The ambulance crew found Vince Allen on the hospital floor, curled into a fetal position, languishing in a soiled diaper. The 15-year-old, an ambulance technician later wrote, was covered with open wounds from "severe body mutilation."

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(ENLARGE)

Vince Allen celebrates his 15th birthday before suffering injuries at Georgia Regional.

Hughes Spalding hospital (ENLARGE)

A photo of Vince Allen taken after his arrival at Hughes Spalding Children's Hospital documents the extent of his injuries, believed to be mostly self-inflicted.

Hughes Spalding hospital (ENLARGE)

Vince Allen's arm bears wounds after arriving at Hughes Spalding.

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When the technician asked what happened during Allen's 12-day stay at the state psychiatric hospital in Atlanta, a nurse said,

"Well ...," and shrugged.

At Hughes Spalding Children's Hospital, where the ambulance crew took Allen for treatment, a physician described Allen as "emaciated." He was dehydrated. His kidneys had failed. Bruises and cuts covered his head, his chest, his abdomen, his legs, his neck, his buttocks. Several wounds, doctors wrote, were "superinfected" – so badly they had to be drained surgically.

Deep, black-crusted wounds and inflamed scratches ran across his body, photographs taken at Hughes Spalding shortly after Allen's admission in January 2006 show. Even his teeth were caked with blood.

The agency that operates the state's seven psychiatric hospitals twice documented Allen's precipitous decline. Yet, in separate investigations, it cleared employees at Georgia Regional Hospital/Atlanta of wrongdoing.

"Unsubstantiated," the agency concluded about allegations of neglect and abuse. "Lack of sufficient evidence."

The injuries to Allen, who is autistic, required 36 days of treatment at Hughes Spalding. Last week his parents sued the agency, the state Department of Human Resources, claiming the boy was "neglected and mistreated to the point of death" at Georgia Regional.

What happened to Allen at Georgia Regional reflects a pattern of poor medical care at the state hospitals. An investigation by The Atlanta Journal-Constitution found that at least 115 patients died under suspicious circumstances and that authorities substantiated almost 200 cases of patient abuse from 2002 through 2006. As many as 21 more questionable deaths occurred in 2007, the newspaper recently reported.

A state-funded study recently questioned the quality of care in the chronically overcrowded and understaffed facilities and recommended more hiring, better pay and closer attention to medical treatment.

What happened after Allen left Georgia Regional illustrates another persistent failing in the state hospitals: deficient investigations into alleged maltreatment or abuse. The Journal-Constitution's review of hundreds of cases found that officials rarely call in police or other outside agencies and often dismiss complaints before compiling all pertinent information.

In Allen's case, the investigator relied only on Georgia Regional's employees and files. The investigator did not examine records from Hughes Spalding or interview doctors there. Her report makes no mention of the photos of Allen's injuries.

A DHR spokeswoman, Dena Smith, declined to comment, citing the pending lawsuit and privacy regulations.

The lawsuit, Allen's medical file and other documents depict grim conditions in the state hospital.

Allen, who is virtually mute, was bathed just twice at Georgia Regional. He never brushed his teeth. His arms and head unrestrained, he scratched and gouged and bit himself over and over. Open sores went untended. When a child protective caseworker visited, Allen was lying half-naked on the floor.

He looked, the caseworker wrote later, as if he had been "whipped."

'Meltdowns'

Doctors diagnosed Allen as autistic when he was 2. For another decade, he lived with his parents, Gwen and David Allen, and his older brother in a tidy house trailer set amid the serene meadows of a Gordon County farm, 75 miles north of Atlanta.

About six years ago, however, Allen's parents could no longer control a growing child who often experienced what they describe as "meltdowns."

"I was about to go out of my mind," Gwen Allen said during a recent interview. "It was physically and emotionally exhausting."

Their only choice, the Allens said, was to place their son in foster care.

