the
child are all treated in the treatment plan for the child.
Q Because of these kinds of situations, is it possible
that parents may misperceive or misinterpret or distort
facts when they are asked information about their chil-
dren?
A Yes, that’s possible.
* * kK kK *
[22]
* * kK kK *
Q But one of the things you said, I believe, was that
it’s often difficult to get parents to volunteer some infor-
mation. An example that might come to mind is, if the
child—excuse me, if the parent had a record of child
abuse, do you think that would be information that they
would readily make available to the screening...
[23]
A I would say they’d be more likely not to readily
make that available than they would but there would be
[23] 372
a certain number of them that might volunteer that in-
formation.
Q And for those who wouldn’t, would it be helpful in
making your decision to hospitalize if a court could dis-
cover that information and make it available?
A If that information were available to the staff, it
would enrich their data base, in making their decision.
Q Okay. When you were describing the admission
procedure, I don’t know if I misunderstood you or not,
but is a child, before he’s admitted to your hospital,
always examined by a psychiatrist at your hospital?
A He is always examined within twenty-four hours
after admission. The psychiatrist may decide to admit
based on the findings of the screening procedure, without
necessarily directly examining that child. I would say
that in most instances he actually does.
Q Would this bea... :
A He definitely does it within twenty-four hours,
which is the requirement of the Georgia law. The Atlanta
Regional Hospital has a one-half-time child psychiatrist
on the staff of this unit. The back-up to him is the psy-
chiatric and other medical staff of the hospital.
Q Okay. You made a distinction before concerning—
it seems like you make an important distinction between
children and adolescents. At what age is the dividing
line?
A The—what we call a pre-adolescent person is a
person through the age of eleven, and an adolescent is a
person age [24] twelve through sixteen. Those criteria
were established by the Division of Mental Health of the
Department of Human Resources.
373 [25]
Q Okay. How are pre-adolescents or children treated
differently than adolescents?
A There is a separate building and staff for pre-adoles-
cent children, and the adolescents are treated—I should
say the—in both cases the treatment plans for these
persons are developed—the treatment plan for the adoles-
cents is developed in the geographic units. That is a
major, essential difference in the way they’re treated. In
both instances—in the instance of both pre-adolescent
and adolescent persons, there is a development of a
specific written treatment plan for each individual, and
in the—another difference is that in—although in the
instance of both the pre-adolescents and adolescents
efforts are made to work with the parents, that is inten-
sely pursued with the pre-adolescent children. Those are
the essential differences in the way these two groups are
treated.
Q Is there a difference in admission procedures?
A There is a difference in the admission procedures.
Q What is that difference?
A The difference is that the adolescent patients are
not—do not go through this elaborate screening procedure
that the pre-adolescent patients go through. .
Q Why would that be?
A The geographic units have—have their admission
policies and procedures which are not—which do not
include this [25] —this very elaborate screening pro-
cedure.
Q Why do you make the distinction between children
and adolescents?
(25] 374
A Well, I suppose it’s because that those units, being
essentially adult units, they—there’s never been a special
admission procedure for the persons who are less than
seventeen.
Q Okay. A child in the scheme at your hospital who
reaches the age of twelve is considered an adolescent?
A Yes.
Q And a twelve-year-old would then be put on a geo-
graphic unit?
A That is the basic policy and practice. It is not fol-
lowed in every instance because the staff on the pre-
adolescent unit will sometimes retain a person a bit beyond
that age limit in the interest of his treatment.
Q And on the geographic wards are adult patients?
Say there might be situations where you would have a
twelve-year-old on a unit with adult patients?
A Yes, that’s correct.
Q What is it, in a child or adolescent which would
make your hospital want to treat them so differently?
A That situation arose through a series of circum-
stances that goes back some years. The hospital never
opened a separate unit for adolescents with a separate
staff, and until 1973 the hospital did not receive and treat
any adolescent patients. The-—in 1973 the Division of
Mental Health established a policy that all persons in the
geographic area of the hospital would be treated, and we
’ began to receive adolescent patients in the adult pro-
grams, and that’s—that’s how that situation, as it now
exists, occurred.
[26] -*
NOTE: (Brief off the record.)
375 (27]
Q Doctor, we were discussing the difference in your
hospital between how children and adolescents are treated,
and you were describing that children are considered to be
persons between—up until the age of eleven, and are con-
sidered adolescents from the age of twelve to sixteen.
A It’s through eleven and from twelve to sixteen.
Q Okay. Is it your opinion, then, that adolescents are
developed to the extent that they could function most
properly on an adult ward?
A They—there is disagreement in psychiatry and in
child psychiatry as to whether adolescents require a
separate unit and a separate staff. There is no disagree-
ment that each adolescent person requires a specific treat-
ment plan, and that most professionals believe they
should have a special treatment program, but that they
do not have to live in a separate unit. Or they may or may
not live in a separate unit, and they are—that is an issue
that the experts will disagree on.
Q Okay. Did you say that you felt that a hearing that .
might be provided for a child, might have some detri-
mental effects on that child?
A I did say that.
Q Do you think those same effects would be present
in an adolescent?
A Yes, I think they could be.
Q How about an adult?
A Let me modify my statement about adolescents to
say that I [27] think it would be less so in an adolescent
who had his personality more formed, and I would not
equate the experience in the three groups. I’m giving you
my opinion. My opinion would be that it could stimulate
[27] 376
—you might want to know in what way would I think it
would be harmful. I think it would-stimulate fantasies in
a pre-adolescent child that he—that might would cause
him to wonder what was going on or what might happen
to him, and that—well, excuse me.
Q Wouldn’t he also wonder what was happening,
what was going on, when his parents take him to be ad-
mitted to the hospital and he finds himself—and he is
accepted by the hospital and he finds himself in the
hospital?
A Yes he would. Either procedure is a ritual or scenario
which could stimulate fantasies that would produce—
could produce anxiety or fear in the child.
Q Okay, but these wouldn’t...
A Uncertainty.
Q These wouldn’t necessarily be present in adoles-
cents?
A I think they might be present—I think that they
could be present, but that their impact on the person
would more likely be less. The person could handle it
better, so to speak. In a more realistic manner—handle it
in a more realistic manner.
Q Okay. Do you know how many adolescents there
are on the adult wards at Atlanta Regional?
A Yes, it would be the numb ‘that we have in the
house at this time. Twenty-two.
[28]
Q I know it’s hard to try to reach specific ages, but
would a child or an adolescent at the age of twelve be
able to handle a hearing without too much detrimental
effect?
377 [29]
A I would not be able to set an arbitrary age on it,
because there would be individual variations.
Q Okay. In other words, a twelve might—a particular
twelve year old may be able to function fine, whereas one
who would be older might have more problems?
A That’s possible, because there’s a tremendous
variation among individual human beings.
Q Do you know if there are any twelve-year-olds on
adult wards?
A Yeah. I don’t specifically know that as of today,
but there very well may be, and there certainly have been.
Q This policy for distinguishing between persons
through the age of eleven and persons through the age of
sixteen, is that a policy specifically of your hospital, or is
that a state-wide policy?
A That is a policy of the Division of Mental Health of
the Department of Human Resources. It’s not a specific
hospital policy.
Q Okay. Excuse me, you said it’s not a specific hospital
policy, but the entire...
A It is a policy of the Division of Mental Health of
the Department of Human Resources. You asked if it
was state-wide, that would make it state-wide.
Q It’s your impression that all of the regional hospitals
make this distinction?
A That’s my understanding. I don’t specifically know
that to be [29] a fact, but that is my impression, yes.
Q Do you have any written policies from the division
that spell out—making this distinction?
< |
:
:
:
’
[29] 378
A I don’t believe I have a written policy that spells
that out.
Q But that policy was told to you?
A That policy was told to me by Doctor Charles Bush,
who was the former Deputy Director of the Division of
Mental Health.
Q And does the same policy...
A And it’s never been rescinded. Excuse me.
Q Okay. Do the same distinctions between children
and adolescents at the admission stage, come from policies
that are also told to you to be state-wide?
A The—you mean in the procedures for admission?
Q Yes.
A Those procedures that I outlined to you are the
procedures of the Atlanta Regional Hospital. I’m not
aware of the specific procedures of the other hospitals.
Q Okay. Doctor, concerning the admissions of chil-
dren, do you know the percentages—excuse me, let me
ask first, is there a certaim standard for diagnosis, a
standard document that you refer to to make diagnosis?
A There is, and it’s—it’s the International Nomen-
clature of Disease, I believe is what it’s called.
Q You do not use*D.S.M.-2?
A Is that the—what is D.S.M.-2?
Q The Diagnostic and...
A Yes, yes, yes, we use that terminology that’s listed
n the Diagnostic and Statistical Manual of the American
Psychiatric |30] Association, I believe, and that list is
379 (30)
contained within the International Nomenclature of
Disease.
Q Okay, I see. Using those diagnostic categories, do
you know which percentage—or what percentages of
various categories that children who are voluntarily ad-
mitted to you hospital, fall under?
A I don’t have that breakdown. I don’t have that
collated.
Q Do you have any idea as to—any approximation as
to which category would be more prevalent than other
categories?
_ A Yes, I would say that the--that the two—two most
prevalent ones would be number one, schizophrenia, and
number two would be behavior disorders of childhood
and adolescence.
Q What would they include?
A Well, the Nomenclature has seven separate classes
that come under that heading. Do you want me to name
those off?
Q Only a few who would think that—some particular
ones of those would be the most common in that category.
a
A I would say that probably the hyperkinetic reaction
would be the most prevalent.
Q Okay. Upon admission, are children and/or adoles-
cents informed of their rights as patients?
A They are.
Q How is that done?
A That is done by the admitting staff in the admitting
process on a verbal basis to the child.
[30] 380
Q Are there any written policies, procedures describ-
ing how to effect this information?
* [31]
A I don’t believe we specifically have that. There are
written policies and procedures in the hospital that—that
do require staff to impart such information to all patients
who are admitted.
Q And that would include children?
A That would include children and adolescents.
Q Are they given any written notice of these rights?
A The—each patient that’s admitted to the hospital
is given a copy of a booklet that is put out by the Division
of Mental Health. It’s called Your Rights Under Geor-
gia’s—in Georgia’s Mental Health Facilities.
Q Is that written especially for children?
A No, it’s not. It is written for—it is written for any
patient admitted, but it is not written especially for
children.
Q Okay. In your experience have you ever observed,
say, an adolescent objecting to his confinement in the
hospital?
A I can’t cite you a specific instance, but we-—he has
every right to do so and there are written hospital policies
and procedures as to what is to be done when a person
does raise such objections. For instance, there is a right
to apply for discharge, and tuere are written policies and
procedures in all units in the hospital’s manuals that are
on all units, that spell out that procedure.
Q A child can do that also?
381 [32]
A I can’t specifically tell you how that’s handled. A
child would have that right, but I can’t tell you that we
systematically practice that as a procedure.
[32]
Q As far as adolescents are concerned, do you know
the procedures that are involved and how they would
effectuate their rights?
A Yes, they can—they can say to any staff member at
any time that they do not wish to be—that they wish to
leave the hospital, and whereupon the standing policy
and procedure is to be carried out. Now the essence of
that is, that the person or his parent or guardian puts
that in writing, and we actually have forms that they can
use for that purpose, which the procedure calls for the
staff making available to them, and then that document
is dealt with so that the case physician reaches a decision
as to whether, within a specified period of time, as to
whether or not that discharge shall be granted, or whether
the hospital shall take steps to prevent it.
Q Can that request for discharge only be done by the
parent or guardian in the case of a voluntary admission
of a juvenile?
A I believe that—that that’s correct, because that is
the—the way that we understand that the law is presently
structured. Code Section 88-5 is what I’m talking about.
Q Okay. And this—and it’s possible that this could
be the same parent or guardian who you said might have
a conflict of interest with the...
A That would be possible.
** & * *&
Se
:
:
:
:
382
[36]
** * * *
Q What would the effect be if there were, say, an
udvocate for the child or adolescent at these rounds or at
the reviews that you [37] have, an advocate who would
not be there to disrupt the proceedings, but just to speak
on behalf of the patient?
A I would say no—no objections to that.
Q Okay. |
A And it could be helpful.
Q In the same sense, do you think it might be helpful
to have an opinion of someone who is outside of the sys-
tem, someone who in the same sense could give a different
perspective like an advocate .. .
A Well, that wouldn’t hurt anything. That wouldn’t
hurt anything, and it could be helpful.
NOTE: (Brief off the record.)
Q Doctor, how many physicians do you have in your
facility?
A We have eleven full-time and the half-time child
psychiatrist.
Q Are these physicians board certified in psychiatry?
