Native American students say school pushed prescribed drugs on kids, threatened punishment

MCLAUGHLIN, S.D. – At first sight, K'lyn Ducheneaux saw something she wanted in the Flandreau Indian School: opportunity.

She saw a chance to excel academically and socially, to gain independence and to spend her high school years exploring outside the boundaries of the Standing Rock Indian Reservation where she grew up.

What Ducheneaux didn't realize, though, was that she would be enrolling in an institution where she and other students, parents and staff say prescription drugs were pushed on schoolchildren, under threat of punishment for not taking the medications and without explicit parental consent.

The school handbook also states that "failure to take prescribed medication" can result in "disciplinary action."

The Bureau of Indian Education, which operates the school, did not directly respond to questions about punishing students for not taking their medications, but a spokesperson acknowledged that "noncompliance by students may result in creating an incident report."

Ducheneaux was just a 14-year-old freshman in 2019 when she got on a bus, traveled 300 miles across the state and arrived on the campus of one of four remaining off-reservation boarding schools for Native American students still run by the federal government.

Located five hours southeast of Standing Rock and just 15 minutes west of the Minnesota border, Flandreau felt vibrant in those first days, she said. Staff members were nice. There were clubs, activities and a music room where she could practice guitar.

But when Ducheneaux looks back now, the 20-year-old sees something very different – and darker.

She recalls a place where prescriptions for psychotropic medications – quetiapine, trazodone, buspirone, fluoxetine – "just kept on coming in," even though she didn't "really know what the purpose was," Ducheneaux said.

Ducheneaux said she tried repeatedly over a four-year period to tell staff at the school and at the Flandreau Santee Sioux Tribal Health Center, which provides health services to Flandreau students, that the medications she'd been prescribed were making her feel "like a zombie" and were exacerbating her depression.

When the staff didn't listen, Ducheneaux resisted taking her medications. In response, she said, staff punished her with extra chores and threats of expulsion.

She even dropped out of the school on multiple occasions in an attempt to escape the medication mandates and punishments, Ducheneaux said. But she returned, lured by the hope that things would improve.

"How I describe it is, it's kind of like a trauma cycle that goes on there," Ducheneaux said. "It's kind of like a cycle where the kids go back into the cycle, thinking it's going to be a little different this time. ... But it's not."

'A health and safety issue'

Ducheneaux said the consequences of the cycle at Flandreau were nearly fatal.

As her pleas went unheeded, she believed the cocktail of medications prescribed to her was harming her and fueling her suicidal thoughts.

"Instead of helping, they kind of just worsened things for me," Ducheneaux said. "The battle (with depression) just kind of got worse when I was on them."

Thousands of reports designated for recording abuse, neglect, injuries, life-threatening incidents and death have been filed since 2008 at the 55 schools the BIE operates directly.

Finally, in the spring of 2023, in the Flandreau girls' dormitory, Ducheneaux took a drastic step.

"When everyone went out to go eat dinner, I stayed behind and I went into my room, turned off all the lights, closed the curtains, locked the door and crawled inside my closet and did what I did," she said.

She said she tied a rope around her neck and tried to kill herself.

While Ducheneaux's experience culminated in an extreme outcome, a Lee Enterprises Public Service Journalism investigation found that she was not the only Flandreau student who says they were punished for not taking prescribed medications.

Former school staff also said they knew of students being written-up and punished for refusing medication.

Rogene Crawford, who worked at Flandreau from 1999 until 2022 as an academic secretary and as a staffer in the girls' dormitory, said students who refused medication would sometimes get written up and be assigned details, such as scrubbing toilets or mopping floors, as punishment.

The use of punishment to push students to take medications, including psychotropic medications, is legally and ethically questionable, experts say.

Federal law includes a " prohibition on mandatory medication" for students with disabilities, and psychiatrists say it's wrong and potentially harmful to coerce people to take prescriptions, except in extreme cases.

The allegation that Flandreau Indian School students could be punished for not taking medication is based not only on the statements of students, guardians and staff. It is also school policy, explicitly described in writing in the Flandreau Indian School Student and Parent handbook for the current school year as well as for years past.

"Students who are on medication will be required to take their prescribed medications," the handbook reads. "Failure to take prescribed medication is a Health and Safety issue and can result in FIS disciplinary action."

The handbook categorizes "refusing to take medications" among the most serious of student infractions, known as "A-Majors," a category that also includes car theft, sexual assault and inciting a riot.

"By your enrollment," the handbook states elsewhere, "you and your parent/guardian have agreed that you are willing to abide by the rules, regulations, policies and procedures embodied in this document."

