Two Minnesota agencies probe missteps at East Bethel treatment center for children and teens

Investigators from two state agencies descended on a newly opened behavioral health residential treatment facility for children last week after it was cited twice for failing to report that a patient stabbed himself and for not following state clinical care regulations.

It is unclear whether the Minnesota Department of Health (MDH) or the Department of Human Services (DHS) will take further action against Cambia Hills of East Bethel, which opened in March as a new type of treatment option for children who often cannot get intensive mental health care in the state, forcing placement in facilities hundreds of miles away.

Dave Hartford, chief operating officer of the 60-bed facility, acknowledged that investigators were on site last week.

"We are still just moving along working with DHS and MDH in terms of fixing things that are being identified that need improvement," he said.

Cambia Hills, however, will be doing that without Hartford, who voluntarily resigned his post. Jeff Bradt, the chief executive of the facility's parent company, the Hills Youth and Family Services of Duluth, said Tuesday that Hartford was not asked to resign and that he is "sorry to see him go."

Investigators interviewed patients and staff at Cambia Hills about safety concerns, self-harm, therapy, grievance procedures and other issues. There are also reports that some children have sent letters to news outlets asking for help.

"If we are missing the mark with some of the kids and they are feeling different, I certainly want to know about it so we can correct anything like that," Hartford said.

Cambia Hills treats children ages 7 to 17 with severe mood disorders such as depression and anxiety, and neurological disabilities such as autism.

"They are not eligible for placement in our facility unless they have failed at every other level of care," Bradt said. "There is the therapeutic challenge to find new ways to serve these kids."

Most patients go directly to the facility after being hospitalized, with many having a history of suicide attempts and self-injury.

Because COVID-19 has made it difficult to hire staff, the facility is only about half full, serving about 35 patients.

Mental health advocates have long pushed for this type of residential care. The city of Forest Lake rejected a proposal to build the facility on the site of a horse farm in 2018, forcing the parent company to move the project to East Bethel.

But last month the Health Department threatened to cut off state and federal funding for Cambia Hills after it discovered that a child had used a pair of scissors to stab himself, according to an investigative report released by the agency.

The child, who was diagnosed with post-traumatic stress disorder, major depressive disorder and attention-deficit/hyperactivity disorder, took the scissors after participating in a craft group. Staff failed to count the number of scissors after the group dispersed even though the patient had a history of suicide attempts and self-injury.

He was found later in the shower, bleeding from his left arm. The facility estimated he lost 2½ pints of blood.

Under MDH regulations, the facility was required to report the incident to the state within 24 hours. Cambia Hills also did not file a report on a child whose arm was discovered to be bruised from the elbow to the wrist.

Hartford said reporting guidelines differ between the MDH and the DHS, which resulted in the errors.

"It is hard when you have a lot of different regulatory sets," he said.

In a letter to the facility, the MDH said that it had satisfactorily changed its policies on incident reporting, which means that it won't lose funding.

Last week, the DHS issued a correction order, requiring Cambia Hills to conduct weekly "clinical supervision" meetings, where the care teams discuss patients' treatment plans.

Hartford said these types of meetings are a legacy from traditional children's residential facilities, which do not provide a higher level of mental health care. Instead, Cambia Hills operates more like a hospital inpatient setting, where treatment plans are assessed in other ways.

"We have some difference of opinion with DHS around some of these regulatory frameworks that really come from other settings," he said.

Hartford requested that the DHS waive the rule and allow an alternative model, which was denied.

Some clinical leaders at Cambia Hills expressed concerns about the lack of clinical supervision meetings and that the proposed alternative would not be sufficient, according to e-mails obtained by the Star Tribune.

Meanwhile, Hartford, a former DHS assistant commissioner, has been with Cambia Hills since it was conceived.

"He was not asked to resign, but it has been sort of a long exhausting road to bring the facility to this point," Bradt said. "He has done an incredible job for us.

"We don't have any model that we can look to that is trying to provide the level of care for the kids we are trying to serve," Bradt added. "I think the reason why we stumbled at this point is just the difficulty of bringing a new facility like this on board."