A There are three of us who are board certified, three
out of the eleven who are certified in psychiatry.
Q And are all the others licensed to practice medicine?
A Yes, they are.
Q Are there any licensed only to practice in a state
institution?
A There are two physicians who are licensed to
practice only in the institution.
383 [38]
Are there any foreign born or trained physicians?
Yes, there are.
How many are they?
- O FP
Four.
2)
Do any of these physicians have difficulty with the
English language?
(38)
A These particular ones do not with the exception of
one, who has, I would say, minimal difficulty, in one phy-
sician whose primary language is Russian.
*~_* * * *
*S
Se
January 20, 1975
I.
Il.
384
EXHIBIT 2
Screening Procedure
CHILD AND YOUTH SERVICES
Policy # 2, Part I
Referral taken by Screening Coordinator.
If coordinator is not available, the referral will be
channeled to any one of the following team mem-
bers.
A. Social Worker
B. Psychologist
C. Assistant director of Education
D. Psychiatrist
Phone Contact Sheet
During the referral (Initial contact) the team mem-
ber taking referral will complete the Phone Contact
Sheet.
Each team member will have xeroxed supply of
Contact Sheets (sheet attached page # la).
Determine as soon as possible if the referral is ap-
propriate (i.e., has been referred to GRHA by
private psychiatrist or psychologist or has been
through a mental health center). If referral is
appropriate complete all questions on Phone Con-
tact Sheet. If it is not a correct referral, supply
person with name and phone number (see attached
page 1B) of the mental health center in his area.
File original Phone Contact Sheet of those referred
elsewhere in manila file folder located in secretary's
file cabinet (drawer labeled ‘“‘Screening’’). The
folder is labeled ““Phone Contacts Referred’.
Contact sheets of those not referred will be filed
under “Phone Contacts—Appointment Scheduled.”
Location for this file will be the same file cabinet
labeled ‘Screening’.
385
Policy # 2, Part I
III. Scheduling the screening appointment.
If the referral is appropriate, schedule a screening
appointment at GRHA no sooner than four work-
ing days after date the contact call is received. The
minimum four day period is to allow the screening
team to gather all the information needed to assist
in the disposition.
Record appointment date on blackboard and in the
screening appointment book located at Ward
Clerk’s desk.
Xerox copies of contact sheet. Place one in each
team member’s communication mail box, place one
in the folder established for child.
Folders to be established for each child scheduled
for screening evaluation. The folders will be located
in the same file cabinet as Phone Contact Sheets
(drawer labeled “‘Screening’’).
After the screening appointment, the original phone
contact sheet in folder labeled ““Phone Contacts—
Appointment Scheduled” will be (1) put in chart
if child admitted, or (2) stapled to folder on child
if child is referred elsewhere for treatment.
The team member taking the call is responsible for
getting (1) contact sheet xeroxed, (2) getting copies
of contact sheet to all other team members, (3)
starting folder on child, (4) recording appointment
on blackboard, (5) recording appointment in
screening appointment book, and (6) putting
original phone contact sheet in correct folder.
The screening team members are:
(1) Coordinator
(2) Social Worker
(3) — (alternate: Psychology Techni-
cian
(4) Psychiatrist
(5) Assistant Director of Education (alternate:
Teachers)
ee
IV.
386
Policy # 2, Part I
Each team member will be responsible for gathering
certain information pertaining to their particular
area.
Assistant Director of Education: Information;
responsibilities.
(1) Contact present or last school attended. —
(2) Visit the school and observe the child in the
classroom, if possible.
(3) If a visit to the school is not possible, contact
the teacher by phone. Counselors or school
social workers are alternates.
(4) If the school is closed (summer, holiday) con-
tact area office, caseworker or parent for in-
formation.
Complete 1 page or less hand written xeroxed
report of findings. Distribute copies to team
members no later than 1 hour prior to screening
appointment.
Put copy in child’s folder.
Put copies of any reports received from schools,
ete. in folder.
V. Psychologist: Responsibilities
(1) Contact the referring agency or doctor to deter-
mine testing information (extent of) available.
(2) Psychological tests will be administered if need
is determined by the psychologist.
Criteria for testing:
(a) No testing available within last six months.
(b) Question as to validity or prior scores.
(c) Determine if child in in TMR, EMR range.
(d) Psychometric services not available at the
community level.
(e) Question of LD problem.
387
Policy # 2, Part I
(3) Possible need for condensed battery of tests.
Though not as thorough as administering com-
plete tests, the condensed version would give
staff a general idea of where the child is funec-
tioning.
(4) Testing, etc. can be administered by the Psy-
chology Technician.
If the Psychologist determines need for testing (by
above criteria) and it is not available on the com-
munity level, the testing is to be completed during
the four day period ; (a) on one of the four days prior
to the sereening appointment, or (b) on the same
day as the screening appointment.
Complete a one page or less handwritten report of
findings. Xerox, distribute copies to team members
prior to screening appointment.
Put copy in folder.
VI. Screening Coordinator.
(1) Receives phone contact.
(2) Schedules appointments.
(3) Periodically checks to see if appointments are:
(a) on board
(b) in notebook for appointments
(ec) folder established on child
(d) phone contact sheets in correct location.
Team members have xeroxed copies.
(e) responsible for getting information from
referring agency. .
(f) involve community mental health center in
screening appointment; determine if repre-
sentative from mental health center will be
at screening appointment; coordinate in-
volvement of community mental health
centers and their contractual agreements
with other agencies and staff member re-
sponsible for implementation of contractual
agreements at GRHA.
VIL.
VIII.
388
Policy # 2, Part I
Social Worker/Social Work Technician
After taking phone contact or receiving notification
of contact and appointment scheduled, the follow-
ing items are to be completed:
(1) Make or coordinate home visit if possible.
(2) Gather as much information as possible on
family. Get reports from DFCS, Juvenile
Court, ete. if involved.
(3) See that agency representatives who attend
screening are treated professionally.
(4) One page or less hand written report on family,
social history. Distribute to team members no
later than one hour prior to screening appoint-
ment.
(5) Xerox copies of information to child’s folder.
Screening appointment.
(1) Thirty minutes before screening appointment
the team members assemble to discuss findings
Primary Therapist tentatively assigned at this
point. If Primary Therapist is not team mem-
ber, is notified to attend screening appoint-
ment.
(2) Client arrives and secretary assists parent or
guardian in completing face sheet.
(3) Team members meet briefly with community
mental health representative, caseworker, and
other involved service workers.
(4) Client and parent or guardian (unless is above
mentioned caseworker, etc) meet with team
members and other agency representatives.
(5) Interview child with parent in room,
(6) Child, parent/guardian asked to remain in
lobby while team members make disposition.
(7) Parent/guardian informed of disposition. If
referred elsewhere, the name and phone number
of referral agency is given to the parent. Dis-
ee
389
Policy # 2, Part I
position is discussed with mental health repre-
sentative.
If admitted:
(1) Primary Therapist above assigned com-
pletes data base with parent’s assistance.
(2) Secretary has parent/guardian complete all
consent forms, other necessary paperwork.
(3) Parent meets with Social Work Technician
to complete research forms.
(4) Staffing coordinator assigns staffing date.
If there are no beds available the child is placed on a
holding list. Admission will be upon availability of a
bed.
Final decision for admission will be with the con-
sulting psychiatrist.
390
(1)
IN THE UNITED STATES DISTRICT COURT
MIDDLE DISTRICT OF GEORGIA
MACON DIVISION
(Caption omitted in printing)
DEPOSITION OF
GLADELLE WHITAKER
Taken on behalf of the Defendants.
APPEARANCES:
For the Plaintiffs: MS. NANCY LINDBLOOM
Attorney at Law
Macon, Georgia
For the Plaintiffs: MR. GERALD R. TARUTIS
Attorney at Law
Macon, Georgia
For the Defendants: MR. DOUGLAS LACKEY
Attorney at Law
Atlanta, Georgia
[2]
This testimony came on to be heard in the District
Office of the Department of Human Resources, located in
Gainesville, Georgia, at approximately 3:00 p.m., Decem-
ber 4th, 1975.
MR. LACKEY: This is the deposition of MRS.
GLADELLE WHITAKER, taken for the purpose of
evidence in the matter of J.L. and J.R. versus Jim Par-
ham, et al. The parties hereto have agreed to reserve all
objections, except as to form.
(Signature of the witness is waived.)
~ee ee ane
391 [3]
GLADELLE WHITAKER,
being first duly sworn, was examined and deposed as
follows:
EXAMINATION BY MR. LACKEY:
Would you state your name for the record?
Gladelle Whitaker.
What is your address?
223 Lucille Lane, Toccoa, Georgia.
What is your occupation?
rer O F&F © F&O
Director for Stephens County Department of
Family and Childrens Services.
MR. LACKEY: Council for the Plaintiffs and
counsel for the Defendants stipulated that Mrs. Whitaker
is the custodian of the file—(To the reporter.) Off the
record.
(The parties went off the record for a brief [3] period
of time.)
MR. LACKEY: Counsel for the Plaintiffs and
counsel for the Defendants have stipulated that Mrs.
Whitaker is the custodian of the record of Jimmy, a
child, a minor child, who will be identified throughout
this Hearing either as J.R. or Jimmy or James. We further
stipulated that certain documents, which have been
excerpted from that record, are true and correct copies of
the documents contained in that record and that parties
will stipulate that these documents are being included in
the Court’s records with this deposition, subject to the
objections, which the Court has directed the parties to
reserve. The documents themselves are broken down in
[3] 392
this fashion: There is one white folder of materials, which
refer to the psychological examination given to the child;
there is one white folder, which contains documents re-
lating to placement attempts, attempts to place the child,
one white folder, which relates to reports of the child’s
behavior in various foster homes and other situations;
there is one group of documents, not in a white folder,
which are the reports of the case worker assigned to
Jimmy, beginning in December of 1974, and continuing
through the present date; there is one set of documents,
which constitute the Court order, the Petition, and sup-
porting documents, which resulted in Jimmy’s custody
being given to the Stephens County Department of
Family and Childrens Service. I don’t know [4] how to
identify the materials in the documents any more clearly
than that, unless you have something you want to add.
MR. TARUTIS: You can say that counsel further
agrees that these documents will not be attached to the
deposition itself, but will be submitted under separate
cover and will be numbered consecutively by counsel,
jointly.
MR. LACKEY: We have stipulated that any ob-
jections to these documents will only be to their relevancy
and not to their—and not to the form of admission. In
other words the documents have been properly tendered,
subject to your objections as relevancy.
MR. TARUTIS: Off the record.
(The parties went off the record for a brief period
of time.)
MR. TARUTIS: Councel further agrees that Mrs.
Whitaker is the custodian of the documents, that the
documents have been properly identified and placed into
7
393 (5]
evidence—have been properly identified and tendered for
placement into evidence.
MR. LACKEY: Subject to your objections?
MR. TARUTIS: Right. Counsel has further
agreed that Mrs. Whitaker is the custodian of these
records and that these records have been properly identi-
fied and tendered into evidence, subjeci to the objections
of Plaintiffs in this matter.
[5]
Q Mrs. Whitaker, you stated your position was County
Director of the Department of Family and Childrens
Services of Stephens County; how long have you been in
this position?
A Seven and a half years.
Where were you employed before you became
County Director?
A Asa case worker with the Stephens County Family
and Childrens Services.
Q How long were you in that position?
A Nine and a half years.
Q As County Director, what are your responsibilities
particularly with respect to adoptions and foster care in
the county? |
A The Department of Family and Children Services
has a responsibility for adoption, foster home placement,
working with protective services for children, which in-
cludes abandoned children, children neglected or referred
to us.
Q Without referring specifically to this case, can you
tell us generally what the procedure is in Stephens County
[5] 394
for the placement for adoption or for foster care for
children in your county?
A Children that are in custody of the department or
who are voluntarily released to the department, are the
ones we actively seek foster homes for or if we have per-
manent [6] custody—you would, you know, consider for
adoption, if they are an adoptable child—we try to use for
foster care a placement of an approved foster home within
our own county. If it’s an adoption, with permanent
custody, we submit material to the District Office, which
engages in finding the adopted home. We don’t seek
adoptive homes for specific children. Then getting back
to the foster care in our own county, foster parents have
the right to state what type of children, age range, etc.,
they can provide or care for in their own home. In the
event that we have a home that is full or does not meet
the needs of a specific child that needs placement, we
come to our District Office stating that we have this child
that needs foster care and that we do not have a home for
him in our county, and would she explore the district
foster homes. She keeps the central file here. A lot of in-
formation is not given to her, such as specifics in homes.