'A right to refuse' But punishing minors who do not want to take medications is considered unethical, except in extreme cases, said Larry Wissow, a child psychiatrist at the University of Washington and Seattle Children's Hospital .

"Any person – any child – just from an ethical point of view, has a right to refuse to take any medication or not to be coerced by force to take it," Wissow said.

Christopher Thomas , a professor emeritus of psychiatry at the University of Texas Medical Branch, said "the only time" he has dealt with mandated medication of a patient was when it was court-ordered. In such cases, Thomas said, the patient was involuntarily hospitalized because they posed a danger to others and themselves. In some cases, Wissow noted, advanced directives can also allow patients to consent to be medicated if their mental health deteriorates in the future.

But Wissow questioned whether someone could "sign away" the right not to be coerced into being medicated by agreeing to abide by the handbook. "I don't know, ethically, how a clinician would accept that sort of a proposition that someone had signed away that right," he said.

Cynthia R. Jacobs, chief executive officer of the Flandreau Santee Sioux Tribal Health Center, did not answer a list of questions about whether clinic staff properly medicate Flandreau Indian School students, including whether clinic staff were aware that students could be punished for not taking prescribed medications.

"The Flandreau Santee Sioux Tribal Health Center provides health services to FIS students," Jacobs wrote in an email. "We cannot share protected health information about students or comment on BIE policies."

A public affairs officer for the Indian Health Service, which reportedly provides funding to the clinic, responded to questions similarly, writing that the Flandreau Santee Sioux Tribal Health Center "is a tribal clinic with school coverage, so we cannot comment on the processes and procedures used at this site." The public affairs officer referred questions to the BIE.

In an email response to questions, a BIE spokesperson said school staff do not prescribe medications to students but acknowledged that Flandreau students "are required to follow the (prescribing) provider's instructions. Depending on the nature of the illness being treated and the prescribed treatments necessary to safeguard both staff and other students, noncompliance by students may result in creating an incident report."

The BIE spokesperson did not, however, confirm or deny that those incident reports result in punishments, despite being specifically asked about the "disciplinary action" described in the school handbook and whether school staff "punish students for not taking medications."

The handbook does define an "incident report" as "documentation of a student's alleged violation of the code of conduct." Once completed, such reports are "forwarded to appropriate personnel ... for consequences or additional follow-up," the handbook says.

'A violation of core ethical principles' Justin Douglas McDonald, a citizen of the Oglala Lakota Nation and professor of psychology at the University of North Dakota who specializes in assessment and treatment of Native Americans, called punishing students for refusing medications "pretty sketchy."

"I've never heard of that," he said. "How do you do that? How do you force somebody, especially a kid, to take medication, and especially if there's parental consent issues that you don't have?"

Wissow said that informed consent is crucial on a practical level, too, as the "effectiveness of medications is not huge" within "the realm of child mental health problems – and especially for things like complex trauma or depression in adolescence."

"The primary treatments for those things are psychotherapeutic," Wissow said.

Wissow argued that there is "tons of evidence" that a medication's effectiveness increases when a patient understands and is "committed" to taking it, rather than being forced.

"If only for that very utilitarian goal of trying to get the most out of any given treatment," Wissow said, "you do your best to work with the family and the child to help them to understand what this is and why it might help. Obviously, the second and huge ethical thing is that to give people a treatment of any kind that they don't fully understand the risks and benefits of is a violation of core ethical principles.

"The other thing is that all of these medicines have potentially beneficial effects, but they also can have significant side effects."

Wissow and McDonald both said that the only way to know whether a patient is experiencing such side effects – and whether psychotropic medications are helping or hurting, more generally – is to solicit and respond to the patients' feedback.

"So what if you're wrong insofar as you've got a kid on a medication that is really bothering them, and the side effects are really difficult for the child. And they don't want to take them because of the side effects, and now you're going to force them to?" McDonald said. "And you're going to punish them if they don't?"

'Rights being violated' The school's policy raises not only ethical questions but also legal ones, according to Alexis DeLaCruz, senior attorney for the Native American Disability Law Center.

The Individuals with Disabilities Education Act, or IDEA Act, prohibits schools from "from requiring parents to obtain a prescription" for controlled substances "as a condition of attending school."

And another federal civil rights law known as Section 504 of the Rehabilitation Act "protects all people with disabilities from discrimination in places that receive federal funding," DeLaCruz said.

Within the federal government's sprawling Bureau of Indian Education school system, allegations of abuse, neglect and even death at BIE schools have emerged over the past two decades.

While the laws provide overlapping civil rights protections to all public school students, including those attending BIE schools, they differ, including in how they define students with disabilities.

