Lincoln Developmental Center

Era of Abuse and Neglect Ends as Remaining Residents Depart

Photo of the Lincoln Developmental Center

On August 31, 2002, the last of Lincoln Developmental Center's (LDC) 370 residents were moved out of the 125-year-old institution. They were relocated to other state-operated centers for people with developmental disabilities and into community integrated living arrangements known as CILAs, depending on the preferences of the residents or their guardians.

Many families of former Lincoln residents have indicated that the transfer of their relatives or wards to other facilities has been positive once past the initial adjustment of settling into a new place. Their sentiments are consistent with information provided to Equip for Equality's (EFE) staff during visits to other state-operated facilities.

After reviewing the application of the Illinois Department of Human Services (DHS), which operates all state facilities, to close LDC, the Health Facilities Planning Board on August 15 voted unanimously to issue the permit allowing the state to permanently close the institution that has been under public scrutiny for more than a year.*

In its decision to close Lincoln, the Planning Board considered the following criteria: the validity of the claims made by DHS regarding the quality of care and budgetary issues at the facility, the possibility that closure would create a demand for services that could not be met by other providers within the service area, and how closure might impact the public's interest by causing undue hardship if services were limited for underserved groups.

Political Ploys

Applauding the Board's decision, EFE President and CEO Zena Naiditch reiterated the agency's strong support of the long overdue decision in a statement to the press. She said, "The Governor's inability to close this dangerous institution quickly due to stonewalling by the American Federation of State, County and Municipal Employees (AFSCME) and local politicians placed the residents at risk of serious harm. It was inexcusable to put individuals with developmental disabilities at risk solely for political and economic reasons."

Unfortunately, both candidates for governor, Democrat Ron Blagojevich and Republican Jim Ryan, have stated that, if elected, they would reopen the shuttered facility.

EFE's Perseverance

In October, 2001, EFE - acting on its authority as the governor - designated and federally mandated Protection and Advocacy System in Illinois - made three unannounced visits to the facility and extensively reviewed its records. What emerged was a chronicle of abuse and neglect extending over more than a decade.

Early in November 2001, EFE went on record in support of permanently closing Lincoln. In a strong plea to the Governor, EFE cited the continuation of more than a decade of abuse and profound neglect of Lincoln residents, resulting in pain and suffering, loss of individual rights, endangered health, numerous hospitalizations and documented deaths.

Earlier that fall, the Illinois Department of Public Health (DPH) had sought decertification of Lincoln because it could not meet minimum standards - sounding the death knell for the Medicaid funding representing one-half of the facility's $35 million annual budget.

Photo of the Lincoln Developmental Center EFE observed a number of incidents when Lincoln staff failed to respond to pica behaviors (ingestion of nonedible objects) in a timely and consistent manner. One resident attempted to eat a cigarette butt that he found in an unsecured garbage container. Others were seen repeatedly swiping the floor, picking at the bottom of their shoes and then putting their hands in their mouths. Some residents bit their hands repeatedly or chewed items they found on the floor. A variety of non-edible and dangerous items, including supplies in an open laundry room, were visible and available to residents exhibiting pica behaviors.

EFE also uncovered a dismal absence of active treatment and programming for Lincoln residents, documenting care that was merely custodial. Frequently, residents were observed as idle, restless, sleeping in chairs or engaging in self-injurious and other maladaptive behaviors such as aggressively striking themselves or walls, or disrobing. Television appeared as the most common activity, often showing provocative and violent programs, and staff involvement with residents was minimal, often becoming activated when outside agency monitors were present.

Based on its serious concerns for the residents' safety, EFE recommended that DPH serve as an independent monitor on an ongoing basis, which resulted in the agency's return to the site several times a week. When DPH observed incidents demonstrating substantial risks to resident safety, it proclaimed an "immediate jeopardy," causing the immediate cessation of Medicaid funding. Based on this new documentation, EFE called for Lincoln's closure again in December.

On Dec. 7, Gov. Ryan and officials from DHS toured Lincoln. He was eye witness to an unattended resident exhibiting pica behaviors who was eating a pen, an incident typical of many observed by EFE during its own monitoring.

