Residential Treatment Programs
Concerns Regarding Abuse and Death in Certain Programs for Troubled Youth Gao ID: GAO-08-146T October 10, 2007Residential treatment programs provide a range of services, including drug and alcohol treatment, confidence building, military-style discipline, and psychological counseling for troubled boys and girls with a variety of addiction, behavioral, and emotional problems. This testimony concerns programs across the country referring to themselves as wilderness therapy programs, boot camps, and academies, among other names. Many cite positive outcomes associated with specific types of residential treatment. There are also allegations regarding the abuse and death of youth enrolled in residential treatment programs. Given concerns about these allegations, particularly in reference to private programs, the Committee asked the General Accountability Office (GAO) to (1) verify whether allegations of abuse and death at residential treatment programs are widespread and (2) examine the facts and circumstances surrounding selected closed cases where a teenager died while enrolled in a private program. To achieve these objectives, GAO conducted numerous interviews and examined documents from closed cases dating as far back as 1990, including police reports, autopsy reports, and state agency oversight reviews and investigations. GAO did not attempt to evaluate the benefits of residential treatment programs or verify the facts regarding the thousands of allegations it reviewed.
GAO found thousands of allegations of abuse, some of which involved death, at residential treatment programs across the country and in American-owned and American-operated facilities abroad between the years 1990 and 2007. Allegations included reports of abuse and death recorded by state agencies and the Department of Health and Human Services, allegations detailed in pending civil and criminal trials with hundreds of plaintiffs, and claims of abuse and death that were posted on the Internet. For example, during 2005 alone, 33 states reported 1,619 staff members involved in incidents of abuse in residential programs. GAO could not identify a more concrete number of allegations because it could not locate a single Web site, federal agency, or other entity that collects comprehensive nationwide data. GAO also examined, in greater detail, 10 closed civil or criminal cases from 1990 through 2004 where a teenager died while enrolled in a private program. GAO found significant evidence of ineffective management in most of the 10 cases, with program leaders neglecting the needs of program participants and staff. This ineffective management compounded the negative consequences of (and sometimes directly resulted in) the hiring of untrained staff; a lack of adequate nourishment; and reckless or negligent operating practices, including a lack of adequate equipment. These factors played a significant role in the deaths GAO examined.
GAO-08-146T, Residential Treatment Programs: Concerns Regarding Abuse and Death in Certain Programs for Troubled Youth
This is the accessible text file for GAO report number GAO-08-146T
entitled 'Residential Treatment Programs: Concerns Regarding Abuse and
Death in Certain Programs for Troubled Youth' which was released on
October 10, 2007.
This text file was formatted by the U.S. Government Accountability
Office (GAO) to be accessible to users with visual impairments, as part
of a longer term project to improve GAO products' accessibility. Every
attempt has been made to maintain the structural and data integrity of
the original printed product. Accessibility features, such as text
descriptions of tables, consecutively numbered footnotes placed at the
end of the file, and the text of agency comment letters, are provided
but may not exactly duplicate the presentation or format of the printed
version. The portable document format (PDF) file is an exact electronic
replica of the printed version. We welcome your feedback. Please E-mail
your comments regarding the contents or accessibility features of this
document to Webmaster@gao.gov.
This is a work of the U.S. government and is not subject to copyright
protection in the United States. It may be reproduced and distributed
in its entirety without further permission from GAO. Because this work
may contain copyrighted images or other material, permission from the
copyright holder may be necessary if you wish to reproduce this
material separately.
Testimony:
Before the Committee on Education and Labor, House of Representatives:
United States Government Accountability Office:
GAO:
For Release on Delivery Expected at 10:30 a.m. EDT:
Wednesday, October 10, 2007:
residential treatment programs:
Concerns Regarding Abuse and Death in Certain Programs for Troubled
Youth:
Statement of Gregory D. Kutz, Managing Director Forensic Audits and
Special Investigations:
Andy O'Connell, Assistant Director:
Forensic Audits and Special Investigations:
GAO-08-146T:
GAO Highlights:
Highlights of GAO-08-146T, a testimony before the Committee on
Education and Labor, House of Representatives.
Why GAO Did This Study:
Residential treatment programs provide a range of services, including
drug and alcohol treatment, confidence building, military-style
discipline, and psychological counseling for troubled boys and girls
with a variety of addiction, behavioral, and emotional problems. This
testimony concerns programs across the country referring to themselves
as wilderness therapy programs, boot camps, and academies, among other
names.
Many cite positive outcomes associated with specific types of
residential treatment. There are also allegations regarding the abuse
and death of youth enrolled in residential treatment programs. Given
concerns about these allegations, particularly in reference to private
programs, the Committee asked GAO to (1) verify whether allegations of
abuse and death at residential treatment programs are widespread and
(2) examine the facts and circumstances surrounding selected closed
cases where a teenager died while enrolled in a private program.
To achieve these objectives, GAO conducted numerous interviews and
examined documents from closed cases dating as far back as 1990,
including police reports, autopsy reports, and state agency oversight
reviews and investigations. GAO did not attempt to evaluate the
benefits of residential treatment programs or verify the facts
regarding the thousands of allegations it reviewed.
What GAO Found:
GAO found thousands of allegations of abuse, some of which involved
death, at residential treatment programs across the country and in
American-owned and American-operated facilities abroad between the
years 1990 and 2007. Allegations included reports of abuse and death
recorded by state agencies and the Department of Health and Human
Services, allegations detailed in pending civil and criminal trials
with hundreds of plaintiffs, and claims of abuse and death that were
posted on the Internet. For example, during 2005 alone, 33 states
reported 1,619 staff members involved in incidents of abuse in
residential programs. GAO could not identify a more concrete number of
allegations because it could not locate a single Web site, federal
agency, or other entity that collects comprehensive nationwide data.
GAO also examined, in greater detail, 10 closed civil or criminal cases
from 1990 through 2004 where a teenager died while enrolled in a
private program. GAO found significant evidence of ineffective
management in most of the 10 cases, with program leaders neglecting the
needs of program participants and staff. This ineffective management
compounded the negative consequences of (and sometimes directly
resulted in) the hiring of untrained staff; a lack of adequate
nourishment; and reckless or negligent operating practices, including a
lack of adequate equipment. These factors played a significant role in
the deaths GAO examined. See the table below for detailed information
related to three of the case studies.
Table: Examples of Case Studies GAO Examined:
Sex/age: Female, 15;
Date of death: May 1990;
Cause of death: Dehydration;
Case details:
* Showed signs of illness for 2 days, such as blurred vision, vomiting
water, and frequent stumbling;
* Program staff thought she was faking her illness to get out of the
program;
* Collapsed and died while hiking;
* Lay dead in the road for 18 hours;
* Program brochure advertised staff as ’highly trained survival
experts“.
Sex/age: Male, 15;
Date of death: Sept. 2000;
Cause of death: Internal bleeding;
Case details:
* Head-injury victim with behavioral challenges who refused to return
to campsite;
* Restrained by staff and held face down in the dirt for 45 minutes;
* Died of a severed artery in the neck
* Death ruled a homicide.
Sex/age: Male, 14;
Date of death: July 2002;
Cause of death: Hyperthermia (high body temperature);
Case details:
* Experienced difficulty while hiking and sat down, breathing heavily
and moaning;
* Fainted and lay motionless;
* One staff member hid behind a tree for 10 minutes to see whether the
victim was ’faking it“;
* Staff member returned and found no pulse;
* Died soon afterwards.
Source: Records including police reports, legal documents, and state
investigative documents.
[End of table]
To view the full product, including the scope and methodology, click on
[hyperlink, http://www.GAO-08-146T].
For more information, contact Gregory D. Kutz at (202) 512-6722 or
kutzg@gao.gov.
[End of section]
Mr. Chairman and Members of the Committee:
Thank you for the opportunity to discuss residential treatment programs
for troubled youth. In the context of this testimony, we are using the
term residential treatment program to refer to entities across the
country and abroad calling themselves wilderness therapy programs,
boarding schools, academies, behavioral modification facilities, and
boot camps, among other names. While some of these programs are funded
publicly by state and local government agencies, others are privately
owned and operated. Private residential treatment programs typically
market their services to the parents of troubled teenagers--boys and
girls with a variety of addiction, behavioral, and emotional problems-
-and provide a range of services, including drug and alcohol treatment,
confidence building, military-style discipline, and psychological
counseling for illnesses such as depression and attention deficit
disorder.
