By the time he was nine years old, he was terrorizing his own family. He'd call his mother a bitch or threaten her with a butcher knife. His six-year-old sister soaked up punches and bites, taunts and threats. He once stomped her face as she lay on the floor watching television.
At school, he assaulted teachers; he provoked classmates. "He would often take pins from bulletin boards or use other sharp objects to stick students," a principal later wrote in a letter summarizing his behavior. That was in the first grade.
He told fanciful tales --a typical childhood pursuit, except most of his stories revolved around guns and murder. He told a teacher he'd seen men enter his house and shoot his baby sister. He said his mother let them do it.
No one could escape his outbursts, including himself. "He would bang his head on the wall," recalls his mother. "He'd say, "I'll kill myself. I'll kill you. I'll stab you.'"
Sometimes, when the rage subsided, he would stop crying long enough to ask her, "What's wrong with me?" But just as soon, the fury would return. "In the blink of an eye, it was almost like he had a split personality; he was totally somebody different," says his mother. "He was so full of violence, rage, anger. I was afraid to be with him."
When he started setting fires -- the doghouse, his bedroom closet -- she could no longer sleep at night. She was too frightened. That's when Tammy Hill decided enough was enough.
Over the next 18 months, there would be trips to the emergency room, Cleveland Clinic, Laurelwood Hospital, and Berea Children's Home, along with visits to a half-dozen social workers and psychiatrists. None proved capable of helping Kenneth Hill soothe his rage. Eventually, everyone agreed: Ken needed to be taken out of his home, away from his family, and put in a residential treatment program. But without money or insurance to pay for such care, Tammy Hill had few choices. So she made a devil's bargain.
In Cuyahoga County Juvenile Court on May 9, 1996, Ken was turned over to the state. Tammy voluntarily relinquished custody of her oldest child, hoping the county's Department of Children and Family Services could succeed where she had not.
Tammy Hill believed she would get her son back as soon as he was fit to return to the family. But that did not happen. Instead, the county wound up keeping Ken for almost four years. Through a series of oversights and mistakes, Ken became lost in the system. His file was misplaced in juvenile court, his case never revisited by a judge, and Ken languished in the crossroads of the county's juvenile justice and social service bureaucracies.
He would spend his final 18 months in the county's custody watching his mother struggle to get him back -- a fight that succeeded only after a beating landed Ken himself in the hospital. Even as a baby, Ken was different. It took her years to realize it, but in retrospect, Tammy Hill has little doubt.
He had his first "episode" before he could even walk. Less than a year old, he was lying on top of Tammy when she felt him stiffen up, straight as a board. His eyes rolled into the back of his head.
Tammy was hysterical, convinced her firstborn was dying, but the neighbors told her it was a seizure. Doctors at Fairview Hospital kept Ken for more than a month, but never figured out what was wrong.
Several months later, Ken was back in a hospital after another seizure. The explanation this time was equally inconclusive. "They told me he was getting angry and having breath-holding spells," Tammy says.
There would be no more seizures, but there was little relief. As Ken grew, so did his problems. At first they were just inconvenient. He wouldn't sleep. He'd constantly cry. But then things became more troublesome. Ken turned aggressive. He couldn't stop moving; he literally bounced off the walls.
Tammy worried, but she didn't want to believe that her son might be wired a little differently from other boys. Her father told her Ken was just a boy being a boy. She hoped that was true.
Ken started kindergarten at Annunciation, a parochial school on Cleveland's West Side, but he didn't finish. He disrupted class. He talked back to teachers. He was expelled the day he commandeered the public address system and began talking nonsense to the whole school.
After he enrolled in public school, Ken's behavior got worse. It was always something. Ken couldn't stay seated. Ken couldn't concentrate. Ken couldn't get along with his classmates. Ken couldn't stop swearing at his teachers.
"When Kenneth was a first-grade student, he exhibited inappropriate behavior almost daily and received numerous office referrals from his teachers," Brooklawn Elementary School Principal Grace Ellis would later write in a letter. "He was given a psychological examination by school district personnel and recommended for placement in a Severe Behavior Handicapped class."