They just make a referral that this home has a vacancy
within this age range. We contact a worker in the other
county giving them some background information, some
information on the child, to see if maybe their foster
parents where the vacancy occurs could take care of this
child. We either get a yes or no answer. If this doesn’t
materialize, then we let her know this, that we need to
try to explore some other source over the state, then she
handles it from there.
[7]
Q How do you go about securing persons to operate
foster homes in Stephens County?
395 [8]
A This is an open decision—always we are open for
people to file an application for foster care. We may have
speaking engagements there at the Civic Club, programs
on the radio or spot announcements, advertisements in
the newspapers. We have been known, say, to run a cam-
paign, but we’re always open for people who may want to
apply to become foster parents.
Q You said that there were speaking engagements and
this type of thing, do you personally do that sort of thing?
A Yes. We involve either myself and maybe, you
know, some of the caseworkers in the services department
also.
Q Do you know how many foster children you have in
the county now for instance?
A No, that’s handled by the specific caseworker
assigned to that responsibility.
Q I believe you stated that you went to the district
and then went to the state. Do you have any connection
as to what occurs at the state level?
A Not really, it’s—you know, we make the request
and the Social Services Director may tell us to get the
material together and mail it directly to a person in the
state. We are responsible for getting the summaries to-
gether and information on the child, that is our respon-
sibility.
[8]
Q Okay. Let’s talk specifically about the matter at
hand, that being Jimmy. Can you tell us when you first
became acquainted with Jimmy?
A Jimmy was brought to my department by a rela-
tive—
[8] 396
Q Before you do that—are you going to refer to those
notes? If you want to look at them, feel free.
MR. TARUTIS: Off the record.
(The parties went off the record for a brief period
of time.)
Q Do you recall when you first became acquainted
with Jimmy’s case?
A Yes. Jimmy was brought to our department by one
of his relatives and a close neighbor of the family when he
was three months old. Upon observations from, you know,
lay people, because there was more than me involved, he
seemed to be malnourished and not fully developed for
three months as a child should be. This seemed to be an
emergency as the child seemed listless, his head was
larger than his body, his stomach protruded, his hands
and his legs were just—no flesh, just very small. So, we
carried the child to the Juvenile Court Judge, who made
an observation and gave us an emergency order at the
time to place him in foster care and get medical examina-
tions. The parents were notified and he set a date for a
Hearing, but the child was placed in an emergency situa-
tion at that particular time and he [9] was carried to a
pediatrician, who gave a written report to the Court, the
Judge, jor the specific Hearing when the parents were in-
volved. The Judge gave us the order for temporary
custody; at the time he was about three and a half months
old. He was placed in a foster home in Stephens County.
The home was an approved home for us for infants, it was
a widow lady. James was hard to discipline, he was a
head-banger and he didn’t seem to be fully developed, as
far as developmental charts. And, this lady, as I said, was
only approved for infants, so when he reached two years
397 [10]
old we thought he might have more stimulation in another
home and develop. So we moved him into another home
about the time he was two years old or just past two
years old. He received good medical care during the time
and it seemed as far as his physical development, to be
fine. He did have the problem of head-banging, destruc-
tiveness, as far as his crib, and I believe he tore up a
playpen by shaking. It was discovered that he had a
hernia and after his placement in the second foster home
he did have an operation in a local—in Stephens County
Hospital for the hernia operation. This lady didn’t feel
that he was up to a two year old range and she felt that
she couldn’t cope with him and his problems of apparent
temper tantrums and frustrations. So, it became necessary
to remove him in an emergency to another lady there in
that county, until we [10] could make some plans for him.
So within that same year we had three placements to
foster homes, in the hospital, before he went into a home
in Fannin County.
Q What year was this, do you recall?
A This is where most of his behavior problems became
apparent, he was referred to Crippled Children’s—this
was in 1964 and ’65.
Q Where did he go next?
A Then he was referred to Aidmore Hospital for an
evaluation, phychological, EEG, in an effort to determine
what was causing the behavior problems, if it was physical
and neurogical. He stayed there about two weeks and
then I moved him from there to a home in Barrow County.
During the time that I did move him—when I went to
Aidmore to pick him up, I was unable to relate to the
child. One of the attendants had to put him in the car. He
[10] 398
spit and threw things, and I had carried toys and stuffed
animals, of course, to entertain him. He even threw those
at me in the car. He seemed very frightened and he held
on to the window handle until he relaxed and went to
sleep. Then when we got to the foster home, he did the
same thing. You know, outside he picked up a rock and,
of course, being uncontrolled as far as aiming it, he hit
the car with the rock, he spit at me. And, it was finally
decided that the foster mother might be able to get him
more accustomed to being at their [11] house if I left. So,
we left him with these people.
Q What were these people’s names?
A Timms. This was in November of 1965, he was
placed with them. They worked real hard with him. We
have records to indicate that they tried real hard to work
with him and seemed to show some degrees of improve-
ment, except at times when his attention span and low
tolerance level would be evident. Then they had to ask for
him to be removed due to circumstances. He never did
quite relate to this particular family, he didn’t stay there
quite two years. Then in July, we found a home and went
to the Satterfields, and this is in White County.
Q What year was this, please?
In 7/18/67.
In July of ’67, he went to the Satterfields?
Right. And, this is where he had his longest stay.
He was there until 6/24 of 1970.
What responsibilities do your foster parents have
A
Q
A
Q How long was he there?
A
Q
with respect to the child’s physical and mental well-being?
399 [13]
A Well, just as any parent would be to their own
natural child. They are supposed to have proper physical
examination, dental examinations. If there is a problem
emotionally, referral to the proper source for evaluation
and [12] treatment, if necessary. Our agency requires in
the smaller children, with infants, monthly examinations
and as they get older, you know, six months exa®nations
or yearly examinations, physically.
Q Iam handing you this file, which I have previously
identified as the file containing the psychological informa-
tion on the child. Do you recall when the child was first
referred for psychological—let me rephrase that, when
the child was first sent for a psychological evaluation?
A This file indicates that the earliest psychological
was done in 1965.
Q Can you recall what—between 1965 and 1970—
what psychological treatment or evaluation that the child
was given?
A This would be under Crippled Children Services
and this was the work with the nurse in Fannin County,
with the referral to Aidmore pediatric psychological
examination, and this is the reports.
Q So the trip to Aidmore was the first psychological
evaluation? |
A That we actually can recall.
Q Now, would you continue and I’m only concerned
with the period, say, between 1965 and 1970. What other
psychological evaluations did he have?
A Now, this is Doctor Clark at Aidmore in October of
[13] ’65, and the EEG was at Emory University Clinic in
[13] 400
October of ’65. This record is a little bit fuller, because it
gives some of the nurses’ reports.
Q Is this still from Aidinore?
A Yes. It’s Crippled Childrens Report, which would
include Aidmore and it’s more than this first one here,
more detail.
Q If you’re going to refer to the documents, why don’t
you—in the future, you don’t have to do it with that
one, but just identify them by date, if you could, and the
letterhead, if there is one?
A I think the transmission of the material—December
12, ’66, this is a psychological evaluation.
© Who was that done by?
A This doesn’t have any name, but when we submit a
social summary for adoption we leave off names and this
looks like a Doctor Young.
Q Who is Doctor Young?
A Florene Young at the Psychological Clinie at the
University of Georgia in Athens. She felt he was a little
bit—I can seem to remember—that she felt he was a little
bit farther advanced and she wanted to test him again.
So, she did so on April the 21st, of ’67.
Q Another psychological evaluation?
A By Doctor Young. And, another one on May 1, ’68.
[14]
Q By the same person?
A Yes, by Doctor Young. Then in ’68, this is when he
started exhibiting problems in the Satterfield home, be-
cause this changes—the psychologist and the referral—
we have a psychiatric evaluation from Doctor Griffin.
401 (15)
Q Who is Doctor Griffin?
A He isa psychiatrist in Gainesville.
Q And, the child was referred to him when?
A October of ’68. He was in the Satterfield home at
that time.
Q He was referred to Doctor Griffin?
A Right. He also was seen by Doctor Goldstein on
the same day.
Q Who is Doctor Goldstein?
A He’s a clinical psychologist.
Q What resulted from these evaluations, anything?
A This indicated that he might need treatment and
we set up ten treatments by psychiatrists.
Q Explain how that occurred, if you would, you say
you set up ten treatments by psychiatrists?
A Well, the funding process and the money available
for those, we have to get it approved and there is a special
form for a request for psychiatric services that needs to
be prepared.
Q Is that document you are referring to the referral
[15] document?
A Yes, referral for psychiatric services. And, this was
referred to the district office at that time, who gave the
approval. That was the current policy in effect at that
time, this was still in 69.
Q What happened after that?
A Then the Mental Health Clinic had something to do
with it, this is a letter by Jean Meeks, who reviewed
[15] 402
Doctor Griffin’s and Doctor Goldstein’s evaluation, be-
cause he was having some problems.
Q Was this leading up to the approval for the ten
treatments?
A No, that’s after that.
Q Did the child receive the treatments?
A Yes.
Q Is that reflected in those files?
A I’m sure. Hall County Mental Health Clinic was to
provide those. That’s the letter indicating where they
were set up. Those ten treatments were given through the
Hall County Service—Mental Health. Then there was a
mental health clinic that was set up as a satellite in
Toccoa and we started taking him to the Toccoa Mental
Health Clinic.
Q Who was in charge of that health clinic?
A This was a Mr. McFarland.
[16]
Q How often was he treated there, do you know?
A It seems that he started in May of 1969, and con-
tinued until he was placed in Central State Hospital, so it
would be a whole year.
Q As I understand, he received treatment in Gaines-
ville—
A Prior to May of ’69, right.
—and then received treatment in this—
On an outpatient basis.
OF &
—period at the mental health clinic?
403 [17]
A Right. This next document that follows in this file
is the running narrative by Mr. McFarland, ACSW. And,
it also has notes—but he was also seen by Doctor Cole
and Doctor Curtis.
Q Who is Doctor Cole?
A Doctor Cole is the Ph.D. and Doctor Curtis is the
psychiatric consultant, they both were connected with the
mental health clinic in Toccoa at that time; that’s from
their records. The next February 2nd, 1970, is a letter
from Mr. McFarland to Nell Crisp, with a copy to
Stephens County Department—Nell Crisp was the case-
worker who supervised Jimmy in the Satterfield foster
home. She was not connected with Stephens County, it
was White County and she was the worker that supervised
him. The next document has medical attachments with
~ some psychologicals prepared [17] by our worker, Barbara
Carpenter, which supplements the social study update for
adoptive placement. And, this next is a copy of the last
contact with Doctor Cole and Doctor Curtis.
Q@ When is that dated?
A June the Ist, 1970.
Q Do you know when the child was sent to Central
State Hospital?
A In June, 1970.
Q Now,.do you recall or is there any—are there any
documents*in that file pertaining to why the child was
sent to Cektral State Hospital?
A In this particular file here, Mrs. Carpenter was our
caseworker and she worked with the mental health clinic
there in Toccoa. And, there is a copy of a letter that she
[17] 404
had sent to Mrs. Pittard here in the district, who was our
Field Rep. at that time, stating that Mr. McFarland had
indicated that there was not any—they had recommended
institutional care and he did not know of any institution
for Jimmy, other than Central State Hospital; this is from
a letter from Mrs. Carpenter to Mrs. Pittard.
Q Do you have any records of any conversations
concerning the same subject to that file?
A This is the one that substantiates it here, it’s a
recording of—caseworkers at that time made recordings
[18] of contacts that they had.
Q And, what does that reflect—he was still in the
Satterfield’s home; is that right?
A Right; it was still hearsay. And, all of this time he
was having trips to the mental health clinic provided
either by our worker or a volunteer worker, or the worker
in that part. This indicates that at one time, through
Mrs. Pittard, that she had—since institutional care was
recommended that we try the Village of St. Joseph or the
Ethyl Harp Home.
Q I'll get to that in a moment. What I’m concerned
about now is, is there anything in that record that indi-
cates who recommended that the child be sent to Central
State Hospital?
A This is in the form of the letter that came from Mr.
McFarland at the mental health clinic, and the contacts
with him and the Public Health Nurse about an applica-
tion to Central State Hospital.
Q I'd like for you to be more specific. What does that
page reflect concerning this?
A This contact on 6/1/70, worker talked with Mr.
405 {20}
McFarland at the mental health clinic, but he could offer
no services for James. He did state that it would probably
be better for James if he could stay with the Satterfields.
Mr. MeFarland says he knows it would be hard for anyone
to [19] live with James since he is starting to express his
anger and hostility outward, and this will probably in-
crease as he gets older. He stated that probably an insti-
tution might be good for him as no one would be trying to
establish a one to one relationship with him as they
would in a home situation.
