East Bethel behavioral center cited for violating state, federal regulations

A behavioral residential treatment facility for adolescents was cited Wednesday for 33 violations of state and federal regulations, just seven months after it opened its doors.

It marks the third time since August that the Minnesota Department of Human Services (DHS) has cited Cambia Hills of East Bethel, one of the first facilities in the state to offer intensive mental health care treatment to children that bridges the gap between outpatient care and hospitalization.

DHS investigators probed the 60-bed facility over eight days in August and uncovered dozens of shortcomings where it lacked safeguards to protect the adolescents in its care, many of whom have a history of suicide attempts and self-injury.

Jeffrey Bradt, chief executive of Cambia Hill's Duluth-based parent organization, said that a request for reconsideration of the DHS findings will be made to state regulators. He did not respond to questions about the findings.

According to an order issued by DHS Wednesday, several staff members improperly had direct contact with residents, even though legally required background checks of the staff members had not been performed or completed.

The agency also said the facility failed to properly monitor the use of physical restraints as well as medications given to residents, resulting in at least one resident receiving an incorrect dose of a psychotropic drug.

Cambia Hills also failed again to submit the required disclosures to state regulators about resident suicide attempts, despite being threatened with the loss of state and federal funding for the same infraction just weeks earlier.

On July 10, the Minnesota Department of Health (MDH), which also regulates the facility, told senior management that the program was in "immediate jeopardy" because it failed to disclose that one resident had been taken to the hospital due to significant blood loss after attempting suicide on July 7.

The "immediate jeopardy" designation, which means that residents are at risk for harm because of shortcomings by a health care provider, was removed after leaders said they would take steps to resolve the problem.

After MDH rescinded the warning to revoke state and federal funding, there were two more suicide attempts.

On July 27, a resident swallowed soap, and three days later there was another incident involving attempted strangulation. Both "were not reported to the commissioner of human services as required," regulators noted.

In the July 7 incident, a resident who was diagnosed with post-traumatic stress disorder, major depressive disorder and attention deficit hyperactivity disorder, cut himself with a pair of scissors after participating in a crafting group. He was found later in the shower, bleeding from his left arm. The facility estimated he lost 2 ½ pints of blood, according to regulatory documents.

In September, DHS determined that the facility was responsible for the neglect that led to the suicide attempt. As a result, Cambia Hills was fined $5,000.

DHS investigators said the facility, rather the staff member, was responsible for the neglect, which regulators deemed "serious."

Although an employee did not count the number of scissors returned to a locked office after the resident participated in the crafting group, the treatment center didn't have the documentation in place to track the cutting tools.

The findings from that incident are mirrored throughout the DHS licensing order issued Wednesday.

Health regulators pay close attention to patient records and treatment plans, as well as documents about employee training and qualifications, to see if care is appropriate or lacking.

Many of the violations uncovered record-keeping shortcomings that not only raised questions about whether residents or their guardians had given informed consent for treatments, but could also lead to inadequate treatment.

Among the deficiencies, investigators found cases where treatment plans were not individualized and residents were not assessed to see if medications were working or needed to be adjusted.

The medication record for one child was incorrect for a psychotropic drug used to treat schizophrenia and bipolar disorder. Instead of receiving the drug once daily as prescribed, staff administered two doses on two separate days.

"The license holder was not aware of the error until a DHS licensor inquired about the discrepancy," the order noted.

In several cases, there was no evidence that the facility had provided training to staff before they began working with residents or provided ongoing education. This included training on gender-based needs of residents.

According a former Cambia Hills administrator, gender identity is an issue for at least 25% of the residents.

When questioned by DHS investigators, several staff members had not complied with or didn't know policies about looking for medication side effects, policies on restraints and care plans.

In addition, the facility did not respond to resident grievances within the legally mandated five business days; licensed mental health professionals were not available within 30 minutes for consultation; some drugs were not stored properly; and alleged sexual misconduct between residents was not reported to state regulators.

Bradt did say in a text message to the Star Tribune that the DHS order had been posted prematurely and that it would be removed from the state website.

A DHS spokeswoman confirmed that the order was published online before the agency sent it to Cambia Hills, but said it would not be removed from public view.

If Cambia Hills does not succeed in its reconsideration request, its license will be restricted for one year and it must seek guidance from DHS about fixing its shortcomings.