Despite Reforms, Abuse Continues at Texas Institutions for Disabled
by Emily Ramshaw and Becca Aaronson October 23, 2011
MEXIA — At the Mexia State Supported Living Center, on the sun-bleached site of a former World War II prisoner-of-war camp an hour east of Waco, residents with profound disabilities and behavioral problems spend their days doing repetitive chores: sticking paper into shredders, folding towels, sorting nuts from bolts. And, in some cases, being physically abused, despite a sweeping federal settlement signed in 2009 to prevent it.
In the last two years, a Mexia worker was caught on video pushing a disabled resident down and stepping on his throat while other employees looked on. A staffer goaded one resident into hitting another with a belt, causing bloody wounds and a trip to the emergency room. A direct care worker showed residents pornographic pictures and tried to get them to perform oral sex on him; another sexually abused two residents.
This pattern of abuse appears pronounced in Mexia, where roughly half of the disabled residents are alleged criminal offenders and nearly a third are under age 21. But two-and-a-half years after Texas officials signed an agreement with the U.S. Attorney General’s office aimed at improving conditions in the state’s 13 institutions — following a U.S. Justice Department investigation that found avoidable deaths, civil rights violations and systemic abuse — a Texas Tribune review of facility monitoring reports and employee disciplinary records shows mistreatment is still relatively commonplace. And though there’s been some evidence of improvement, the state’s federally designated disability watchdog group Disability Rights says that halfway into the five-year settlement agreement, not even a quarter of its requirements have been met.
“It’s all just as bad,” said Beth Mitchell, Disability Rights’ supervising attorney. “The numbers suggest less physical abuse, but we still see a lot of really significant cases. I can’t tell you that there’s one shining example of a wonderful facility, because there’s not.”
Officials with the Department of Aging and Disability Services, which oversees the state supported living centers, point to evidence of compliance, from advances in security to improvements in staffing. Nearly 3,500 security cameras have been installed across Texas’ institutions for the disabled. Each facility has an independent investigator to monitor abuse. New employees are now fingerprinted and run through background checks before they’re hired, and existing employees are subject to random drug tests.
Today, 94 percent of facility jobs are filled, a marked improvement over past years, even with the influx of more than a thousand new positions established under the settlement agreement. Staff turnover has dropped. And there are now more than three employees for every resident, in part because the census at the state supported living centers has dropped by nearly 800 residents since late 2008.
But despite this falling population, more consistent staffing and annual spending that has grown by nearly 50 percent since 2006, abuse allegations have continued to rise steadily, with the percent of confirmed allegations hovering at 9 percent. The agency attributes this to better investigations: In the last fiscal year, 375 workers were fired or forced to resign because they abused or neglected disabled residents, more than in any of the previous three years.
Justice Department officials declined to comment on Texas’ efforts thus far. But Aging and Disability Services spokeswoman Cecilia Fedorov said meeting the terms of the agreement is intended to be a “long-term” process and that “milestone dates” laid out in the agreement are guidelines, not deadlines.
“While progress toward and achievement of substantial compliance has been slower than anticipated by the state,” she said in a statement, “efforts continue to be sustained in every facility.”
Federal investigators have a lengthy history with Texas’ state-supported living centers, formerly known as state schools. The Justice Department sent a team into a Lubbock facility in 2005, releasing a highly critical report in 2006 that cited more than 17 deaths at the institution in the previous 18 months.
Clearly not swayed by the improvements state leaders had made, in 2008, the Justice Department announced it would investigate conditions in all 13 Texas institutions. Four months later, investigators published a scathing rebuke, saying residents’ constitutional rights had been violated, and threatened legal action if Texas didn’t resolve the problems.
In May 2009, four years after the initial investigation in Lubbock, state leaders signed a five-year, $112 million settlement agreement with the U.S. Attorney General’s office, pledging to improve standards of care, increase oversight and monitoring, and enhance staffing.
On a recent visit to the 500-acre Mexia State Supported Living Center, many of these efforts were visible, from paper signs listing the phone number of an abuse and neglect hotline to strategically placed surveillance cameras to the nondescript dormitory office that’s home to a state abuse investigator. A sign at the entrance to the property advertised: “Now hiring!”