Q That’s the Director of your mental health center
there?
A At that time, yes.
Q And, was it at this time that you had him sent to
Central State Hospital?
A Yes.
Q Now, |..’s consider the other steps that you all—is
Jimmy on the—have you taken any steps to have Jimmy
adopted, do you recall? How does that work?
A Permanent custody was given to our department in
1966, and actually when we have permanent custody of a
child when we’ve been—you know the Court Order says
for the purpose of placement for adoption. We then pre-
pare what we call a social study on the child, you know,
summary of life experiences, current health, emotional
and social adjustments, paternal background. And, be-
cause Jimmy had had so many moves and problems, we
made an urgent request to the state office to try to find a
home for him for adoption, prior to him going to the
Satterfields. So, once [20] a study is submitted it is sup-
posed to be available for consideration at any time. This
is on the state level.
[20] 406
Q So, the adoption procedure is on a state level and
the county has nothing to do with it?
A That’s right. The county’s part is submitting the
social study.
Q Now, before Jimmy being sent to Central State
Hospital, were there any other institutional alternatives
considered?
A Yes, we did explore—we wrote letters to the Ethyl
Harp Home and the Village of St. Joseph. Those two
institutions at that time, to our knowledge, would take
children with problems such as Jimmys or an I.Q. level
such as Jimmys. And, this record that I was just referring
to also points out that Mrs. Luce, who was the admission
counsel at the Ethyl Harp Home, happen to be in our
office on another matter and she looked at Jimmy’s
records and said it’s not likely that they could meet their
program.
Q That was at the Ethyl Harp’s Home?
A Right. That recording is in response to the letter we
wrote to them.
Q And, that response is in this file, which is marked
psychological?
A Right. Recording by the caseworker.
Q What about at the other institution you mentioned,
{21} St. Joseph’s?
A The Village of St. Joseph requires that there be
a foster home situation for them to have their visits, you
know, to return to on holidays or week-ends. And, we did
keep the Satterfields in mind, because they were very
fond of Jimmy and we wandered if this could be a resource
407 (22)
for him to, you know, have to go back to for visits. And,
they said they could not take on this responsibility.
Q So, you had no foster home?
A No foster home and the institution plan fell through.
Q Okay. So, he was sent to Central State?
A Right, but we were in consultation with the people
in mental health on this and this was the advice given.
And, we talked to Doctor Charles Bush in Atlanta by
telephone and told him the situation and then he called
back and told us that Jimmy could go on the 25th. So,
this was all in June of 1970.
Q Did you have any recommendations from any other
person, other than this—is it Doctor McFarland or Mr.
McFarland?
A Mr. McFarland.
Q Mr. McFarland. Were there any recommendations
other than from his center that the child be institution-
alized?
A I’m not familiar with that, unless I searched back
(22] through the records.
Q Was that the primary you sought institution-
alization?
A The children’s unit at that time had just been
established, the building at Central State, and this was
the type of recommendation that—they were saying that
they could treat children such as Jimmy. At this time
they had to have an I.Q. of over seventy and they could
deal with problems such as he had. Now, those regulations
are changed now, but this was true in 1970, when Jimmy
was there in ’70.
[22] 408
Q Now, considering the periods since 1970, did you all
make any efforts after 1970 to do anything with Jimmy?
A Yes,—may I add something?
Q Sure.
A When Jimmy was taken to Central State and went
through the admission procedure, they did some more
testing to see if he was eligible to be admitted. I’m sure
after he got there, if they found out that he was ineligible,
they would not have taken him that day, but they did go
through this.
Q Let me phrase the question like this: When a child
from your county is taken out of a foster home and put
into an institution, what happens at the county level then
concerning any future placement of him?
A Well, always the purpose of the county department
when we have custody of a child is try to move him on
into [23] something that is permanent. If it’s temporary
custody, work with his parents to get him back with his
parents. If that doesn’t materialize permanent custody
that leads us to permanent placement.
Q So, you all are solely responsible for the child?
A Right.
Is an active file maintained on the child?
A Right. There is never a time our department should
have a child hanging in limbo. I mean the purpose is to
work toward permanency.
Q Is he assigned to a caseworker?
A Right.
Q Now, after 1970, can you tell us briefly what at-
409 [24]
tempts were made on Jimmy’s behalf to get him out of the
hospital or to place him somewhere else?
A Basically, we kept the Satterfields still in mind for
Jimmy, because they were real fond of him and I think
it was really heartbreaking for them to let him go. They
did have him back on visits. Each time there was a visit,
holiday time, when he first was admitted, he did return to
the Satterfields for visits in their home. The record indi-
cates that in ’71 was the last time he had a visit. So we
checked back in the record and found out that he had
been a disturbing factor during that visit and she had
other foster children in the home. So she discontinued
having him [24] back for visits, because he didn’t seem to
relate well with the other foster children.
Q Mrs. Satterfield had other foster children?
A Yes, after ’71.
Q Do you recall how many she had?
A That was not a home in Stephens County, but from
the record, I seem to recall that there were two girls there.
Q In addition to Jimmy?
A Right.
Q So, Mrs. Satterfield—this wasn’t her only experience
with a foster child?
A That’s right. I believe at that particular time the
last time he was there, he got upset and tore the screen
door off and broke up some canned vegetables, and tore
his own shirt off.
Q What other attempts were made to secure a place-
ment that you recall?
[24] 410
A Now, I was checking the dates—we had a request
in Toccoa, Stephens County, by some people who wanted
to be boarding parents. So, during Christmas of 1971, we
brought Jimmy to spend the Christmas holidays with
them. And, this is unusual, I know, but after Jimmy
visited with them, they withdrew their application to
become boarding parents. Then we did try to find some-
thing else for Jimmy [25] and we always went back to the
Satterfields, you know, to see if they would take him and
we got a negative reply until 1974, but also during that
time we had another couple in Stephens County that was
interested in becoming boarding parents. Jimmy did not
visit with them, but we did ask them if they would take
him for one of his holiday visits, they said, no, that they
would not be able to take him. So the next visit was back
with the Satterfields in ’74, this was summer of ’74. And,
continuing effort to follow any lead had always been in the
back of our minds, because I did some speaking at Civic
Clubs and carried some pictures of Jimmy at one time to
a Civic Club meeting to see if we could solicit some
interest for him as a particular child. He was referred to
Child Service and Family Counseling through Mrs.
Dixon in Atlanta, you know, for possible placement.
Q Well, I'll get back to that in a moment, I want you
to go into some detail. Are the Satterfields not in Stephens
County?
A No, they are in White County.
Q How was that placement arranged originally, do
you recall?
A Through the district.
Q Through the district?
A Like we explained, you know, if we didn’t have a
a er re =~ &
411 [27]
[26] place in our county, district, we would consult a
Field Rep.
Q So, there has been some coordination through the
district for Jimmy?
A Right.
Q Now, what efforts, when you were relating how you
did this procedure, you said you went from the county to
the district to the state; were any efforts made by the
county to get him into the state placement system?
A Right. The one that I recall most was in ’73, to Mrs.
Dixon from Child Service and Family Counsel. Also
during ’73, we sent materials to Muscogee County for
foster home recruitment for special children. This was an
effort on their part to try to see what they could do to
meet the needs of special children.
Q Muscogee County?
Q Yes.
Q Do you know any more about that program than
what you just described?
A I just know that it was approved—the District
Office, we learned that they were starting a recruitment
campaign. It probably came through the state, that they
would take any child with special needs through the state
and do the publicity. We sent some pictures in that area
of the state, because he was not known, with a short
summary about him. This was sent to Muscogee County
to be included, [27] but we had no feedback from that.
Q By no feedback, I take it you mean no offers to
take him?
A Right.
[27] 412
Q Now, you also mentioned at the same time something
about a state list; would you explain that?
A Yes. I understand that children that are hard to
place or children with special needs, a small summary is
prepared and circulated throughout the state through the
Field Reps., it comes from the state office.
Q Did you refer Jimmy to the state for that purpose?
A Yes.
Q Is that reflected in your records?
A I don’t believe it’s in any of these records, but for a
telephone conversation I had, I knew he was still con-
sidered on that list as of November of ’74.
Q Now, is it your belief that Jimmy is still on that
list—what is the state list, can you explain that?
A It’s just a memo type thing that bus children re-
ferred to by first name and their birthdate and maybe
which county has custody, and just a brief description.
Q And, Jimmy’s been on that list since when in 1973?
A As far as I can—feel like it’s 1973. I thought I
might have quoted that in this material right here, but I
[28] don’t see that I did.
Q Now, were there any other instances where during
this period there w@e inquiries made to other institu-
tions besides Central State?
A No, other than the Village of St. Joseph and Ethyl
Harp’s that I’ve already talked about. We did a special
adoptive search that I haven’t mentioned. The Casper
home in Hall County and the Helton—individual parents.
Q Go ahead and explain that.
ee
413 [29]
A This was through our district helping referring us
to possibilities. One was the Casper home in Hall County,
this would be adoption, and this was in a letter of June in
1972. And, then Helton was an individual single parent
adoption and this was a White County man. Then there
was also an inquiry into Franklin County, which would
either be adoption or foster boarding care leading into
adoption.
Q Do you know what happened to the possible place-
ment with the Caspers?
A The letter in the folder from Barbara Griffin indi-
cates that they were having some financial reversals at the
time and would not be considered for Jimmy or for any
child.
Q What happened to the single parent placement?
A This man lived next door to his family and would
[29] rely on his family providing care for a child that he
would adopt and his father died of cancer, so he with-
drew, but anyway altogether.
Q So do you know of any other placements that have
been attempted on behalf of Jimmy during this period?
A That’s about all I recall, until it gets to this case-
worker who is involved with him now. We didn’t make
any reference to those state referrals where we had one
piece of evidence from District Three that they didn’t
have a home for James.
Q Would you explain what that is?
A That was one of the referrals statewide from the
Field Rep. similar to this issued. Mitch Turner, you know,
replied on a memo that he didn’t have a home for a child
such as this.
[29] 414
Q That’s where your district refers to somebody else?
A Right.
Q
So, there were responses from other counties I take
A Right.
Q Are you familiar with the Alpine Center?
A We know of the Alpine Center, it’s not a residential
center.
Q Did you investigate that as a possible—
A Yes, we found out it was not residential, it had
[30] been suggested. It’s to treat emotional problems, but
it’s not a school level and it’s associated here in Gaines-
ville, I think, in conjunction with Brenau College, but not
residential.
Q Is that the third institution that you—
A Right. We grasped at most anything we heard
about.
Q Now, I may have asked you, I’m not sure—do you
ever stop recruiting for foster homes?
A No.
Q And, do you know if you have any children await-
ing a foster home now besides Jimmy?
A We do not have any.
Q And, he is assigned a caseworker?
A Right.
Q Do you know if he has always been assigned a
caseworker?
——
415 (31]
A Yes, this is a policy in our department to consider
the case load. There is a card on each active child, it
becomes the case load for the caseworker, assuming the
child with their responsibilities.
Q So, on every active child there is a file and there is
some sort of index card also?
A Statistical card, right.
@ Are there any reports that are filed by the depart-
ment which reflect the existence or non-existence [31] of
this child?
A Right, with a monthly report.
() It’s a file reflecting —
A Eacr child that we’re responsible for and the
activity of that particular child.
() And, Jimmy is carried on each of these monthly
reports?
A Right.
() Are you responsible for those reports?
A The caseworker and a clerical worker.
() I mean do they come to you or through you?
A Well, I see them once, but they are supposed to be
accurate and prepared when they get to my desk.
() Now, the third file that we haven’t mentioned any-
thing about concerns reports on Jimmy’s behavior. How
are these reports—aad particular those that are filed in
that file I just gave you—how are those reports prepared
or by whom are they prepared?
A I need to go back, because procedures have changed,
the current—is different. Back when Jimmy came into
[31] 416
care, the home county and the worker responsible for the
case would prepare a narrative, social summary data,
information that we may have obtained from neighbors
or foster mothers. If the child was in another county in a
foster home, Stephens County would not go into another
[32] county, you know, to visit with this child. He became
the responsibility for supervision for the worker assigned
to supervise that particular foster home. The responsi-
bility was that they would keep a case record and narra-
tive pertaining to each visit, office contact, telephone call
that pertained to this particular child and they were to
share these records with the county of responsibility.
Q And, that’s how those records are prepared?
A That’s right, that was the procedure, back when
Jimmy came into care.
Q How long was that the procedure, do you recall?
A Well, it was there when I came and I think it just
has changed with this CSIS data control.
Q A recent change, when did this form—
A I think it must have been ’74 or ’73.
