By Jim Schutze
By Rachel Watts
By Lauren Drewes Daniels
By Anna Merlan
By Lee Escobedo
By Eric Nicholson
From their notes, which Maloney discovered as part of his lawsuit, the staff didn't know what to do with Randy--beyond altering his medications, physically restraining him and placing him in locked seclusion.
During his first 10 days at the unit, Randy was restrained almost every day--a routine that continued unabated throughout his stay at Laurel Ridge, according to the testimony of Dr. Robert Demski, Randy's attending physician who was deposed as part of the lawsuit. Demski has worked on a contract basis as one of Laurel Ridge's primary psychiatrists since the facility opened in the late 1980s. During the deposition, Maloney asked him whether the frequency with which Randy was restrained was unusual for the kids on that unit.
"No," Demski responded.
"What does that tell you?" Maloney asked.
"We've got a lot of sick kids."
"What's that tell you about the individual kid in terms of therapy, treatment?" Maloney pressed.
"Well, it tells me that I need to keep working on the medications, changing them or giving them more time to kick in."
Demski periodically met with Randy during his stay at Laurel Ridge, but he testified that he didn't give Randy any individualized psychiatric counseling and he mostly relied on the nurses and mental health workers to keep him apprised of his progress. He did the same for all the kids under his wing at Laurel Ridge.
"I did not do therapy," said Demski, who resigned not long after Steele's death. "I simply prescribed medications, evaluated diagnoses to make sure they were correct and evaluated the results of the medication."
Because it is a medical model unit, San Saba is more expensive to run than the other units at Laurel Ridge. Typically, Medicaid only authorizes children to stay there for up to 28 days. If a child's status is still acute when those days are up, however, the facility can appeal to Medicaid with a request to keep the child there. On February 4, 2000, Randy's 28 days were up, and he was promptly transferred to a "stepped-down" unit--a decision Maloney says cost him his life.
On the very day Randy was transferred, he was physically restrained and given a shot of Thorazine to calm him down. Despite the behavior, the facility made no attempt to keep Randy at San Saba. In his deposition, Maloney asked Demski why. "Didn't feel it was necessary," Demski said. "The appeals take weeks, if you get it." When asked directly if the decision to transfer Randy was a financial one, Demski pointedly told Maloney he should ask the Medicaid office.
During the deposition, Demski didn't try to mask his disdain for the various rules and regulations he had to comply with at Laurel Ridge. At one point, he was asked why the San Saba unit had nurses on it but the other units didn't.
"The patients themselves were not that different in many ways, but you have a morass of regulations put out by the federal government, by the state, by other agencies that you have to comply with. It's a very difficult thing," Demski said. "So in doing that we would cover all the bases, make sure that we had the proper people in place, and a lot was to satisfy the demands, be they reasonable or not, by various agencies which sent us these patients."
The rules and regulations didn't require Laurel Ridge to keep a medical doctor on site. Nor did they require nurses to be always present on the San Gabriel unit, where Randy was transferred. If they had been there, Randy might still be alive today: The nurses at San Saba restrained Randy some 25 times in 28 days, but he was never once injured. Once in the hands of San Gabriel's mental health workers, however, Randy survived just two days.
Sometime on the afternoon of February 6, Randy had to be physically restrained, during which he was given a shot of Thorazine. It was in the aftermath of that restraint that he suffered his final takedown. It happened around 3 p.m., just as the second-shift workers were clocking onto the job. One of the oncoming workers, Cathy Rodriguez, noticed that Randy had wet his pants again and told him to go change his clothes. Randy didn't because he had no clean clothes. Rodriguez ordered him to take a shower, telling him she'd bring him some clothes.
On his way back to his room, with Rodriguez on his tail, Randy went into the group room and began running around. Again Rodriguez ordered him to his room. He started throwing books and toys. When Rodriguez tried to "escort" Randy to his room, he lashed out.
Rodriguez put him in a basket hold, forcing him to sit on the ground. Later, her colleague David Spicer came in and held Randy's feet. Together, they flipped the wriggling boy onto his stomach and held him facedown on the floor. That's the prone position, the same one used on Clayborne and which became illegal under new laws just months later. Randy began to hyperventilate. At one point he screamed out, "I can't breathe."
"We sat him up, checked him," Spicer said in his deposition. "He was breathing, talking, yelling, cursing. OK, he's breathing, you know, back down he went."