EXHIBIT i STATE OF VERMONT. SUPERIOR COURT FAMILY DIVISION Chittenden Unit Docket No. 222-5-19 Chjv ) ) In re: GW ) ) ) AFFIDAVIT OF PAUL CAPCARA NOW COMES Paul Capcara, RN, MPH having been duly swom, and deposes and says as follows: 1, 1am a Registered Nurse licensed in the State of Vermont. I have a Master of Public Health Degrco with a concentration in maternal and child health, and a Bachelor of Science degrec in Nursing from Johns Hopkins University. I have been trained and certified in three national patient management techniques for verbal de-escalation and physical restraint including: Crisis Prevention Institute (CPI); Professional Assault Crisis Training (Pro-ACT); and Management of Aggressive Behavior (MOAB). 2. have worked as the Director and Clinical Manager of three inpatient psychiatric units in Vermiont, In 2014 and 2015, I served as the Clinical Manager at the Brattleboro Retreat’s inpatient unit for adolescents. This is the only adolescent psychiatric hospital in Vermont. Tam currently the director of a 10-bed inpatient psychiatric unit at Cottage Hospital in Woodsville, NH and an adjunct professor of mental health nursing at Norwich University. 3. In my current rote at the hospital, I am responsible for overseeing the hiring, training, and monitoring of staff, as well as day-to-day operations on the unit. ] am responsible for supervising and monitoring staff performance of restraints and seclusion. | um also responsible for ensuring that restraint and seclusion practices conform with all applic policies, procedures, laws, and regulations. I had these same responsibilities in my prior roles at the Brattleboro Retreat and Central Vermont Medical Center (CVMC). 4. Additionally, 1am responsible for helping develop and monitor the implementation of treatment plans for persons suffering from mental illness as part of a multidisciplinury treatment team, One of the primary goals of such plans isto reduce the need for emergency involuntary procedures stich as seclusion and restraint. Thave successfully decreaied the use of restraint and seclusion in the inpatient settings where Ihave worked. 6. Tbecame femiliar with Grace Welch when she was » patient at CVMC. I worked with her Girectly and supervised other staff members who were providing care to her 7. The evidence forming the basis for my opinion is as follows:10. u. a. Licensing Regulations for Residential Treatment Centers in Vermont published by the VT Department tor Children and Families (DCF) b. Orientation Handbook for Woodside Residents containing information about Woodside rules and provedutes, residents’ rights, security procedures, and stat code of ethics; &. Woodside training documents entitled Dangerous Behavior Control Techniques and Advanced Communication Techniques; d. Woodside’s policies governing use-of-force and North Unit placements; ©. Woodside incident reports from Grace's most recent admission to the facility; £ Approximately fifteen videos of restraints at Woodside involving five different children; Woodside documentation for other children subject to restraint, seclusion, and North Unit placements; h, Multiple visits to the Woodside facility, a tour of the facility, an explanation of the servives reportedly provided at the facility, interviews with three Woodside residents, and discussions with Woodside’s leadership; i. Regulatory investigations detailing inappropriate uses of restraint and seclusion at Woodside. In my opinion, the technique used to restrain children at Woodside constitutes an excessive use of force, poses serious risks of physical and emotional lam, and does not conform to any known national restraint technique designed for use with adolescents. ‘The techaique appestrs to have been developed by Woodside Director Jay Simons based on an adult law-enforcement or corrections model, as opposed to a treatment mode! Stuff at Woodside are trained to force # youth's arms in an elevated position behind his or her back while restraining the youth in a prone position. This technique places the shoulder joints in a position of hyperextension and applies pressure to the eTbows and wrists, This same positioning of the arms is used when youth are “escorted” involuntarily. During escorts, youth are bent over at the waist and the anns are pulled up behind the youth and twisted. A reasonable person would understand that this technique is likely to cause significant pain. Itis also liable to injure the tendons, muscles, and ligaments surrounding the shoulder, wrist, and elbow joints. During prone restraint, the youth's feet are positioned such that one or both feet ure pushed into the buttocks, This technique has the potential to injure the youth's knee and ankle joints, as well as the muscles in the thighs. A reasonable person would also understand thal this technique is likely to cause pain. The technique itself is also capable of impeding the young person's ability to breathe. Pulling the arms back snd pushing the feet into the butlock places the body in a position similar to a “hog ic.” This positioning makes it difficult for the young person to expend his or ber chest cavity and take in oxygen. This effect can be even more pronounced ‘when the child is obese, extremely agitated, or suffers from a médical condition such ss asthma. The videos that | have viewed provide ample evidence that the restraint technique used at Woodside is unnecessarily painful,13, Ihave also viewed video where staff placed downward pressure on a child’s torso during restraint, placed pressure on a child’s head, or placed pressure on a child's throat. Placing downward pressure on a child’s torso or pressure on a child’s throat can lead to asphyxiation and death. Contacting the head can also lead to serious injury. 