Culture of cruelty persists at state-run mental health facility despite decades of warnings

“What I am presently seeing occur at Choate and hearing occur at other facilities concerns me more than it has my entire career,” Barry Smoot, a decades-long IDHS employee, wrote to Illinois Department of Human Services Secretary Grace Hou on May 26, 2021.

Hou responded that same day, agreeing to meet.

But no meeting took place. Instead, Hou suggested Smoot start by sharing his concerns with her chief of staff, Ryan Croke, and the director of the Division of Developmental Disabilities, Allison Stark, according to records of the exchange. But those meetings never happened, either. Stark left the agency in July.

It would take more than a year and multiple high-profile arrests related to abuse at the facility before the agency unveiled a plan. In June, Hou sent a letter addressed to “stakeholders” in which she acknowledged for the first time “serious allegations about resident abuse and neglect” at the facility near the small town of Anna.

The reform plan she outlined includes hiring four new security officers, installing 10 surveillance cameras on the facility grounds, having staff undergo new training and increasing the presence of senior IDHS officials in residential units.

At least 26 Choate employees have been arrested on felony charges over the past decade, according to reporting by Capitol News Illinois, Lee Enterprises and ProPublica. The local state’s attorney has filed charges against more than a dozen of those arrested, including three administrators, since 2019, when Hou was appointed IDHS secretary by Gov. J.B. Pritzker. Charges have been dropped against two of the administrators charged with official misconduct and obstruction of justice.

Jerry Nowicki / Capitol News Illinois

Marisa Kollias, a spokesperson for the agency, said the facility is working expeditiously to implement reforms but cautioned it will take time. Senior IDHS officials told reporters in an interview the training and monitoring have been underway for months, the department has hired one new security officer and the cameras are on backorder, and no date has been set for installation.

In a written statement, Kollias said the agency determined, “based on information gathered” after the secretary’s initial response to Smoot, “that it was inadvisable for IDHS management staff to communicate with him any further.” The department did not provide any details.

Whitney Curtis / ProPublica

Camera controversy

Smoot was not the first to raise alarms. The inspector general’s office at IDHS has repeatedly cited the facility for failing to adhere to rules regarding reporting and investigating abuse and neglect allegations.

IDHS’s inspector general recommended the installation of cameras in the course of 21 investigations into abuse and neglect allegations at Choate between fiscal years 2015 and 2021, according to a review of internal records. Each time, Choate officials responded it was “not an option due to budget concerns.”

This summer, advocates and insiders praised Hou’s announcement that IDHS would install cameras. But, while almost all incidents of alleged abuse and neglect occur inside, the spokesperson told reporters the cameras would be placed outside.

“This is all being done for show,” former Office of the Inspector General supervisor and Choate unit director Charles Bingaman, who retired from IDHS in 2013, said about the outdoor cameras. “I predict that it will have no real impact on patient safety.”

Senior IDHS officials acknowledged in an interview the inspector general had previously recommended interior cameras. But placing cameras in interior common areas on a residential unit requires the consent of every resident, or their guardian, and Kollias said parent groups had not supported the move.

Long history of problems

States across the nation have closed large facilities like Choate in the past 20 years, following a U.S. Supreme Court ruling that it is unconstitutional to segregate people with disabilities from the rest of society.

Illinois has been a holdout. It houses more people with developmental disabilities in large institutions and spends more to operate those institutions, relative to statewide personal income, than almost every other state, according to a review of data compiled by researchers with the University of Kansas.

But, for years, the state has also failed to intervene when abuse patterns are found inside its institutions.

In 1992, the American Civil Liberties Union of Illinois sued on behalf of patients, alleging that poor conditions at state-run psychiatric hospitals, including Choate, violated patients’ rights to safety and medical care. The parties settled, and Illinois agreed to enhance staffing and training.

Then, in 2005, after two patients died from neglect at Choate, Equip for Equality, a legal advocacy organization for people with disabilities, found unsafe conditions and poor treatment of residents. The group — which had been appointed by the state to monitor the facility — called Choate’s practices “archaic.”

In response, the U.S. Department of Justice’s Civil Rights Division launched an investigation and warned the state in 2009 the Choate staff’s failures to help residents successfully transfer out of the facility violated the Americans with Disabilities Act. The facility had also failed to protect them from harm and provide adequate health and psychiatric care, the DOJ found. Again in 2021, Equip for Equality was appointed to monitor conditions inside Choate.

Smoot, who also had worked as an investigator for the IDHS inspector general, said leadership’s slow response left him deeply troubled. Earlier this year, he self-published a book, “Failure to Protect,” outlining his concerns.

And on the last day of his 20-year career with IDHS, Smoot sent Hou an email to let her know no one had followed up with him.

This time, there wasn’t a response, according to records of the email exchange obtained by reporters. Smoot said he hoped someone would heed his warning. “Without any time left,” he said in an interview, “it was a Hail Mary pass.”