Many cite positive outcomes associated with specific types of
residential treatment. There are also allegations regarding the abuse
and death of youth enrolled in residential treatment programs. Given
concerns about these allegations, particularly in reference to private
programs, you asked us to (1) verify whether allegations of abuse and
death at residential treatment programs are widespread and (2) examine
the facts and circumstances surrounding selected closed cases where a
teenager died while enrolled in a private program.
To verify whether allegations of abuse and death at residential
treatment programs are widespread, we gathered available information
about allegations made over the last 17 years by performing interviews
with relevant experts, reviewing relevant studies and documents,
conducting Internet searches for Web sites making allegations,
reviewing data from the National Child Abuse and Neglect Data System
(NCANDS),[Footnote 1] and reviewing relevant state and federal court
documents. We were unable to disaggregate information on public and
private programs; consequently, the information we present includes
allegations against both types.
To select our case studies, we identified numerous closed civil and
criminal cases in which a court was asked to decide whether a private
residential treatment program was responsible for the death of an
enrolled teenager. When identifying our cases, we specifically excluded
teenager deaths at public programs such as state-sponsored foster
programs, juvenile justice programs for delinquent youth, or programs
that exclusively treat psychological disorders or substance abuse in a
hospital setting. We focused on deaths between the years 1990 and 2004
to illustrate the long-standing issues presented by private residential
treatment programs. We limited our cases to closed cases and, thus,
ongoing cases from the last several years were not included in our
work. We selected these 10 cases based on several factors including
victim age, program location, type of program the victim attended, and
date of death.
We then examined, in more detail, the facts and circumstances of the
death and any related abuse of the victim. To validate the facts and
circumstances of each case, and to the extent possible, we conducted
interviews with related parties, including current and former program
staff and officials, attorneys and law enforcement officials involved
in the cases, and the parents of the victims. Further, we reviewed
available documentation to support the facts of each case including
(but not limited to) marketing materials, police reports, autopsy
reports, and state agency oversight reviews and investigations. In
addition, we conducted site visits at nine residential treatment
programs to obtain a firsthand perspective on how residential treatment
programs operate. Five of these nine programs were related to the still-
operational programs discussed in our cases--either because they were
the same program or represented a permutation of the original program
operating under a different name or in a new location. Where we
obtained financial information about the programs, we converted this
information to 2007 dollars so that the information was comparable.
It is important to emphasize that residential treatment programs are
intended to help youth with serious problems--in some cases, these
problems constitute life-threatening addictions and diseases. We did
not attempt to evaluate the benefits of residential treatment programs
in dealing with these serious problems. Moreover, it is not possible to
generalize the results of our investigation as applying to all
residential treatment programs, whether privately or publicly funded.
We found it difficult to obtain an overall picture of the extent of the
residential treatment program industry. For example, while states often
regulate publicly funded programs, a number of states do not license or
otherwise regulate private programs. Because programs determine how to
describe themselves, especially in their marketing materials, there is
no standard definition for "wilderness therapy program," "boot camp,"
or other terms used to describe the types of programs and facilities
considered to be part of this industry. GAO is completing a
comprehensive review of state and federal oversight of residential
treatment programs for youth with behavioral and emotional challenges
and expects to report next year.
We performed our work from June through September of 2007 in accordance
with the quality standards for investigations set forth by the
President's Council on Integrity and Efficiency.
Summary:
We found thousands of allegations of abuse, some of which involved
death, at residential treatment programs across the country and in
American-owned and American-operated facilities abroad between the
years 1990 and 2007. Allegations included reports of abuse and death
recorded by state agencies and the Department of Health and Human
Services, allegations detailed in pending civil and criminal cases with
hundreds of plaintiffs, and claims of abuse and death that were posted
on the Internet. For example, according to the most recent NCANDS data,
during 2005 alone 33 states reported 1,619 staff members involved in
incidents of abuse in residential programs. Because there are no
specific reporting requirements or definitions for private programs in
particular, we could not determine what percentage of the thousands of
allegations we found are related to such programs.
We also examined, in greater detail, 10 closed cases where a teenager
died while enrolled in a private program. We found significant evidence
of ineffective management in most of these 10 cases, with program
leaders neglecting the needs of program participants and staff. This
ineffective management compounded the negative consequences of (and
sometimes directly resulted in) the hiring of untrained staff; a lack
of adequate nourishment; and reckless or negligent operating practices,
including a lack of adequate equipment. These factors played a
significant role in most of the deaths we examined. For example:
* In May 1990, a 15-year-old female was enrolled in a 9-week wilderness
program. Although the program brochure claimed that counselors were
"highly trained survival experts," they did not recognize the signs of
dehydration when she began complaining of blurred vision, stumbling,
and vomiting water 3 days into a hike. According to police documents,
on the fifth day and after nearly 2 days of serious symptoms, the dying
teen finally collapsed and became unresponsive, at which point
counselors attempted to signal for help using a fire because they were
not equipped with radios. Police documents state that the victim lay
dead in a dirt road for 18 hours before rescuers arrived.
* In another example, we learned that, in July 2001, a 14-year-old male
enrolled in a boot camp became so dehydrated that he began to eat dirt
from the desert floor. Witnesses said that when he eventually fell
unconscious and appeared to have a seizure, the program director told
staff members to put the victim in the flatbed of a pickup truck and
drive him to a hotel. When they could not revive him at the hotel, they
put him back in the flatbed of the truck, returned to the camp, and
placed the teen's limp body onto his sleeping bag. The program director
assured his staff that "everything will be okay" but the victim died
soon afterwards.
* In December 2001, on Christmas Day, a 16-year-old female was climbing
in an extremely dangerous area unsupervised by program staff. According
to documents we reviewed, the girl slipped, fell about 50 feet into a
crevasse, and died of massive brain trauma about 3 weeks later. An
investigation revealed numerous licensing and safety violations with
the program, including an improperly low staff-to-youth ratio, failure
of staff to scout the hiking location prior to the hike, and no first
aid kit (it was left at the base camp).
Background:
Since the early 1990s, hundreds of residential treatment programs and
facilities have been established in the United States by state agencies
and private companies. Many of these programs are intended to provide a
less-restrictive alternative to incarceration or hospitalization for
youth who may require intervention to address emotional or behavioral
challenges. As mentioned earlier, it is difficult to obtain an overall
picture of the extent of this industry. According to a 2006 report by
the Substance Abuse and Mental Health Services Administration, state
officials identified 71 different types of residential treatment
programs for youth with mental illness across the country.[Footnote 2]
A wide range of government or private entities, including government
agencies and faith-based organizations, can operate these programs.
Each residential treatment program may focus on a specific client type,
such as those with substance abuse disorders or suicidal tendencies. In
addition, the programs provide a range of services, either on-site or
through links with community programs, including educational, medical,
psychiatric, and clinical/mental health services.
Regarding oversight of residential treatment programs, states have
taken a variety of approaches ranging from statutory regulations that
require licensing to no oversight. States differ in how they license
and monitor the various types of programs in terms of both the agencies
involved and the types of requirements. For example, some states have
centralized licensing and monitoring within a single agency, while
other states have decentralized these functions among three or more
different agencies. There are currently no federal laws that define and
regulate residential treatment programs. However, three federal
agencies--the Departments of Health and Human Services, Justice, and
Education--administer programs that can provide funds to states to
support eligible youth who have been placed in some residential
treatment programs. For example, the Department of Health and Human
Services, through its Administration for Children and Families,
administers programs that provide funding to states for a wide range of
child welfare services, including foster care, as well as improved
handling, investigation, and prosecution of youth maltreatment
cases.[Footnote 3]
In addition to the lack of a standard, commonly recognized definition
for residential treatment programs, there are no standard definitions
for specific types of programs--wilderness therapy programs, boot
camps, and boarding schools, for instance. For our purposes, we define
these programs based on the characteristics we identified during our
review of the 10 case studies. For example, in the context of our
report, we defined wilderness therapy program to mean a program that
places youth in different natural environments, including forests,
mountains, and deserts. Figure 1 shows images we took near the
wilderness therapy programs we visited.
Figure 1: Environments Where Wilderness Therapy Programs Operate:
[See PDF for image]
Source: GAO.
Note: These images show the surroundings that youth enrolled in a
wilderness treatment program might encounter. Clockwise from the upper
left, these images show (1) West Virginia woodlands, (2) an Oregon
river, and (3) a Utah mountain range.