Q Based on your position as the County Director and
your experience since 1963 with this child, do you have
any opinion as to why you haven’t been able to get him
into a foster home?
A Well, mostly the records here indicate that he was
given up, because of the behavior patterns and foster
parents have been unable to cope with him. This is re-
flected throughout each placement that he has had.
Q Have the same problems been reflected in every
home?
417 [34]
[33]
A It seems that even with visits, you know, he has
exhibited some kind of behavior that has not been accept-
able to foster parents. Now, I really have not talked to a
lot of them just to say why can’t you have him, you
know, this way. They just have the right to choose to
accept or reject a child we ask them to care for.
Q Have you observed any improvement, based on
those reports, say in his recent visits?
A From the record it indicates that one of his visits
that he had in ’74,—he loves watches, this is a favorite
thing of his and he got a little upset, he couldn’t watch a
special television program and went into a room and tore
this watch up, and an electrical receptacle on the wall,
he pulled apart.
Q And, he’s still demonstrating these behavior traits?
A On one of the visits back to the Satterfields, he
seemed concerned about a pair of shoes he had on and he
reacted to this, about the shoes,—to destroy—
Q Are you all still attempting to place Jimmy in a
foster home?
A Yes.
Q Have you made any attempts to place him in a
home with persons with any particular qualifications?
A Actually, I don’t think we’ve had any requests,
other than the one that we had in ’74. One of their refer-
ences [34] when we got their application and we contacted
references, they had had some experience with emotional
children.
Q Who were those persons?
[34] 418
A Mr. and Mrs. Pritchard. And, this might be re-
ferred to Mrs. Schoonmaker later.
( She was the social worker at that time?
A Right, she was the one handling it.
MR. LACKEY: I’m through.
MR. TARUTIS: Off the record.
(The parties went off the record for a brief period
of time.)
EXAMINATION BY MS. LINDBLOOM:
Q Mrs. Whitaker, I would like to just clarify a few
things when you were speaking about how you as a direc-
tor of the local county defacs (DFCS) office would go
about obtaining foster home placement for a child that
was your responsibility. You mentioned—and what I
would like to do is summarize what I think you were say-
ing, if I’m correct, please tell me; if I’m not, you can just
react to what I have to say. For foster home placement as
opposed to adoption, the local county defacs (DFCS)
office looks within their county as a first step; is that
correct?
A Right. A foster home has to be an approved home.
It means it has to have gone through an application pro-
cess, studied, and met requirements, and already approved
before [35] we place a child in it. Some of the homes are
already in existence when we have a child to place in
foster care.
(. And, the local county defaes (DFCS) office would
go out and check out the home and would approve it or
not, but would also be doing the recruitment of actual
foster parents?
419 [36]
A Right. So it can be an on-going process. You can
have an approved home and you can have homes in
application status, you can have homes in study status.
We use homes that are already in approved status.
Q But. basically, most of the foster homes that you
actually have that are developed within your county or
developed by the local office or is it—
A By the local office.
Q You made reference to referring a case if you're
unsuccessful at the county level to the state?
A No, to the district first.
Q What responsibilities does the district office have,
what is your understanding of what they would do?
A Well, since the Field Rep. or—or Social Services
Director—we might give them three titles, you know,
keeps a master list. She delegates this to her secretary,
because she is mostly_here all the time and we would say,
you know, we have so and so to place, age so and so,
we don’t have any homes in our county for this child,
[36] would you give us a list of some vacancies, because
most of the homes that are already approved, they know
the age range that they can take. In other words, we
wouldn’t take a teenager and try and place him in a home,
an approved home for infants. So, then she doesn’t get
into the aspects of behavior or social background of the
child, she just gives us a list of vacancies. Then we would
make the direct contact with the worker who supervises
that home in the district level.
Q Okay. It’s your expectation would be that once you
made a referral to the district office, that you would be
getting the names or possible sources back and you your-
self would be making the contact?
(36) : 420
A Right. And, the name of the worker who supervises
the home would be given to us, too.
Q Okay, fine. What about further than that, beyond
the district office, if you’re still hunting?
A If we don’t find a place for this child there within
our district from one of the resources that she has given
to us, we get back with the Field Rep. in some manner,
you know, to tell her this didn’t work out we need a place.
And, then, she through—at that time the process would
be that she would contact people in similar positions over
the state to ask if—then give them some background
information on the child, if they had a home to take care
of [37] a child such as this. This would be across district
lines.
Q You mentioned before to state offices. Now, is that
the next step in this process?
A Right. Now, I believe since I said this—when this
case came up and what current regulations are, are a
little bit different. And, I think when Mrs. Taylor comes
in she might give you what’s current, but what I’m speak-
ing about is what we might have done then, because I
think now it is on a state level with the circulation list as
I said, you know, circulating throughout other districts.
You know the little summary and sent to Mrs. Dixon’s
office, but anyway it gets circulated one way or another.
I think at the time we were working with Jimmy it was
through the district level and like I might feel like—I
might see another Field Rep. and say, you know, I have
need of this, either by telephone—and she tried to stay as
close to us so the transportaticn would not be a big prob-
lem. It’s unusual to have a child in South Georgia, you
know, boarded from North Georgia, ete.
421 (38]
Q At this point is it the person in the district office
level that’s initiating these contacts? In other words, you
mentioned like Mrs. Dixon as a contact, would the district
office person make that contact or would you again at the
local defacs (DFCS) office do that?
A We would get the material together and it would be
[38] according to whatever our Field Rep. told us to do.
If she said mail it directly to Mrs. Dixon, with a copy to
her, we would do this.
Q So the local defaes (DFCS) office then would
strictly go by the recommendations of the disttict office?
A What they advised us to do. Now, in this particular
file here on Jimmy is a letter that went directly to Mrs.
Dixon, addressed to her.
Q From yourse!f?
A Right. Well, from our county office, the worker who
was handling it at the time. And, that was for, you know,
referral to Child Services and Family Counsel.
Q What was your expectation in writing the letter to
Mrs. Dixon as to what her responsibilities or what her
action would then be after a referral from you?
A Then we would expect that she handled it from
writing or getting it to the proper source. And, we ©o
have a letter, I think it’s addressed to Mrs. Mildred Clark
in Child Services and Family Counseling, enclosing this
material.
Q Okay. So you said that you would expect that she
would handle it from there?
Q Right.
Q In other words, that she would then—
[38] 422
A Make the contacts necessary.
Q Is this above and beyond, let’s say, even the efforts
[39] that the district office would make?
A Right. On up to another level.
Q Did you ever receive any response from Mrs. Dixon
back, you know, to your letter?
A Not to our county, no.
Q Again, that would be just your assumption that
once you made the contact with her—
A Could I speak from some previous experience from
referrals that went like from our state office to Child
Service and Family Counseling, that did bring some re-
sults, Child Service and Family Counseling then did get
back in touch with us on their own, that did bring some
results from a request. They made a call to us and said,
you know, we understand you have this child. Now, I’m
not speaking of Jimmy, I'm talking about something that
did bring results.
Q Right, that’s fine, I’m trying to understand now
how the system operates. So, basically, from what you’ve
said, you would continue—local defacs (DFCS) office
would continue efforts for foster homes, that would be on
a continuing basis?
A Right.
Q And, then if you were unsuccessful you then con-
tacted the district office and if further help was needed
you would make the contact to Mrs. Dixon?
A Right.
(40)
Q Again, to clarify that adoptions—okay, you were
separating these that they are done differently, so the pro-
tr. -
423 (41)
cedure is different for adoption. Now, as the local defacs
(DFCS) office, could we just get that clarified what your
first step is?
A We have to have permanent custody of the child,
with the right to place it for adoption. We prepare the
social summary, social data, background information and
submit it to the district office, because we cannot search
for a home for a particular child.
Q Is the primary responsibility then for recruitment
in terms of adoption, we’re speaking now of adoption, is
that in the district office or is that in the local defacs
(DFCS) office?
A It’s mostly outside of the county level; it could be
district or it could be state.
Q Okay. And, your understanding of the responsibility
of a local defacs (DFCS) office would be to prepare, you
mentioned, like the social summary and refer that in turn
to the district office?
A Right. They would not have any idea that this
child was available for adoption, unless they got the
material from us. And, it has to have the verification of
the child’s birth, the court order attached that we do have
the right to seek a home for him with the right place for
[41] adoption; his background information summary of
life experiences, social information, emotional problems,
all the medical attached to it, any reports on psychologi-
cal—
Q But, basically, recruitment then, in terms of any
efforts that were made and in terms of an adoption, you
know, on this basis, would be at the district office level
as opposed to your owr defacs (DFCS), local defacs
(DFCS) level?
[41] 424
A Right.
Q Who makes the decision as to what type of place-
ment to seek for a child—again, make the assumption the
child is in your custody, who makes the decision? We’ve
talked here about adoption, we’ve talked about foster
home placement, who makes that decision?
A We have to either have a custody order from the
Judge or a voluntary request from the parents to place
the child.
Q Okay. In the case of Jimmy—maybe it would be
helpful to come down to specifics—how was it decided as
to the type of placement to seek for Jimmy?
A At the time he was brought into foster care, on the
local level, he was an infant, we had a home that was
approved to take care of infants in his age, you know,—
Q A foster home?
A —already set up. Now, infant homes—I need [42] to
clarify that approved for infants, is from zero to two.
Q When we were talking generally before about the
procedure for adoptions, when we were just speaking
previously, you mentioned that this was basically that
once you made your report, this is basically the district
office responsibility, that they would do the actual re-
cruitment for adoptive homes; is that correct?
A I don’t think you would use the word recruitment,
because people are applying for adoption all the time and
we’re doing studies, you know, for adoption and approval.
They may seek through what is already approved to see if
there is an appropriate home for the social study they
have received on a child. Now, our understanding, for
Child Service and Family Counseling, they have the
425 [43]
social study first and seeks a home for the child that is
ready to be placed.
Q In other words, would the district office notify you
of what efforts that they were making in terms of adop-
tion?
A If it was it could be on just verbal conference type—
you know, through contacts at conferences. This is where
a lot of these are discussed, our problems and our efforts
and our needs. We have conferences with our district level
and particular where it becomes their problem area.
[43]
Q Specifically, in Jimmy’s case, was a decision made
to either choose to make efforts like for foster home place-
ment or for adoption or for both?
A After he was in permanent custody it was both,
either one that we had. We preferred adoption after he
was available for adoption, because that request that
went out before he went to the Satterfield home was say-
ing please, urgent, you know, we need to get him into a
permanent situation, rather than so many moves.
Q Okay. Then both were pursued, but adoption was
preferred?
A Preferably, yes. You need to move a child into
permanency.
Q Certainly. Are you aware of—to the best of your
understanding or your knowledge, is the adoption search
still being conducted right now and has it been?
A I don’t have anything to substantiate in this record,
but in our records that it was; but I understand there is a
letter somewhere that Mrs. Poss and Mrs. Dixon were
[43] 426
agreeing to Child Service and Family Counsel, whichever
home would be appropiate, if they could find either
foster or adoption. This is in July, ’73.
Q But to your knowledge, do you have any idea what
has happened in terms of the adoption?
A Not now, no.
[44]
( You mentioned in terms of your familiarity with
J.R’s case that you were a caseworker at the Stephens
County defaes (DFCS) before you becaime director; is
that correct?
A Right.
Q So you were familiar then with Jimmy’s case prior
to the time of his admission then to Central State in
June, ’70?
A Basically, until ’68, would be my primary respon-
sibility. From 1962 to 1968, I was the caseworker with
Jimmy.
( Could you explain a little bit more as to who actual-
ly made the decision that James was going to be institu-
tionalized or the decision making process that resulted in
that?
A I’m not sure that I would know the answer.
Q Could you be a little bit more specific?
A I think that I personally would have the knowledge
of, you know, how that decision was made. I have just
quoted from the records that the caseworker had contact
with Mr. McFarland and he said, you know, that he
would recommend institution. I did not have direct
knowledge at that time.
427 (45]
© You did or did not then have personal knowledge
or involvement in that decision?
A Not directly, because the caseworker handles it
and I’m sure that it was in consultation with our Social
Services Director and the caseworker, and probably I
was in [45] on it, but I can’t recall, you know, the direct
account of it.
(Q Is there a procedure—in other words, is there or do
you have any directives in any of your manuals or any
guidelines that you have as to how a decision is supposed
to be made by a local defaes (DFCS) office, such as ad-
mitting a child to an institution, assuming the child is in
defaes (DFCS) custody?
A Well, other than what I had said and consultation
with the Social Services Director.
Q It’s your understanding that the Social Services
Director would discuss this?