Mostly, there was the rage, which got worse as Ken got older. Instead of poking classmates with pins, he began talking of suicide and murder. He was fascinated with guns, knives, and setting fires. He openly spoke of killing himself, his mother, and his brother and sister.
It didn't help that his home life was unsettled. Ken was only five when his parents divorced, and he didn't like the idea of someone taking his dad's place. He once told a doctor that he sometimes acted out because he didn't like his mother's boyfriend, and that he wanted more of his mother's attention.
In late 1994, his troubles took a more serious turn. Tammy was doing dishes when she heard Ken screaming from his bedroom. She found him sitting on the top bunk of his bed with a sheet tied around his neck, the other end around one of the bedposts. "He looked at me, and he was serious," Tammy says, "and he says, "I just want you to see me when I jump off of here and die.'"
Tammy took Ken to the MetroHealth Medical Center emergency room, where he was sedated with Haldol. Then he was transferred to the Cleveland Clinic and admitted to the psychiatric unit. He was two months shy of his ninth birthday.
At the Cleveland Clinic, Ken was diagnosed with reactive attachment disorder, oppositional defiant disorder, and attention deficit-hyperactivity disorder (ADHD). A psychiatrist noted Ken's "tendency to become overwhelmed by aggression and morbidity at times." Ken was given a prescription for Ritalin and released after 10 days. Doctors told his mother to take Ken for follow-up counseling at the Guidance Centers, an agency that provides behavioral health-care services for children.
Over the next year, Ken's situation continued to decline. In June 1995, he threatened family members with a baseball bat and tried to jump out a window. On a screening visit at the Guidance Centers (now known as Applewood Centers), he became violent, "throwing chairs, physically abusing his mother, threatening to kill his mother," according to a summary of treatment later prepared by Louise Gottlob, a social worker at the centers. "Ken could not calm himself down, and as a result the police had to be called to restrain him and place him in a temporary crisis bed at Berea Children's Home."
Days after Ken was placed at the Children's Home, Tammy Hill attended a meeting at the Cuyahoga County Department of Children and Family Services building in downtown Cleveland. Gottlob from the Guidance Centers was there, as well as a social worker and supervisor from the DCFS.
"It was agreed upon at that meeting to not have Ken removed from his home, as his mother was not abusive or neglectful," Gottlob later wrote. Instead, Ken was referred to the Positive Education Program, designed to help kids with severe behavioral problems, and told to continue with in-home family therapy and further treatment from the Guidance Centers. The goal, Gottlob noted, "was for Ken to not make attempts at hurting himself or others."
That goal proved unattainable. Six weeks after that meeting, Ken tried to choke his brother. A week later, Ken attacked family members. Eleven days later, he did it again. Then in early September, Tammy took Ken back to the Cleveland Clinic, where he stayed for two days. This time, doctors diagnosed Ken with ADHD, conduct disorder, and oppositional defiant disorder, and gave him more drugs -- Methylphenidate, Imipramine, and Mellaril.
As his 10th birthday neared, those who had treated him were all converging on a similar conclusion: Ken needed to be taken out of his home and placed in a residential treatment facility.
"His feelings and resultant behaviors are so out-of-control, and his denial of need for help is so firm," wrote psychiatrist E.W. Hilton, "that I do not foresee outpatient or in-home treatment being effective and therefore recommend residential placement as both necessary and in Kenneth's current best interest."
But needing help and getting help are different planets in the mental health universe.With three kids, another on the way, and a modest job from which she had taken temporary leave, Tammy Hill had trouble enough meeting the everyday challenges of a single parent, let alone extraordinary ones -- like paying $40,000 to $50,000 a year to get Ken the treatment he needed.
Tammy didn't have insurance, and like many parents whose children have psychological or behavioral problems, she faced her own Gordian knot: How would she pay for the help her son needed? In her search for an answer, she stumbled into a maddening tangle of bad laws, bad luck, and bad advice.