[End of figure]
According to wilderness therapy program material, these settings are
intended to remove the "distractions" and "temptations" of modern life
from teens, forcing them to focus on themselves and their
relationships. Included as part of a wilderness training program,
participants keep journals that often include entries related to why
they are in the program and their experiences and goals while in the
wilderness. These journals, which program staff read, are part of the
individual and group therapy provided in the field. As part of the
wilderness experience, these programs also teach basic survival skills,
such as setting up a tent and camp, starting a fire, and cooking food.
Figure 2 is photo montage of living arrangements for youth enrolled in
the wilderness programs we visited.
Figure 2: Living Arrangements at Wilderness Therapy Programs GAO
Visited:
[See PDF for image]
Source: GAO.
Note: The top two images show living arrangements at two wilderness
therapy programs--a "time out" shelter (upper left) and an enrolled
youth's campsite (upper right). The bottom two images show the girls'
tent (lower left) and the shelter for group therapy and meetings (lower
right) for the middle phase of a residential treatment program.
[End of figure]
Some wilderness therapy programs may include a boot camp element.
However, many boot camps (which can also be called behavioral
modification facilities) exist independently of wilderness training. In
the context of our report, a boot camp is a residential treatment
program in which strict discipline and regime are dominant principles.
Some military-style boot camp programs also emphasize uniformity and
austere living conditions. Figure 3 is a photo montage illustrating a
boot camp which minimizes creature comfort and emphasizes organization
and discipline.
Figure 3: Interior of a Boot Camp Facility That GAO Visited:
[See PDF for image]
Source: GAO.
Note: These images show the interior of a boot camp facility. Clockwise
from the upper left, the images show (1) the overall layout of "the
boot camp" room in the facility, where male enrollees spend the
majority of their indoor time and sleep on the floor; (2) the limited
supplies and personal items of enrollees, including a rolled sleeping
bag and mat; (3) bathroom facilities; and (4) a room with bunk beds for
youth in the advanced phase of the program.
[End of figure]
A third type of residential treatment program is known as a boarding
school. Although these programs may combine wilderness or boot camp
elements, boarding schools (also called academies) are generally
advertised as providing academic education beyond the survival skills a
wilderness therapy program might teach. This academic education is
sometimes approved by the state in which the program operates and may
also be transferable as elective credits toward high school. These
programs often enroll youth whose parents force them to attend against
their will. The schools can include fences and other security measures
to ensure that youth do not leave without permission. Figure 4 shows
some of the features boarding schools may employ to keep youth in the
facilities.
Figure 4: Security Features Employed at a Boarding School GAO Visited:
[See PDF for image]
Source: GAO.
Note: These images show the exterior of a boarding school. Clockwise
from the upper left, the images show (1) a close-up of the video
surveillance equipment and motion detectors in place on the outside of
the school; (2) tall exterior fencing and motion detector; and (3) an
angle of the facility exterior that clearly displays security features,
including video monitoring, lighting, fencing, and wire mesh over the
windows.
[End of figure]
A variety of ancillary services related to residential treatment
programs are available for an additional fee in some programs. These
services include:
* Referral services and educational consultants to assist parents in
selecting a program.
* Transport services to pick up a youth and bring him or her to the
program. Parents frequently use a transport service if their child is
unwilling to attend the program.
* Additional individual, group, or family counseling or therapy
sessions as part of treatment. These services may be located on the
premises or nearby.
* Financial services, such as loans, to assist parents in covering the
expense of residential treatment programs.
These services are marketed toward parents and, with the exception of
financial services, are not regulated by the federal government.
Widespread Allegations of Abuse and Death at Residential Treatment
Programs:
We found thousands of allegations of abuse, some of which involved
death, at public and private residential treatment programs across the
country between the years 1990 and 2007. We are unable to identify a
more concrete number of allegations because we could not locate a
single Web site, federal agency, or other entity that collects
comprehensive nationwide data related to this issue. Although the
NCANDS database, operated by the Department of Health and Human
Services, collects some data from states, data submission is voluntary
and not all states with residential treatment programs contribute
information. According to the most recent NCANDS data, during 2005
alone 33 states reported 1,619 staff members involved in incidents of
abuse in residential programs. Because of limited data collection and
reporting, we could not determine the numbers of incidents of abuse and
death associated with private programs.
It is important to emphasize that allegations should not be confused
with proof of actual abuse. However, in terms of meeting our objective,
the thousands of allegations we found came from a number of sources
besides NCANDS. For example:
* We identified claims of abuse and death in pending and closed civil
or criminal proceedings with dozens of plaintiffs alleging abuse. For
instance, according to one pending civil lawsuit filed as recently as
July 2007, dozens of parents allege that their children were subjected
to over 30 separate types of abuse.
* We found attorneys around the country who represent youth and groups
of youth who allege that abuse took place while these youth were
enrolled in residential treatment programs. For example, an attorney
based in New Jersey with whom we spoke has counseled dozens of youth
who alleged they were abused in residential treatment programs in past
cases, as has another attorney, a retired prosecutor, who advocates for
abuse victims.
* We found that allegations are posted on various Web sites advocating
for the shutdown of certain programs. Past participants in wilderness
programs and other youth residential treatment programs have
individually or collectively set up sites claiming abuse and death. The
Internet contains an unknown number of such Web sites. One site on the
Internet, for example, identifies over 100 youth who it claims died in
various programs. In other instances, parents of victims who have died
or were abused in these programs have similarly set up an unknown
number of Web sites. Conversely, there are also an unknown number of
sites that promote and advocate the benefits of various programs.
Because there are no specific reporting requirements or definitions for
private programs in particular, we could not determine what percentage
of the thousands of allegations we found are related to such programs.
There is likely a small percentage of overlapping allegations given our
inability to reconcile information from the sources we used.
Cases of Death at Selected Residential Treatment Programs:
We selected 10 closed cases from private programs to examine in greater
detail. Specifically, these cases were focused on the death of a
teenager in a private residential treatment program that occurred
between 1990 and 2004. We found significant evidence of ineffective
management in most of these 10 cases, with many examples of how program
leaders neglected the needs of program participants and staff. In some
cases, program leaders gave their staff bad advice when they were
alerted to the health problems of a teen. In other cases, program
leaders appeared to be so concerned with boosting enrollment that they
told parents their programs could provide services that they were not
qualified to offer and could not provide. Several cases reveal program
leaders who claimed to have credentials in therapy or medicine that
they did not have, leading parents to trust them with teens who had
serious mental or physical disabilities requiring proper treatment.
These ineffective management techniques compounded the negative
consequences of (and sometimes directly resulted in) the hiring of
untrained staff; a lack of adequate nourishment; and reckless or
negligent operating practices, including a lack of adequate equipment.
These specific factors played a significant role in most of the deaths
we examined.
* Untrained staff. A common theme of many of the cases we examined is
that staff misinterpreted legitimate medical emergencies. Rather than
recognizing the signs of dehydration, heat stroke, or illness, staff
assumed that a dying teen was in fact attempting to use trickery to get
out of the program. This resulted in the death of teenagers from
common, treatable illnesses. In some cases, teens who fell ill from
less-common ailments exhibited their symptoms for many days, dying
slowly while untrained staff continued to believe the teen was "faking
it." Unfortunately, in almost all of our cases, staff only realized
that a teen was in distress when it was already too late.
* Lack of adequate nourishment. In many cases, program philosophy
(e.g., "tough love") was taken to such an extreme that teenagers were
undernourished. One program fed teenagers an apple for breakfast, a
carrot for lunch, and a bowl of beans for dinner while requiring
extensive physical activity in harsh conditions. Another program forced
teenagers to fast for 2 days. Teenagers were also given equal rations
of food regardless of their height, weight, or other dietary needs. In
this program, an ill teenager lost 20 percent of his body weight over
the course of about a month. Unbeknownst to staff, the teenager was
simultaneously suffering from a perforated ulcer.
* Reckless or negligent operating practices. In at least two cases,
program staff set out to lead hikes in unfamiliar territory that they
had not scouted in advance. Important items such as radios and first
aid kits were left behind. In another case, program operators did not
take into account the need for an adjustment period between a
teenager's comfortable home life and the wilderness; this endangered
the safety of one teenager, who suddenly found herself in an unfamiliar
environment. State licensing initiatives attempt, in part, to minimize
the risk that some programs may endanger teenagers through reckless and
negligent practices; however, not all programs we examined were covered
by operating licenses. Furthermore, some licensed programs deviated
from the terms of their licenses, leading states, after the death of a
teen, to take action against programs that had flouted health and
safety guidelines.
See table 1 for a summary of the cases we examined.
