The state’s strategy for keeping peace at Louisiana’s only facility caring for the intellectually disabled received a crippling blow in a legal action held behind closed courtroom doors.

Three residents who had violently attacked staff — two of whom were seen setting fire to a residence hall — successfully challenged their transfer from Pinecrest Supports and Services Center to a secured mental illness hospital. Their legal action was held behind closed doors in Alexandria’s 9th Judicial District Court. It ended last week when the Louisiana Department of Health agreed to find another placement for the three within the next 60 days.

The settlement effectively stops one of the health department's key efforts to lower levels of violence at Pinecrest. The state also is increasing staff training on how to de-escalate situations before they become violent.

The health department began shifting some of the most aggressive Pinecrest residents within days of The Advocate reporting in late March that direct care staff was being beaten up regularly by a younger population, newly arrived because of years of budget cuts.

“I want to know, are they placing these individuals back at Pinecrest, where they were attacking people?” said James Ray, a field representative for the American Federation of State, County and Municipal Employees, which represents many of Pinecrest’s direct care staff.

The 95-year-old facility with about 430 residents is staffed predominantly by middle-aged women who for years had cared for largely docile individuals with profound intellectual disabilities — bathing, feeding and otherwise helping them through the day.

“They’re there because the state couldn’t find another facility to place them,” Ray said of the facility's residents. “What happens in 60 days? And what happens to the others who were removed from Pinecrest?”

Officials with both the health department and the state Mental Health Advocacy Service, which represented the three residents in the legal action, could provide no answers. They refused comment, citing patient confidentiality. The same reason was given for why the legal proceedings were not held in public.

The settlement was confirmed by The Advocate through three sources familiar with the legal action. The Advocate chose not to disclose the names and patient numbers of the three litigants.

To save money, the state began about seven years ago relocating Pinecrest clients to private facilities, which generally took those without behavioral problems. Lawmakers in 2013 closed all the other state facilities for the intellectually disabled, except Pinecrest, as well as reduced services offered by other agencies.

This left a concentration of people diagnosed with milder forms of intellectual disabilities but with violent backgrounds. Pinecrest was required to take these people and has limited legal options on moving them elsewhere.

Patient confidentiality laws forbade the health department from releasing reports of violence between residents. But forms required to be filed when a state employee might miss work because of an on-the-job incident are public record.

For the year prior to Feb. 28, the staff filed 524 worker compensation reports after being punched, kicked, bitten, scratched or otherwise assaulted by their charges, whose names were redacted from the forms. Three years ago, virtually no incidents of violence on the staff were reported.

About a half dozen unruly Pinecrest residents were moved in April to the Central Health State Hospital, near Alexandria, and the 170-year-old Eastern Louisiana Mental Health System, 35 miles north of Baton Rouge in Jackson. Both are secured facilities that treat mental illnesses whose populations include residents with criminal charges.

Two of the three residents filing legal challenges to their removals were seen by staff setting fire to curtains in an attempt to burn down a residence hall on the Pinecrest campus, said Sonja Perry, a direct care giver for nearly 20 years and head of AFSCME Local 712 at Pinecrest. All three men had repeatedly punched, scratched and thrown things at the women charged with caring for them, she said.

Perry refused to identify the patients by name but said they were well known to her members. She allowed that the staff fears the prospect of the three — along with the others — being returned Pinecrest. “We are very much afraid,” Perry said.

Speaking in general, not specifically about the residents who were moved or the legal action, officials with the health department and Mental Health Advisory, said state and federal law requires institutionalized residents to receive appropriate care in line with the diagnosis that caused them to be placed in care. Mental illness facilities generally do not provide the services needed for patients diagnosed with intellectual disabilities.

“It’s apples and oranges. The way you treat people who have troubles with poor social skills is far different from mental illness, which is treatable with medications and other services,” said Joseph Seyler, director Mental Advocacy Service. The independent agency under the Office of the Governor provides legal services to those placed in mental institutions.

Pinecrest Supports and Services Center is an intermediate care facility for people with intellectual/developmental disabilities who don’t have other options such as living with a family member or in a community placement. It is not a "secure" setting.

“For some people, it might not be the most appropriate facility,” health Deputy Secretary Michelle Alletto wrote in an emailed statement in response to specific questions about the future of the three residents. Her statewide duties include overseeing Pinecrest.

“For example,” Alletto wrote, “an individual at Pinecrest might move out because they require acute medical care in a hospital, or they require in-patient psychiatric care. As you have seen, too, some people have been moved out because of criminal behavior.”

Follow Mark Ballard on Twitter, @MarkBallardCnb.