Mental Anguish at Texas West Oaks Hospital
Amanda Lilley was only six years old and could be loving, sweet and delightful, requiring hugs of any visitors before they left her house.
But when she was out of control, tables would be flipped, chairs smashed and the kittens she loved needed to run for cover. She once took on four men at St. Luke's Hospital and ripped out her own IV. Diagnosed as mentally retarded, autistic and with a mild seizure disorder, she'd been pooping her pants, acting up on the school bus and kicking, hitting or biting indiscriminately anyone who crossed her path. Hit by a seizure, she would stare into space without moving.
Her parents, Loretta and Jim, who have five other children, love Amanda despite her troubles. Sometimes the medication she's prescribed is enough, and sometimes nothing slows her down.
In February of 2006 she had spent a few days at Texas West Oaks Hospital, the private psychiatric facility in west Houston. As she was released, she was referred to another facility, but as her mother Loretta puts it, "They wouldn't touch her."
Back at their Conroe home, she was sleeping only two hours a night. Mom stayed with her in a locked bedroom. Dad slept out on the couch in the living room to make sure Amanda didn't go out the locked front door (as she had other times, only to be brought back by the police).
Amanda did not get any better, so they decided to take her back to West Oaks. On the way over, Amanda tried to jump out of the car onto the highway.
In the days following Amanda's February 21, 2006, check-in, staff members issued a litany of complaints. She wasn't doing well. No one wanted to room with her. She had to sleep on the couch. She had no boundaries with the male staff.
On February 28, Loretta received a voice message at about7 p.m. asking her to call West Oaks. The staffer said Amanda had hurt her arm. It wasn't anything real bad; they were just letting her know about it. She had been sent to her room for acting out in the TV room, and then the accident occurred. They were going to have a doctor look at it. Reassured, Loretta said okay.
The next day, Loretta called in and was told everything was fine. The doctor had looked at Amanda's arm, and she was fine. "Fine" was the operative word.
On March 2, Loretta came to pick up Amanda to take her to a special education assessment at the Conroe school district. That's when she found her daughter's right arm dangling limply by her side. She discovered how swollen and discolored it was when she got her into the outside light in the parking lot.
That's when she took Amanda to an emergency room and found out that yes, Amanda's arm was broken.
That's also when she decided West Oaks Hospital and its personnel didn't know what they were doing.
Increasingly, other voices are joining her in this complaint. Critics say that West Oaks is understaffed, conducts poor or no training of its employees, doesn't supervise its patients well and keeps inadequate records that make determining what is going on at this private facility very difficult.
The Texas Department of State Health Services has fined West Oaks Hospital a total of $155,000 since March 29, 2007, for three separate episodes in which there were violations of state licensing regulations. The state reports these findings without patient names or date of occurrence, so it is next to impossible to determine what specific cases were involved. In any event, West Oaks was cited for everything from "failure to assure humane treatment of its patients that assures protection from harm" to "failure to monitor patients" correctly to "failure to provide a sanitary environment."
What is specifically known from other reports is that on June 14, 2007, patient Mario Vidaurre died at West Oaks when the one-on-one tech assigned to him beat him to death [see "Death in a Box," by Margaret Downing, October 25, 2007]. An investigation by the state found West Oaks was at fault. On March 22, 2007, Alan Chambers, a man who was supposed to be under suicide watch, hung himself behind the closed door of his room on Unit 1. On May 12, 2006, a 17-year-old girl who tried to hang herself with one of her shoelaces was allowed to keep the other shoelace of the pair in her West Oaks room.
Frederick Williams, the tech who fought with Vidaurre and caused his death, has left the psychiatric center and retained an attorney to represent him in a lawsuit against his former employer. He's arguing he had no business being assigned to Vidaurre; he never got trained for that kind of job.
Amanda Lilley ended up with an untreated broken arm. As bad as that was, it could have been worse.
West Oaks, at 6500 Hornwood, is accredited with the Joint Commission on Accreditation of Health Care Organizations. It enjoys a generally good reputation in Houston. When local public psychiatric hospitals' beds are full, they often redirect patients to West Oaks.
Its executive medical director, Dr. George Santos, is highly regarded. He was named to the Harris County Hospital District Board of Managers just this March; County Judge Ed Emmett spoke of Santos's "impeccable credentials." Santos did not return a call from the Houston Press.