Table 1: Summary of Victim Information:
Case: 1;
Victim information: Female, 15, California resident;
Program attended: Utah wilderness therapy program (death occurred in
Arizona);
Date of death: May 1990;
Cause of death: Dehydration;
Case details:
* Died while hiking on fifth day of program;
* Exhibited signs of illness for 2 days, such as throwing up water,
falling down, and complaining of blurred vision;
* Collapsed due to dehydration;
* Lay dead for 18 hours on dirt road;
* Program brochure given to parents had advertised program staff as
"highly trained survival experts";
* Died on federal land.
Case: 2;
Victim information: Female, 16, Florida resident;
Program attended: Utah wilderness therapy program;
Date of death: June 1990;
Cause of death: Heat stroke;
Case details:
* Died while hiking on third day of program;
* Program had not considered child's adjustment from a coastal, sea-
level residence to a high desert wilderness area;
* Died of "exertional heatstroke" while hiking;
* Program owner acquitted of criminal charges but placed on state list
of suspected child abusers.
Case: 3;
Victim information: Male, 16, Arizona resident;
Program attended: Utah wilderness therapy program;
Date of death: March 1994;
Cause of death: Acute infection resulting from perforated ulcer;
Case details:
* Exhibited signs of physical distress for nearly 3 weeks, such as
severe abdominal pain, significant weight loss (20 percent of body
weight), loss of bodily functions, and weakness;
* Collapsed and became unresponsive;
* Air lifted to hospital and pronounced dead on arrival; * Died on
federal land.
Case: 4;
Victim information: Male, 15, Oregon resident;
Program attended: Oregon wilderness therapy program;
Date of death: Sept. 2000;
Cause of death: Severed artery;
Case details:
* Refused to return to campsite but did not behave violently;
* Restrained by staff and held face down to the ground for almost 45
minutes;
* Died of severed artery in neck;
* Death ruled a homicide;
* Grand jury declined to issue an indictment; * Died on federal land.
Case: 5;
Victim information: Male, 14, Massachusetts resident;
Program attended: West Virginia residential school and wilderness
therapy program;
Date of death: Feb. 2001;
Cause of death: Suicide (hanging);
Case details: * Attempted suicide twice before enrolling in program; *
On the fifth day of program cut arm several times with camp-issued
pocket knife; * Staff did not take the knife away; * Hung himself near
his tent the next day; * Program had no suicide prevention plan.
Case: 6;
Victim information: Male, 14, Arizona resident;
Program attended: Arizona boot camp;
Date of death: July 2001;
Cause of death: Dehydration;
Case details:
* On seventh day was punished for asking to go home;
* Forced to sit in 113-degree desert heat;
* Was delirious and dehydrated;
* Taken to motel room, placed in shower tub, left unattended;
* Staff returned victim to camp in the flatbed of a pickup truck and
placed his limp body onto his sleeping bag;
* Staff later found him unresponsive and he died at the hospital.
Case: 7;
Victim information: Female, 16, Virginia resident;
Program attended: Utah wilderness therapy program;
Date of death: Jan. 2002;
Cause of death: Massive head trauma;
Case details:
* Fell while hiking on Christmas Day;
* Staff had not scouted extremely dangerous area beforehand;
* Staff had no medical equipment, against its licensing agreement;
* Took about one hour for first paramedics to arrive;
* Died on federal land.
Case: 8;
Victim information: Female, 15, California resident;
Program attended: Oregon wilderness therapy program (also operated in
Nevada at time of death);
Date of death: May 2002;
Cause of death: Dehydration/ heat stroke;
Case details:
* Died while hiking on first day of program;
* Told others she had taken methamphetamines before the hike, but was
not screened for drug before hike;
* Experienced signs of distress for several hours while hiking;
* Collapsed and stopped breathing;
* Died of heat stroke complicated by the methamphetamines and
prescription medication;
* Died on federal land.
Case: 9;
Victim information: Male, 14, Texas resident;
Program attended: Utah wilderness therapy program;
Date of death: July 2002;
Cause of death: Hyperthermia (excessive body temperature);
Case details:
* On a 3-mile hike in desert heat;
* Complained of thirst and refused to continue hike;
* Left in the sun for an hour and stopped breathing;
* Staff member hid behind a tree for 10 minutes thinking the victim was
"faking" illness;
* Help arrived over an hour after death;
* Died on federal land.
Case: 10;
Victim information: Male, 15, California resident;
Program attended: Missouri boot camp and boarding school;
Date of death: Nov. 2004;
Cause of death: Complications of rhabdomyolysis due to a probable
spider bite;
Case details:
* Displayed signs of distress for several days;
* Program's medical officer told staff victim was "faking it";
* Became lifeless and could hardly move;
* Punished for being too weak to exercise and forced to wear a 20-pound
sandbag around his neck;
* Autopsy reported death was caused by complications of rhabdomyolysis
due to a probable spider bite, but also found numerous bruises all over
the victim's body.
Source: Records including police reports, legal documents, and state
investigative documents.
[End of table]
Case One:
The victim was a 15-year-old female. Her parents told us that she was a
date-rape victim who suffered from depression, and that in 1990 she
enrolled in a 9-week wilderness program in Utah to build confidence and
improve her self-esteem. The victim and her parents found out about the
program through a friend who claimed to know the owner. The parents of
the victim spoke with the owner of the program several times and
reviewed brochures from the owner. The brochure stated that the
program's counselors were "highly trained survival experts" and that
"the professional experience and expertise" of its staff was
"unparalleled." The fees and tuition for the program cost a little over
$20,600 (or about $327 per day). The victim and her parents ultimately
decided that this program would meet their needs and pursued
enrollment.
The victim's parents said they trusted the brochures, the program
owner, and the program staff. However, the parents were not informed
that the program was completely new and that their daughter would be
going on the program's first wilderness trek. Program staff were not
familiar with the area, relied upon maps and a compass to navigate the
difficult terrain, and became lost. As a result, they crossed into the
state of Arizona and wandered onto Bureau of Land Management (BLM)
land. According to a lawsuit filed by her parents, the victim
complained of general nausea, was not eating, and began vomiting water
on about the third day of the 5-day hike. Staff ignored her complaints
and thought she was "faking it" to get out of the program. Police
documents indicate that the two staff members leading the hike stated
that they did not realize the victim was slowly dehydrating, despite
the fact that she was vomiting water and had not eaten any food.
On the fifth day of the hike, the victim fell several times and was
described by the other hikers as being "in distress." It does not
appear that staff took any action to help her. At about 5:45 p.m. on
the fifth day, the victim collapsed in the road and stopped breathing.
According to police records, staff did not call for help because they
were not equipped with radios--instead, they performed CPR and
attempted to signal for help using a signal fire. CPR did not revive
the victim; she died by the side of the road and her body was covered
with a tarp. The following afternoon, a BLM helicopter airlifted her
body to a nearby city for autopsy. The death certificate for the victim
states that she died of dehydration due to exposure. Although local
police investigated the death, no charges were filed. Utah officials
wanted to pursue the case, but they did not have grounds to do so
because the victim died in Arizona. The parents of the victim filed a
civil suit and settled out of court for an undisclosed sum.
Soon after the victim's death and 6 months after opening, the founder
closed the program and moved to Nevada, where she operated in that
state until her program was ordered to close by authorities there. In a
hearing granting a preliminary judgment that enjoined the operator of
the program, the judge said that he would not shelter this program,
which was in effect hiding from the controls of the adjoining state. He
chastised the program owner for running a money-making operation while
trying to escape the oversight of the state, writing, "[The owner]
wishes to conduct a wilderness survival program for children for
profit, without state regulation" and she "hide[s] the children from
the investigating state authorities and appear[s] uncooperative towards
them." He expressed further concerns, including a statement that
participants in the program did not appear to be receiving "adequate
care and protection" and that qualified and competent counselors were
not in charge of the program. The judge also noted that one of the
adult counselors was "an ex-felon and a fugitive." After this program
closed, the program founder returned to Utah and joined yet another
program where another death occurred 5 years later (this death is
detailed in case seven). We found that the founder of this residential
treatment program had a history in the industry--prior to opening the
program discussed in this case, she worked as an administrator in the
program covered in another case (case two). Today, the program founder
is still working in the industry as a consultant, providing advice to
parents who may not know of her history.
Case Two:
The victim was a 16-year-old female who had just celebrated her
birthday. According to her mother, in 1990 the victim was enrolled in a
9-week wilderness therapy program because she suffered from depression
and struggled with drug abuse. The victim's mother obtained brochures
from the program owner and discussed the program with him and other
program staff. According to the mother, the program owner answered all
her questions and "really sold the program." She told us:
"I understood there would be highly trained and qualified people with
[my daughter] who could handle any emergency— they boasted of a 13-year
flawless safety record, [and] I thought to myself 'why should I worry?
