The Arizona Daily Star, March 8, 1998
Legislators want more oversight of youth centers
By Jane Erikson and Alisa Wabnik
Four Tucson lawmakers are asking for more oversight of behavioral treatment facilities like Desert Hills, saying existing rules and procedures failed to prevent the death of 15-year-old Edith Campos last month.
To avoid future tragedies, the legislators said they want more frequent inspections of facilities treating children; more and better-trained staff members to work in those facilities; and possible licensing for staff members who now are unlicensed.
Campos, of San Ysidro, Calif., died Feb. 4, two days after she was physically restrained, then stopped breathing, at the Desert Hills Center for Youth & Families.
Ongoing investigations into her death have revealed a series of injuries involving youths being treated at Desert Hills' two Tucson facilities in recent years. In fact, a 1994 state Child Protective Services report on Desert Hills described ``a definite pattern and incidents of abuse toward residents.''
And with the death last Monday of 16-year-old Nick Contreraz at the Arizona Boys Ranch Oracle site, a correctional facility with campuses around the state, the legislators say they are even more alarmed about the risks children face in state-licensed facilities.
Contreraz died following an afternoon-long confrontation with staff members who were trying to force him to work and do ``remedial exercises.'' The preliminary autopsy report was inconclusive, but Pinal County sheriff's deputies are continuing to investigate.
``I don't want to believe that when kids are in a place that's supposed to help them, the people in charge of their care abuse them. That's horrible. That's unthinkable,'' said Rep. Herschella Horton, D-Tucson. ``As a legislator, I need to demand (better) oversight for these kids.''
Three of Horton's legislative colleagues - Republican Sen. Ann Day and Democratic Sens. Ruth Solomon and Elaine Richardson - voiced similar concerns.
``We can't afford to have children killed and have their lives in danger,'' said Day, who chairs the Senate Health Committee. ``I don't have all the facts yet . . . but I think the oversight is lax.''
Desert Hills officials have repeatedly declined to answer questions about the incidents, citing their obligation to honor patients' confidentiality.
The officials also issued a statement last week in which they emphasized that Desert Hills' current owner, Youth and Family-Centered Services of Austin, Texas, only took over the Tucson facilities on Nov. 1 and should not be held accountable for incidents before then.
More training promised
On Friday, Desert Hills submitted a draft plan to the state, pledging to increase staff training in restraints, cardiopulmonary resuscitation and defusing power struggles with patients.
The only state licensing agency for Desert Hills and other behavioral-treatment facilities is the Arizona Department of Health Services. A state law requiring additional licensing by Child Protective Services was considered redundant and was repealed in 1994.
The Arizona Boys Ranch is licensed by the Department of Economic Security and is considered a child welfare agency because its main function is correctional, rather than therapeutic, said assistant DES Director James Hart.
Both agencies require facilities they license to report incidents in which children are injured or killed.
In addition, federal law requires the health department to conduct annual site visits to its facilities that admit children covered by the state's Medicaid health plan.
Otherwise, the DHS staff relies on reports from the national Joint Commission on Accreditation of Healthcare Organizations, said Linda Palmer, the health department's assistant director for licensing.
But the Chicago-based commission visits behavioral health facilities only once every three years. And it does not require facilities to report what it terms ``sentinel events,'' such as patient deaths and injuries.
Last year, the commission re-accredited a psychiatric hospital in Virginia in which a 31-year-old woman died in June 1996. She had been bound spread-eagled in a bed for 300 hours during the final month of her life, despite her physician's orders a year earlier that such restraint could kill her, according to newspaper accounts. The woman suffered from asthma, heart disease and epileptic seizures.
Since Campos' death at Desert Hills, records from police and other agencies have confirmed at least eight incidents since 1993 in which youths suffered injuries ranging from facial abrasions from being dragged along the floor to a broken arm and a broken back.
In addition, those records document numerous examples of employees who lacked training in the use of physical restraints, in apparent violation of state regulations.
Incident reports filed by Desert Hills with CPS show that in 1994, 40 patients - and 18 employees - were injured while patients were being restrained. The reports show that six of the 10 employees involved in the restraints had not been trained.
