Resistance is Futile

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"They tell you when to get up, when to eat, when you can smoke, when you can watch TV. The atmosphere is very punitive. I have clients there that have enough money for a cell phone and not once have they been able to keep it--staff always finds a reason to take it away," Presas says. "The fact that a death like Mr. Stafford's happens is a clear indication that something drastic has to be done. It's a total betrayal of trust that people have in this state agency. It shouldn't happen. One dead is just too many."

Deaths as the result of restraints occur at all types of facilities, from state hospitals and group homes for the mentally retarded to nursing homes, but Laurel Ridge Hospital in San Antonio keeps finding itself at the center of the controversy.

Laurel Ridge is a subsidiary of The Brown Schools, a Nashville-based corporation that was founded in Texas in 1940. Today, The Brown Schools is one of the largest privately run companies in the nation providing mental health care services for youths. Laurel Ridge is a long-term residential treatment center that accepts kids from all over the country and relies on Medicaid to pay for their care.

Located on an open campus just outside the city, Laurel Ridge has the appearance of a state-of-the-art home for troubled youths. The main building boasts stucco walls and smooth arched doorways, while a gracious red tile roof completes the Spanish look. Set beneath a dense collection of shade trees, the place looks like a Southwestern oasis.

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 Courant series, 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.

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Rose Farley
Contact: Rose Farley

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