The workers on duty that morning — many of them veterans with decades of experience — helped residents with their daily tasks, from planting carrots in a garden to removing staples from paper for shredding. They showed off squeaky clean cement and linoleum-floored dormitories, an on-site hair salon, a café with a juke box and old movie posters. They shuttled residents between bedrooms and bathrooms and therapy sessions, interacting with a familial warmth that made the facility’s confirmed abuse allegations seem hard to fathom.
Yet firing records show awful abuse continues, and not just at Mexia. In the years since the settlement agreement was signed, a staffer at the Lubbock State Supported Living Center beat a resident he was trying to shave and slammed his head into a cabinet. An employee at the Richmond State Supported Living Center was captured on video kicking a resident in the legs, punching him in the neck and chest and striking him on the head. And a staffer at the Abilene facility kicked a resident in the head eight times. At Mexia, an employee started a romantic liaison with a resident, sending the resident nude photos and calling the resident’s cell phone 452 times. Another worker there failed to supervise a resident, who was able to construct a Molotov Cocktail.
In late spring, seven staffers at the Corpus Christi State Supported Living Center were fired for abuse allegations that still haven’t been disclosed. That’s the same facility where dozens of employees were fired in 2009 for forcing disabled residents into staged fights. Five were convicted of crimes.
Fedorov, the Aging and Disability Services spokeswoman, said the agency has zero tolerance for any abuse or neglect whatsoever. She said for the most part, the workers at these facilities are amazing — but that with any public entity, from a school district to a hospital system, there will at times be bad apples.
“You have good days and bad days anywhere,” she said. “No matter what you do, from fingerprints to employment history, bad things sometimes happen.”
But watchdogs say that’s not an acceptable explanation. Whether the Justice Department will acknowledge it, they say, Texas is not living up to its end of the bargain — as evidenced by the results of frequent status reports released on each facility by independent monitors.
Mitchell said the federal settlement requires facilities to come into compliance with 171 provisions by the end of the agreement — and that they should have made “substantial” progress on at least 150 of them so far. On average, she said, the state supported living centers have only met 20 percent of those 150 provisions, according to Disability Rights’ analysis of facility monitoring reports. The Richmond and Corpus Christi state supported living centers haven’t even broken 13 percent, Mitchell said.
Mitchell said despite reductions in staff turnover, keeping qualified people in their direct care or nursing jobs is still a major problem. She said breakdowns in communication still prevent residents from getting the proper therapy and treatment they need. And while security cameras have reduced abuse, it still happens outside their view. In some cases, Mitchell said, facilities will come into compliance with certain standards — and then fall back out of it again.
“As much as the department wants to continue to say they have fixed their problems, we don’t see that, and I don’t think the monitors see that,” Mitchell said. “The fact that we’re still seeing a lot of abuse cases that are pretty significant — the only lucky thing is that now they’re being caught on camera.”
http://www.texastribune.org/library/data/abuse-neglect-texas-disabled-institutions/
Perry Downplayed Allegations at Centers for Disabled
by Emily Ramshaw
Texas Governor Rick Perry, Department of Aging and Disability Services, Disabilities, Rick Perry Issues
Enlargephoto illustration by: Bob Daemmrich / Caleb Bryant Miller / Todd Wiseman
Part two of two.
Yesterday: Two years after Texas leaders signed a federal agreement to improve care at the state’s institutions, not even a quarter of its terms have been met, and mistreatment is still commonplace.
Texas Gov. Rick Perry’s presidential campaign hinges on one overarching message: that states perform best when left to their own devices and federal regulators should butt out. Yet during his decade-long tenure in the governor’s office, Perry and his staff repeatedly downplayed the severity of abuse and neglect allegations at Texas’ state-run institutions for the disabled — until conditions became so dire that the U.S. attorney general was forced to intervene.
“They haven’t taken it seriously,” said Joe Tate, a policy specialist with Community Now!, an organization that supports the closure of Texas’ institutions for the disabled. “We hear all the time from lawmakers that there’s not the political will to make changes. That political will — the knowledge that we have deadly, dangerous institutions — could come from the governor’s office.”
Perry spokeswoman Lucy Nashed said the governor’s office has taken reports of abuse and neglect in Texas' state-supported living centers seriously from the very beginning. Early in his first term, he signed legislation and issued an executive order designed to improve conditions and give disabled residents more options to move out of the institutions.
