By Jim Schutze
By Rachel Watts
By Lauren Drewes Daniels
By Anna Merlan
By Lee Escobedo
They held him there for more than 20 minutes, at which point they heard him gasp. Rodriguez lifted Randy to his feet.
"I noticed some liquid coming out of the corner of his mouth," Spicer said. "Cathy then called out his name, 'Randy.' He was unresponsive. She laid him back down on his back, and she checked for a pulse, and we had a pulse, but we had no breathing."
Apparently, Randy had vomited. Rodriguez swept Randy's mouth with her fingers to check his air passage and began slapping his back. She then attempted CPR, blowing into his mouth and pushing on his chest. Spicer, meanwhile, had no idea if what Rodriguez was doing was correct. "I'd never seen anybody perform CPR before."
Worse, according to Maloney, Rodriguez had never performed CPR before. As a result, Maloney contends, Rodriguez and Spicer were totally unprepared to determine whether or not they were putting Randy's life in jeopardy.
"It is utterly and completely indefensible from a moral or legal standpoint not to provide nursing care for each unit around the clock," Maloney says. "To suggest that a mental health care worker is capable of assessing the physical health of a child is reprehensible."
Randy was taken by ambulance to a local hospital where he was pronounced dead.
When asked whether Laurel Ridge should employ a doctor to be on site 24 hours a day, The Brown Schools COO Thornton pointed out that rules governing staffing don't require it. Besides, she doesn't see the point.
"The patients are not there for medical problems. To have an internist or something there wouldn't be needed," Thornton says, adding, "We're not a medical hospital."
Like Roshelle Clayborne, Randy Steele's death was ruled to be the result of a heart attack brought on by natural causes. As far as Laurel Ridge is concerned, Randy's death was an "act of God," according to the answer the facility's lawyer filed to Maloney's lawsuit. Alternatively, the facility is arguing, Randy's death is his own fault. The injuries he sustained, they say, are the result of "pre-existing medical or psychological conditions or disabilities that are in no way the responsibility of" Laurel Ridge.
As in the Clayborne case, attorney Maloney says a lack of adequately trained workers contributed to Steele's death. Specifically, Maloney says Laurel Ridge follows a morally bankrupt treatment program in which it relies on entry-level workers, instead of doctors and nurses, to care for children who are so sick they can't function in mainstream society.
But Maloney is not an advocate for more rules. "This industry already is regulated to death. Staffing is the scandal of these places."
Maloney's arguments echo what most mental health advocates, including health care providers, say is the root of the problems relating to restraints: Facilities can't or won't keep enough quality workers on the job. Instead of treating its patients' illnesses, they simply medicate and warehouse them.
Peggy Perry, the woman who oversees the state's adult psychiatric facilities, won't dispute that she has trouble with staffing. At TDMHMR, Perry says she is constantly battling high turnover rates--particularly among nurses, who in the past five years have left the agency at an average rate of 36 percent a year.
While Laurel Ridge is a for-profit corporation, TDMHMR is dependent on state lawmakers for money, and, historically, they haven't given enough of it to help people like Perry offer competitive salaries. The problem has been exacerbated as the state's economy boomed and workers were in short supply. State lawmakers did provide some rare relief when they recently voted to give all state employees a raise; they even increased the salary rates for their mental health workers. Still, the pay for an entry-level mental health aide at TDMHMR is just $1,423 a month.
"It had gotten to the point that in most areas folks could go to McDonald's or Taco Bell and almost make more money working there," Perry says.
Fort Worth Senator Mike Moncrief, one of the mentally ill's best advocates in Austin, has been trying for years to pass restraint-related legislation, among other efforts on behalf of the disabled, but his efforts never seem to get past the Finance Committee. Today Moncrief fears his colleagues have missed their window of opportunity: They failed to pass more funding for social services programs when times were good. Now that the economy has turned south, Moncrief is dreading what'll happen next session.
"We have painted ourselves into a corner. We have not kept up with the growth of the state and the demand that places on our social services," Moncrief says. "We need more eyes and ears telling us what's going on in these facilities, not less. We need to pay those providers a commensurate rate of reimbursement for their services. We need to pay our doctors on time. It's a huge financial issue."
The end result, Perry concedes, is patients really don't get any effective treatment--especially at places like Terrell, where they are simply kept until their medications kick in and they no longer appear to be a threat to themselves or others. Then they are sent away.