Inhospitable and in Denial

The parents of two little girls placed them in the Broward Children's Center hoping their daughters would be cured. Something went wrong.

Broward Children's Center President Bill Beggs claims center staff did nothing wrong in medicating Jenna.

"We certainly are cooperating fully with the investigation, and if the investigation shows culpability on our part and we find culpability on our part, we will address that," says Beggs. "But frankly, I don't anticipate there will be."

With missing records and no explanation, Broward County Medical Examiner Joshua Perper says the case is a frustrating puzzle with missing pieces.

Jenna's case in some ways mirrors another case at the center, involving a two-year-old named Cristal McBean. It wasn't a flash from the sky that caused Cristal to become permanently brain-damaged in 1994; it was, according to a medical malpractice attorney, a series of indefensible decisions made by Broward Children's Center staffers. Key issues raised in that case included the violation of doctor's orders and questionable training of staff.

The center continues to deny any wrongdoing in that case, too, even after damaging information surfaced that prompted the center's insurance company to pay a $4 million settlement to Cristal's family before the case ever got to court.

The cases of Jenna and Cristal both remain, to some extent, mysteries, due in no small part to the center's habit of substituting explanations with denials of blame.

Broward Children's Center's main facility is officially licensed as a nursing home but is much like, and often referred to, as a pediatric intensive care unit. It is the only residential nursing facility in the state designed solely for medically dependent children.

It's a place full of heartbreaking stories -- birth defects, chronic disorders, abused children, catastrophic injury. It's also an expensive place to stay. The children in the 36-bed facility are attached to tens of thousands of dollars' worth of state-of-the-art machinery that keeps them alive. The state has given the center, which is regulated by the Agency For Health Care Administration, some $3.6 million in Medicaid money this year as of November 11. The center, which has been much honored and enjoys an all-but-unblemished reputation for helping children, also raises cash with grants and fundraisers.

In addition to the main facility, the center also runs three group homes, one for young adults and the other two for severely retarded children, most of whom suffer from cerebral palsy and rely on wheelchairs and feeding tubes. The kids in the group homes, say staffers, aren't as medically fragile as those in the main facility.

Because Jenna could breathe on her own, she was put in one of the group homes, a remodeled, white stucco house in a working-class neighborhood in Pompano Beach, about a mile away from the main facility. The white-tiled group home's main room -- complete with a television, sofa, and chairs -- opens to a kitchen on one side and a hallway on the other. The hall is lined with rooms where the 12 children sleep, usually two in each. The hallway empties into another little room in back where the medication is kept in locked cabinets and a padlocked refrigerator.

When Jenna was moved in, Broward Children's Center staffers remarked on her condition in notes: "No ability to make decisions and no memory or understanding... unable to communicate to make needs known... unable to take oral feeding... totally dependent for dressing, bathing, toiletry, locomotion, transfers and eating."

All of the children in the group home went to a center-run preschool, according to staffers, except Jenna, who was taken to another group home or to the main facility to spend her days. School would do her no good. She spent most of her time in bed. But both her mother and father noticed something different about her while she was in the center: She didn't seem as agitated as she was at home. Instead she was always calm or, as her mother would later put it to an assistant medical examiner, "knocked out."

For about a year, Jenna had been on Mellaril, which is the trade name for thioridazine. Thioridazine (pronounced "THIGH-a-RID-a-zeen") is a powerful neuroleptic, the name given to drugs that act directly on the central nervous system and are used primarily for psychiatric patients. Thioridazine's basic function is to block production of dopamine, a chemical that transmits nerve impulses deep in the brain. While it isn't fully understood, dopamine is known to be crucial in making us who we are; it has a profound impact on movement and emotion. As if it were fuel for the central nervous system, those who lack it can literally lose the ability to move. Parkinson's disease, the most famous victim of which is Muhammad Ali, is caused by a natural deficiency of dopamine.

Thioridazine was developed in the 1950s to treat schizophrenics, who are believed to have a natural overproduction of dopamine. In addition to mental disease, the drug is also used in nursing homes as a tranquilizer. In blocking the production of dopamine, it also depresses the entire central nervous system, which reduces agitation and, according to critics of the drug, can lead to a kind of "zombification" of the user. Studies have shown that nursing homes, in general, often overprescribe thioridazine as a "chemical restraint" for residents or, as some critics call it, a chemical straitjacket.

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