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In 2005, when he learned problems in the state-supported living centers had not abated, his office said he made sure the Department of Aging and Disability Services, which oversees Texas’ 13 institutions, had the resources to fund reform.
“Gov. Perry is committed to ensuring the safety of the residents in these facilities, and we take each of these claims very seriously,” Nashed said. “We continue to monitor the progress they are making toward meeting the terms of the agreement.”
But a look back at the timeline of abuse reports — and the response of the governor’s office to them — paints a far more nuanced picture.
After the U.S. Department of Justice released a report critical of conditions at the Lubbock State School in 2006 — saying there had been more than 17 deaths there in 18 months — the governor’s office suggested the problems had already been solved.
“Some would like to ramp up another emotional issue,” Perry spokesman Robert Black said at the time, referring to a recent abuse and neglect scandal in Texas’ juvenile justice system, the Texas Youth Commission (TYC).
When a 2007 Dallas Morning News investigation found hundreds of mentally and physically disabled residents of the state-supported living centers had suffered serious abuse at the hands of those paid to watch over them, Perry’s office cautioned against any assumptions that the system was flawed and said despite reports of physical and sexual assault, the centers shouldn’t be compared to the abuse-ridden TYC.
“It’s important not to sensationalize these incidents,” then-spokeswoman Krista Moody said. “They should not be portrayed as though they happened yesterday and no action has been taken.”
And in August 2008, when the Justice Department announced it was going to investigate conditions inside all of Texas’ institutions for the disabled — not just in Lubbock — Perry’s office was nonplussed.
“We expected that [the Department of Justice] would expand their investigation to all state schools as they have done in other states,” spokeswoman Allison Castle said. She added that the governor is “always interested in ways to improve state government.”
Four months later — and two years after the original Justice Department report — the U.S. attorney general’s office sent Perry a 60-page letter threatening legal action if Texas didn’t resolve the problems, including residents dying of preventable conditions and hundreds of employees being fired for abuse and neglect.
Only when faced with legal action and monetary damages did Perry’s tone shift: In February 2009 he declared protecting the residents of Texas’ institutions for the disabled a legislative emergency. In May 2009, the state reached an agreement with U.S. Attorney General Eric Holder to spend $112 million over five years to improve care and enhance staffing at the institutions.
Asked at the time why it had taken so long to pass needed legislation, Perry said that health and human services agencies have “always been difficult to address” and that Texas was a big state with lots of needs. “My focus has always been, when an issue bubbles up to the top, to bring in the best people you can find,” he said.
Halfway through the five-year settlement agreement, Texas’ federally appointed watchdog group says the state has met just 20 percent of the standards required to comply. To this, too, the governor’s office is taking a glass-half-full approach.
“The governor expects DADS to continue to work toward full compliance of the settlement agreement,” Nashed said. “While there is still work to be done, each facility and their staff continue to make significant progress toward substantial compliance, including better reporting, investigation, prosecution and firing of individuals who commit these crimes.
http://www.texastribune.org/texas-state-agencies/aging-and-disability-services/perry-downplayed-abuse-institutions-disabled/
Boy Dies Of Restraint-Related Asphyxiation
by Emily Ramshaw and Terri Langford, Houston Chronicle 11/8/2010
A 16-year-old boy has died of an apparent restraint-related asphyxiation at the Daystar Residential Treatment Center, the same facility where children with disabilities were forced to fight each other a couple of years ago.
Michael Owens died Friday night after he stopped breathing at the Manvel facility, outside of Houston. A monitor who was ordered to the facility in light of the forced fights has since left Daystar and was not there when the death occurred, according to the Houston Chronicle.
A news release indicates Brazoria County authorities are conducting an investigation into the child's death. Daystar attorney John Carsey said he hadn't heard about Friday's death. "That's news to me," he said.
Earlier this year, the Tribune and the Houston Chronicle revealed that workers at Daystar provoked seven developmentally disabled girls into a fight of biting and bruising as staffers laughed, cheered and promised the winners after-school snacks.