It began with the cops. Tammy was told that one way to get Ken help was to involve the juvenile court. Involving the court, she was told, meant involving the police. So one day in October, after Ken broke several windows and attempted to hit her, Tammy called the cops. "I was told that this was the easiest way to make them do something," she says.
Calling the police on a nine-year-old is not as crazy or uncommon as it sounds. "If nothing is working, we sometimes encourage parents to get the court involved," says Dr. Kevin Martin, a child and adolescent psychiatrist who is the medical director for Applewood Centers. "What we explain is that it is in the child's best interest in helping them get placed."
"Beat them up, lock them up, or give them up," is the way some child advocates describe the dilemma parents confront in obtaining care for their children.
Ken was declared delinquent and put on probation, after admitting to charges of vandalism and domestic violence. Five days after the delinquency hearing, Tammy asked the court to transfer temporary legal guardianship of Ken to Janet Jabo (now Janet Comodeca), a close friend Tammy had known since childhood, who lived in her building. The guardianship would allow Ken to receive coverage under Jabo's insurance -- coverage he would soon need. After another episode of explosive behavior several months later, in March 1996, he was admitted to Laurelwood Hospital for eight days.
Less than a week after being released from Laurelwood, Ken was at it again: "On this day I observed Kenneth when he arrived home from school," County Board of Mental Retardation caseworker Tom Stevens wrote after a home visit. "In a matter of a few minutes, I saw Kenneth change from well-mannered to quite violent and aggressive. He began throwing ceramic objects at the wall and at his mother, as a reaction to demands placed on him. He then began taking pictures off of walls and destroying them, and attempted to hit his mother in the stomach, who was 7 1/2 months pregnant at the time. Later, Kenneth went into the basement and began hitting the walls with a bat and pulled electrical wires out of the wall. Shortly thereafter, Kenneth's grandmother arrived, and Kenneth punched her very hard in the middle of her back . . . Kenneth was readmitted to Laurelwood, where he remains as of this writing."
By April 1996, Jabo's insurance coverage for Ken had run out, and Laurelwood doctors told Tammy that Ken was stable and could go home. But the family refused to accept him. Three psychiatrists had told the family that Ken needed to stay in a residential facility.
One of the psychiatrists, Dr. Elizabeth Hill, wrote that "prognosis is poor if he returns to the outpatient setting. He requires long-term treatment in a structured setting in order to have a good chance at turning around his pattern of behavior."
Even the social worker from the DCFS agreed. "All recommendations are for [residential treatment]," the worker noted in a department staffing report, written while Ken was in Laurelwood. "However, no one is accepting him unless CFS has custody."
To Tammy, it seemed there was only one option: Custody of Ken would have to be given to the county, in order to place him in the appropriate treatment facility.
On April 20, 1996, Jabo wrote to Juvenile Court Judge Robert A. Ferrari, pleading for a hearing. "We want to bring [Ken] home, but he will continue to be at significant risk of harming other members of his family," she wrote. "I am at a total, complete loss; this seems to be a no-win situation. I beg you to review, and advise us on how to get Kenny the treatment he so desperately needs."
At a hearing two weeks later, Ferrari declared Ken dependent -- a seldom-used legal designation that carries the same force as when a child is declared abused or neglected, although it includes no finding of fault against a parent. Ken was placed in the temporary custody of the DCFS. Ferrari ordered the county to find a spot for Ken at Beechbrook, Berea Children's Home, or Cleveland Christian Home.
Turning Ken over to the DCFS was an unusual move, but one motivated by good intentions. The day Ken left her care, Tammy was relieved. "We went in, and I remember Judge Ferrari -- he had his robe on, but he didn't even sit behind the bench," she says. "He came down, and he sat with us all there . . . I just remember sitting there; I just felt like the world had been literally lifted off my shoulders," she says.
But Tammy Hill's world would be plagued by unforeseen consequences for years to come.Tammy Hill's decision to give up her son is a startlingly familiar one to families with deeply troubled children.
