A shocking error in treatment

The Boston Globe
December 21, 2007
Friday THIRD EDITION

THE JUDGE ROTENBERG Educational Center is the only school in the nation that routinely uses skin shocks to control self-destructive and violent behavior by autistic, retarded, and emotionally disabled patients. But the Canton-based center is too error-prone to be allowed to keep using aversive therapy without intensive and ongoing oversight by state health officials. The state Executive Office of Health and Human Services must decide soon if the controversial program warrants continued support and student placements.

There is a role for aversive therapy if it is practiced with great restraint and respect. But such was not the case in August, when two emotionally disturbed teens in a Stoughton group home run by the Rotenberg center were given dozens of electrical shocks at the direction of a telephone caller posing as a medical supervisor. That caller was later identified as a former student. The fact that the staff was so easily duped speaks to both poor screening of new hires and a dangerous lack of training. On that night, at least, the center resembled not a therapeutic environment but the infamous Milgram experiment, which measured the willingness of ordinary people to hurt a test subject based on nothing more than the verbal order of a phony scientist.

Critics of the center are many, and include a majority of the Massachusetts Senate, which has tried to ban Rotenberg's controversial treatment. But the testimonials from Rotenberg families speak with greater authority. The skin-shock techniques often stop or reduce the eye gouging, head banging, self-mutilation, and assaults that defy the practitioners of positive reinforcement, drugs, and other traditional therapies. Rotenberg's roughly 200 students typically arrive on the doorstep having attended four prior programs, according to school founder Matthew Israel.

Several state agencies monitor the Rotenberg Center. But the buck stops with the certifying agency - the state Department of Mental Retardation. This week, DMR recertified the Rotenberg Center for one year. But the agency should be prepared to withdraw that certification if a pending study by the state Disabled Persons Protection Commission uncovers additional problems at the center. Wisely, the state has sent no new clients to the center for aversive treatment since January.

Israel says the center has implemented a slew of new supervisory and monitoring practices for its 38 group homes. But the overnight shift still lacks direct supervision by a registered nurse or other licensed medical professional. That doesn't inspire confidence.

The decision to apply aversive techniques rests in the hands of parents and a probate court judge who vets each case with medical experts. The question isn't so much whether skin shocks are an acceptable form of treatment, but whether the Rotenberg Center is the right place to do it.