Problems with reporting
Other agencies also require incident reports, but are sometimes inconsistent in sharing information. A review of records obtained by the Star from CPS and the health department show some reports never get to the right people.
And each agency blames the other when asked why their files don't match up.
``I think one of the things we need to take a look at is the role of the various agencies,'' said Flora Sotomayor, field operations manager for CPS.
``We need to establish some better-defined protocols for notifying each other and determine who's going to take the lead in terms of these investigations, because it's not always real clear.''
The Tucson lawmakers said they want to address that and other issues to prevent future tragedies.
``It's a pity that we tend to react after a crisis,'' Solomon said. ``Sometimes it takes a crisis to get us to move and take action.''
Day said she is most concerned that health department inspectors only visit facilities such as Desert Hills once a year. She brought up her concern in a meeting with agency officials on Thursday.
More funding is urged
``They said they don't have enough money'' to conduct more frequent visits, Day said. ``So if we are going to require better monitoring, we're going to have to put more money behind it.''
Solomon, the Senate assistant minority leader, also called for more money and more staffing.
``What makes a whole lot of difference is providing adequate funding so that staffing levels can be adequate and training levels can be adequate,'' she said.
Agencies will resist increasing their staffs without additional state funds, Solomon said.
``There's not a big bottom line if you have adequate staff and adequately trained staff,'' she said. ``There's not a lot of money left over.''
Horton called for placing a state worker in facilities as a type of patient advocate ``that the kids would feel safe talking to.''
Desert Hills started its own patient advocate program in 1994, with a person employed by the facility. The Department of Juvenile Corrections has had a monitor at the facility 40 hours a week since Campos died, and CPS has had extra staff members visiting the facility.
Starting yesterday, the two agencies and the health department are placing a monitor at Desert Hills seven days a week.
``We've got a whole bunch of folks in there right now,'' Horton said Friday. ``My concern is, what happens when they all go away?''
Technicians aren't licensed
She also suggested that psychiatric technicians - employees who have frequent contact with patients at Desert Hills and other treatment facilities - be licensed.
Currently there is no such requirement, although the health department specifies minimum qualifications for the positions. They include experience ranging from a bachelor's degree or one year of experience for an entry-level position, to three years' experience for the more senior level psych-tech positions.
Psych techs also must be fingerprinted before they can begin working.
Richardson said she wants to review state requirements for pre-employment screening. Under current rules, any employee who will have contact with children must be fingerprinted to check for criminal histories, health department officials said.
``Perhaps we need to look at raising the standards,'' Richardson said.
The four legislators may have trouble selling their ideas for reform to some conservative legislative leaders who are seeking deregulation of state agencies, rather than added controls.
``I think we in the Legislature get into a lot of trouble when we go off on emotional binges, if you will, when the emotion is high and we overreact,'' said Rep. Bob Burns, the Glendale Republican who chairs the House Appropriations Committee.
Skepticism of CPS
Burns said he was unfamiliar with either the Desert Hills or Boys Ranch incidents. But he said he is skeptical of CPS reports, recalling that in 1994, Melvin McDonald, a former U.S. attorney hired by Boys Ranch, accused CPS of bias in its report substantiating 13 allegations of abuse at the Boys Ranch main campus in Queen Creek, east of Phoenix.
In June 1994, a 17-year-old Mississippi boy drowned in a canal during a reported escape attempt from the Boys Ranch.
``We need to investigate fully before we decide to throw some more regulations at it,'' Burns said. ``Maybe it was just an accident. You could throw all the regulations you want on it and it still could have happened.''
But the Tucson legislators say they are unwilling to wait for the next tragedy to occur.
``According to what I read in the paper, I see a pattern. We saw that happen with Donovan Hendrix,'' said Horton, referring to a 5-year-old Marana boy who died from child abuse despite previous reports from multiple agencies that he was being abused.
``We don't need to keep seeing it happen,'' she said. ``Been there, done that, don't ever want to go there again.''