In order to "receive special education services under the IDEA Act ," DeLaCruz said, a student must have a condition that meets the definition of 13 "very specific" types of disability, one of which is "emotional disturbance." But under Section 504 of the Rehabilitation Act, she said, "there is no specific" criteria for eligibility.

"The only requirement is that you either have a disability or are regarded as having a disability, and it substantially limits one or more of what are considered activities of daily living," DeLaCruz said. "So in the education context: thinking, learning, reading, concentrating."

While rejecting the notion that a prescription for a psychotropic medication would automatically suggest a student has a disability, DeLaCruz said "common sense tells us usually an ethical doctor is prescribing medications based on a condition."

And the fact that many of the students interviewed for this story acknowledged their mental health struggles also suggests federal laws should have protected these students, DeLaCruz said.

In Ducheneaux's case, her disabilities included depression, according to her grandmother and guardian, Naomi Johnson. Johnson noted the girl had also been diagnosed with a learning disability and had an individualized learning program as a result.

"At the risk of not making an overly broad generalization, if someone says, 'I struggle with anxiety and depression,' then that is enough to trigger Section 504 protections because it's a mental health issue that's impacting your ability to think, drive, concentrate, that kind of a thing," DeLaCruz said.

DeLaCruz acknowledged she doesn't have enough information to determine whether discrimination took place at Flandreau, but she did say that "there are individual remedies, both under IDEA and Section 504, if students and families have concerns about their individual students' treatment or their rights being violated."

"There are child welfare and disability rights lawyers around the country that have been very vocal about how concerning it is when medications are either forced on children or adults or used improperly to control behavior," DeLa Cruz added. "And I do think that any sort of inappropriate use or misuse of medication is likely a violation of that individual's civil rights, both under Section 504 and potentially under the IDEA."

Asked whether Flandreau Indian School's policies are "in compliance with federal law," a BIE spokesperson wrote, "FIS does not impose any requirement that students with disabilities obtain a prescription for a controlled substance (as defined in 34 C.F.R. 300.174 ) as a condition of attending school, receiving services, or receiving an evaluation for a disability."

But the BIE has a history of failing to implement the provisions of both IDEA and Section 504.

The U.S. Department of Education has repeatedly found that the BIE "needs intervention" to comply with the IDEA Act.

The bureau also allegedly failed to abide by Section 504 of the Rehabilitation Act until the matter was partially settled in a 2020 lawsuit that DeLeCruz and the Native American Disability Law Center helped nine child plaintiffs file against the bureau. That suit alleged that the BIE had failed to provide a quality education and had discriminated against students with disabilities at Havasupai Elementary School, a bureau-operated school located on the floor of the Grand Canyon on the Havasupai Indian Reservation in Arizona.

"As a result of that historic settlement," DeLaCruz said, "the federal government, for the first time ever, agreed to draft and implement written policies telling Native students with disabilities and their families what their specific rights are under Section 504."

In 2022, an independent monitor found lingering issues at Havasupai Elementary.

"Although no clear Section 504 deficiencies exist," the monitor's report said, "the protections and supports are under utilized due primarily to challenges like chronic staff shortages, a toxic school climate, and lack of an instructional leader."

"It's really no secret or surprise that the BIE continues to fail in meeting the needs of students with disabilities, certainly at its (bureau) operated schools, because publicly available reports and data demonstrate that that's still happening," DeLaCruz said.

'I'm Not Going To Take That' Ducheneaux said she repeatedly told staff she didn't want to take the medications prescribed to her, that she sometimes refused her medication and that, when she did, she would be written up.

Three write-ups would lead to a violation. And such a violation, she said, meant you were not allowed to participate in extracurricular activities, had to "stay in your room" and were assigned extra "details."

"A detail," she said, "is like this list of chores you do, like sweep, mop, (clean) bathrooms."

She said this was commonplace.

"There were a lot of girls that were like, 'No, I'm not going to take that,'" Ducheneaux said.

In response, she said, staff would say things like, "Well, just take it, because if you don't, you're gonna get written up."

One of those other students was Ducheneaux's relative, Santana Vazquez, who is now 16 and currently attends Flandreau. Though Ducheneaux is technically Vazquez's aunt, they are more like sisters, as they share a guardian in Johnson and have largely been raised together on Standing Rock.

Within a couple of months of starting at Flandreau as a 13-year-old freshman in 2022, Vazquez said she too was subjected to confusing and invasive medical treatment.

