Residential Treatment Programs: Concerns Regarding Abuse and	 
Death in Certain Programs for Troubled Youth (10-OCT-07,	 
GAO-08-146T).							 
                                                                 
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 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.	 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-08-146T					        
    ACCNO:   A77188						        
  TITLE:     Residential Treatment Programs: Concerns Regarding Abuse 
and Death in Certain Programs for Troubled Youth		 
     DATE:   10/10/2007 
  SUBJECT:   Child abuse					 
	     Crime victims					 
	     Criminal liability 				 
	     Data collection					 
	     Mental health care services			 
	     Program evaluation 				 
	     Program management 				 
	     Regulation 					 
	     Reporting requirements				 
	     Safety regulation					 
	     State-administered programs			 
	     Teenagers						 
	     Program implementation				 
	     Social programs					 
	     National Child Abuse and Neglect Data		 
	     System						 
                                                                 

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GAO-08-146T

   

     * [1]Summary
     * [2]Background
     * [3]Widespread Allegations of Abuse and Death at Residential Tre
     * [4]Cases of Death at Selected Residential Treatment Programs

          * [5]Case One
          * [6]Case Two
          * [7]Case Three
          * [8]Case Four
          * [9]Case Five
          * [10]Case Six
          * [11]Case Seven
          * [12]Case Eight
          * [13]Case Nine
          * [14]Case Ten

     * [15]Contacts and Acknowledgments
     * [16]GAO's Mission
     * [17]Obtaining Copies of GAO Reports and Testimony

          * [18]Order by Mail or Phone

     * [19]To Report Fraud, Waste, and Abuse in Federal Programs
     * [20]Congressional Relations
     * [21]Public Affairs
     * [22]PDF6-Ordering Information.pdf

          * [23]Order by Mail or Phone

                 United States Government Accountability Office

Testimony

GAO

Before the Committee on Education and Labor, House of Representatives

For Release on Delivery      RESIDENTIAL TREATMENT PROGRAMS                
Expected at 10:30 a.m. EDT                                                 
Wednesday, October 10, 2007                                                
                                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

RESIDENTIAL TREATMENT PROGRAMS

  Concerns Regarding Abuse and Death in Certain Programs for Troubled Youth

    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.

                     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 ï¿½highly trained survival 
expertsï¿½. 

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 ï¿½faking itï¿½; 
* Staff member returned and found no pulse; 
* Died soon afterwards. 

Source: Records  including  police  reports, legal  documents,  and  state
investigative documents.

United States Government Accountability Office

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),^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.

^1According 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.

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:

o 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.

     o 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.
     o 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
lessrestrictive 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.^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.

^2For 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).

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.

^3Under Titles IV-B and IV-E of the Social Security Act and the Child  Abuse
and Neglect Prevention and Treatment Act.

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

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.

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

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.

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 militarystyle 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

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.

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

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.

A variety of ancillary services related to residential treatment programs
are available for an additional fee in some programs. These services
include:

     o Referral services and educational consultants to assist parents in
       selecting a program.
     o 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.
     o Additional individual, group, or family counseling or therapy sessions
       as part of treatment. These services may be located on the premises or
       nearby.
     o 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:

o 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.

     o 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.
     o 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.

     o 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
       lesscommon 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.
     o 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.
     o 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.
									 
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.^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.

^4The 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.

  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.^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.

^5Cutting 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.

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.^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.

     o 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.
     o 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.

^6This is  according  to  information  from the  U.S.  National  Library  of
Medicine, National Institutes of Health.

o 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 5year 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:

     o Program management did not have an emergency or accident plan in
       place.
     o 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.

o 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.^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.

^7According 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.

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.^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.

^8According to  the  National Library  of  Medicine, rhabdomyolysis  is  the
breakdown of  muscle  fibers resulting  in  the release  of  muscle  fiber
contents into the bloodstream.

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 [email protected]. Contact points for our Offices of
Congressional Relations and Public Affairs may be found on
the last page of this testimony.

  (192250)

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