A Yes. And, we say this is the recommendation, you
know, by our contacts.
() Basically, then, the records you were quoting from
was referring to the caseworker at the time; in other
words, the records and things you were referring to—
A Right, were from the records, right.
() You explained before now that James was in White
County, the Satterfields were in White County, that he
was in a foster home in White County, but he did maintain
a Stephens County caseworker; is that correct?
A Right; her responsibility.
Q What was her name at that time who was the case-
worker that we are speaking about?
[45] 428
A lLet’s see, probably—probably, two caseworkers
[46] at that time, Mrs. Theo Bracewell, because I read in
the record where she had provided some transportation
for him at the beginning sessions of mental health and
then she left and Mrs. Carpenter was the caseworker
assigned to Jimmy. It was Mrs. Carpenter’s records and
recordings that I was referring to earlier.
Q So, basically, talking about Mrs. Carpenter’s per-
sonal involvement, to the best of your knowledge, did she
personally visit James, did she talk with him and visited
into the Satterfield home?
A It’s not the usual policy for our worker to go into
another home to supervise, but she did have contact with
him by providing some of the transportation to the mental
health clinic. We either can do that or pay the foster
mother to provide it, because he is our financial respon-
sibility.
() Okay. Let me just understand this. She did not
have any personal—in other words, she did not go into
the Satterfield home?
A Not as supervision, this was done by Mrs. Crisp
and I think he had a couple other workers in White
County at the same time.
() You mentioned before that it was Mrs. Carpenter’s
records that you were referring to in terms of the times of
admission?
[47]
A Right.
() To your knowledge, did Mrs. Carpenter have any
kind of training or any clinical or psychiatric training?
ee
429 [48]
A No, I’m sure she was going on the recommendations
of the mental health clinic, because if he was referred this
is the people she would be using.
Q Is there anything in the record that indicates like
any procedures that she might have gone through, in
terms of getting—authorizing such a step? In other
words, you mentioned the record that she did keep and
the notations of telephone calls, was there any form that
she had to fill out in terms of getting anyone’s authoriza-
tion, for instance your authorization to make the move
that she did?
A No. I think the calls visit meant that she had volun-
tary placement agreement and we don’t have a copy of
that in our files, and I’m not sure if one was carried. I
really do not know. I do know that from the record she
called Doctor Bush, you know, in Atlanta, Doctor Charles
Bush, and he made a call to Central State and said he
could be brought on such and such a date.
Q Okay. I know this is a series of sheets, but can we
move to the one where it starts up at the top telephone
calls, move down, the next item down would be field trip,
dated 6/24/70; do you see the page I’m referring to, up at
the top?
[48]
A (Indicated yes.)
Q Could you read at the top where it says telephone
call, could you read what that says there?
A Worker talked with Doctor Charles Bush?
Q Right. Yes, please.
A With the State Health Department about emer-
gency admission of James for Central State Hospital. He
[48] 430
said he would check on this and call me back. In a few
minutes Doctor Bush called and said he had talked with
CSH and that we could bring James on either Wednesday
or Thursday, June 24th or June 25th, between nine a. m.
and four p. m. Doctor Bush said that since we have per-
manent custody of James, all we need to do is complete the
voluntary admission form and carry it back with us. No
Court Order is needed.
Q Okay, fine. To your knowledge, other than this was
Doctor Bush ever sent a complete record or background
on James? In other words, what I’m asking is, was there
ever any personal involvement of Doctor Bush with
James’ case?
A That I do not know. If he’s with mental health, he
could have had access to the mental health records.
Q I would like to also refer you to something else we
spoke of before and this is when you went through on the
psychiatric evaluation, that folder, and you mentioned
the cumulative running reports of the Stephens County
Mental [49] Health Clinic in Toecoa had kept on James
beginning in May of ’69, continuing through on to his
admission. You mentioned that Mr. McFarland, a recom-
menation from him—and we’re talking now about the
reasons and the basis behind James admission—in that
report do you see the notation that begins 5/26/70?
A (Indicated yes.)
Q Could you read that, please?
A This is by Doctor Curtiss, a psychiatric consultant
with the mental health clinic in Stephens County. This
young man is having an acting out problem. He basically
acts out in an agressive fashion and is sometimes almost
uncontrollable in his behavior. However, he seems to have
431 [50]
made considerable progress and strength since staying in
the present foster home. The present foster mother seems
to take a very firm, but loving approach with him, which
I think is very desirable. The difficulty in school I think
has been that the teacher, which he has now, is not able to
deal with his acting out behavior as realistically now as
the one he had previously. It is my recommendation that
he be placed in a school where there is a relatively firm
reasonable displinary policy, which is consistently applied.
I would also feel that it would be a benefit to him if he
could stay in the foster home for an additional year since
he has been in seven different foster homes, and I feel that
[50] this must be very upsetting to him. If he has to move
it would be even more upsetting to him. I do not feel that
medication is indicated that would be of much value since
as much medicine as would be required to tranquilize him
would essentially knock him out.
Q What was the date of that report again?
A This notation from the record is dated 5/26/70.
And, as far as I can determine that’s the only time Doctor
Curtiss saw him.
Q Was it your understanding either from the records
or if you have personal knowledge, do you have a record
of either Doctor McFarland or Doctor Curtiss initiating,
making some type of request to you to place James in
Central State, do you have any record that this is what
happened or was being issued from Mrs. Carpenter to
them? Sarey
A I think what would be done is that she would be in
contact with them in discussing this case and for their
recommendations, because I—this would be an opinion—
that our workers would not go to the idea of Central
State, unless it was given to us from somebody else for
[50] 432
the particular person. And, I read from this letter where
she wrote to Mrs. Pittard indicating that she had been
in contact with Mr. McFarland on June 1, 1970, but he
did not know of any institutions other than possibly
Central State Hospital.
Q You mentioned in there that there was a letter,
[51] February, 1970, of Mr. McFarland to you, do you
have that there?
A Yes. It’s to Mrs. Crisp.
Q In the record that you’ve gone over and you’ve
been speaking about now before, is there any other indi-
cation of any other information that Mrs. Carpenter
might have used to make this decision to have James
admitted to Central State Hospital?
A I really don’t think that it was Mrs. Carpenter’s
decision, I think that it was recommended to her to follow
through with the recommendation.
Q Who was it recommended to her by, do you have
any documentation of that?
A That’s the letter I read to you where she had just
mentioned that she had written to Mrs. Pittard that she
had been in contact with Mr. McFarland and that he did
not know of any institution, other than Central State
Hospital for James.
Q Are you referring now back to receipt of Mrs.
Carpenter’s notations of June Ist, where she said again
a notation for telephone call, that she talked with Mr.
McFarland at the mental health clinic, but he could offer
no services, he did state that it would probably better for
James if he could stay with the Satterfields?
A I’m quoting from a letter, which she has under her
433 [53]
[52] signature that she had sent to the Field Rep. She said
I talked with Mr. McFarland about any suggestions he
might have for James, but he did not know of any institu-
tions, other than possibly Central State Hospital.
Q Okay. Basically, we’re talking about the same date,
the notation on here is also June Ist, 1970; is that correct?
A Right. But this is what involved in decision making,
because we said we needed to bring in the Field Rep. on a
decision such as this and this was her notification of this
decision.
Q Do you have any documentation from Mrs. Pittard
back to Barbara Carpenter that she authorizes or recom-
mends admission to Central State for James?
A I don’t think the word authorize is what we would
need. I think there is a letter from Mrs. Pittard somewhere
making some suggestions, but it’s not in this particular
folder.
Q Was there any written authorization or approval
from anyone, other than what we have here in terms of
Mrs. Carpenter’s efforts, prior to the time of admission,
the efforts that she made in the notations here, is there
any documentation of anyone within defacs (DFCS),
either at the state level or going down, who either noting
approval of the decision or authorizing such a decision?
[53]
A AsI say, I don’t think the word authorizing is what
we have and what we do. It was recommended to us and
she was following a recommendation by contacting Doctor
Bush in Atlanta to see if this was a possibility. And, he
gave his approval stating that the child could be admitted
and gave her an admission date.
Q Mrs. Whitaker, you had mentioned when you were
talking about—when Mr. Lackey was asking about the
a Se
[53] 434
behavior folder and you were going through and speaking
about that—you mentioned an improvement that your
records had indicated, your records had indicated some
improvements, and you mentioned, I believe, a foster
home visit in ’74, where James had exhibited some type of
agressive behavior, whatever, acting out; is that personal
knowledge or is that just that you remember from reading
the records?
A This would be personal knowledge of Mrs. Schoon-
maker who is here. This would be from the record, which
would be recent, but she would be the caseworker that
would be directly involved in this particular instance.
Q Are you aware of the Central State Hospital recom-
mendations and reports of James’ behavior and improve-
ments since he was hospitalized?
A Is this the recent material that we got in November
that we requested?
Q Well, specifically, that, but also on a continuing
[54] basis since James has been placed in there; are you
aware of the Central State Hospital personnel, their
reports and recommendations, in terms of James’ im-
provement?
A lI think the only thing we have that’s in writing
from them is the recent one that we got back in November
that I requested to update his material. And, then the
last one I think that’s in the record is in ’73 that they sent
us.
Q Okay. You have a report from ’73, and then the
next information is—
A The one we have in ’75, right.
Q In your efforts within your county, or in the county,
Ae 2 Tinie Cente Sali
435 (55)
to recruit for foster homes, within your experience, do you
find that some children may be easier to place than others?
A Over the years, yes.
Q Could you elaborate on that and give us the benefit
of your—
A Occasionally, there are children who are placed that
maybe do not react to specific foster parents or specific
foster parents may not react to them that maybe might
be something different in school or on the playground,
agressive behavior, acting out, that would cause them to
ask us to move a child, but those situations are rarer than
successful ones.
Q Based on your experience in attempting to locate
[55] and work with foster homes, can you make any state-
ment, in other words, as to like the age, is it easier to place
like a girl than a boy, a two year old child as opposed to
a twelve year old child; in other words, do you find—
A Very definitely. The younger the child, the easier it
is to find a place. And, preschool, very definitely, easy.
For school age children it’s hard to find homes for and
teenagers, it’s just almost nil.
Q Is there any other—I’ve mentioned age as a factor
there, is there any other factor that might come into play
there, in other words, that would make placement more
difficult?
A Well, it’s been a good number of years since I’ve
really has the direct contact, you know, but foster parents
do seem to be more selective now than they did in the past
when I really handled it. This is from, you know, problems
that’s coming across the desk.
Q Well, a child, let’s say, that has a physical handicap,
would that child be easier to place, harder to place?
[55] 436
A I think it depends on the handicap. In all the years
experience, I’ve never had a handicap child.
Q Let’s assume that you were going to be working to
place a particular child, let’s assume that was what you
were setting out to do, if that child was presently in an
[56] institution, do you think that would have any affect
on whether it would be easier or harder to place that
child, having been institutionalized?
A What we do is that we tell the people that we are
contacting about his background and what it is, then we
give them the right to accept or reject.
Q Do you feel, based on your experience, that the
foster parents that you’ve come in contact with that that
would be a negative factor in terms of their interest?
A At times it has, because we have to be honest with
them and tell them what the problems have been and what
the good points are. They need to be aware of this.
Q Do you think that going to the weight, in other
words, of the child’s present institutionalization, would
that have any affect like if the child was young and insti-
tutionalized, would it be a drawback?
A I think it would be dependent—that would be pure
speculation on my part and it would not be a definite
answer.
MR. TARUTIS: Off the record.
(The parties went off the record for a brief period
of time.)
MS. LINDBLOOM: That’s all.
RE-EXAMINATION BY MR. LACKEY:
Q Counsel for the Plaintiff had you read certain
[57] portions of that summary. Specifically, she had you
437 [58]
read a portion beginning the fourth paragraph down from
the top, styled telephone call. Would you drop down one
paragraph, is this the contact you were referring to con-
cerning the Ethyl Harp’s Home?
A Yes.
Q Where was the child during this period, where was
he located?
A He was still in the Satterfield’s home and they had
requested his removal, and these were in our efforts to
find a replacement for him.
Q In other words, on 6/17/70, the Satterfields re-
quested that the child be removed from their home?
A It was earlier than that, wasn’t it?
Q Well, I was just looking at the log and what it says
there.
A This is—the 6/17/70 was their decision that they
could not have him back to visit with them if we did send
him to St. Joseph’s or this was the—our efforts to find
another place—I’m not sure when the Satterfields decided
that they couldn’t keep him, but it’s in correspondence
and this reflects, you know, the activity that Mrs. Car-
penter did in trying to find a replacement for him to go to
from the Satterfield home.