West Oaks takes on more difficult cases than most mental health facilities want to deal with, and some relatives say they welcome it as an alternative to a state mental institution.
That was the case for Mary (not her real name) and her family, who came to West Oaks from Illinois. Mary's younger 17-year-old sister, whom we'll call Renee, had been a patient at the prestigious Mayo Clinic in Rochester, Minnesota, but had to leave. An acute-care facility, the Mayo Clinic had already had Renee there longer than the three-to-five-day standard stay. Renee had already exhausted most of the psychiatric hospitals near her home, so they had to look farther for a place where she could stay for a longer time, Mary says. The Mayo Clinic referred Renee to the also prestigious Menninger Clinic in Houston.
But Renee was too tough for Menninger, at 2801 Gessner Drive. The morning after her arrival, she grabbed a pair of scissors and injured several staff members, Mary says. Menninger said it was transferring her, and when Renee's mom put up a protest, she was told they had the right to move her without the family's consent. Mary says Menninger told them that they usually transfer to Baylor, but its beds were full, so Renee was admitted to the adolescent program at West Oaks on May 11, 2006.
What Renee's family found upon their arrival convinced them their concern was warranted. Mary describes West Oaks as dirty and dark, and as "a large cement room with a cement floor." As Mary later wrote in a letter to the Mayo Clinic, "The staff frequently laughed, joked, talked and used foul language among themselves while ignoring the needs of the children." Kids were sitting around, staring, watching some TV, but not engaged in anything, she says. This differed from other facilities where her sister had stayed, which had very structured activities. She wonders if part of the reason it seemed so disorganized was that West Oaks had an influx of adolescent patients from Hurricane Katrina.
Because of her violent behavior, Renee was assigned a one-on-one caretaker. Mary talked with her and found out she was a nursing school dropout. Mary says the woman told her she had received no training from West Oaks.
When she and her mother came to visit, Mary says the heavily medicated Renee was afraid to talk about her treatment, waiting until staff stepped away to mention anything. "She told me that they were threatening to hit her if she hit them. She was very afraid that she would get out of control and have a violent episode and not be able to control herself."
While the phone reports her family was getting from West Oaks were consistently positive, Mary says they'd arrive to find unexplained bruises and cuts on Renee's body. They found out later, she says, that Renee had gotten scissors again. They found out because Renee told them, and then the staff finally confirmed it.
Renee's back was injured when a tech wrestled her to the floor when she was acting out and got on top of her to hold her down, Mary says, adding that her 5'8" sister weighed about 110 pounds then.
Another time, Mary says, "They were moving across the room with her and they didn't have the right number of people, and they ended up dropping her. She was very banged up by the time she left."
On May 12, Renee attempted suicide in her room, using one of her shoelaces to try to hang herself. "They took that shoelace away and put it in her chart, but they left the other shoelace in the shoe in her room," Mary says. She discovered this when they had a subsequent family therapy meeting during which Renee asked when she was getting her shoelace back, because she wanted both of them. The counselor did a double take and asked if she still had the shoelace. Renee said, "Yeah, it's in my room," according to Mary.
The family was finally able to get a doctor to release Renee to the Mayo Clinic. She left West Oaks early in the morning of May 15, 2006, and was back at Mayo the next day. According to Mary, Renee got a lot worse during her brief stay at West Oaks. "There was a lot of undoing to do once she got back up to Mayo Clinic."
Caught up in dealing with a very troubled sister in crisis, Mary says she now regrets not taking more names or pressing forward more immediately with more state agencies about her sister's experiences. Months later, she contacted Menninger Clinic's Vice President for Quality Services, Pegi Pung, who wrote her that she would be forwarding her complaints to the Menninger staffers who referred Renee to West Oaks, as well as to Menninger's "clinical team who review the facilities where we refer patients." Pung wrote that she would get back to her with the results of that investigation.