Why would anything happen to her?'"
Believing that the program would help her daughter, the victim's mother
and stepfather secured a personal loan to pay the $25,600 in tuition
for the program (or about $400 per day). She also paid about $4,415 to
have a transport service come to the family home and take her daughter
to the program. The victim's mother and stepfather hired the service
because they were afraid their daughter would run away when told that
she was being enrolled in the program. According to the victim's
mother, two people came to the family home at 4 a.m. to take her
daughter to the program's location in the Utah desert, where a group
hike was already under way.
Three days into the program, the victim collapsed and died while
hiking. According to the program brochure, the first 5 days of the
program are "days and nights of physical and mental stress with forced
march, night hikes, and limited food and water. Youth are stripped
mentally and physically of material facades and all manipulatory
tools." After the victim collapsed, one of the counselors on the hike
administered CPR until an emergency helicopter and nurse arrived to
take the victim to a hospital, where she was pronounced dead. According
to the victim's mother, her daughter died of "exertional heatstroke."
The program had not made any accommodation or allowed for any
adjustment for the fact that her daughter had traveled from a coastal,
sea-level residence in Florida to the high desert wilderness of Utah.
The mother of the victim also said that program staff did not have salt
tablets or other supplies that are commonly used to offset the affects
of heat.
Shortly after the victim died, the 9-week wilderness program closed. A
state hearing brought to light complaints of child abuse in the program
and the owner of the program was charged with negligent homicide. He
was acquitted of criminal charges. However, the state child protective
services agency concluded that child abuse had occurred and placed the
owner on Utah's registry of child abusers, preventing him from working
in the state at a licensed child treatment facility. Two other program
staff agreed to cooperate with the prosecution to avoid standing trial;
these staff were given probation and prohibited from being involved
with similar programs for up to 5 years. In 1994, the divorced parents
of the victim split a $260,000 settlement resulting from a civil suit
against the owner.
After this program closed, its owner opened and operated a number of
domestic and foreign residential treatment programs over the next
several years. Although he was listed on the Utah registry of suspected
child abusers, the program owner opened and operated these programs
elsewhere--many of which were ultimately shut down by state officials
and foreign governments because of alleged and proven child abuse. At
least one of these programs is still operating abroad and is marketed
on the Internet, along with 10 other programs considered to be part of
the same network. As discussed above, the program owner in our first
case originally worked in this program as an administrator before it
closed.
Case Three:
The victim was a 16-year-old male. According to his parents, in 1994
they enrolled him in a 9-week wilderness therapy program in Utah
because of minor drug use, academic underachievement, and association
with a new peer group that was having a negative impact on him. The
parents learned of the program from an acquaintance and got a program
brochure that "looked great" in their opinion. They thought the program
was well-suited for their son because it was an outdoor program
focusing on small groups of youth who were about the same age. They
spoke with the program owner and his wife, who flew to Phoenix,
Arizona, to talk with them. To be able to afford the program's cost of
about $18,500 (or $263 per day), the victim's parents told us they took
out a second mortgage on their house. They also paid nearly $2,000 to
have their son transported to the campsite in the program owner's
private plane. At the time they enrolled their son, the parents were
unaware that this program was started by two former employees of a
program where a teenager had died (this program is discussed in our
second case).
According to the victim's father, his son became sick around the 11th
day of the program. According to court and other documents, the victim
began exhibiting signs of physical distress and suffered from severe
abdominal pain, weakness, weight loss, and loss of bodily functions.
Although the victim collapsed several times during daily hikes,
accounts we reviewed indicate that staff ignored the victim's pleas for
help. He was forced to continue on for 20 days in this condition. After
his final collapse 31 days into the program, staff could not detect any
respiration or pulse. Only at this time did staff radio program
headquarters and request help, although they were expected to report
any illnesses or disciplinary incidents and had signed an agreement
when employed stating that they were responsible for "the safety and
welfare of fellow staff members and students." The victim was airlifted
to a nearby hospital and was pronounced dead upon arrival. The 5-foot
10-inch victim, already a thin boy, had dropped from 131 to 108 pounds-
-a loss of nearly 20 percent of his body weight during his month-long
enrollment.[Footnote 4]
The victim's father told us that when he was notified of his son's
death, he could only think that "some terrible accident" had occurred.
But according to the autopsy report, the victim died of acute
peritonitis--an infection related to a perforated ulcer. This condition
would have been treatable provided there had been early medical
attention. The father told us that the mortician, against his usual
policy, showed him the condition of his son's body because it was
"something that needed to be investigated." The victim's father told us
he "buckled at the knees" when he saw the body of his son--emaciated
and covered with cuts, bruises, abrasions, blisters, and a full-body
rash; what he saw was unrecognizable as his son except for a childhood
scar above the eye.
In the wake of the death, the state revoked the program's operating
license. According to the state's licensing director, the program
closed 3 months later because the attorney general's office had
initiated an investigation into child abuse in the program, although no
abuse was found after examining the 30 to 40 youth who were also
enrolled in the program when the victim died. The state attorney
general's office and a local county prosecutor filed criminal charges
against the program owners and several staff members. After a change of
venue, one defendant went to trial and was convicted of "abuse or
neglect of a disabled child" in this case. Five other defendants
pleaded guilty to a number of other charges--five guilty pleas on
negligent homicide and two on failure to comply with a license. The
defendants in the case were sentenced to probation and community
service. The parents of the victim subsequently filed a civil suit that
was settled out of court for an undisclosed amount.
Case Four:
The victim was a 15-year-old male. According to the victim's mother, in
2000 she enrolled her son in a wilderness program in Oregon to build
his confidence and develop self-esteem in the wake of a childhood car
accident. The accident had resulted in her son sustaining a severe head
injury, among other injuries. After an extensive Internet search and
discussions with representatives of various wilderness programs and
camps for head-injury victims, the mother told us she selected a
program that she believed would meet her son's needs. What "sold me on
the program," she said, was the program owner's repeated assurances
over the telephone that the program was "a perfect fit" for her son.
She told us that to pay for the $27,500 program, she withdrew money
from her retirement account. The program was between 60 to 90 days
(about $305 to $450 per day) depending on a youth's progression through
the program.
The victim's mother said that she became suspicious about the program
when she dropped her son off. She said that the program director and
another staff person disregarded her statements about her son's "likes
and dislikes," despite believing that the program would take into
account the personal needs of her son. Later, she filed a lawsuit
alleging that the staff had no experience dealing with brain-injured
children and others with certain handicaps who were in the program.
What she also did not know was that the founder of the program was
himself a former employee of two other wilderness programs in another
state where deaths had occurred (we discuss these programs in cases two
and three). The program founder also employed staff who had been
charged with child abuse while employed at other wilderness programs.
According to her lawsuit, her son left the program headquarters on a
group hike with three counselors and three other students. Several days
into the multiday hike, while camping under permit on BLM land, the
victim refused to return to the campsite after being escorted by a
counselor about 200 yards to relieve himself. Two counselors then
attempted to lead him back to the campsite. According to an account of
the incident, when he continued to refuse, they tried to force him to
return and they all fell to the ground together. The two counselors
subsequently held the victim face down in the dirt until he stopped
struggling; by one account a counselor sat on the victim for almost 45
minutes. When the counselors realized the victim was no longer
breathing, they telephoned for help and requested a 9-1-1 operator's
advice on administering CPR. The victim's mother told us that she found
out about the situation when program staff called to tell her that her
son was being airlifted to a medical center. Shortly afterwards, a
nurse called and urged her to come to the hospital with her husband.
They were not able to make it in time--on the drive to the hospital,
her son's doctor called, advised her to pull to the side of the road,
and informed her that her son had died. The victim's mother told us
that she was informed, after the autopsy, that the main artery in her
son's neck had been torn. The cause of death was listed as a homicide.
In September 2000, after the boy's death, one of the counselors was
charged with criminally negligent homicide. A grand jury subsequently
declined to indict him. The victim's mother told us that at the grand
jury hearing, she found out from parents of other youth in the program
that they had been charged different amounts of money for the same
program, and that program officials had told them what they wanted to
hear about the program's ability to meet each of their children's
special needs. In early 2001, the mother of the victim filed a $1.5
million wrongful death lawsuit against the program, its parent company,
and its president. The lawsuit was settled in 2002 for an undisclosed
amount.