The fight was one of more than 250 incidents of confirmed abuse and mistreatment in residential treatment centers during the past two years, based on the Tribune/Chronicle review of state records.
http://www.texastribune.org/texas-dept-criminal-justice/corpus-christi-fight-club/boy-dies-of-restraint-related-asphyxiation/
IF slick rick is elected, it will be AMERICA FOR THE RICK, BY THE RICH, AND ONLY THE RICH...
by Emily Ramshaw and Becca Aaronson October 23, 2011
MEXIA — At the Mexia State Supported Living Center, on the sun-bleached site of a former World War II prisoner-of-war camp an hour east of Waco, residents with profound disabilities and behavioral problems spend their days doing repetitive chores: sticking paper into shredders, folding towels, sorting nuts from bolts. And, in some cases, being physically abused, despite a sweeping federal settlement signed in 2009 to prevent it.
In the last two years, a Mexia worker was caught on video pushing a disabled resident down and stepping on his throat while other employees looked on. A staffer goaded one resident into hitting another with a belt, causing bloody wounds and a trip to the emergency room. A direct care worker showed residents pornographic pictures and tried to get them to perform oral sex on him; another sexually abused two residents.
This pattern of abuse appears pronounced in Mexia, where roughly half of the disabled residents are alleged criminal offenders and nearly a third are under age 21. But two-and-a-half years after Texas officials signed an agreement with the U.S. Attorney General’s office aimed at improving conditions in the state’s 13 institutions — following a U.S. Justice Department investigation that found avoidable deaths, civil rights violations and systemic abuse — a Texas Tribune review of facility monitoring reports and employee disciplinary records shows mistreatment is still relatively commonplace. And though there’s been some evidence of improvement, the state’s federally designated disability watchdog group Disability Rights says that halfway into the five-year settlement agreement, not even a quarter of its requirements have been met.
“It’s all just as bad,” said Beth Mitchell, Disability Rights’ supervising attorney. “The numbers suggest less physical abuse, but we still see a lot of really significant cases. I can’t tell you that there’s one shining example of a wonderful facility, because there’s not.”
Officials with the Department of Aging and Disability Services, which oversees the state supported living centers, point to evidence of compliance, from advances in security to improvements in staffing. Nearly 3,500 security cameras have been installed across Texas’ institutions for the disabled. Each facility has an independent investigator to monitor abuse. New employees are now fingerprinted and run through background checks before they’re hired, and existing employees are subject to random drug tests.
Today, 94 percent of facility jobs are filled, a marked improvement over past years, even with the influx of more than a thousand new positions established under the settlement agreement. Staff turnover has dropped. And there are now more than three employees for every resident, in part because the census at the state supported living centers has dropped by nearly 800 residents since late 2008.
But despite this falling population, more consistent staffing and annual spending that has grown by nearly 50 percent since 2006, abuse allegations have continued to rise steadily, with the percent of confirmed allegations hovering at 9 percent. The agency attributes this to better investigations: In the last fiscal year, 375 workers were fired or forced to resign because they abused or neglected disabled residents, more than in any of the previous three years.
Justice Department officials declined to comment on Texas’ efforts thus far. But Aging and Disability Services spokeswoman Cecilia Fedorov said meeting the terms of the agreement is intended to be a “long-term” process and that “milestone dates” laid out in the agreement are guidelines, not deadlines.
“While progress toward and achievement of substantial compliance has been slower than anticipated by the state,” she said in a statement, “efforts continue to be sustained in every facility.”
Federal investigators have a lengthy history with Texas’ state-supported living centers, formerly known as state schools. The Justice Department sent a team into a Lubbock facility in 2005, releasing a highly critical report in 2006 that cited more than 17 deaths at the institution in the previous 18 months.
Clearly not swayed by the improvements state leaders had made, in 2008, the Justice Department announced it would investigate conditions in all 13 Texas institutions. Four months later, investigators published a scathing rebuke, saying residents’ constitutional rights had been violated, and threatened legal action if Texas didn’t resolve the problems.
In May 2009, four years after the initial investigation in Lubbock, state leaders signed a five-year, $112 million settlement agreement with the U.S. Attorney General’s office, pledging to improve standards of care, increase oversight and monitoring, and enhance staffing.
On a recent visit to the 500-acre Mexia State Supported Living Center, many of these efforts were visible, from paper signs listing the phone number of an abuse and neglect hotline to strategically placed surveillance cameras to the nondescript dormitory office that’s home to a state abuse investigator. A sign at the entrance to the property advertised: “Now hiring!”