A month later, when Mary received the exact same letter from Pung, she called the administrator. Pung told her she needed to call West Oaks, Mary says. When Mary protested that West Oaks was the problem, she says Pung told her she couldn't do anything about it and that Mary needed to talk with West Oaks. According to Mary, when she argued that Menninger had a responsibility because it was referring patients to West Oaks, Pung said that if Menninger has someone in an acute situation, they have to go somewhere, and if there are no beds open elsewhere, then West Oaks is the choice. Pung did not respond to calls from the Press, but another senior vice president, Shawna Morris, did on her behalf. Asked why Menninger would continue to refer patients to West Oaks when a relative was reporting bad treatment there, her response was:
"We really can't comment on it. It's not our case; it's not our patient; it didn't happen at Menninger. So I stand behind what Pegi Pung put in her letter, that Menninger cannot really get involved in another provider and the relationship that patient has with what happened at another facility. I regret that we really cannot comment any further on this case." Asked again why they would continue to send patients to West Oaks when it has been sanctioned by the state, Morris said:
"We refer patients to facilities that can provide a level of care that Menninger does not provide. So we refer patients to West Oaks, we refer patients to Kingwood Hospital, to the Methodist Hospital, to IntraCare, to all of the acute locked units. When we can't take care of the patients, we can't keep them, so we refer them out to the local hospitals."
Even if the state has fined them and said they aren't taking care of patients correctly, that they have unsanitary conditions? "I really can't comment on that," Morris said.
Mary got a better response from the state of Texas. In a letter dated April 15, 2007, Ronda Tewell of the Health Facility Compliance Division of the Texas Department of State Health Services wrote her that their investigation of West Oaks's treatment of her sister showed that "the facility had violated one or more of the applicable regulatory requirements." Violations were identified and deficiencies cited. As to what the state specifically found wrong, it won't say.
Lucinda DeBruce, CEO of West Oaks, did not return calls from the Press for comment on this story. Janet Codamo, West Oaks's director of performance improvement, also did not return calls.
Schoolteacher Annetta Hudson worked for West Oaks from 2004 until 2007, one year full-time, the other two part-time. "I don't know about that hospital. They have a lot of things that aren't right," she says.
"We're supposed to have certain classes...and they don't do it, but when the state gets ready to come in, they want you to sign all these papers that make it look like you have gone to all these classes."
Hudson said she went outside West Oaks to keep up her training, such as keeping herself current in CPR classes.
Staffing was always a problem, she says. During the day there would be three techs, one medications nurse and one RN who would do all the charting for 20 patients on a unit. In the evening this would drop to two techs, and the overnight shift, she says, would often drop to one tech. In the juvenile units, she says, the chart nurse would be responsible for three units.
Often, she says, counselors might make it to one group patient session, but for the most part the techs were running these meetings.
Whereas Hudson had previously worked as a nurse's aide and holds a pharmacist technician's license, she says many of the techs hired had no background in psychiatry. "Mostly they hire big guys. They don't do too many females, but they did a lot of big guys. Some of those guys have been in prison or jail."
She says she left because West Oaks wasn't giving raises, and she and others were stuck at $11 an hour. She says she saw several changes in management while there, but no real changes in operation. They did renovate three units before she left.
The Reverend Perry Boutte worked as a tech for West Oaks for one month in 2005 before he injured himself on another job and was unable to return to work. He complained to West Oaks and the state of Texas, saying he saw adult patients fraternizing with adolescent patients and staffers making no attempt to stop this.
Boutte says he had gone to West Oaks to work on his license for chemical dependency counseling, but was instead sent to psych. He says he has numerous years of experience working in psychiatric hospitals, but most of his co-workers did not. "There was a one-week orientation, and then people were just thrown out on the floor."
There wasn't sufficient staff to do the job with, Boutte says. Added to that, he says, "it just seemed like the people they had working there didn't know what they were doing. It was just a constant chaotic situation; everything was always up in the air."
In 2001, West Oaks was acquired by Psychiatric Solutions, Inc., which also owns Cypress Creek Hospital in Houston and Kingwood Pines in Kingwood in the Houston area. The company, headquartered in Franklin, Tennessee, owns other facilities in Texas, and its 2007 10-K filing to the U. S. Securities and Exchange Commission says it operates 90 owned or leased in-patient facilities, with more than 10,000 licensed beds in 31 states, Puerto Rico and the U.S. Virgin Islands. In a recent press release, it said it ranked 49th on Fortune magazine's 100 Fastest Growing Companies in America list.
The 10-K report of PSI (PSYS on the New York stock exchange) declares its operating strategy: "We intend to focus on improving our profitability by optimizing staffing ratios, controlling contract labor costs and reducing supply costs through group purchasing."
In its 10-K, Psychiatric Solutions disclosed that it was spending 54.6 percent of its total revenue on salaries, wages and benefits. This was a slight decrease from 2006, when it spent 55.2 percent of its total revenue on the so-called SWB package.
