By Jim Schutze
By Rachel Watts
By Lauren Drewes Daniels
By Anna Merlan
By Lee Escobedo
By Eric Nicholson
It was behind that neat exterior where 16-year-old Roshelle Clayborne died four years ago. Officially, Clayborne died of natural causes, the medical examiner pointing to a bad heart she had inherited from her father. But there was nothing natural about the way Clayborne died.
Known to be a "hell-raiser" who was routinely restrained, Clayborne was put facedown in a prone hold after she attacked staff with a pencil on August 18, 1997. Clayborne complained she couldn't breathe, but staff ignored her and shot her full of Thorazine. They stood around and watched as Clayborne lost control of her bowels and grew still, blood trickling from her mouth. Later, they rolled her onto a blanket and dragged her into an 8-by-10-foot seclusion room, where she died alone.
Clayborne's death, exposed in The Hartford Courantseries, was investigated by the Texas Department of Protective and Regulatory Services (TDPRS), the state agency that regulates treatment centers for mentally ill youths and that for years has sent children who become wards of the state to Laurel Ridge for care. The department cited the facility for numerous rules infractions, concluding that the restraint used on Clayborne was improper and carried out by mental health care workers who were inadequately trained and supervised.
Instead of shutting the place down, the department placed Laurel Ridge on a year's probation after it promised to make improvements. The facility successfully completed probation in December 1998 and is currently licensed, though TDPRS no longer sends its own kids there for care.
Today, Laurel Ridge is under new management and claims that it has stepped up its training programs and drastically reduced the need for emergency interventions, says Sherry Thornton, the chief operating officer of The Brown Schools.
"We really focus on de-escalation techniques. In the two and a half years I've been with the company, it's been our main focus," Thornton says, adding that the use of seclusions in particular has declined. "We have some facilities that are totally seclusion free. We don't use it at all."
Thornton, however, declined to release any specific information documenting how much the corporation's use of restraints and seclusions has declined. When asked what specific procedures Laurel Ridge has changed since Clayborne's death, Thornton says she doesn't know because she was not around at the time. "I've only been with the company for a couple of years," she says.
San Antonio attorney Tim Maloney doesn't believe Laurel Ridge has changed the way it treats its kids because 9-year-old Randy Steele died there just last year--after he was restrained in the same manner as Clayborne. Maloney is representing Leonard and Holly Steele, Randy's parents, who sued Laurel Ridge for gross negligence last fall.
Laurel Ridge representatives refused to discuss the case, except to note that Steele's death was ruled to be a result of natural causes and that state investigators have already cleared the facility of any wrongdoing after they investigated the matter.
Whether Laurel Ridge is negligent in Steele's death is a question a jury may soon weigh; the case is set to go to trial in February. Still, Steele's death illustrates that the treatment of the mentally ill hasn't advanced very far. It suggests that, despite new regulations, some patients--particularly children--are still regularly restrained, sometimes on a daily basis.
Randy Steele had always been a very sick boy.
His mental illness emerged at age 2, when he was diagnosed with attention deficit hyperactivity disorder and put on medication. As he grew older, his condition worsened. He set fires and threatened to kill himself. He hit his parents. He hit other children. His teachers couldn't control him. Neither could his parents. He rolled in and out of various treatment programs, where he was only given more drugs.
Randy didn't want to stay at Laurel Ridge, a point he communicated by repeatedly kicking his father on the day he arrived in January 2000. By then, the boy was taking four medications, including lithium and Thorazine, and his behavior was uncontrollable.
The past efforts to medicate Randy's illness into submission were clearly not working. The Steeles put Randy in Laurel Ridge, hoping they would find some other way to help their son.
Despite its name, Laurel Ridge is not a hospital. In fact, it does not pay to keep a single medical doctor on site. Instead, mental health workers who are not required to have any medical training run all but one of its dormitory-like units, to which patients are assigned depending on their age, sex and the level of care they need.
Randy Steele was assigned to the San Saba unit, a so-called "medical model" unit, unique on campus because it is the only unit in which there are nurses on duty 24 hours a day. It is reserved for kids like Randy whose conditions are acute.
Randy's behavior didn't change while he was at San Saba. Day after day he got into fights with other students, and he constantly broke the rules. One day he was restrained twice--once for throwing a chair and twice because he became "aggressive" after he refused to eat his lunch and was denied dessert. He wet his pants so often his alternative set of clothes was constantly being washed. At one point, Randy's lithium was increased so much it went outside the normal limits and had to be reduced.