He thrived at foster homes in North Georgia and DeKalb County. In October 2005, however, Allen entered Georgia Regional for treatment of "agitation," his medical records say. Doctors gave him mood-stabilizing medicine and released him after four days.

After Allen's psychiatrist later changed his medications, the lawsuit alleges, the boy's behavior again deteriorated. The psychiatrist, Dr. Iverson Bell Jr., who also is named in the suit, declined to comment.

On Jan. 10, 2006, Allen re-entered Georgia Regional.

Allen, who wore a protective helmet, wandered the halls of the hospital's adolescent unit during his first three days there, records say, agitated and hitting himself.

On the fourth day, he struck a staff member, and doctors prescribed tranquilizers to subdue him.

Allen was barely eating or drinking and was becoming dehydrated, records show. His weight had plummeted — to 85 pounds, down from 110 two months earlier.

Still, records show, hospital workers gave him no intravenous fluids to combat dehydration. They gave him no antibiotics to fight infection. As Allen continued biting himself and digging his fingernails into open wounds, they did not restrain his arms or place protective mittens on his hands.

Instead, his parents' lawsuit alleges, the hospital staff "allowed Allen to remain in a fetal position on a virtually constant basis, lying in his own urine and feces for hours at a time."

By Allen's 11th day at Georgia Regional, records indicate, he was too weak to stand or sit on his own. After nurses twice summoned doctors the next day, a physician ordered Allen's transfer to an emergency room. Rather than call 911, however, a nurse summoned a nonemergency ambulance. It arrived 2 1/2 hours later.

The ambulance crew took 1 1/2 pages to document Allen's condition: "Severe dehydration." "Possible starvation." "Possible severe neglect/abuse."

Allen was in septic shock from a blood infection and near death when he arrived at Hughes Spalding, records show. He had MRSA, or methicillin-resistant Staphylococcus aureus, which can be fatal.

His foster mother took photos showing extensive bruising across his lower back and buttocks. Those wounds, two medical consultants told his family's lawyer, Robert Finnell of Rome, may have been caused by "intentional abuse."

Differing conclusions

Two state investigators filed reports that are remarkably similar to other accounts of Allen's hospital stay – except for their conclusions.

While Allen was at Georgia Regional, his foster mother complained to the state Division of Family and Children Services, which investigates child abuse and neglect. Like the state hospitals, the division is part of DHR.

A DFCS caseworker found Allen in his hospital room half-naked and covered with wounds.

But "the caseworker simply documented this in her file and left," according to the Georgia Advocacy Office, an independent state-funded agency that investigates the treatment of disabled people. Its staff has reviewed the DFCS records.

"She did not question the care the teenager was receiving at the hospital," the advocacy group's report said, "and failed to report the neglect to anyone at the hospital or within DFCS."

Hughes Spalding doctors complained about Allen's treatment to DHR's investigative arm, the Office of Regulatory Services.

That agency's investigator confirmed a lack of treatment for Allen's wounds and dehydration. But she also wrote that the staff assigned to Allen had been trained in handling children with autism and developmental delays and that workers had set "goals and techniques for decreasing self-injurious behavior."

Despite Allen's extensive wounds, the investigator said she found no evidence that Georgia Regional failed to prevent his "self-mutilating behavior" or that it allowed him to stop eating and drinking.

Less than a month later, on the same adolescent unit at Georgia Regional, 14-year-old Sarah Elizabeth Crider died of an intestinal blockage that went untreated. Her death became a touchstone for problems at the state mental hospitals. The state recently paid $1.25 million to settle a claim filed by her family.

Allen now is 17. His injuries, his parents say, left him prone to infections, made it difficult for him to walk and restricted his use of the extremities that had the most severe wounds.

He moves, his parents say, like an old man.

Allen's parents say no state official ever contacted them after the ordeal. They got neither an apology nor an explanation.

They did, however, get a bill – for $3,962.25 for Allen's care at Georgia Regional.