EFE staff made 12 unannounced visits to Lincoln, from Oct. 2001 through Aug. 1, 2002, totaling more than 40 hours of independent monitoring, including on evenings and weekends. Early in January 2002, the Illinois House conducted public hearings to listen to testimony about conditions at Lincoln, and Gov. Ryan ordered DHS to develop two plans: one for closure, the other for downsizing to regain federal certification. He also noted that DHS and EFE were to continue their routine monitoring of LDC.

"Even with DHS and two independent agencies acting as watchdogs, the conditions of abuse and neglect prevailed," said Naiditch. "Ultimately, the conclusion was the same. Lincoln was beyond fixing, and the only solution remaining was to close the facility."

Photo of the Lincoln Developmental Center In February, when the Governor ordered that more than 150 residents be transferred to other state facilities with plans for those remaining to eventually be moved into 10 10-bed group homes to be built on the facility's grounds, EFE again registered its displeasure, stating that the investment of more money into Lincoln, given its history of serious and continuous problems, was a mistake.

As late as June, although there was an impending "do or die" full certification survey that would have left LDC with no right to further hearings, administrative review or appeal if it failed the inspection, DPH declared another "immediate jeopardy," resulting in the immediate cutoff of Medicaid funding. On June 10, Gov. Ryan announced that the process of closing Lincoln would begin on July 10, acknowledging that the continuing health and safety issues were no longer tolerable. Two days later, the Illinois Senate failed to override the Governor's amendatory veto of 2003 funding for Lincoln.

The continuing health and safety issues cited by Gov. Ryan, which resulted in the June "immediate jeopardy" included:

A resident known to engage in self-injurious behaviors, including the insertion of items into body cavities, who is supposed to be within staff eyesight at all times when awake and checked at 15-minute intervals when sleeping, was found with a broken hanger inserted into his rectum.
A resident who exhibited pica behaviors and was to be within staff eyesight at all times was left in a washroom unattended.
A resident known to insert objects into his nose and who was to be within staff eyesight at all times was able to leave his group unnoticed and wander to a day training site elsewhere on Lincoln's campus.
A resident diagnosed with pneumonia was found sleeping in his room while staff, who were charged with knowing his whereabouts at all times, believed he was at a day training program, unaware he had actually been in his room for several hours.

Legal Wrangles

The battle to save Lincoln from closure was also waged in the courts, with an ongoing saga of attempts to prevent the state from striking the final blow. In January 2002, following Gov. Ryan's order to either close or continue to downsize the center, AFSCME and parents of a Lincoln resident sought injunctive relief in the Circuit Court of Logan County against the Governor, the State of Illinois and DHS, among others, to block closure. The trial court denied the petition.

In March, the state further reduced LDC's population even further, and the plaintiffs filed an amended complaint for injunctive relief. In April, the trial court entered a preliminary injunction requiring defendants to apply for a permit from the Planning Board prior to proceeding with any plans to downsize the center. The state responded by filing an interlocutory appeal, which was withdrawn after application for the permit was made by DHS Secretary Linda Renée Baker.

In June, Gov. Ryan reversed his earlier decision, following several more egregious abuse and neglect incidents, and announced his final decision to close Lincoln, ordering the additional transfer of residents the first week in July. Plaintiffs filed another motion for a temporary restraining order, which was granted and which prohibited the state from involuntarily transferring any residents pending Planning Board approval. On June 16, the appellate court reversed the temporary restraining order to allow the transfers ordered by Gov. Ryan to proceed. Even with the inevitability of Lincoln's complete demise at hand, AFSCME mounted what appeared to be a last stand by filing a petition on July 25 with the Illinois Supreme Court to appeal the decision reversing the temporary restraining order. The petition was denied on October 2. =

* Section 2 of the Illinois Health Facilities Planning Act. 20 ILCS 3960/2# establishes the Illinois Health Facilities Planning Act and creates a procedure to address the trend of the increasing costs of health care arising from unnecessary construction or modification of health care facilities.

The Act states that the procedure "shall represent an attempt by the State of Illinois to improve the financial ability of the public to obtain necessary health services and to establish an orderly and comprehensive health care delivery system which will guarantee the availability of QUALITY health care to the general public." =

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