Office of Child Advocate faults St. Mary’s Home for Children for ‘minimal solutions’

“I like not getting into restraints every second. I like being able to go on the computer. Also I like my teacher.” 

That’s one of the positive reviews by a young resident of St. Mary’s Home for Children included in a dossier dated March 4 and compiled by the North Providence residential facility, which houses and treats kids and teens with psychiatric disorders.

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The six pages of mostly handwritten notes are but one appendix in the home’s formal response to a report by the Office of the Child Advocate, the agency that oversees and advocates for children in state care. Widely publicized in January, the child advocate’s 119-page report detailed abuse, negligence, assault and other mishaps in care during an eight month-long investigation into St. Mary’s Home last year. 

St. Mary’s Home offered 26 pages that address specific claims in the child advocate’s report. An additional 138 pages of appendices acknowledged the need for transparency: Letters concerning two more investigations into St. Mary’s are included, as is a Feb. 9 notice from Social Current — an independent not-for-profit accreditor of behavioral health care and social service organizations — that St. Mary’s accreditation is on probation.

But the inclusion of children’s voices is unique, as they have been given little opportunity to speak thus far. How unfiltered these comments are is unclear. A spokesperson for St. Mary’s did not return comment on the notes’ origins or whether they were incentivized. One child’s note ends with “P.S. I would really like to know what the surprise is and get it please. :)”  

Still, the responses — many of them on handwriting practice paper, the kind with dashed lines to help kids shape letters and learn penmanship — lead to no easy conclusions about their lives. One kid likes to play in the snow. Another wrote they enjoyed the bonfire and field day. A kid with neater, more mature handwriting asked for more activities, while the first letter in the bunch expressed that St. Mary’s is finally “hearing us kids but I would love to see more action.”

For North Providence Mayor Charles Lombardi, enough action has apparently been taken for a celebration to occur: This week he declared Monday, March 18, 2024, to be St. Mary’s Home for Children Day. He’s also a St. Mary’s board member. 

Asked about what motivated the declaration, Lombardi said in a phone interview: “They’re a 145 year-old institution and they asked if we could recognize that, so we chose to do it.”

Child advocate calls response ‘wholly inadequate’

But for Acting Child Advocate Katelyn Medeiros, St. Mary’s has a long way to go before celebration is in order. She replied to St. Mary’s 163-page response with a reiteration of her office’s expectations: A clear plan of action with zero confusion over execution.

“Instead, we received a response that is wholly inadequate given the nature of the allegations and the gravity of the findings,” Medeiros wrote in her March 14 reply to the March 4 letter. “It should be noted that some of those ‘clarifying’ the actions of St. Mary’s are the same people identified throughout the investigation and under whose leadership and supervision, these failures occurred. It is important that St. Mary’s response not be used as an opportunity to rewrite history or skew objective findings through a subjective lens.” 

“To be clear, simply labeling a statement as ‘objective’ does not necessarily make it so,” replied Charles A. Montorio-Archer, St. Mary’s interim CEO, in a letter dated March 15. The March 4 response, he wrote, challenged some of the key vignettes in the child advocate report because they were simply untrue.

Montorio-Archer was named interim CEO on Jan. 8. Since then, St. Mary’s welcomed to its board of directors Marianne Raimondo, dean of Rhode Island College’s School of Business, and an associate professor of health care management and policy who directs the college’s Healthcare Administration program. Raimondo is also a licensed clinical social worker.

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St. Mary’s said it also filled two new clinical positions, hiring an interim medical director and clinical director to enhance the care it provides to youths. The March 4 response includes more than a dozen pages of changes the residential facility has made and plans to make, including enhanced training protocols, more frequent progress reports and regular reviewing of security footage, among other things.    

“The response lacks accountability for what transpired and offers minimal solutions for substantive impactful change,” Medeiros wrote.

“We appreciate the concerns of these agencies, and have decided to continue to focus on getting the work done to address the concerns that have been raised,” Montorio-Archer said in a statement to Rhode Island Current. “We are ready, willing and able to collaborate with the OCA, DCYF (Department of Children, Youth and Families), DRRI (Disability Rights Rhode Island), and all other government stakeholders to improve the lives of every child in state care, whether at St. Mary’s or with other providers.”

Whose dog was it anyway?

St. Mary’s has uploaded their response to the child advocate on the home’s website. It itemizes and attempts to debunk several of the dark anecdotes relayed in the child advocate report and in earlier media coverage. Most scandalous was an alleged comment from former CEO Carlene Casciano-McCann, who was quoted as saying the facilities were unfit even for a canine: “I wouldn’t let my dog come here.”

“Please note that I never said I would not send my dog to St. Mary’s — it is a complete lie. I also asked Katy [Medeiros] to retract it and she did not respond to me,” Casciano-McCann stated in the March 4 response.  

The St. Mary’s letter, however, does not deny that someone said those words, and reroutes the blame through two sources. According to Michael Burgess — the resident program manager at St. Mary’s who is named frequently in the child advocate’s original report — it was Chris Strnad of the Department of Children, Youth and Families (DCYF) who relayed the dog quote from a “Judge Ortiz.” Associate Justice Elizabeth Ortiz Whited of the Rhode Island Family Court did not respond to a request for comment.    