The Centers for Medicare and Medicaid Services, part of the U.S. Department of Health and Human Services, puts out an annual report used to develop its Medicare psychiatric payment system. Its 2007 survey of all psychiatric care facilities shows that about 65.8 percent of all revenue is spent on staffing at the average psychiatric hospital.
So Psychiatric Solutions and its hospitals are spending more than 11 percentage points less on staffing than the average psychiatric hospital. It also appears to be practicing economics by hiring a significant number of part-time employees. "As of December 31, 2007, we employed approximately 21,800 employees, of whom approximately 14,800 are full-time." This means that 7,000 employees were part-time, roughly 32 percent of its workforce.
Psychiatric Solutions responded to inquiries from the Houston Press by e-mail. The company's statement ignored questions about its own corporate operations and hiring policy and instead just couched its answers in terms of West Oaks. In total, it read:
"Our doctors, nurses, and therapy staff are sincerely committed to providing the best possible treatment to our patients in a manner which is caring, respectful, and focused principally on the safety and well-being of the patient.
"We work closely with the state of Texas, the Joint Commission, CMS and other regulatory agencies in order to ensure full compliance with all applicable requirements.
"West Oaks, like most health care providers, employs some part-time staff to allow for flexibility as patient populations shift.
"All staff are required to complete an orientation and extensive clinical training led by certified instructors before they go into clinical areas. Many programs are facilitated by the facility medical staff and all are approved by applicable oversight groups.
"Our staffing levels meet or exceed State requirements at all times."
Another Psychiatric Solutions facility, Cypress Creek in Houston, has also been sanctioned by the state in the past year. Its violations in two separate incidents resulted in $65,000 in fines and mirrored those cited at the West Oaks facility.
Mary says when she went to visit her sister Renee, she saw a male and a female staff member flirt and then grope each other right in front of her. She said the same sort of thing occurred among the patients, and the staff made no attempt to stop the activity. In addition, she says, staff members often reacted angrily, screaming and slamming doors themselves, which often sparked crying on the children's part. Patients who were going out of control were ignored, she says, and her mom was almost hit in the head with a chair thrown by a patient.
Patients were mocked by doctors and staff, she says. For example, one girl having trouble manipulating her silverware in order to feed herself was laughed at by staff members, who didn't help her either, Mary says.
In a somewhat bizarre twist, Frederick Williams, the tech who got in a fight with 41-year-old Vidaurre that led to the patient's death, has retained an attorney to represent him in a lawsuit against West Oaks, claiming he never should have been put in the position of providing one-on-one care to Vidaurre because he'd never been trained to do something like that.
Williams was alone with Vidaurre in the smoking area of the hospital when Vidaurre, who had been agitated for days, punched him in the face. A fight broke out in the locked courtyard area which has no video cameras, buzzer or alarm system. By the time it was over, Mario Vidaurre was dead. The autopsy report showed Vidaurre had suffered multiple rib fractures, laceration of the heart and injuries to his intestines, back, abdomen, chest, wrist, face, neck, buttocks, shoulders, both forearms and both knees.
Attorney Kerry Guidry of Robert Kwok & Associates says Frederick Williams was seriously injured as well.
"He broke his hand, had surgery on his hand, knocked his head open, cut it pretty severely and then his mental anguish and the mental aspects of taking another man's life. Even in self-defense that's taken a heavy toll on him."
Williams was no-billed by a grand jury that found he acted in self-defense, but an investigation by the Texas Department of State Health Services found that "the facility staff failed to protect the patient's rights to a safe environment and therefore resulted in the patient's death."
Williams's suit hasn't been filed yet, but it's going to say that they didn't properly train Williams as a one-on-one caretaker of someone as violently disturbed as Vidaurre and they didn't staff adequately, Guidry says. "It's pretty obvious he never should have been there by himself."
If Williams had been trained a little better, if there had been more help available, or if there had been an alarm system in the hospital's smoking area where the two men were by themselves, Guidry says Mario Vidaurre might not have died.
Muhammad "Mo" Aziz is the attorney who took on West Oaks when Chaz Vidaurre came to him with the story of his brother's death. Although it looked for a while as though West Oaks was going to settle the case, Aziz says it now appears it will be tried, and he has filed the lawsuit alleging medical malpractice.