14, All of the restraint protocols 1 am familiar with are widely used in treatment settings. ‘These models all teach staff to keep joints straight to reduce the potential for pain and injury, to not apply pressure to joints or the torso, and prohibit staff from elevating arms behind an individual. Those modcls also discourage contact with the head, neck, joints or torso for the reasons described above. 15, In general, the use of highly invasive and potentially traumatizing interventions such es physical restraint, es well as the use of seclusion, undermine a youth’s trust in staff, hinders the development of a therapeutic relationship, and reduces the chance that the youth will be uble to benefit from treatment. Trust and the establishment of a therapeutic alliance with staff are essential components of effective treatmeat. As a result, in all trealment settings with which | am familiar such interventions are reserved for emergency iativns in which there is # risk of serious physical harm to the person or others, and are time limited and discontinued as soon as itis sufe to do so. 16, Woodside provides its stuff members with “personal protective equipment,” that does not confonn with personal protective equipment standardly used in a treatment setting, including a riot shield. No other treatment facility in Vermont, including the Brattleboro Retreat and the Vermont State Llospital, permits its staf¥ to utilize this type of equipment with patients or residents, Persons with mental illness are likely to experience the use of | this type of equipment as threatening and traumatizing, and the use has the potential to increase the likelihood that residents will become dysregulated and escalate their behavior requiring the staff to utilize a high-level physical intervention. 17, Additionally, state snd federal regulations place limitations on the use of restraint and seclusion in treatment facilities, These practices are meant to be utilized as a last resort and only when the resident or patient's behavior is likely to imminently cause serious physical hann to himself or others and no less restrictive intervention has been ssucexssful, Limitations on the use of restraint exist because restraint can be physically and emotionally traumatizing to residents and staff and has the potential to cause physical injury to residents and staff 18, Excessive use of high-level interventions such as restraint and seclusion in residents with a history of traume also has the negative effect of reinforcing the resident's previous ‘experience thut adults will use physical force and violent acts to control them when they are losing contral, instead of helping them learn self-regulation and coping skills. 19, Limitations on the use of seclusion exist because excessive use of scclusion ean increase self-harming behaviors and suicidality, worsen mental health symuptoms, decrease the strength of the therapeutic alliance between the patient and his or her treatment providers, and reduce the chances of treatment success 20, Restraint and seclusion should be viewed as “treatment failures” as opposed to components of treatment plan. When staff find that they have to use restraint and seclusion repeatedly with the same resident or patient, the treatment team should workwith the resident or patient to modify the treatment plan to identify less restrictive and more effective interventions. 21. The use of “segregation units,” and “special management units,” is not present in many ‘treatment settings and when itis, itis typically a very time-timited intervention. Overuse Of these interventions can cause harm to the patient or residents and reduces the likelihood of treatment success. 22. When combined with excessive periods of seclusion end the denial of wecess to ‘constructive and therapeutic activites like reading, exercise, or educational opportunities, the use of a segregation unit can be extremely harmful to adolescents, 23. It appears that Grace, like other children 1 have met at Woodside, has been subjected to ‘barunful and inappropriate use of seclusion and segregation. 24, | have reviewed incident reports indicating that staff have forcibly removed Grace’s clothing on one occasion and have removed her safety smock on at least three occasions. ‘When her smack was removed, Grace was left naked in her cell for several hours. | have not encountered this practice in any treatment setting and itis traurnatic, unnecessary, and dehumanizing, I believe this practice constitutes child abuse, should be discontinued immediately, and should be investigated by DCF. 25. Having overseen the care of Grace in an inpatient setting, it is my opinion that the interventions Woodside has employed for the expressed purpose of maintaining Grace's safely, including forcible removal of clothing, repeated use of restraint, continued segregation, and excessive use of seclusion are unnecessary and likely to cause significant emotional harm. These interventions also have the potential to cause physical injury to Grace. 26. It is my professional opinion that keeping Grace at Woodside is likely to cause psychological trauma and may result in serious physical harm, 27. have repeatedly testified about my concems regarding the unususl and harmful practices at Woodside for over a year. DCF's leadership has known about the dangerous ‘conditions as the result of my testimony and that of other expert witnesses, as well as their own internal investigations. Despite this knowledge, the dangerous und harmful practices persist. pa: / 20/19 Boi [151