Denied by St. Mary’s is an advocate-reported incident that alleged a child did not get their requested birthday meal. But St. Mary’s said the youth was eventually served their desired lunch of Chinese takeout. St. Mary’s also reframes the opening salvo in the child advocate’s report — that a teen allegedly overdosed last April in a bathroom on campus. According to St. Mary’s, DCYF is in possession of a toxicology report that disproves this claim. DCYF said the report could not be shared publicly because of confidentiality reasons.      

“It is disheartening that the Letter casts these substantial efforts aside out of hand,” Montorio-Archer wrote on March 15. “While the Response may not have been in the OCA’s [child advocate’s] preferred format, I think we can both agree that our mission is too important to promote form over substance.”

The child advocate’s report also challenged St. Mary’s status as a psychiatric residential treatment facility (PRTF), which is federally designated as it relates to Medicaid reimbursements. The child advocate report suggested St. Mary’s was masquerading as a “true PRTF” while leaving certain requirements unsatisfied  — a compromise alleged to have been made with DCYF’s approval.  

“St. Mary’s has never been allowed a modification to conduct services as a PRTF,” the home responded on March 4. “St. Mary’s has committed to following PRTF Certification standards as they were written in the PRTF Certification between St. Mary’s and DCYF.”

“DCYF can confirm that St. Mary’s meets the federal requirements of a Psychiatric Residential Treatment Facility (PRTF) that are conveyed in the state’s certification standards,” said Damaris Teixeira, a DCYF spokesperson, in an email.

Both a 2021 DCYF document and a 2022 document from the state’s Executive Office of Health and Human Services designate St. Mary’s as fulfilling psychiatric residential treatment facility requirements, with monitoring in place to reevaluate that designation as needed.    

Questions about psychiatric residential treatment facility status

St. Mary’s status as a psychiatric residential treatment facility also factors into the Rhode Island Department of Health’s investigation of the facility. Three documents obtained by Rhode Island Current detail evidence collected in January and February. While not as damning as the child advocate’s report, health officials found a list of deficiencies that could threaten St. Mary’s psychiatric residential treatment facility status. After completing a facility survey, the health department addressed a letter to St. Mary’s on Feb 15 that advised St. Mary’s take “corrective action” or risk losing its residential facility status with Medicaid.

The first set of deficiencies relate to federal stipulations, most of them involving emergency preparedness. When surveyed in January, St. Mary’s lacked comprehensive emergency plans, as well as an emergency supply of food and water. Another set of deficiencies related to state regulations that require vaccinations for health care workers. Of the 18 personnel files reviewed, 17 lacked records of vaccination for seasonal flu, chickenpox, mumps and tetanus. Another 13 staff lacked any documentation for tuberculosis vaccination, and 14 were missing records of their hepatitis B vaccines. A third document is a “plan of correction” that outlines the steps St. Mary’s would need to take to resolve these issues.

The up-in-the-air status of St. Mary’s federal designation could prove more important as the home continues its 12-bed expansion for adolescent females — one that’s also a psychiatric residential treatment facility, and set to open in 2025. The March 4 response from St. Mary’s noted that Gilbane Building Company is the contractor for the $11 million project funded by federal pandemic funds. Contaminated soils on the building site delayed the project, but a $250,000 Environmental Protection Agency grant was secured to help remediate the soils.   

Advocate vs. advocate

St. Mary’s Home officials weren’t the only readers who took umbrage with the child advocate’s report. So did Disability Rights Rhode Island, a Providence nonprofit advocacy organization, which wanted identifying information unredacted for its own investigative purposes.

As a protection and advocacy agency, Disability Rights is federally mandated to investigate reports of the mistreatment of Rhode Islanders with disabilities, including mental disorders — legal powers that are largely granted by the Protection and Advocacy for Individuals with Mental Illness Act of 1986 (PAIMI).   

When, on Jan. 23, the child advocate’s office refused to provide an unredacted copy of their report to Disability Rights, the state’s protection agency stepped back momentarily and rescinded its request in a wish to avoid litigation. A month later, Disability Rights asked DCYF for the unredacted report — and were pointed right back to the child advocate, who denied the request once more.

So on March 15, Disability Rights filed a complaint against Medeiros in U.S. District Court, challenging her office’s “refusal” as a violation of its legal entitlements.   

“Upon information and belief, some of the youth placed at St. Mary’s Home for Children and referenced in the investigation report are youth with mental illness in the custody of DCYF,” the complaint said. “In other words, the State is their guardian.”

Disability Rights is arguing that the law guarantees it access to the records of these children with disabilities who may have been abused. With consent of a child’s parents or guardians, that access would also apply to records of children who are not in state care but who may have been abused at St. Mary’s Home.

The Office of Child Advocate denied the request based on the state laws that define their office’s duties and rights, noting that they are asked to keep private all records involving care or treatment of children. But the same general law prescribes that “records shall be available to persons approved, upon application for good cause, by the family court.”

It’s not uncommon for such organizations to file or get involved in lawsuits involving young people with disabilities, like a 2022 lawsuit brought by North Carolina Disability Rights against the state’s foster care system, said attorney Allison Mahoney, founder of child welfare law firm ALM Law. 

Mahoney said it was unsurprising that Disability Rights would make a legal push to get the records it wants. 

“I don’t know of similar cases to this one where they are seeking access to records,” she said.

This story has been updated to include a quote from North Providence Mayor Charles Lombardi.