Due in part to the victim's death, in early 2002, Oregon implemented
its outdoor licensing requirements. The state's Department of Justice
subsequently filed a complaint alleging numerous violations of the
state's Unlawful Trade Practices Act and civil racketeering laws,
including charges that the program misrepresented its safety procedures
and criminally mistreated enrolled youth. In an incident unconnected to
this case, the program was also charged with child abuse related to
frostbite. As a result of these complaints, in February of 2002, the
program entered into agreement with the state's attorney general to
modify program operations and pay a $5,000 fee. The program continued
to work with the State of Oregon throughout 2002 to comply with the
agreement. In the summer of 2002, BLM revoked the camping permit for
the program due, in part, to the victim's death. The program closed in
December of 2002.
Case Five:
The victim was a 14-year-old male. According to his father, in 2001 the
victim was enrolled in a private West Virginia residential treatment
center and boarding school. He told us that his son had been diagnosed
with clinical depression, had attempted suicide twice, was on
medication, and was being treated by a psychiatrist. Because their son
was having difficulties in his school, the parents--in consultation
with their son's psychiatrist--decided their son would benefit by
attending a school that was more sensitive to their son's problems. To
identify a suitable school, the family hired an education consultant
who said he was a member of an educational consultants' association and
that he specialized in matching troubled teens with appropriate
treatment programs. The parents discussed their son's personality,
medical history (including his previous suicide attempts), and
treatment needs with the consultant. According to the father, the
consultant "quickly" recommended the West Virginia school. The program
was licensed by the state and cost almost $23,000 (or about $255 per
day).
According to the parents and court documents, the victim committed
suicide 6 days into the program. On the day before he killed himself,
while participating in the first phase of the program ("survival
training"), the victim deliberately cut his left arm four times from
wrist to elbow using a pocket knife issued to him by the school. After
cutting himself, the victim approached a counselor and showed him what
he had done, pleading with the counselor to take the knife away before
he hurt himself again.[Footnote 5] He also asked the counselor to call
his mother and tell her that he wanted to go home. The counselor spoke
with the victim, elicited a promise from him not to hurt himself again,
and gave the knife back. The next evening the victim hung himself with
a cord not far from his tent. Four hours passed before the program
chose to notify the family about the suicide. When the owner of the
program finally called the family to notify them, according to the
father, the owner said, "There was nothing we could do."
In the aftermath of the suicide, the family learned that the program
did not have any procedures for addressing suicidal behavior even
though it had marketed itself as being able to provide appropriate
therapy to its students. Moreover, one of the program owners, whom the
father considered the head therapist, did not have any formal training
to provide therapy. The family also learned that the owner and another
counselor had visited their son's campsite, as previously scheduled,
the day he died. During this visit, field staff told them about the
self-inflicted injury and statements the victim had made the night
before. According to the father, the owner then advised field staff
that the victim was being manipulative in an attempt to be sent home,
and that the staff should ignore him to discourage further manipulative
behavior.
The owners and the program were indicted by a grand jury on criminal
charges of child neglect resulting in death. According to the
transcript, the judge who was assigned to the case pushed the parties
not to choose a bench trial to avoid a lengthy and complicated trial.
The program owner pleaded no contest to the charge of child neglect
resulting in death with a fine of $5,000 in exchange for dismissal of
charges. The state conducted an investigation into the circumstances
and initially planned to close the program. However, the program owners
negotiated an agreement with the state not to shut down the program in
exchange for a change of ownership and management. According to the
victim's father, the family of the victim subsequently filed a civil
suit and a settlement was reached for $1.2 million, which included the
owners admitting and accepting personal responsibility for the suicide.
This program remains open and operating. Within the last 18 months, a
group of investors purchased the program and are planning to open and
operate other programs around the country, according to the program
administrators with whom we spoke. As part of our work we also learned
that the program has a U.S. Forest Service permit however, because it
has not filed all required usage reports nor paid required permit fees
in almost 8 years, it is in violation of the terms of the permit. We
estimate that the program owes the U.S. Forest Service tens of
thousands of dollars, although we could not calculate the actual debt.
Case Six:
The victim was a 14-year-old male. According to police documents, the
victim's mother enrolled him in a military-style Arizona boot camp in
2001 to address behavioral problems. The mother told us that she
"thought it would be a good idea." In addition, she told us that her
son suffered from some hearing loss, a learning disability, Attention
Deficit Hyperactivity Disorder (ADHD), and depression. To address these
issues her son was taking medication and attending therapy sessions.
According to the mother, her son's therapist had recommended the
program, which he described as a "tough love" program and "what [her
son] needed." The mother said she trusted the recommendation of her
son's therapist; in addition, she spoke with other parents who had
children in the program, who also recommended the program to her. She
initially enrolled her son in a daytime Saturday program in the spring
of 2001 so he could continue attending regular school during the week.
Because her son continued to have behavioral problems, she then
enrolled him in the program's 5-week summer camp, which she said cost
between $4,600 and $5,700 (between $131 and $162 per day). Her
understanding was that strenuous program activities took place in the
evening and that during the day youth would be in the shade.
Police documents indicate about 50 youth between the ages of 6 and 17
were enrolled in the summer program. According to police, youth were
forced to wear black clothing and to sleep in sleeping bags placed on
concrete pads that had been standing in direct sunlight during the day.
Both black clothing and concrete absorb heat. Moreover, according to
documents subsequently filed by the prosecutor, youth were fed an
insufficient diet of a single apple for breakfast, a single carrot for
lunch, and a bowl of beans for dinner. On the day the victim died, the
temperature was approximately 113 degrees Fahrenheit, according to the
investigating detective. His report stated that on that day, the
program owner asked whether any youth wanted to leave the program; he
then segregated those who wanted to leave the program, which included
the victim, and forced them to sit in the midday sun for "several
hours" while the other participants were allowed to sit in the shade.
Witnesses said that while sitting in the sun, the victim began "eating
dirt because he was hungry." Witnesses also stated that the victim "had
become delirious and dehydrated— saw water everywhere, and had to
'chase the Indians.'" Later on the victim appeared to have a convulsive
seizure, but the camp staff present "felt he was faking," according to
the detective's report. One staff member reported that the victim had a
pulse rate of 180, more than double what is considered a reasonable
resting heart rate for a teenager.[Footnote 6] The program owner then
directed two staff and three youth enrolled in the program to take the
victim to the owner's room at a nearby motel to "cool him down and
clean up." They placed the victim in the flatbed of a staff member's
pickup truck and drove to the motel.
Over the next several hours, the following series of events occurred.
* In the owner's hotel room, the limp victim was stripped and placed
into the shower with the water running. The investigating detective
told us that the victim was left alone for 15 to 20 minutes for his
"privacy." During this time, one of the two staff members telephoned
the program owner about the victim's serious condition; the owner is
said to have told the staff person that "everything will be okay."
However, when staff members returned to the bathroom they saw the
victim facedown in the water. The victim had defecated and vomited on
himself.
* After cleaning up the victim, a staff member removed him from the
shower and placed him on the hotel room floor. Another staff member
began pressing the victim's stomach with his hands, at which point,
according to the staff member's personal account, mud began oozing out
of the victim's mouth. The staff member then used one of his feet to
press even harder on the victim's stomach, which resulted in the victim
vomiting even more mud and a rock about the size of quarter. At this
point, a staff member again called the owner to say the boy was not
responding; the owner instructed them to take the victim back to the
camp. They placed the victim in the flatbed of the pickup truck for the
drive back.
* Staff placed the victim on his sleeping bag upon returning to camp.
He was reportedly breathing at this time, but then stopped breathing
and was again put in the back of the pickup truck to take him for help.
However, one staff member expressed his concern that the boy would die
unless they called 9-1-1 immediately. The county sheriff's office
reported receiving a telephone call at approximately 9:43 p.m. that
evening saying a camp participant "had been eating dirt all day, had
refused water, and was now in an unconscious state and not breathing."
This is the first recorded instance in which the program owner or staff
sought medical attention for the victim. Instructions on how to perform
CPR were given and emergency help was dispatched.
The victim was pronounced dead after being airlifted to a local medical
center. The medical examiner who conducted the autopsy expressed
concern that the victim had not been adequately hydrated and had not
received enough food while at the camp. His preliminary ruling on the
cause of death was that "of near drowning brought on by dehydration."
