Hospitals sometimes failed to properly supervise patients known to be dangerous or didn't notify police and state regulators of the attacks, government records show.
The alleged victims — all under age 18 and some as young as 7 years old — were among society's most defenseless citizens: youths with serious mental illness who were admitted in crisis to the taxpayer-financed institutions. In the 18 cases since July 2008, all but four of the alleged victims were wards of the state with traumatic histories of abuse and neglect, government records show.
DCFS, tasked with protecting children from abuse, frequently conducted only cursory investigations, the Tribune found. The Illinois Department of Public Health, which licenses and inspects medical facilities, was able to file reports and cite patient-safety deficiencies in only three of the cases. Both agencies said they are hamstrung by weak laws and inadequate resources.
In the end, no penalties were levied against the half-dozen psychiatric hospitals where the alleged sexual assaults took place, and not one of the alleged perpetrators was arrested or prosecuted, the government records and interviews show.
At Chicago Lakeshore Hospital on the North Side last year, three male patients allegedly sneaked into the room of a 15-year-old girl at night. She told police that she tried to push away one of the boys, but he grabbed her by her hair and raped her. When hospital staff finally entered the room, the boys refused to leave and fought staff, with one of them kicking a 60-year-old nurse, according to a court memo.
But a hospital employee told police that "taking into consideration victim's current mental state ... this is not (a) bona fide incident."
The Tribune identified three other reports alleging that youths had been sexually assaulted or abused at Lakeshore since July 2008.
In one case, state health inspectors cited Lakeshore after an 11-year-old boy alleged that two male patients sodomized him in a bathroom that should have been locked and supervised by hospital staff. Inspectors said the hospital failed to document that staff had made required 15-minute checks on the two alleged assailants, one of whom had been admitted with "special observations orders for assault precautions."
None of the hospitals would discuss specific cases with the Tribune because of medical privacy laws, but a statement from Lakeshore said it has responded to assault reports by making improvements in "patient safety and positive clinical outcomes." Lakeshore added that its patients "often behave in unpredictable ways" but said the hospital "believes it does a better job" of promptly reporting assault allegations to DCFS and other authorities "than any other facility in Illinois."
Experts say sexual assaults of youths in psychiatric hospitals are generally underreported — but the devastating events often reveal systemic shortfalls in staff levels or in monitoring and treatment practices.
On Trib Nation, reporter David Jackson describes the origins of this story.
Because many young patients are admitted to psychiatric hospitals with histories of sexual and physical trauma, "both exploitive behavior and being exploited are entirely predictable. ... One of the fundamental responsibilities of any clinical program is to keep the children safe," said Clarence Sundram, the former chairman of New York state's Commission on Quality of Care for the Mentally Disabled.
Overall, the 18 cases uncovered by the newspaper involved five reported rapes. There were nine reports of sexual abuse such as molestation; in two of those, the alleged victims were 7 years old. In the remaining four cases, hospital or government authorities labeled the sex "consensual" — although that is a serious violation of standard clinical practice and DCFS policies, and even though the juveniles involved were as young as 12, records show.
"The fact that they are even able to have what some term 'consensual sex' is just abhorrent, because it says the system failed to keep kids safe and make them better," said Cook County Public Guardian Robert Harris.
In addition to the 18 cases the Tribune identified, records show two alleged rapes of mentally disabled DCFS wards who were 18 and 20 years old. The newspaper found several other assault reports that it did not count because the alleged victims gave contradictory statements, recanted, or did not appear credible based on police or other government documents.
In July 2008, after the Tribune exposed a string of reported sexual attacks of young wards at west suburban Riveredge psychiatric hospital, DCFS launched several reforms: the agency tightened reporting of assault allegations, hired two additional hospital safety monitors and assigned a team of University of Illinois at Chicago experts to investigate conditions at the psychiatric facilities. The UIC team is now completing an examination of Lakeshore's staffing levels and training as well as the alleged sexual assaults there.
"We continue to press this issue in every way we can," DCFS spokesman Marlowe said. But Marlowe added that DCFS would welcome new legislation to give the agency and the health department the staff and legal authority they need "to ensure safe, quality care in psychiatric hospitals."
The Tribune pieced together the 18 recent accounts using police reports, public health records, DCFS documents and court files. In some cases, the records were incomplete and hospital staff cast doubt on the veracity of the young patients. However, Marlowe said, the hospitals sometimes offered DCFS investigators "fronts, fabrications and flat-out lies."
The cases indicate breakdowns at every step of the investigative process.
In seven of the nine alleged sexual abuse cases, hospitals did not inform police of the alleged crimes, records show. In some cases when police were called, the officers were apparently impeded by medical privacy laws from learning the names of all the parties or witnesses involved.
DCFS and the health department, which also share responsibility for investigating the sexual assault allegations, don't get police reports and rarely coordinate their investigations with each other, records and interviews show.
The DCFS investigations into these incidents failed to find neglect or lack of supervision by hospital staff.
In one example, police were called to Hartgrove Hospital on the city's West Side when a juvenile patient alleged he was punched and forced to perform oral sex on a male patient, then raped when he tried to resist. The alleged victim was hospitalized with abrasions consistent with rape, a police report said.
DCFS' brief investigative report didn't mention a rape allegation or note the alleged victim's abrasions — but it extensively quoted a Hartgrove worker who said "he makes rounds every 15 minutes in the room of each patient to check to see if they are all right. He state(s) that patient safety is his first priority."
The neglect allegation was ruled "unfounded."
In a written statement, Hartgrove said it "takes the safety and well-being of its patients very seriously" and "complies with the reporting requirements mandated by the state agencies and all regulatory entities."
Another problem crops up because state laws enable DCFS to open neglect investigations only on individual hospital employees — and not on the hospitals or the top administrators who set policy and staffing levels, according to Marlowe. As a result, cases are "unfounded" even when DCFS investigators conclude the hospitals were negligent.
In another example from Hartgrove, a 13-year-old male patient performed oral sex on a 15-year-old DCFS ward in a day room crowded with roughly 14 other youths and only one hospital employee to monitor them, records show. The worker said he was distracted by trying to defuse a "conflict" among other youths in the room.
A DCFS investigation determined that "the level of supervision in the day room was inadequate" but concluded that "the institute Hartgrove is the perpetrator" of negligence, and not the lone employee. As a result, the case was "unfounded" and closed with no disciplinary action.
Unlike DCFS, the health department does have the authority to revoke a facility's license. But the health department says it lacks the authority and inspection staff to investigate all but a few of the alleged child sexual assaults. And it does not have the legal ability to levy fines on hospitals when it does cite safety infractions.
Health department spokeswoman Melaney Arnold conceded that her agency is "extremely limited under current law in enforcement action against hospitals that violate regulations."
Since a new state law took effect in January, hospitals have been required to notify the health department of assault or abuse allegations. But, Arnold said, none has done so.
In the past legislative session, the department proposed establishing a $30 bed fee from hospitals to hire additional inspectors, but the bill was killed by opposition from Republican lawmakers and the powerful hospital industry, said bill co-sponsor Rep. Mary Flowers, D-Chicago.