Q And, all these attempts to place him in St. Joseph’s
(58] and the Ethyl Harp’s Home all preceded your send-
ing him to Central State Hospital?
A Right.
MR. LACKEY: That’s all.
(Deposition concluded.)
** *# * *
438
(1)
IN THE UNITED STATES DISTRICT COURT
MIDDLE DISTRICT OF GEORGIA
MACON DIVISION
(Caption omitted in printing)
Deposition of DOCTOR EUGENE C. JARRETT, III,
taken on the 4th day of December, 1975, in Room 534
of the Georgia Department of Health Building, 47 Trinity
Avenue, 8.W., Atlanta, Georgia, before Jean M.. Wall,
Court Reporter T-24, 1521 Mercer Way, Decatur, Georgia
APPEARANCES:
For the Plaintiffs: GERALD R. TARUTIS, ESQ.
DAVID GOREN, ESQ.
STEVE GRANBERG, ESQ.
Georgia Legal Services Programs
Macon Regional Office
653 Second Street
Macon, Georgia 31201
For the Defendants: DOROTHY Y. KIRKLEY, ESQ.
Assistant Attorney General
Department of Law
132 Judicial Building
Atlanta, Georgia 30334
[2]
MR. GOREN: The stipulations are all formalities are
waived and objections are reserved until the time of trial.
MS. KIRKLEY: Except as to the form of the question
and the responsiveness of the answer.
NOTE: (The signature of the witness was specifically
waived by his attorney of record, DOROTHY
Y. KIRKLEY, ESQ.)
439 [3]
EUGENE C. JARRETT, If], HAVING BEEN DULY
SWORN AS A WITNESS, TESTIFIED AS FOLLOWS:
EXAMINATION BY MS. KIRKLEY:
Q Would you state your full name for the record,
please?
A Eugene Coleman Jarrett, III.
NOTE: (Defendant’s Exhibit Number One was marked
for purposes of identification.)
Would you identify Exhibit One, please, Doctor?
This is my curriculum vitae.
And you are a pediatrician, is that correct?
Yes.
Are you a psychiatrist as well?
No.
What is your present position?
> OF OD PO PO
I am the superintendent of Southwestern State
Hospital.
Q How long have you been superintendent?
A Since September 19th, 1973.
Q What is your role and what are your duties as
superintendent of the hospital?
(3)
A To administratively oversee the programatic func-
tions, with the programs directors to develop various
treatment programs that the hospital is responsible for
providing to the citizens.
Q Since you are-a pediatrician, are you also the med-
ical director?
|
[3] 440
A No, Doctor William Bailey is the clinical director.
Doctor Bailey is a psychiatrist.
Q Okay.
NOTE: (Defendant’s Exhibit Number Two was marked
for purposes of identification.)
Q Would you identify Exhibit Two, please?
A Exhibit Two is a computer printout of information
relative to patients admitted to Southwestern from its
opening in 1966 till the present time, patients under
eighteen years of age, with their dates of admission, date
of birth, primary diagnostic code, and the type of com-
mitment and their discharge date or whether they’re still
an in-patient, is there also included on this list.
Q And when was this list prepared, Doctor?
A This list was prepared approximately the middle of
November, but up-dated Monday, which would have
been December the Ist.
Q Was it prepared at the hospital?
A Yes.
Q And who in the hospital was responsible for getting
this information?
A The department of administrative services unit,
which operates a computer at the hospital developed the
computer printout. The medical records section, along
with my administrative [4] assistant, brought the whole
listing up to date.
NOTE: (Brief off the record.)
A I might clarify on that, that those with no dis-
charge date or no indication as in-patients, were not cor-
. (ase nite cen crime
441 (4]
rectly listed on the computer. Only those with complete
information were complete.
Q You mean there were some listed on the computer
that weren’t actually there?
A No, the computer read things—was not properly
programed, so some of them are listed multiple times,
the same patient. Some of them were admitted over
eighteen, so forth and so on.
Q Did somebody go back and double check, and that’s
how you found that out?
A Yes.
Q Is that correct?
A Right, each patient was checked individually.
NOTE: (Brief off the record.)
Q All right, Doctor, would you explain again, the
process by which the information on Exhibit Two was
derived?
A We requested from the department of administra-
tive services, computer section at Southwestern, a listing
of patients admitted to the hospital under eighteen years
of age. This listing was obtained and in cross checking,
or double checking the entries, errors were found. These
errors have been corrected on the computer listing. Ba-
sically any line listing, or any entry of a patient, date
of admission, date of birth, diagnostic information, com-
mitment code and discharge date, has been verified. Those
with discharge dates, commitment code changes, reflect
corrections of the originally received computer informa-
tion.
442
[5]
() And seventeen is the commitment code for volun-
tary patients under age eighteen, admitted by their par-
ents, is that correct?
A Correct.
() And have you double checked to make sure that
all of the seventeens show up on this list someplace or
another?
A Right, as best we can determine, they’re all here,
through our double, and in several cases, triple checking.
Q) And that —the double and triple checks were done
manually, is that correct?
A Yes.
() Would it be possible to have the computer program
corrected?
A Yes.
() How long would that take, do you know?
AI really can’t answer. I might mention, also, that
some patients were admitted to our hospital prior to our
having a child and adolescent program, their need for
children’s services being obtained then, through the pro-
gram at Central State Hospital, their discharge date may
have been from that program, and it’s indicated as “Dis-
charge CSH” and the date,
(2) Would they have been transferred back to you?
A Not necessarily at that time.
(2 You mean you—for a part of the time your child
and adolescent case load was physically at Central State
Hospital?
443 (6]
A Correct.
() And so they would handle the discharge?
A Yes.
() How long has the child and adolescent program
been in operation at Southwestern?
(6)
A We began efforts when I arrived in September, ’73,
to obtain a program— funding for a program. We obtained
this through a Federal grant. After training staff, the
patient admission aspects began in April of 1974.
Q Do you have separate child and adolescent units,
or is it all one unit?
A One unit.
Q And how many patients?
A We have a maximum capacity of twenty patients.
We presently have twelve patients,
() Doctor, what are the general admission procedures
used for children and adolescents?
A Very simply defined, the child is admitted through
a community program. To explain that further, it is our
feeling that children should not simply be admitted di-
rectly to the hospital with no definite effort put forth to
take care of the child’s needs in the home, not only for
the child’s benefit, but because many times the child’s
problems are an integral part of a family problem situa-
tion. So any referral for admission is first of all processed,
or evaluated, by community mental health people, and
then, if institutional admission is to be considered, the
institutional staff is involved in a final determination of
what the treatment plan will be for that child, and that
(6) 444
child’s family. It may then include a short term admis-
sion, or an admission to an institution for the child.
Q Okay. Do you ever admit children without them
having previously been seen by a community mental
health service?
[7]
A We have not at this point. I can’t, of course, say
what the future will bring, but we have received direct
referrals from Juvenile Courts, Department of Family
and Children Services, and other individuals. Our first
step is to get the community mental health program,
child and adolescent representatives, to hook them in
with the referring agency or individual, to initiate this
evaluation prior to admission. Or prior to a consideration
for admission.
Q. As superintendent of the hospital, what is your
relationship with the community mental health programs
in your area?
A Very close, really. We are working on and have
worked—succeeded to various degrees, with a similar
process of this as far as adult patients are concerned,
also. We have a very close working relationship with the
community mental health in all areas of our service area.
Q Are you familiar with what the evaluation process
would be in a community mental health center?
A For the children?
Q For the children, yes.
. A This would include a social evaluation of the home
situation, possibly—probably an evaluation of the child’s
school situation, psychological testing to indicate—or as
ane States Sa
445 [8]
part of the evaluation. The social evaluation would be a
look at the family, its arrangements, interactions, finan-
cial needs, and everything, and out of this would come,
really, not just a plan for the child, but more than likely
a plan for the whole family, as an effort to help the child.
Q Do you know in what percentage of the cases the
family as well [8] as the child, is treated in the community
program?
A Ican’t give you an exact percentage, but I would—
from the cases that I have reviewed in our program, I
would say better than ninety percent, if there is a family.
I think with all of the cases we have now that have fami-
lies, that the family members are involved in some kind
of community mental health program, while the child is
in the hospital and returning home.
Q What efforts do you use to make sure that the par-
ents are involved in the treatment program?
A Varying efforts, really. First of all, it’s just to try
to help them understand why the need is there for this
to happen. If this is unsuccessful, and if all the members
of the helping agency group that are involved with the
child, see the family as resisting, then they would become
involved in whatevery way is appropriate to make sure
that the child’s needs are met. And the Department of
Family and Children Services is frequently involved in
this type of situation.
Q What would their involvement be?
A Well, they would be sometimes the referring agency
for the child to begin with, they might be asked for
assistance for the family if the mental health people saw
the family needed this and the family had not been able
[8] 446
—had not obtained help before. They would be brought
in as an additional assistance group to try to help resolve
some of the family’s problems. If they see the family as
not being the proper place for this child, then, of course,
it is part of their responsibility to work to correct this,
and on some cases, it has meant that the child—D.F.C:S.
has, with the assistance of the Juvenile Court, helped the
child to [9] find a better place to live, and this has been
a part, then, of his betterment of his mental health situ-
ation.
Q After the evaluation takes place at the community
mental health center, is an effort made for treatment to
be given to the child at home?
A Yes. This is the whole thing most of the time. The
evaluation occurs there and the treatment is initiated
and accomplished there. That’s why I mentioned earlier
that only those children, where institutional care and
treatment is thought to be—or going to be a part of the
child’s need, will the hospital staff become more inti-
mately involved in this pre-admission planning. Now,
they may be brought in as consultants on cases that will
remain in the community, but they are always part of
the pre-admission planning for any child, where this
institutional admission is to be considered. In some cases,
the institutional admission will never occur, because the
final outcome of all the planning is that it can be accom-
plished in the community, and it is accomplished there.
But before the child gets to hospital, everybody to be
involved with his case has been involved, and agrees with
the decision to be made, and has been a part of the
development of his treatment plan.
Q Just in a general way, what factors would enter
ean CO Aen ta
447 [10 “A”
into a decision to hospitalize the child, rather than try-
ing to treat him at home?
A Oh, certain things such as medical needs. You
many need the child—if he is overtly psychotic, it may
be that the medical decision that he needs to be in a
situation where he can be watched extremely closely
while medication — medical treatment [10 “‘A’’] is inititated
for his psychosis. And once he is stabilized, then he would
be returned—once the medication regimen is stabilized,
he would then be returned home to continue this. It may
be that the family situation has been so disrupted or dis-
ruptive to members, that a brief separation is necessary
to allow the community people to help the parents to
begin to learn how to deal with the child while the child
is in the institution, treatment routines are established
to be applied in the home. Sometimes separation is just
necessary to begin to get an accurate view of the situation
and to develop a treatment process.
Q Would that last factor be particularly prevalent in
cases of behavior disorders?
A I can’t really say whether it would be more preva-
lent with behavior than with psychosis. It would oceur
more often, because there are more behavior disorders
than there are true psychoses, probably.
Q Do you have any rough idea of the percentage of
children admitted with behavior disorders?
A In our program at the present time, it would have
to be an estimate, but probably eighty percent of our
program, patients thus far, have been behavioral dis-
orders as opposed to psychotic children. What we think
we see is the program becoming better known through
the region, more psychotic children are gradually increas-
$
:
|
(10 “A”’] 448
ing. Maybe they’re better identified, or whatever the
reason may be.
Q Do you know what the average length of stay is
on the children and adolescent unit?
A At the present time it’s around sixty days.
(10 “4
NOTE: (Defendant’s Exhibit Number Three was marked
for purposes of identification.)
Q Would you identify Exhibit Three, please?
A Exhibit Three is information copied from the rec-
ords of the patients in the institution under eighteen
years of age on December the Ist, 1975. This is not a
complete chart, but what we felt would be pertinent
portions of the chart.
(2 What does it include for each person?
A It includes the admission summary, which is the
face sheet, including administrative and other data; it
includes the referral form which is used by the community
to refer patients to the in-patient program at the insti-
tution. It includes a psychiatric admission note; it will
include a social service summary; and it will include
other things depending upon the individual case, the
treatment team meetings, treatment plans, progress notes,
and a discharge summary, if the patient has been in
before and is returning, and information of that type.
Q Okay.
NOTE: (Defendant’s Exhibit Number Four was marked
for purposes of identification.)
A I might mention I have indicated that two of these
patients, in the upper right-hand corner, it says two
Re ee eee oe ee ee eee re
449 [11]
hundred not in C&A, these are individuals who are sev-
enteen years of age, and because of their maturity, they
are not housed in the child and adolescent program.