Aziz, of Abraham, Watkins, Nichols, Sorrels & Friend, has just become involved in another case against West Oaks. He is representing Alma and Alveh Chambers, parents of Alan Chambers. Brought to West Oaks after trying to kill himself, Alan was allowed to go into his room, slamming the door behind him, and remain there undisturbed long enough to tear up and braid the bed linen he used to hang himself with.
Cynthia Pickett, attorney with the firm of Doyle Restrepo Harvin & Robbins, is representing Alan Chambers's wife Linda and the couple's three children, ranging in age from ten to 17, in a similar action against West Oaks.
Both attorneys make the same point: Why was an obviously disturbed and agitated man, who'd just been brought in after attempting to kill himself, left to his own devices?
His twin brother Greg says Alan started going in and out of depression when he was about 38. He'd get treatment for around three months and then would be good for another year and a half. Eventually, the bouts of depression took their toll and Alan moved out of his home, taking a garage apartment.
On the day of his suicide attempt, he'd gone to his wife's office and slit his wrists in what everyone described as superficial cuts. From there, he returned to his apartment, where he took every pill he had and then tried to assemble a pipe gun just as EMTs broke into his apartment, Pickett says.
Greg says his groggy brother was taken first to Cy Fair Hospital off Jones and 1960 and then on to West Oaks, arriving there at about 3 a.m. on March 21, 2007. Alan had been treated there on an outpatient basis for his deepening depression over the Christmas holidays, Pickett says.
At West Oaks, Alan was initially assigned to Unit 2. At all times he was under suicide watch. He promptly tried to leave the floor and was reassigned to Unit 1, where they could allegedly tighten the suicide precautions and the watch on him. When his medications wore off, he got violent. It was noted on the charts that he should be monitored very, very closely, Pickett says.
Later that same day, in the afternoon, Greg came to see his brother, but Alan was in a bad mood and they talked for only ten to 15 minutes in the TV room before Greg thought it best to go. The next day, Alan's parents came to see him about 4:30 p.m. Alan still had on his bloody work shirt and became upset when his mother tried to persuade him to change it, Greg says. Greg's wife had brought over clothes for Alan earlier. Instead, Alan asked his mother to get him out of there, and when she told him she thought he should stay, he went in his room and slammed the door, Greg says.
By the time Greg and his wife got there, at about 5:15 p.m., their parents were gone. He asked to see his brother, but was stopped at the nursing desk and told his brother might not want to see them. While they waited, an orderly went to Alan's room to check on him, opened the door, hesitated a moment and then said, "He hung himself."
A nurse went in the room, and Greg and his wife were close behind. Alan had looped his makeshift rope over a closet door. They pushed the beds back, and Greg and a nurse began alternating CPR. Greg remembers that his twin's hands were still warm.
As he stayed in the room with his brother, Greg, an engineer with training in emergency trauma at offshore rigs, says the scene was chaotic. One or two of the staff members appeared to know what they were doing, but the rest, he says, didn't. An ambulance finally arrived and took Alan to Memorial Hermann Southwest. Over the next several days his family, including Alan's wife, remained at his side, optimistic that their vigil would have a positive outcome.
That night, as Greg tried to compose himself in the wake of trying to save his brother, he and his wife were pulled into a room with a West Oaks director and another person. "They were saying if people are suicidal, they're going to do it anyway. I couldn't believe they were telling me they have no control."
"What is particularly tragic about this is that he was still in the bloody clothes that he'd appeared in," Pickett says. "They had not changed him into any hospital gowns. Somebody's in a hospital in which they're there for over 24 hours in bloody clothes. Who's paying attention?
"They just absolutely ignored him."
At the time of his hanging on March 22, 2007, Alan Chambers had been at West Oaks for about 38 hours. He died about five days later at Memorial Hermann Southwest, three hours after the family took him off life support.
At least every 15 days for more than two years now, Loretta Lilley has carefully saved the same message on her cell phone. It is her one bit of proof that West Oaks administrators knew her daughter had not been cared for correctly.
In the message, Kelly Turner, program director for youth services at West Oaks, says she's talked with Janet Codamo, director of performance improvement, and chief nursing officer Joyce Winters about what happened to Amanda.
"I'm doing a thorough investigation, and training and disciplinary action is needed. I'm so sorry, and I'm appalled at what happened to Amanda, and I want to know how she's doing, and if you have any questions, anything at all, please, please call me."