Nationally, nearly one in five families with children suffering from severe mental health problems are forced to give up custody of their children because they can't afford to pay for treatment, according to a survey conducted last year by the National Alliance for the Mentally Ill.
Similarly, in half of the states in the country -- including Ohio -- parents who can't afford private treatment have reported being told that they must give up custody so their children can receive mental health care, says a study released last year by the Washington, D.C.-based Bazelon Center for Mental Health Law.
The Bazelon Center found that, after relinquishing custody, families have limited chances to influence important decisions about their child's treatment, health care, and education. The state, meanwhile, is forced to pay for expensive residential treatment, often in lieu of less expensive alternatives that would allow a child to remain at home.
For Tammy Hill, there was another drawback. It would take her four years to regain the son she voluntarily handed over.
It wasn't supposed to happen that way, of course. When Ken was sent to the Cleveland Christian Home after Judge Ferrari's ruling in May 1996, Tammy believed she would be given ample opportunity to influence what kind of help her son received. And she never thought it would be so long before her son returned home.
Under Ohio law, after assuming responsibility for Ken, the Department of Children and Family Services was supposed to draft a case plan for his treatment, submit it to the court, and hold case review hearings -- at which Tammy would be welcome -- at least every six months.
In addition, the court was supposed to hold an annual review hearing on Ken's status. The reasons for such hearings are straightforward: A child in the temporary custody of the county should be moving either toward reunification with his parents or toward a more permanent living arrangement, such as long-term foster care or adoption. Indeed, at the time of Ken's placement, Ohio law stated that temporary custody expired after one year (though extensions could drag that out for an additional year). Basically, the law gave an agency two years, at the most, to either find a better place for a child or return the child to his parents. More recent laws are even more strict. Now, if a child is in custody for any 12 of 22 months, the child must be put in a more permanent environment or given back to the parents.
But much of what the law requires didn't happen in Ken's case. Court documents reveal that Ken never received his annual review before a judge. After he was sent to the Cleveland Christian Home, the DCFS also never filed a case plan for Ken's treatment with the court; nor did it notify the court when Ken was transferred to another facility. It couldn't. The court file had been misplaced.
Kenneth Hill's case had literally been lost in the fissures between the juvenile court and the DCFS, and no one ever took the responsibility to make things right.
Indeed, because of confusion and mistakes, Tammy Hill was never given the opportunity -- in front of a judge, at least -- to try to retake custody of her son, even long after she wanted him back home.
"To a certain degree, this was an error on the part of the court, and the parties failed to file anything that would bring it to the attention of the court," says Richard Graham, the chief magistrate for the Cuyahoga County Juvenile Court. "It was kind of a combo of errors."The Cleveland Christian Home was a highly structured environment, where Ken was monitored virtually 24 hours a day. He loved it when he and the other residents got to go hiking or on their yearly trip to Cedar Point or Geauga Lake amusement parks, but he hated the older building and still had trouble getting along with others. He was often restrained for his behavior.
But if he was less than enthusiastic about the setting, he was at least getting the services he needed. Along with his medication, he had a one-on-one session with a counselor every week, as well as a weekly family counseling session at Tammy's home, which was just a few blocks away.
After two years, however, the workers at Cleveland Christian Home felt there was little more they could do for Ken. He would have to be moved to another facility.
By that time, the summer of 1998, Tammy had decided she wanted Ken home, but the prospect of a reunion soon became impossible. Her relationship with her then-boyfriend, who was also her youngest son's father, had dissolved into turmoil. Tammy would find herself fighting not just to bring Ken home, but to keep her three other children as well.
That summer, Tammy and her boyfriend, George Schauer, were involved in at least two physical altercations. Ken, home for a visit, saw one of the fights and was hit in the leg trying to break it up. Schauer was eventually convicted on charges of aggravated burglary, kidnapping, and domestic violence springing from one of the incidents.
The dispute between Tammy and her ex-boyfriend played an important role in the lives of Ken and his siblings over the next year. In early December 1998, right after Schauer was arraigned, the county's child abuse hotline received 19 anonymous calls, accusing Tammy of various crimes and misdeeds as a mother. None of the accusations proved true, but the complaints drew the county's attention.