The workers on duty that morning — many of them veterans with decades of experience — helped residents with their daily tasks, from planting carrots in a garden to removing staples from paper for shredding. They showed off squeaky clean cement and linoleum-floored dormitories, an on-site hair salon, a café with a juke box and old movie posters. They shuttled residents between bedrooms and bathrooms and therapy sessions, interacting with a familial warmth that made the facility’s confirmed abuse allegations seem hard to fathom.
Yet firing records show awful abuse continues, and not just at Mexia. In the years since the settlement agreement was signed, a staffer at the Lubbock State Supported Living Center beat a resident he was trying to shave and slammed his head into a cabinet. An employee at the Richmond State Supported Living Center was captured on video kicking a resident in the legs, punching him in the neck and chest and striking him on the head. And a staffer at the Abilene facility kicked a resident in the head eight times. At Mexia, an employee started a romantic liaison with a resident, sending the resident nude photos and calling the resident’s cell phone 452 times. Another worker there failed to supervise a resident, who was able to construct a Molotov Cocktail.
In late spring, seven staffers at the Corpus Christi State Supported Living Center were fired for abuse allegations that still haven’t been disclosed. That’s the same facility where dozens of employees were fired in 2009 for forcing disabled residents into staged fights. Five were convicted of crimes.
Fedorov, the Aging and Disability Services spokeswoman, said the agency has zero tolerance for any abuse or neglect whatsoever. She said for the most part, the workers at these facilities are amazing — but that with any public entity, from a school district to a hospital system, there will at times be bad apples.
“You have good days and bad days anywhere,” she said. “No matter what you do, from fingerprints to employment history, bad things sometimes happen.”
But watchdogs say that’s not an acceptable explanation. Whether the Justice Department will acknowledge it, they say, Texas is not living up to its end of the bargain — as evidenced by the results of frequent status reports released on each facility by independent monitors.
Mitchell said the federal settlement requires facilities to come into compliance with 171 provisions by the end of the agreement — and that they should have made “substantial” progress on at least 150 of them so far. On average, she said, the state supported living centers have only met 20 percent of those 150 provisions, according to Disability Rights’ analysis of facility monitoring reports. The Richmond and Corpus Christi state supported living centers haven’t even broken 13 percent, Mitchell said.
Mitchell said despite reductions in staff turnover, keeping qualified people in their direct care or nursing jobs is still a major problem. She said breakdowns in communication still prevent residents from getting the proper therapy and treatment they need. And while security cameras have reduced abuse, it still happens outside their view. In some cases, Mitchell said, facilities will come into compliance with certain standards — and then fall back out of it again.
“As much as the department wants to continue to say they have fixed their problems, we don’t see that, and I don’t think the monitors see that,” Mitchell said. “The fact that we’re still seeing a lot of abuse cases that are pretty significant — the only lucky thing is that now they’re being caught on camera.”
http://www.texastribune.org/library/data/abuse-neglect-texas-disabled-institutions/
Perry Downplayed Allegations at Centers for Disabled
by Emily Ramshaw
Texas Governor Rick Perry, Department of Aging and Disability Services, Disabilities, Rick Perry Issues
Enlargephoto illustration by: Bob Daemmrich / Caleb Bryant Miller / Todd Wiseman
Part two of two.
Yesterday: Two years after Texas leaders signed a federal agreement to improve care at the state’s institutions, not even a quarter of its terms have been met, and mistreatment is still commonplace.
Texas Gov. Rick Perry’s presidential campaign hinges on one overarching message: that states perform best when left to their own devices and federal regulators should butt out. Yet during his decade-long tenure in the governor’s office, Perry and his staff repeatedly downplayed the severity of abuse and neglect allegations at Texas’ state-run institutions for the disabled — until conditions became so dire that the U.S. attorney general was forced to intervene.
“They haven’t taken it seriously,” said Joe Tate, a policy specialist with Community Now!, an organization that supports the closure of Texas’ institutions for the disabled. “We hear all the time from lawmakers that there’s not the political will to make changes. That political will — the knowledge that we have deadly, dangerous institutions — could come from the governor’s office.”
Perry spokeswoman Lucy Nashed said the governor’s office has taken reports of abuse and neglect in Texas' state-supported living centers seriously from the very beginning. Early in his first term, he signed legislation and issued an executive order designed to improve conditions and give disabled residents more options to move out of the institutions.
The Tribune thanks our Supporting Sponsors
In 2005, when he learned problems in the state-supported living centers had not abated, his office said he made sure the Department of Aging and Disability Services, which oversees Texas’ 13 institutions, had the resources to fund reform.
“Gov. Perry is committed to ensuring the safety of the residents in these facilities, and we take each of these claims very seriously,” Nashed said. “We continue to monitor the progress they are making toward meeting the terms of the agreement.”
But a look back at the timeline of abuse reports — and the response of the governor’s office to them — paints a far more nuanced picture.
After the U.S. Department of Justice released a report critical of conditions at the Lubbock State School in 2006 — saying there had been more than 17 deaths there in 18 months — the governor’s office suggested the problems had already been solved.
“Some would like to ramp up another emotional issue,” Perry spokesman Robert Black said at the time, referring to a recent abuse and neglect scandal in Texas’ juvenile justice system, the Texas Youth Commission (TYC).
When a 2007 Dallas Morning News investigation found hundreds of mentally and physically disabled residents of the state-supported living centers had suffered serious abuse at the hands of those paid to watch over them, Perry’s office cautioned against any assumptions that the system was flawed and said despite reports of physical and sexual assault, the centers shouldn’t be compared to the abuse-ridden TYC.
“It’s important not to sensationalize these incidents,” then-spokeswoman Krista Moody said. “They should not be portrayed as though they happened yesterday and no action has been taken.”
And in August 2008, when the Justice Department announced it was going to investigate conditions inside all of Texas’ institutions for the disabled — not just in Lubbock — Perry’s office was nonplussed.
“We expected that [the Department of Justice] would expand their investigation to all state schools as they have done in other states,” spokeswoman Allison Castle said. She added that the governor is “always interested in ways to improve state government.”
Four months later — and two years after the original Justice Department report — the U.S. attorney general’s office sent Perry a 60-page letter threatening legal action if Texas didn’t resolve the problems, including residents dying of preventable conditions and hundreds of employees being fired for abuse and neglect.
Only when faced with legal action and monetary damages did Perry’s tone shift: In February 2009 he declared protecting the residents of Texas’ institutions for the disabled a legislative emergency. In May 2009, the state reached an agreement with U.S. Attorney General Eric Holder to spend $112 million over five years to improve care and enhance staffing at the institutions.
Asked at the time why it had taken so long to pass needed legislation, Perry said that health and human services agencies have “always been difficult to address” and that Texas was a big state with lots of needs. “My focus has always been, when an issue bubbles up to the top, to bring in the best people you can find,” he said.
Halfway through the five-year settlement agreement, Texas’ federally appointed watchdog group says the state has met just 20 percent of the standards required to comply. To this, too, the governor’s office is taking a glass-half-full approach.
“The governor expects DADS to continue to work toward full compliance of the settlement agreement,” Nashed said. “While there is still work to be done, each facility and their staff continue to make significant progress toward substantial compliance, including better reporting, investigation, prosecution and firing of individuals who commit these crimes.
http://www.texastribune.org/texas-state-agencies/aging-and-disability-services/perry-downplayed-abuse-institutions-disabled/
Boy Dies Of Restraint-Related Asphyxiation
by Emily Ramshaw and Terri Langford, Houston Chronicle 11/8/2010
A 16-year-old boy has died of an apparent restraint-related asphyxiation at the Daystar Residential Treatment Center, the same facility where children with disabilities were forced to fight each other a couple of years ago.
Michael Owens died Friday night after he stopped breathing at the Manvel facility, outside of Houston. A monitor who was ordered to the facility in light of the forced fights has since left Daystar and was not there when the death occurred, according to the Houston Chronicle.
A news release indicates Brazoria County authorities are conducting an investigation into the child's death. Daystar attorney John Carsey said he hadn't heard about Friday's death. "That's news to me," he said.
Earlier this year, the Tribune and the Houston Chronicle revealed that workers at Daystar provoked seven developmentally disabled girls into a fight of biting and bruising as staffers laughed, cheered and promised the winners after-school snacks.
The fight was one of more than 250 incidents of confirmed abuse and mistreatment in residential treatment centers during the past two years, based on the Tribune/Chronicle review of state records.
http://www.texastribune.org/texas-dept-criminal-justice/corpus-christi-fight-club/boy-dies-of-restraint-related-asphyxiation/
IF slick rick is elected, it will be AMERICA FOR THE RICK, BY THE RICH, AND ONLY THE RICH...