Later, Turner goes on to say: "I want you to know that we are definitely taking this with a heavy heart and very, very firm measures. This is not acceptable, and I am truly so very sorry."
Loretta says right after she found out Amanda's arm was broken, she called the hospital and spoke with Codamo, who told Loretta that her daughter did not get the proper attention and should have had an X-ray; Loretta also spoke with Winters, who told her that "the staff doesn't keep good records."
From all of this, Lilley was encouraged to believe that West Oaks would set about changing some of its policies. She did think it was strange that Turner called her from her cell phone rather than one of the West Oaks phones. Now, Lilley says, she thinks that was done so there would be no official record at West Oaks that a call with such an admission was ever made.
She filed a complaint with the Texas Department of State Health Services. The agency issued a finding of "inconclusive for abuse." Loretta wonders if they would have substantiated an allegation of neglect — as she understood it, children are not supposed to be behind closed doors at the facility, even for time-out. "You do not put an autistic, mentally retarded child with a seizure disorder in her room unsupervised by herself. That to me is neglect."
Former employee Hudson confirmed the policy is to keep the doors open for children because there's too great an opportunity they'll get into trouble if left unsupervised in their rooms.
Loretta says her husband made the rounds of attorneys, but no one would take Amanda's case, saying it wasn't provable or there wasn't enough money in it. She appealed to her congressman, Kevin Brady, for help, and she says he told her the best thing she could do was to move out of Texas if she wanted to get help with Amanda's problems.
Amanda is eight years old now, living at home with good days and bad. She went through a period where she ripped out her own teeth. She scratched her ears repeatedly till they bled. When sensations overcome her, she hides in a box in the front room closet. She loves purses and changing clothes and cats. But she's strangled a kitten — it scratched her — and has tried to drown and has hit other kittens until someone intervened.
Her accounts of how her arm broke vary and sometimes differ from the hospital's version that she was slamming her door and then hit it with her hand. Sometimes she says she was being bad, other times that a "black man pushed" her. The truth will probably never be known. There's no record that a doctor looked at it, despite what Loretta was told by phone. On March 1 a note on the nursing chart says there was no pain in that location, which Loretta finds darkly humorous now.
A short while after getting out of West Oaks for the second time, Amanda was sent to Austin State Hospital after being rough with her siblings and beating her mother with her permanent cast to the point where Loretta was bleeding. It took them three weeks to detox her off her meds before they could evaluate her.
Back in public school in Conroe, Amanda is working to regain some of her lost skills. Being mainstreamed in kindergarten was a nonstarter; she doesn't get along well with kids her age, and she was having a lot of seizures. Now that she is in special life skills classes at Armstrong Elementary with a lot of structure, she's doing better. She can count to ten and is learning shapes and colors. She's stuck at age four right now mentally; it's unknown whether she'll improve. At night, she sleeps in diapers. The parents have learned some better techniques to help calm her.
Her mom and dad say they will never put her in an institution, but they have checked out some other mental health programs in Texas. Amanda has pica as well — she eats dirt and paper — and many places won't take her because of that.
Jim works in vinyl siding and is on the road a lot. So most of the work with Amanda falls on Loretta, a homemaker who now goes to seminars all the time trying to find out more about the mental health system.
They do have help now through the Home Community Based program. Tabitha Etheridge comes for a 3-to-7 p.m. shift five days a week to help with Amanda. They're waiting to see how long she lasts; Amanda has routed a succession of helpers.
They know they won't put her back in West Oaks, but they really don't have too many other options. Emergency room runs usually are a disaster; upset by her surroundings, Amanda runs through the room hurting other patients, Loretta says. They don't want to put her in another psychiatric hospital. An autistic treatment center might be the answer; there are only a few in this area, and funding is tricky. Autistic service dogs are supposed to be calming miracle workers, but they cost $6,000, Loretta says.
She wrote a poem to Amanda, working out some of her frustrations, but declaring her love for her at the same time. It reads, in part:
I hate your disabilities and all that goes with it
But without those disabilities I wouldn't have the Amanda I know and love
You are my Amanda my sweet little Amanda
"The only option I have is to take care of her myself with the help of Tabitha," Loretta says. "I don't know what there is out there for parents like myself, but I can guarantee you it's not hospitalization. You don't know what's going on behind their doors."
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