Q Are there some seventeen year olds that are in the
child and adolescent program?
A Not at the present time. The program is basically
limited to [11] children sixteen and under, but with the
flexibility that if you have a child who is seventeen, or
even older than that, possibly, whose physical maturity
and personality maturity is not to the point where he
should be involved in the adult program, he would be
involved in the child and adolescent program.
Q Would you identify Exhibit Four, please?
A Exhibit Four is briefly described, a referral process
for community mental health programs to use in the re-
ferral of patients for admission consideration.
Q And it states in writing basically the policies we've
been discussing, is that correct?
A Correct.
Q Once a child is admitted to the hospital, what type
of reviews are made of his case after admission?
A The treatment team, which includes not only peo-
ple at the hospital, but also child and adolescent repre-
sentatives in the community, would be involved with
this child and his family. They review the child’s situa-
tion minimally of once a month. The hospital treatment
team reviews the child’s situation minimally once weekly.
These reviews follow an outline—follow—reviews of the
child’s treatment plan, which is developed according to a
specific outline, to assure that all the parts are covered.
This review, will, in the course of the child’s treatment,
[11] 450
include his progress relative to visits home during the
institutional stay, as well as his progress within the
institutional program.
[12]
Q Now let me understand, there are two separate
reviews, one conducted with community staff involved,
and one conducted by the hospital staff?
A Correct.
Q And the hospital staff reviews are at least weekly?
A They will be more frequently than the total team
review, because of travel and other problems in getting
the team together—time problems; but that’s correct.
The team involved intimately with the child in the insti-
tution reviews the plan weekly. The total team, which is
the team involved with the child’s family as well as the
child in the community, and the institutional team, review
the whole situation minimally once a month.
Q Is there ever a review conducted by hospital staff
that are iwt directly involved in the case?
A Not at the present time. We are trying to work out |
some mechanism to accomplish what is commonly called
utilization review, where third parties, or non-involved
representatives, review the programs, not only in this
situation, but in others. The only outside review at the
present moment, would be the Division of Mental Health
staff members, who would review the function of the
whole child and adolescent program. This occurs mini-
mally once yearly, when the grant for the program is
reviewed for renewal, and more often depending upon
their travel capabilities to visit the institution.
Q Would they review individual cases at that time?
451 [13]
A As part of this, yes. They would not review every
case, but could select cases at random for review.
Q Would they particularly select cases that have been
there for [13] any length of time, longer than six months
or longer than...
A Not necessarily. Of course, we don’t have any cases
of that type at the present time. I don’t believe we have
any child that’s been in this program six months.
NOTE: (Defendant’s Exhibit Number Five was marked
for purposes of identification.)
Q Would you identify Exhibit Five, please?
A Exhibit Five is the outline followed—to be in the
development of the patient’s treatment plan.
Q Okay. While a child is an in-patient, is his family
still being treated in the community?
A Yes. The family is involved in treatment in the
community, the child will go home and stay with the
family on weekends as often as is possible. What we have
in some cases, is the child stays within the hospital pro-
gram Monday through Friday and goes home every week-
end. This is two reasons, one to maintain the involve-
ment of the family with their child; the second reason is
to be able to assess the progress that the child is making
—and the family is making in being able to deal with
the problems that they have to deal with, and modify-
ing the treatment programs as indicated by the success
or lack of success on these visits.
Q Do you find in general, a reluctance on the part of
parents to take their children out of the hospital when
the staff recommends this is the best plan?
[13] 452
A No, not really. Not if they understand that this is
the way the program runs at the very beginning. The
exception being, of course, the parent who does not wish
to have the child in [14] the home to begin with. This
type of problem would be identified in the evaluated
phase, attempts made to work with it, and if it cannot be
resolved, it might be a situation where another family
might be better for the child.
() So what steps would you have to take if that sit-
uation arose?
A This would be taken by the Department of Family
and Children Services through the Juvenile Court sys-
tem. They would have been involved, in other words,
enough with the case to know the necessity of this action.
NOTE: (Brief off the record.)
NOTE: (Defendant’s Exhibit Number Six was marked
for purposes of identification.)
(’ Would you identify Exhibit Six, please?
A Exhibit Six is a very brief description of the child
and adolescent program for this twenty-four counties in
southwest Georgia that we are responsible for.
NOTE: (Defendant’s Exhibit Number Seven was marked
for purposes of identification.)
Q What about Exhibit Seven?
A Exhibit Seven simply defines some guidelines which
we—which are used in our involvement with the psycho-
educational center program in that area. The psychoedu-
cational center being the community educational program
for children with emotional and other problems. We have
a teacher within the child and adolescent unit at the in-
Pe eee
453 [15]
stitution, but the patients—is an attempt to assure that,
as part of their treatment, we feel that they need to be
involved in an educational program. So we have the in-
patient program as the—for those who cannot [15] com-
pete in any kind of community program, and then as
soon as they are able to leave the institution educational
system, they go to this community program; as soon as
they can leave that, then they go to a special education
program in the—in a public school in the area; all of this
being preparatory work to try to help this phase of their
development, so they will be able to easily re-enter their
school system when they return home.
Q One of the contentions in this case, Doctor, is that
voluntary admissions of children to hospitals should be
preceded in every case by judicial proceedings. Is it your
opinion, as superintendent of a hospital, that judicial pro-
ceedings in the admission of children would be beneficial?
A No, I don’t really think so, not with the system,
particularly, that we have in operation here. What we
have found, is that when we have been contacted by the
juvenile authorities, when they found that there was
available for their use, community mental health assis-
tance for this child and this family, that they were pleased
to know this, and used it, and use it appropriately. They
can be of help, of course, when judicial assistance is nec-
essary to get things done that need to be done, but I
don’t feel that in every case they need to be involved.
Q As a pediatrician, is it your opinion that judicial
proceedings might have any harmful effect on children?
A That’s a difficult question to answer, really. If the
judicial proceeding involves trials, court appearances,
things of this sort, then I certainly feel this could be very
Ce Se
(15] 454
frightening to the child, unless handled in a definitely
very appropriate [16] manner. Children see things —
maybe based upon what they see on television and in
movies, but they do have opinions or thoughts about
court and what all court involves. And a court hearing
can be handled in such a way that it does not frighten
the child, I’m sure. I also think that it could be handled
in a way that would frighten the child and could actually
aggravate problems rather than help them.
Q Have you attended any judicial proceedings your-
self?
A No.
Q So you’re not...
A So I can’t—as I said, I can’t really answer the
question but just except my own personal feelings.
Q That’s all the questions I have.
EXAMINATION BY MR. GRANBERG:
Q Doctor Jarrett, you were saying, when we had some
problems about this computer printout, I think you said
it was originally incorrectly programed, is that right?
A (Nods in the affirmative.)
Q I just want to ask you about a couple of them—of
the things that are on that in regard to another state-
ment I believe you made later. I’m not—I don’t want
to put words in your mouth. I believe at one time you
said the longest anybody had been there, the present
people, is six months?
A In the present C&A program since it developed in
April of ’74.
OO et Se ret, 6 ee!
455 [17]
Q The longest anybody has ever stayed is six months?
A In the C&A—no, I don’t think we have anybody
in the C&A program that we have, who has—that have
been in it for six [17] months. Now we may have, in the
older patients in the hospital, people who might have
been admitted under eighteen, who may have stayed in
the institutional program for more than six months.
Q Okay. Do you know--there may be people who
were admitted under the statute—the statute we’re talk-
ing about, when I refer to that, will be 88-503.1, the
voluntary admission statute, .. .
A Right.
Q ... that there may be children in there who were
admitted pursuant to that statute, before the ch” ‘ren
and adolescent unit came into being. . .
A Right.
Q ...who are now in the children and adolescent
unit?
A We have one boy that you have information on
that is in that program now, that had been admitted to
Central State, and I think had been admitted to South-
western, prior to having the child and adolescent pro-
gram. But of those in the program now .. .
Q Now, let me just—I think this is one—maybe you
can explain it... Okay. What we are referring to is one
of the pages on the patient listing, and if you could just
look at that for a second and tell me if—is this person
now in the C&A unit?
A Which one are you pointing to?
Q This one right here, I’m sorry.
[17] 456
A This one right here?
Q Yes.
A That person was discharged June the 27th, 1975.
The next one [18] should be an in-patient.
Q I’m sorry, I meant—I was referring to 3322.
A Okay. That person would have been admitted No-
vember the 22nd, 1972; this person would be an in-patient
now. This person is not in the C&A program according
to her birthdate.
Q I see.
A She would be seventeen, I believe, so she would be
on an adult unit.
Q Okay. Would you just look at this one and tell us
about that. I think this is it, 3534.
A Okay. That’s an in-patient—this is a mental re-
tardation diagnosis.
Q Okay, that was our mistake. That was the wrong
number. Okay. But there are—I don’t want to over-state
this, but there are people, then, who were admitted pur-
suant to the statute who have been there longer than six
months, and are somewhere in your hospital, and are
under, at the present time, eighteen? For example that
one—the first one that we just discussed. She may not
be in the C&A unit, but she is under eighteen, she is in
the hospital . . .
A According to that data that’s correct, but I’d have
to calculate her birthdate to see whether she is still under
eighteen or not, because this information here is supposed
to be only the patients that we have...
ee ee ne ane
t
457 [19]
Q Okay. Without trying to pin you down too much,
is it possible that there are people who were admitted—
children admitted under the statute and are now some-
where—not necessarily the C&A unit, but somewhere in
your hospital, ard are under eighteen?
[19]
A It is possible, but I would say that these would be
people who are over the age range for our present C&A
program; in other words, seventeen.
Q Why is the cut-off sixteen? I guess I should—up to
sixteen. Why is it...
A At the age of puberty, many things change in ad-
diton to a person’s physical being. Attitudes change along
with this, personalities change, and do forth. In our
efforts to develop a child and adolescent program, since
it is small, and since we didn’t have any funds to develop
the broad range thing, we felt that it would be necessary
to try to keep the population in the program, one that
would not be disruptive to itself, in other words. And to
mix too many different types of people together, we felt
would mean that the patients themselves would be detri-
mental to one another.
Q I can understand that premise, or the dichotomy
there, the cutoff line.
A That’s why I said earlier, too, that though the pro-
gram states, I think, on the program description, gen-
erally sixteen or under, something of this sort, we retain
the flexibility within the program to have anyone, even
eighteen or—theoretically, even older than that, whose
personality is being—is more in keeping with a child or
adolescent program. If that type of treatment is what
they need, then we have no hard and fast rule that says
they cannot be included in this program.
[19] 458
Q No age limit at all. Do you have any—do you have
any people now who are seventeen years or older in the
children and adolescent unit?
[20]
A I think we have one boy who is either seventeen or
almost seventeen.
Q Okay. Have you had any, let’s say, in the last six
months with the exception of that child? Have you had
any children seventeen or older in the children and ado-
lescent unit? Or in the last year?
A Right. I can think of one child that I think was
seventeen. Others, the program staff has been involved
with, they may be living on an adult unit, but coming
to the child and adolescent program on a day basis.
Q Assuming, then, what we were just talking about,
would it be fair to say that although the program—your
hospital does say that it has no end limit to the people
who could be in the children and adolescent unit, if doc-
tors—physicians deem that treatment there would be
most beneficial to that person, that there have been
none, or few, children—-children or adults seventeen years
or older who have in fact been admitted as full-time
patients to the children and adolescent unit?
A Few, correct.
kk KK *
[24]
*e ee *
. Q Let me ask you a few questions about your specific
institution—hospital. What is the total number of people,
approximately, in the hospital right now?
A Total number of in-patients would be about five
hundred and ninety.
-~ i cts Cc gl
PB —s vs
459 [25]
Q And—so right now there are—how many people in
children and adolescents, approximately?
A Twelve or fourteen at the present moment.
Q And the other ones are adults, voluntarily com-
mitted or involuntarily committed?
(25)
A There would be adults, both voluntary and invol-
untary, and mentally retarded—we have one unit for
mentally retarded, a hundred and twenty beds. This is
for individuals who have medical nursing care needs,
physical handicaps of a severe degree.
Q I see. The—in regards to your staff, how many
physicians do you have, the number of physicians?
A Presently on board we have fifteen, I believe it is.
Q Now on board, is that a term of art...
A That means working.
Q Okay. The doctors, how many of them are licensed
to practice in Georgia, do you know?
A Nine.
Q And then the remainder are—I forget, Doctor Skel-
ton yesterday gave us the correct terminology . . .
A They have a limited license, institutional permit.
Q Institutional permit.
A To practice within the institution.
Q So is that true, that the remaining six have an
institutional permit?
A Yes.
[25] 460
Q Do you have any American B
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