Boulevard Heights school student died of effects of restraint and medication

Aug. 11—The combined effects of physical restraint and an antipsychotic medication led to the death of a Fort Worth student with autism in March, medical examiners ruled Wednesday.

Xavier Hernandez, 21, died March 1 at John Peter Smith Hospital after being physically restrained at Boulevard Heights, a Fort Worth school for students with disabilities.

Hernandez's cause of death was "chlorpromazine toxicity in the setting of physical restraint," according to the Tarrant County Medical Examiner's Office. His manner of death is undetermined.

District officials have confirmed that Hernandez was physically restrained at school before he died. Clint Bond, a spokesman for the district, said no one at Boulevard Heights administered medication to Hernandez on the day he died.

Julie Dopheide, a professor of clinical pharmacy and psychiatry and behavioral sciences at the University of Southern California School of Pharmacy, said chlorpromazine was the first antipsychotic medication on the market. It was developed in France in the early 1950s and was in wide use for decades before it was replaced by newer antipsychotic medications in the 1990s. It's still commonly used as a sedative for aggressive behaviors in children and teenagers, Dopheide said.

When someone who is on chlorpromazine is physically restrained, it can create a dangerous combination, Dopheide said. Physical restraints can impede circulation. Chlorpromazine has a sedative effect, she said, so the two together could have a compounding effect on blood flow and oxygenation. People with developmental disabilities are at increased risk of seizures and muscle side effects, and the drug can make those more likely, she said. The drug can also disrupt the body's temperature regulation, making it more likely for a person to overheat, she said.

It's rare for a person to die of chlorpromazine toxicity because patients generally don't take enough of it to cause these problems, Dopheide said. But in the right circumstances, it's possible, she said.

Hernandez's death prompted an investigation by Disability Rights Texas, a Dallas-based organization that advocates for people with disabilities. The group is also investigating a separate incident at Boulevard Heights in which teachers roughly restrained Toni Crenshaw, a fourth-grader at the school. Isabella Ellis, a bystander who recorded video of the restraint, said it appeared that a teacher was sitting on Toni.

Last month, members of the Self-Determination Group, a North Texas self-advocacy group for people age 14 and up with disabilities, called on the Fort Worth school district to bring in an outside investigator to review the district's policies regarding physical restraints and make recommendations for improvements.

Bond, the district spokesman, said the district engaged a third party after the incident to conduct an investigation "that included, but was not limited to, practices, policies and procedures related to restraints."

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