A social worker who visited Tammy's home found it "in an unsafe and deplorable condition," according to a complaint filed in court. There were clothes lying on the floor, a backed-up sink, a single mattress for the children, a broken washing machine, and broken furniture.
The county took immediate custody of Tammy's other three children, a standard move in such cases. It didn't help Tammy's cause that she had been involved in an abusive relationship.
At a hearing several days later, Tammy told Magistrate Michael Tilip that she had cleaned the home and bought food and beds for the children. (Tammy maintains that the home was not in as bad a condition as the DCFS alleged in the complaint.)
Tilip ordered the county to give Tammy back her children, but her tangles with the county would not soon be over. The county filed two more complaints during the next year, and in September 1999, the county was granted protective supervision of her children. Tammy maintained custody, but she was ordered to attend domestic violence counseling and parenting classes. She was also told she needed a bigger house before she would be allowed to bring Ken home. With her father's help, she bought one in November.
Tammy's trouble with both her ex-boyfriend and the county were simmering down by the fall of 1999, when Ken was transferred from the Cleveland Christian Home to the East Side Group Home, a facility run by the Positive Education Program (PEP), a highly successful organization that deals with developmentally disabled and behaviorally challenged children. It was supposed to be a transitional thing, his mother was told, but Ken, for one, had begun to think he might never go home.
He had been promised too many times that it would soon be over, that he would be able to live with his family again. He didn't trust anybody anymore -- not even his mother. When they would talk on the phone, he'd just ask, "When am I going to get out of here?"
"I'm trying," she'd tell him.
He didn't believe her. He stopped calling.
He liked the PEP home. It was clean, the food was good, and the staff treated the residents well. He would still have bouts of explosive behavior, but even the county social worker said Ken had "progressed exceptionally" during the year. School, which had always been a struggle, was going better, and Ken improved several grade levels during the year.
Still, he wanted out, and it looked as if that might never happen. In August 1999, 11 months after he'd been transferred to the home, he snapped. He sneaked out in the middle of the night and hitched a ride to his mother's house, banging on her door at three in the morning.
Several days later, in a letter he wrote to Judge Ferrari, Ken -- in a scrawling hand that looks more like that of a seven-year-old than of a teenager -- explained his rationale: "I want to come home," he wrote. "My [case] worker is saying I can't. She said I'm going to a foster home and maybe someone will adopt me. She said my mom is bad, that she hits me and she doesn't. She told me she took my sister and brothers away because she is bad. She tells me I'm retarded when I'm not. My mom is a good mom and she loves me enough to help me even though I don't like it here. Please Let Me go home."
It wasn't to be. It would take another six and a half months before Ken and his mother were reunited.In a case full of sad ironies, perhaps the fattest one of all is this: Though the county's Department of Children and Family Services ended up having temporary custody of Ken for almost four years -- long after it legally should have -- the county never really wanted him.
On June 6, 1996, a month after Ken was placed in DCFS custody, the agency filed a notice of appeal with the court arguing that, since Ken had already been declared delinquent, he belonged in the juvenile justice system.
Basically, the DCFS was arguing that Ken wasn't its problem.
"It's their case," says William Denihan, who's been executive director of the DCFS since January 1999. "Delinquency is theirs. They own that. I don't own that. And I don't have to own that."
The appeal was dismissed -- the transcripts of the case weren't submitted on time -- but the filing still had a significant effect on Ken's case because, during the appeal, his court file was misplaced. No one knows how, and nobody looked for it for almost two years. It wasn't found again until this spring.
Though the DCFS wasn't responsible for the file, the department had physical custody of Ken. But it did little to ensure that the law was followed in his handling. His treatment plan was never submitted to the court, and no one from the agency ever notified the court that a review hearing needed to be held.
There is some question, in fact, whether it was even legal for the DCFS to keep Ken in its custody after one year, since no one had ever gone to court and asked for an extension of the arrangement.
Even Denihan agrees that someone should have asked why Ken's case wasn't being reviewed by the court, as state law requires. "There should've been some kind of a hearing; somebody should raise the question," he says. "From our viewpoint, we're not the court, we don't sit on the dockets, but we can ask the questions. And I accept the responsibility that we should ask the question."
But he also says that the court and the mother share responsibility for letting Ken slip through the cracks. According to the agency's records, Tammy Hill did not show up at four semi-annual review hearings held during the first two years of Ken's custody. It was only after she faced the possibility of losing her other children, DCFS staffers say, that she started attending the reviews. Tammy Hill denies that she was ever notified about any of the reviews prior to December 1998.
Whatever the case, the court did not revisit Ken's custody for four years. By default, Ken remained in the county's custody, and apparently no one asked why.
"We can learn from all these cases," Denihan says. "But I want folks to know that's not the way these cases are handled. I know it's not typical."Instead of going home, in the fall of 1999, Ken was moved again -- this time at his own request. He was sent to Looking Glass, a facility on Detroit Avenue that is geared toward older, more responsible teenagers.
Looking Glass was indeed different from the other residential facilities where Ken had lived. Accustomed to the strict routine and rules, he couldn't believe the freedom Looking Glass residents were given. He could smoke; he could leave the building. Still, Ken had a hard time getting along with the other kids, all of whom were several years older and some of whom weren't even juveniles anymore. "Everybody put me down," he says.
Tammy, meanwhile, worried about his safety. She knew he didn't get along with the other kids, and she knew he didn't get along with some of the staff. But Ken, now 14, was stoic about the situation. "Don't worry," he told her. "I'm used to this."
Finally, at the end of February, things came to a head. One night as the residents sat in the Looking Glass's television room, Ken tried to interest them in a card trick. Nobody cared, and Ken became frustrated. He started yapping with a resident named Richard Lopez, an 18-year-old kid who was a half-foot taller and 90 pounds heavier than Ken. Then he threw the deck of cards in Lopez's face.
"Lopez jumped up and chased the victim into the front main office area . . . grabbed the victim, violently slamming him to the floor," according to the police report.
Ken was taken to Metro, where he was treated for a dislocated shoulder and a broken collarbone.
Things happened quickly after that. Even before Ken got hurt, Tammy had been calling everybody she could think of to try to get him out. Friends from church, a lady from her battered women's support group, her victim witness advocate -- all had been enlisted to barrage the court and the county with questions about Ken.
On March 17, the DCFS gave the green light for Ken to go home. In the staffing report from that meeting, there is no mention of Ken's injuries; nor has anyone ever told Tammy that the county agreed to let Ken go home because he had been hurt. But she can't help thinking it played a part.
Six days later, in a hurried court hearing, a judge agreed it was time for Ken to return to his mother. After four years, it was over in less than 15 minutes. He is 14 now, and his mother is glad to have him around. When he isn't playing video games on the PlayStation in the basement, he's talking about sports: the Indians, the Vikings -- contemplating why the latter could have made the horrifying mistake of releasing Randall Cunningham.
He wants to play football this fall, but Mom isn't so sure.
At his PEP school in Shaker Heights, he's reviewing what he's learned over the last couple of years, hoping he'll be allowed to go to public school this fall, though he admits he'd miss some things at the PEP school. "The teachers are great," he says. This week he's in Kentucky with a church youth group.
For once, he's contemplating the future beyond just getting back home. He thinks about trying to be a veterinarian or a lawyer. "Because I'm a good talker, man. I'm smooth."
Tammy Hill also thought about a lawyer, even talked to a few of them about what happened, about why her son was kept from her for so long. But she isn't going to sue anybody, she says. She doesn't want any money. Her motivation was pretty simple, and she's accomplished her goal. She wanted the court, the county, the social workers out of her life. She wanted her kid back.
"I just want to go on with my life and get things back to normal," she says. After four years, however, her understanding of ordinariness has changed a bit. "I guess I'm not sure what normal is anymore."