CPR, 911 call for youth were delayed

When a youth at the Bowling Brook Preparatory School lost consciousness last week while being restrained by staff, workers delayed administering CPR or calling for an ambulance because they believed he was pretending to be asleep, according to a report sent by the school to the Maryland Department of Juvenile Services.

When the paramedics were finally summoned, 17-year-old Isaiah Simmons was rushed to Carroll Hospital Center, where he was pronounced dead.


Bowling Brook's account of the efforts by staff to restrain Simmons for at least three hours is contained in a required report to the juvenile services agency, which placed Simmons in the residential program for juvenile offenders. The report, released yesterday, describes in clinical terms the hours of restraint and what happened when Simmons lost consciousness.

" [In] time, [Simmons] stopped struggling and became nonresponsive," the report says. "The collective thinking of intervening staff and students was that [Simmons] was feigning sleep.


"[Simmons] was then raised from the prone position to the seated and brought outside, for staff to assess and check vital signs. Within minutes, [Simmons] was returned back in to the house for staff to administer CPR as the ambulance was simultaneously called."

Medical experts say it can be dangerous to delay even for few minutes beginning cardiopulmonary resuscitation or calling an ambulance.

"It's been well documented that the sooner you start CPR, the better the chances are that patients will survive," Eric J. Beauvois, an emergency room physician at St. Joseph Medical Center in Baltimore, said yesterday. "The sooner you can get the paramedics involved and the sooner you can get the patient in the hospital, the better. All those will increase your chance of resuscitation. A matter of minutes can make a difference."

Bowling Brook's report provides the first detailed description by the school of the Jan. 23 incident that ended with Simmons' death. It differs significantly in tone from the vivid account given by Ronnell Williams, 18, one of at least six Bowling Brook students who witnessed the incident.

"They grabbed [Simmons] and slammed his ass down," Williams said yesterday in an interview. "He was face down ... eagle-spread, his arms was out and his legs, too," he said. "There were five staff. One on each leg, one on each arm, and one had his knees on [Simmons'] back."

"He told them he was hurting," Williams said. "He told them he couldn't breathe. Nobody wanted to believe him."

At least three other student eyewitnesses have given similar accounts to their lawyers, including statements that staff "sat on" Simmons as they restrained him, according to the Maryland public defender's office.

Bowling Brook, through its public relations agency, released a statement last night expressing confidence that the Carroll County sheriff's investigation into the death "will reveal that Bowling Brook's procedures were appropriate, that our staff acted in accordance with our procedures and in a manner consistent with Maryland law."


In response to allegations that staff have restrained students by sitting or kneeling on them, the school "categorically" denied that workers ever sat or knelt on the "head or torso" of Isaiah Simmons. The statement did not address allegations that staff sat on Simmons' back, as Williams and others have claimed.

School officials said that their staff training program meets or exceeds legal requirements in Maryland, including in the use of physical restraint, and that the "vast majority" of staff have four-year college degrees. The counselors involved in the incident with Simmons were "senior staff of the highest caliber with advanced training," the statement said.

While the state medical examiner has not determined the cause of Simmons' death, one medical authority says it appears to fit the general pattern for what is known as "positional asphyxia."

That can occur when a person is being restrained after a period of intense physical exertion, and is positioned on his stomach with weight applied to the back, said Harry J. MacDannald, a pulmonary and critical care physician at John Muir Hospital in Walnut Creek, Calif.

"What happens is when individuals struggle for long periods of time, their muscles become fatigued," said MacDannald, who has studied positional asphyxia. "They get respiratory muscle fatigue. If they are then placed face down, when the person breathes, their chest is compressed. It takes even more work to breathe under those circumstances. Eventually, they just stop breathing."

Authorities yesterday continued to remove students from Bowling Brook, for decades a well-regarded residential program outside Westminster. As of yesterday, 15 of 72 young offenders placed there by the Department of Juvenile Services had been removed from the school, said Edward Hopkins, a department spokesman. All but one of the 15 were sent home to parents or guardians, he said.


Many of the youths were removed at the request of their lawyers in the Maryland public defender's office.

In Annapolis, youth advocates and a deputy public defender urged the Senate Judicial Proceedings Committee to expand the state's supervision of privately run programs such as Bowling Brook by giving the state's independent monitor authority to oversee their operations. State Sen. Bobby A. Zirkin, a Baltimore County Democrat, said he planned to introduce legislation today that would give the independent monitor that authority.

Simmons was the first youth in the custody of the Department of Juvenile Services to die since 2001, when a girl committed suicide at another center. The department placed Simmons at Bowling Brook after he was found responsible in juvenile court for an armed robbery.

The Department of Juvenile Services released Bowling Brook's written account of the hours before Simmons' death in response to a request by The Sun.

The school's report says the confrontation and prolonged physical restraint started at 4:45 p.m. and ended when an ambulance was called more than three hours later, at 8:15 p.m.

The incident began when a school counselor overheard Simmons say he would "spaz out" if staff confronted him, the report says.


A Bowling Brook staff member questioned Simmons about that statement. Simmons responded by threatening to fight or even "shoot" another student, according to the report.

Believing that Simmons' comments and body language were potentially "explosive," staff tried to calm the situation by using techniques described in the report only as "touch, proximity, and other para-verbal methods of de-escalation." The youth was then restrained in a seated position.

When Simmons continued to resist, more staff members and several students joined in the restraining efforts. Four staff members then "rolled" Simmons into a "more restricted prone position," according to the school's account.

Because Simmons continued threatening to hurt others and himself, he was moved to another part of the school to "redirect the dynamic of the interaction." There, in the presence of several other students, Simmons continued to struggle and threatened "to urinate and defecate."

Simmons then began to cooperate, the report says, though he was still in the "restraint position." When one staffer tried to engage him in conversation, the teenager spoke of his 22-month -old daughter and of his absent father. But he later resumed struggling and making threats.

After an unspecified period of time, the report says, "Simmons stopped struggling and became non-responsive."


The school's report draws this conclusion: "Actions of all staff were in compliance with Bowling Brook policies. Staff followed procedures in dealing with unfortunate medical emergency."

One of the staff members who called 911 told the dispatcher that nothing was unusual in the way workers restrained Simmons.

"We're trained in that," the worker said, according to tape of the 911 call released by Carroll County authorities. "It was the same thing we do all the time when we have an aggressive kid. I don't know what happened. He was in a restraint, and then he stopped responding."

Sun reporter Laura McCandlish contributed to this article.