After a criminal investigation was conducted, the court ultimately
concluded that there was "clear and convincing evidence" that program
staff were not trained to handle medical emergencies related to
dehydration and lack of nutrition. The founder (and chief executive
officer) of the program was convicted in 2005 of felony reckless
manslaughter and felony aggravated assault and sentenced to 6-year and
5-year terms, respectively. He was also ordered to pay over $7,000 in
restitution to the family. In addition, program staff were convicted of
various charges, including trespassing, child abuse, and negligent
homicide but were put on probation. According to the detective, no
staff member at the camp was trained to administer medication or basic
medical treatment, including first aid. The mother filed a civil suit
that was settled for an undisclosed amount of money. The program closed
in 2001.
Case Seven:
The victim was a 16-year-old female. Because of defiant, violent
behavior, her parents enrolled her in a Utah wilderness and boarding
school program in 2001, which was a state-licensed program for youth 13
to 18 years old. The 5 month program cost around $29,000 (or about $193
per day) and operated on both private and federal land. The parents
also hired a transport service at a cost of over $3,000 to take their
daughter to the program. We found that the director and another
executive of this wilderness program had both worked at the same
program discussed in our second case and the executive owned the
program discussed in our first case.
According to program documents and the statements of staff members, a
group hiking in this program would normally require three staff--one in
front leading the hike, one in the middle of the group, and one at the
end of the group. However, this standard structure had been relaxed on
the day the victim fell. It was Christmas Day, and only one staff
member accompanied four youth. While hiking in a steep and dangerous
area that staff had not previously scouted out, the victim ran ahead of
the group with two others, slipped on a steep rock face, and fell more
than 50 feet into a crevasse according to statements of the other two
youth--one of whom ran back to inform the program staff of the
accident. The staff radioed the base camp to report the accident, then
called 9-1-1. One of the staff members at the accident scene was an
emergency medical technician (EMT) and administered first aid. However,
in violation of the program licensing agreement, the first aid kit they
were required to have with them had been left at the base camp. An
ambulance arrived about 1 hour after the victim fell. First responders
decided to have the victim airlifted to a medical center, but the
helicopter did not arrive until about 1-1/2 hours after they made the
decision to call for an airlift.
According to the coroner's report, the victim died about 3 weeks later
in a hospital without ever regaining consciousness. She had suffered
massive head trauma, a broken arm, broken teeth, and a collapsed lung.
As a result of the death, the state planned to revoke the program's
outdoor youth program license based on multiple violations. In addition
to an inappropriate staff-to-child ratio (four youth for one staff
member, rather than three to one), failure to prescreen the hiking
area, and hiking without a first aid kit, the state identified the
following additional license violations:
* Program management did not have an emergency or accident plan in
place.
* Two of the four staff members who escorted the nine youth in the
wilderness had little experience--one had 1 month of program experience
and the other had 9 days. Neither of them had completed the required
staff training.
* The two most senior staff members on the trip had less than 6 months
of wilderness experience--but they remained at the camp while other two
inexperienced staff members led the hike.
A lawsuit filed by the family in November 2002 claims that the program
did not take reasonable measures to keep the youth in the program safe,
especially given the "hiking inexperience" of the youth and the
"insufficient number of staff." Specifically, the suit claims that the
program's executive director waited for an hour before calling
assistance after the victim fell. Additionally, the suit claims that
staff only had one radio and no medical equipment or emergency plan.
The parents filed an initial lawsuit for $6 million but eventually
settled in 2003 for $200,000 before attorneys' fees and health
insurance reimbursement were taken out.
The program closed in May 2002 due to fiscal insolvency. However, its
parent program--a boarding school licensed by the state--is still in
operation. We have not been able to determine whether the wilderness
director at the time of the victim's death is still in the industry.
However, the other program executive remains in the industry, working
as a referral agent for parents seeking assistance in identifying
programs for troubled youth.
Case Eight:
The victim, who died in 2002, was a 15-year-old female. The parents of
the victim told us that she suffered from depression, suicidal
thoughts, and bipolar disorder. She also reportedly had a history of
drug use, including methamphetamines, marijuana, and cocaine. Her
parents explained that they selected a program after researching
several programs and consulting with an educational advisor. Although
the program was based in Oregon, it operated a 3-week wilderness
program in Nevada, which was closer to the family home. The total cost
of the program was over $9,200 (or about $438 per day), which included
a nonrefundable deposit and over $300 for equipment.
The parents of the victim drove their daughter several hundred miles to
enroll her in the program. Because of the distance involved, they
stayed overnight in a motel nearby. The next day, when the parents
arrived home, they found a phone message waiting for them--it was from
the program, saying that their daughter had been in an accident and
that she was receiving CPR. According to documents we reviewed, three
staff members led seven students on a hike on the first day of the
program. The victim fell several times while hiking. The last time she
fell, she lost muscle control and had difficulty breathing. The EMT on
the expedition had recently completed classroom certification and had
no practical field experience. While the staff called for help, the EMT
and other staff began CPR and administered epinephrine doses to keep
her heart beating during the 3 hours it took a rescue helicopter to
arrive. The victim was airlifted to a nearby hospital where she was
pronounced dead.
The victim's death was ruled an accident by the coroner--heat stroke
complicated by drug-induced dehydration. According to other youth on
the hike, they were aware the victim had taken methamphetamines prior
to the hike. The victim had had a drug screening done 1 week before
entering the program; she tested positive for methamphetamine, which
the program director knew but the staff did not. However, the program
did not make a determination whether detoxification was necessary,
which was required by the state where the program was operating
(Nevada), according to a court document. The victim was also taking
prescribed psychotropic medications, which affected her body's ability
to regulate heat and remain hydrated.
At the time the victim died, this private wilderness treatment program
had been in operation for about 15 years in Oregon. Although it claimed
to be accredited by the Joint Commission on Heath Care Organizations,
this accreditation covered only the base program--not the wilderness
program or its drug and alcohol component in which the victim
participated.[Footnote 7] Moreover, even though the wilderness program
attended by the victim had been running for 2 years, it was not
licensed to operate in Nevada. The district attorney's office declined
to file criminal child abuse and neglect charges against two program
counselors, although those charges had been recommended by
investigating officers. The parents of the victim were never told why
criminal charges were never filed. They subsequently filed a civil
lawsuit and settled against the program for an undisclosed sum. Two
other deaths occurred in this program shortly after the first--one
resulted from a previously unknown heart defect and the other from a
fallen tree.
Although the wilderness program had a federal permit to operate in
Nevada, it was not licensed by that state. After the death, that state
investigated and ordered the program closed. The parent company had
(and continues to maintain) state licenses in Oregon to operate as a
drug and alcohol youth treatment center, an outpatient mental health
facility, and an outdoor youth facility, as well as federal land
permits from BLM and the U.S. Forest Service. According to program
officials, the program has modified its procedures and policies--it no
longer enrolls youth taking the medication that affected the victim's
ability to regulate her body temperature.
Case Nine:
The victim was a 14-year-old male who died in July 2002. According to
documents we reviewed, the mother of the victim placed her son in this
Utah wilderness program to correct behavioral problems. The victim kept
a journal with him during his stay at the program. It stated that he
had ADHD and bipolar disorder. His enrollment form indicates that he
also had impulse control disorder and that he was taking three
prescription medications. His physical examination, performed about 1
month before he entered the program, confirms that he was taking these
medications. We could not determine how much the program cost at the
time.
According to documents we reviewed, the victim had been in the program
for about 8 days when, on a morning hike on BLM land, he began to show
signs of hyperthermia (excessively high body temperature). He sat down,
breathing heavily and moaning. Two staff members, including one who was
an EMT, initially attended to him, but they could not determine if he
was truly ill or simply "faking" a problem to get out of hiking. When
the victim became unresponsive and appeared to be unconscious, the
staff radioed the program director to consult with him. The director
advised the staff to move the victim into the shade. The director also
suggested checking to see whether the victim was feigning
unconsciousness by raising his hand and letting go to see whether it
dropped onto his face. They followed the director's instructions.
Apparently, because the victim's hand fell to his side rather than his
face, the staff member who was an EMT concluded that the victim was
only pretending to be ill. While the EMT left to check on other youth
in the program, a staff member reportedly hid behind a tree to see
whether the victim would get up--reasoning that if the victim were
faking sickness, he would get up if he thought nobody was watching. As
the victim lay dying, the staff member hid behind the tree for 10
minutes. He failed to see the victim move after this amount of time, so
he returned to where the victim lay. He could not find a pulse on the
victim. Finally realizing that he was dealing with a medical emergency,
the staff member summoned the EMT and they began CPR. The program
manager was contacted, and he called for emergency help. Due to
difficult terrain and confusion about the exact location of the victim,
it took over an hour for the first response team to reach the victim.
An attempt to airlift the victim was canceled because a rescue team
determined that the victim was already dead.
