Longform

Resistance is Futile

Page 5 of 8


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.

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.

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Rose Farley
Contact: Rose Farley

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