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On January 1, 2017, the KHI News Service became part of KCUR public radio’s new initiative, the Kansas News Service. The Kansas News Service will continue to cover health policy news and broaden its scope to include education and politics. All stories produced by the former KHI News Service are archived here. Stories and photos may be republished at no cost with proper attribution and a link back to KHI.org.

Audit finds Larned sexual predator program near capacity

Report warns of staffing challenges, cost increases at state hospital

By Meg Wingerter | January 26, 2016

Audit finds Larned sexual predator program near capacity
Photo by Megan Hart Lynn Retz, a senior auditor, told the Senate Public Health and Welfare Committee that Larned State Hospital’s sexual predator program was at 92 percent of capacity.

Larned State Hospital could run out of room in its unit to treat sexual predators as early as next year, which may force the state to treat some offenders in community settings or set up a separate secured facility, according to a report from Legislative Post Audit.

The Larned program treats offenders who have completed their prison sentences but were involuntarily committed because a judge or jury found they were “sexually violent predators.” The label applies to offenders who have a “mental abnormality or personality disorder” that makes it likely they will engage in sexual violence again if not treated.

As of December 2014, the sexually violent predator program was 92 percent full, and the number of offenders is expected to keep growing. If current trends continue, the program likely will exceed its capacity between 2017 and 2020, senior auditor Lynn Retz told the Senate Public Health and Welfare Committee on Tuesday afternoon.

“Unless changes are made, the sexual predator treatment program would exceed capacity in the next few years,” she said. “Far more offenders are committed to the program each year than are released.”

The Post Audit report also estimated costs would more than double by 2025 and that Larned would struggle to find enough staff for the program, mostly due to a lack of available labor in the rural area around it, Retz said.

Treating low-risk offenders in a community setting would reduce the population of the Larned unit by 12 percent by 2025 and cut costs by $7.5 million to $8 million, Retz said. On the other hand, it could raise the risk of an offender committing another crime, according to the audit.

New York pursued a community-based program for lower-risk offenders, including regular visits from parole officers, GPS tracking, curfews and polygraph testing, according to the audit. Of the 152 who had been treated in community settings between 2007 and 2013, three have been charged with another sex crime, for a roughly 2 percent recidivism rate.

Concerns about community settings

Some committee members expressed disbelief that sexually violent predators could be treated in community settings.

“With that population, I think really the only low risk is those that are too old to be a threat to anyone else,” said Sen. Mitch Holmes, a Republican from St. John.

Another option would be to separate “medically infirm” residents from the rest of the offender population, Retz said. That would reduce the population in the program at Larned by 15 percent but would have little effect on costs, because any savings would be wiped out by the need to build and staff a new secured facility, she said.

Sen. Laura Kelly, a Democrat from Topeka, suggested the state could consolidate its veterans’ homes in Dodge City and Winfield into one facility and renovate the other for use as a facility for geriatric sexually violent predators. Legislative Post Audit didn’t have a cost estimate for that idea.

A third option would treat sexually violent predators with intellectual or developmental disabilities in a separate facility. That would decrease the offender population by 13 percent to 16 percent but would increase costs by $6.5 million to $8 million, according to the audit. It might increase the number of offenders completing the program, however, Retz said.

“This would likely be more beneficial to those residents, as they did not appear to progress through treatment,” she said.

“With that population, I think really the only low risk is those that are too old to be a threat to anyone else.”

- Sen. Mitch Holmes, a Republican from St. John

Three other options weren’t found to be likely to reduce the offender population, and didn’t affect costs substantially or actually increased them.

The audit also found problems at Larned with understaffing, improper documentation and a program that didn’t appear to meet offenders’ treatment needs.

The program has authorization for 359 staff positions, but the vacancy rate for nurses and mental health technicians was 38 percent as of February. That has resulted in significant overtime expenses, and the audit said the state may want to consider building a second unit somewhere else if officials decide to pursue one.

“We noted the remote location of the program, the limited pool of applicants and undesirable working conditions all likely contributed to staffing shortages,” the audit said.

Larned is one of two state-run inpatient treatment facilities for Kansans with severe and persistent mental illness. The other is in Osawatomie.

Problems with documentation

Kansas’ treatment program isn’t individualized, Retz said, and doesn’t use a risk assessment tool to determine which offenders represent a greater risk to the general population or what treatment each should receive.

The audit found that, in some cases, offenders who had completed the clinical requirements for their phase weren’t able to move on because they hadn’t spent enough time on recreational activities like walking or reading, meaning they would have to wait three months and reapply.

“Kansas placed a greater emphasis on nonclinical requirements to progress to the next stage than other states we looked at,” Retz said.

Most offenders are in phase two or three of the seven-phase program, although the average offender had been in the program for eight years, Retz said. Only three offenders have completed all seven phases since 1994, 13 have been released by courts on technicalities and 28 have died without completing their treatment.

The audit also found offenders who completed the first five phases of the treatment plan often still lacked skills to find a job or even shop and cook for themselves.

The program also had problems with documentation, to the point that it wasn’t clear if offenders actually had completed a stage or received required therapies. The Department of Social and Rehabilitation Services, later renamed as the Kansas Department for Aging and Disability Services, also failed to file annual reports to the Legislature from 2010 to 2014.

“Staff could only estimate for us the frequency of resident participation,” Retz said.

The Post Audit report recommended that KDADS start using tools to determine the risk that an offender will commit another crime and how best to treat each offender. It also recommended that the agency regularly evaluate offenders’ progress and needs.

Tim Keck, interim secretary of KDADS, told the committee later Tuesday afternoon that the agency had made “significant” progress on addressing the audit’s recommendations since it first was released in April. For example, 95 percent of offenders in the Larned program now have individualized treatment plans, he said.

“We hope to have that at 100 percent soon,” he said.

The Larned program met most legal requirements related to patient rights, according to the audit, but may have run afoul of the statute mandating appropriate services because it didn’t offer some educational services, like GED classes or treatments for drug or alcohol addiction. A law passed last year struck those requirements.

The committee didn’t issue any recommendations on implementing the audit’s findings.