After being sent to the Flandreau Santee Sioux Tribal Health Center to have "blood work" done, Vazquez said she was diagnosed with anemia and soon found herself taken out of school for three or four hours a day, twice a week, to get iron infusions and attend counseling.

The counselor, she said, "was really nice." But a psychiatrist, she said, prescribed her "all these meds that I didn't really need."

At one point, Vazquez said, she was supposed to take 12 pills every morning and every night. The pills made her so nauseous, she said, that they "made me throw up every morning."

She said she told staff but that they weren't responsive, except to write her up and punish her with chores when she refused to take the meds.

Mariah Fassett, who was a student at Flandreau from 2021 until 2023, said students were not only getting written up but also threatened with expulsion for resisting medication.

"One of the first red flags I noticed was how much students had to be in line in the morning to get their meds," Fassett said. "And then, how much of them were getting written up and getting threatened on being sent home on a health and safety hazard if you refused your medication."

The school handbook says that A-Major infractions like "refusing to take medications" will "result in a hearing."

"Through the hearing process," the handbook continues, "expulsion may be deemed appropriate."

Alerus Hanks, a close friend of Fassett's, said she was one of the students who were threatened with expulsion.

While she acknowledged that psychotropic medications have been an important resource for her as she has dealt with ADHD and depression since before she arrived at Flandreau, Hanks said she was prescribed "a lot more" medications at the school, to negative effect.

"They always asked if I needed to up it (the dosage of medication), or asked if I needed something else," Hanks said. "They never gave the chance for my body to get used to it. It was just always a constant change of different meds, a constant change of the dosage, a constant change of, like, everything."

"Even I thought it was a little crazy," Hanks added. "Because at one point, I was on two different sleeping medications because I have insomnia. And at the time, they had me on benadryl, and then they had me on – I think it was trazodone."

After she began having seizures that she believed were connected to her medications and that have ceased since she left Flandreau, Hanks said she had "no choice" but to keep taking them, "because I couldn't get any more write ups. Otherwise, I'd get sent home and get expelled."

'I'd just kind of given up' Some three hours after her suicide attempt, Ducheneaux said, she awoke with "these little, tiny things all over my face" – likely petechiae, a form of internal bleeding sometimes associated with asphyxia – as well as "bruising."

Then she went to tell a staff member what she had done.

"I told her that I strangled myself in an attempt to die," she said. "And she (the staff member) looks at me in the eye, and she laughs a little bit. She tells me, 'Do you need Tylenol for it?'"

Ducheneaux said staff did not call for an ambulance or immediately take her to the emergency room. Instead, she said, a staff member threatened to have her jailed. During a phone call she was having with Ducheneaux at the time, Johnson said she overheard "hollering at K'lyn" and threats that she would be jailed.

While that did not happen, Ducheneaux said staff isolated her for a week in a suite of rooms that were usually used as a lounge and TV room for dorm residents.

And while she was allowed to contact a counselor by phone during this period, she said she didn't have easy access to a phone. She said she was never visited by a counselor, psychiatrist or other mental-health professional.

Dormitory staff, she said, brought her meals and medications.

"I'd just kind of given up on trying to tell them no, that I don't want to" take those medications, Ducheneaux said. "So I would just take it."

As Native American students face what one BIE superintendent called "extreme challenges," Circle of Nations School welcomed a reporter and photographer inside. "We want the exposure," an administrator said.

About five days into her isolation, Ducheneaux said Flandreau staff finally took her to the emergency room, where "they didn't do nothing. They had to just discharge me."

Ultimately, Ducheneaux and Vazquez both said, Ducheneaux was written up for her suicide attempt.

Asked about Ducheneaux's account, a BIE spokesperson wrote that the bureau "does not comment on specific student incidents."

The spokesperson added, though, that students have "24-hour access to mental health support and virtual counseling services" and that "staff immediately begin working with health professionals and families" whenever "suicidal ideation or a suicide attempt occurs."

"During this process, the school ensures that students are not left alone and are in a safe location," the spokesperson added. "If any incidents are noted, they are documented as health or safety violations rather than as disciplinary write-ups."

"If you are in crisis, please call, text or chat with the Suicide and Crisis Lifeline at 988, or contact the Crisis Text Line by texting TALK to 741741. BIE students and staff interested in receiving Behavioral Health and Wellness Program services may call 1-844-ASK-BHWP (1-855-275-2497) and select Option 1 for Immediate Individual Crisis Support.

Contact us: Ted McDermott is a reporter for the Public Service Journalism Team at Lee Enterprises. He can be reached at .

Up next: Parents and guardians of Flandreau students say they were 'shocked' to discover their kids had been prescribed medication at the federally operated boarding school.