According to the coroner's report, the victim died of hyperthermia.
State Department of Human Services officials initially found no
indication that the program had violated its licensing requirements,
and the medical examiner could not find any signs of abuse.
Subsequently, the Department of Human Services ruled that there were,
in fact, licensing violations, and the state charged the program
manager and the program owner with child abuse homicide (a second
degree felony charge). The program manager was found not guilty of the
charges; additionally, it was found that he did not violate the
program's license regarding water, nutrition, health care, and other
state licensing requirements. Moreover, the court concluded that the
State did not prove that the program owner engaged in reckless
behavior. Later that year, however, an administrative law judge
affirmed the Department of Human Services' decision to revoke the
program's license after the judge found that there was evidence of
violations. The owner complied with the judge and closed the program in
late 2003. About 16 months later, the owner applied for and received a
new license to start a new program. According to the Utah director of
licensing, as of September 2007, there have been "no problems" with the
new program. We could not find conclusive information as to whether the
parents of the victim filed a civil case and, if so, what the outcome
was.
Case Ten:
The victim was a 15-year-old male. According to investigative reports
compiled after his death, the victim's grades dropped during the 2003-
2004 school year and he was withdrawing from his parents. His parents
threatened to send him to a boarding or juvenile detention facility if
he did not improve during summer school in 2004. The victim ran away
from home several times that summer, leading his frustrated parents to
enroll him in a boot camp program. When they told him about the
enrollment, he ran away again--the day before he was taken to the
program in a remote area of Missouri. The 5-month program describes
itself as a boot camp and boarding school. Because it is a private
facility, the state in which it is located does not require a license.
According to Internet documents, the program costs almost $23,000 (or
about $164 per day).
Investigative documents we reviewed indicate that at the time the
parents enrolled the teenager, he did not have any issues in his
medical history. Staff logs indicate that the victim was considered to
be a continuous problem from the time he entered the program--he did
not adhere to program rules and was otherwise noncompliant. By the
second day of the boot camp phase of the program, staff noticed that
the victim exhibited an oozing bump on his arm. School records and
state investigation reports showed that the victim subsequently began
to complain of muscle soreness, stumbled frequently, and vomited. As
days passed, students noticed the victim was not acting normally, and
reported that he defecated involuntarily on more than one occasion,
including in the shower. Staff notes confirmed that the victim
defecated and urinated on himself numerous times. Although he was
reported to have fallen frequently and told staff he was feeling weak
or ill, the staff interpreted this as being rebellious. The victim was
"taken down"--forced to the floor and held there--on more than one
occasion for misbehaving, according to documents we reviewed. Staff
also tied a 20-pound sandbag around the victim's neck when he was too
sick to exercise, forcing him to carry it around with him and not
permitting him to sit down. Staff finally placed him in the "sick bay"
in the morning on the day that he died. By midafternoon of that day, a
staff member checking on him intermittently found the victim without a
pulse. He yelled for assistance from other staff members, calling the
school medical officer and the program owners. A responding staff
member began CPR. The program medical officer called 9-1-1 after she
arrived in the sick bay. An ambulance arrived about 30 minutes after
the 9-1-1 call and transported the victim to a nearby hospital, where
he was pronounced dead.
The victim died from complications of rhabdomyolysis due to a probable
spider bite, according to the medical examiner's report.[Footnote 8] A
multiagency investigation was launched by state and local parties in
the aftermath of the death. The state social services' abuse
investigation determined that staff did not recognize the victim's
medical distress or provide adequate treatment for the victim's bite.
Although the investigation found evidence of staff neglect and
concluded that earlier medical treatment may have prevented the death
of the victim, no criminal charges were filed against the program, its
owners, or any staff. The state also found indications that documents
submitted by the program during the investigation may have been
altered. The family of the victim filed a civil suit against the
program and several of its staff in 2005 and settled out of court for
$1 million, according to the judge.
This program is open and operating. The tuition is currently $4,500 per
month plus a $2,500 "start-up fee." The program owner claims to have 25
years of experience working with children and teenagers. Members of her
family also operate a referral program and a transport service out of
program offices located separately from the actual program facility.
During the course of our review, we found that current and former
employees with this program filed abuse complaints with the local law
enforcement agency but that no criminal investigation has been
undertaken.
Mr. Chairman and Members of the Committee, this concludes my statement.
We would be pleased to answer any questions that you may have at this
time.
Contacts and Acknowledgments:
For further information about this testimony, please contact Gregory D.
Kutz at (202) 512-6722 or kutzg@gao.gov. Contact points for our Offices
of Congressional Relations and Public Affairs may be found on the last
page of this testimony.
Footnotes:
[1] According to the Administration for Children and Families (part of
the U.S. Department of Health and Human Services), NCANDS is a
voluntary national data collection and analysis system created in
response to the requirements of the Child Abuse Prevention and
Treatment Act.
[2] For addition information, see H. T. Ireys, L. Achman, and A. Takyi.
State Regulation of Residential Facilities for Children with Mental
Illness. DHHS Pub. No. (SMA) 06-4167 (Rockville, Md.: Center for Mental
Health Services, Substance Abuse and Mental Health Services
Administration, 2006).
[3] Under Titles IV-B and IV-E of the Social Security Act and the Child
Abuse and Neglect Prevention and Treatment Act.
[4] The program consisted of four phases. At the start of the second
phase, students were required to fast for 2 days. During this phase,
students slept under tarpaulins and, at the end of their fast, they
were each given a supply of food and told that they were responsible
for cooking and rationing it themselves. This food supply was the same
for all participants and was supposed to last each of them for a week.
[5] Cutting is a common practice of superficially cutting oneself to
draw attention and is often associated with adolescent mental health
and behavioral issues. It is not considered an attempt to commit
suicide, based on information in the American Psychiatric Association's
2003 Practice Guidelines for the Assessment and Treatment of Patients
with Suicidal Behaviors.
[6] This is according to information from the U.S. National Library of
Medicine, National Institutes of Health.
[7] According to its Web site, the Joint Commission on Health Care
Organizations evaluates and accredits nearly 15,000 health care
organizations and programs in the United States. It maintains state-of-
the-art standards that focus on improving the quality and safety of
care provided by health care organizations. Its comprehensive
accreditation process evaluates an organization's compliance with these
standards and other accreditation requirements.
[8] According to the National Library of Medicine, rhabdomyolysis is
the breakdown of muscle fibers resulting in the release of muscle fiber
contents into the bloodstream.
GAO's Mission:
The Government Accountability Office, the audit, evaluation, and
investigative arm of Congress, exists to support Congress in meeting
its constitutional responsibilities and to help improve the performance
and accountability of the federal government for the American people.
GAO examines the use of public funds; evaluates federal programs and
policies; and provides analyses, recommendations, and other assistance
to help Congress make informed oversight, policy, and funding
decisions. GAO's commitment to good government is reflected in its core
values of accountability, integrity, and reliability.
Obtaining Copies of GAO Reports and Testimony:
The fastest and easiest way to obtain copies of GAO documents at no
cost is through GAO's Web site [hyperlink, http://www.gao.gov]. Each
weekday, GAO posts newly released reports, testimony, and
correspondence on its Web site. To have GAO e-mail you a list of newly
posted products every afternoon, go to [hyperlink, http://www.gao.gov]
and select "E-mail Updates."
Order by Mail or Phone:
The first copy of each printed report is free. Additional copies are $2
each. A check or money order should be made out to the Superintendent
of Documents. GAO also accepts VISA and Mastercard. Orders for 100 or
more copies mailed to a single address are discounted 25 percent.
Orders should be sent to:
U.S. Government Accountability Office:
441 G Street NW, Room LM:
Washington, DC 20548:
To order by Phone:
Voice: (202) 512-6000:
TDD: (202) 512-2537:
Fax: (202) 512-6061:
To Report Fraud, Waste, and Abuse in Federal Programs:
Contact:
Web site: [hyperlink, http://www.gao.gov/fraudnet/fraudnet.htm]:
E-mail: fraudnet@gao.gov:
Automated answering system: (800) 424-5454 or (202) 512-7470:
Congressional Relations:
Gloria Jarmon, Managing Director, JarmonG@gao.gov:
(202) 512-4400:
U.S. Government Accountability Office:
441 G Street NW, Room 7125:
Washington, DC 20548:
Public Affairs:
Susan Becker, Acting Manager, BeckerS@gao.gov:
(202) 512-4800:
U.S. Government Accountability Office, 441 G Street NW, Room 7149
Washington, DC 20548:
