Five months before a student at the Bowling Brook Preparatory School collapsed and died while being restrained by staff, the school's nurse told the Department of Juvenile Services that she was concerned about the safety of youths held there, according to documents obtained by The Sun.
Janis Miller complained in August to the state about the staff's handling of several youths - including one who was badly bruised and scraped while being restrained. Bowling Brook director Michael Sunday later rebuked her for sending the teenager to a hospital emergency room, her written report said.
"My only concern is for the students. ... I could not live with myself if something happened to one of them that could permanently disable them or cost them their life," Miller wrote state officials Aug. 26. "Right now, I feel I am their only advocate."
In an interview, Miller said no state authorities responded to her complaint until the death of Isaiah Simmons, 17, in January.
A spokesman for the Department of Juvenile Services said yesterday that officials at the time regarded Miller's complaints as a "medical management issue," and they concluded the matter was best handled internally by Bowling Brook.
"In hindsight, this should have been given a lot more attention than it was given," said Edward Hopkins, the spokesman.
Steven Heisler, an attorney representing Simmons' family, said they were outraged to learn from a reporter of Miller's unsuccessful efforts to get the state's attention.
"If this is in fact true that the state was warned and failed to take action to investigate and stop these practices, it is reprehensible," Heisler said. "Had they taken action, Isaiah might be alive today."
Sunday and other officials at Bowling Brook did not respond yesterday to requests for comment.
The methods allegedly used to restrain Simmons at Bowling Brook, a privately run residential program for juvenile offenders, have provoked criticism from medical experts.
Witnesses have said they saw staff members sit on the struggling teen until he passed out during a restraint that lasted three hours. In a written statement, Bowling Brook officials denied any improper conduct.
The cause and manner of Simmons' death have not yet been established. The Carroll County Sheriff's Office is handling the investigation
Students and former Bowling Brook employees have said it was not unusual for youths to be held to the ground by staff, sometimes for hours, as a way of controlling disruptive behavior or punishing disobedience.
In an interview yesterday, a former Bowling Brook administrator, Maile Barrett, described an incident last year in which she saw a senior counselor sitting atop a prone student and "singing" while other counselors stood around and watched.
Putting pressure on someone's back while holding him facedown can restrict breathing and lead to death by "positional asphyxia," experts say. Bowling Brook officials have "categorically" denied their workers ever sat on students and said counselors use proper restraint techniques.
The Department of Juvenile Services placed Simmons at Bowling Brook two weeks before his death, after a juvenile court found him responsible for a robbery. In February 2006, he used a box cutter to rob another juvenile of a cell phone near the Inner Harbor.
Miller's written complaint offers insight into the management and culture of the once well-regarded residential school in Carroll County.
A licensed practical nurse who has worked at Bowling Brook for four years, Miller said she reported her concerns last summer after consulting with the state's nursing licensing board.
She said she noticed a change in the school's culture in March, after returning from eight weeks off to recuperate from surgery. Staff were more aggressive in confronting youths, she said, and "cursing" at students became commonplace.
Lack of treatment
Her complaint to the state details allegations of improper medical treatment, such as students going without prescribed medications for conditions such as diabetes, depression and seizures. But she decided she had to register her concerns with state officials after she saw the injuries a student sustained while being restrained by staff July 16.
"I've been working with restraints for five years before this job, and I never saw a kid look like that before," said Miller, who previously worked at Hoffman Homes for Youth, a psychiatric residential treatment program for children in Pennsylvania. "He looked like he'd been hit by a car."
She said the student, identified in records as Raymond Aur, 17, had "a large abrasion" and yellowish bruise on his face and other bruises on his torso. His body appeared "contorted," with his neck twisted toward one shoulder, according to her report to the state.
The Baltimore teenager has told The Sun that Bowling Brook workers took him outside and, during a lengthy restraint, pressed his face into fresh-cut grass as punishment for talking during a meal. At one point he urinated on himself, he said.
After talking with Maile Barrett, who was her supervisor, Miller said, she called the school's consulting physician. He recommended the youth be taken to the emergency room.
Physicians at Carroll County General Hospital "did not find any facial, cranial or shoulder fracturing of any kind," said Bowling Brook's incident report, written by Barrett.
About two weeks later, Bowling Brook director Sunday called Miller and Barrett into the school's conference room, according to Miller's written complaint to the state. Also present was Brian Hayden, who is listed in tax returns as the treasurer of the nonprofit school's board of directors.
Not 'team player'
During the meeting, Miller said, Sunday chastised her and Barrett for insubordination, saying the women had disregarded the consensus of counselors that Aur did not require a hospital visit.
"The team decided that Raymond Aur wasn't going to the ER," Sunday said, according to Miller's report, yet they "sidestepped" other staff and called the doctor.
"We were yelled at for not being team players," Barrett said in an interview.
Barrett was a 10-year veteran of Bowling Brook and the school's compliance officer since 1998 when she quit one week before Simmons' death. She said she left, in part, because Sunday made it clear after the Aur incident that she would not be promoted.
"Once you're labeled not a team player, you might as well kiss your butt goodbye," Barrett said. "I felt like I was being pressured out of the door."
Meanwhile, Miller said, she was haunted by Aur's treatment. "There were sleepless nights," she said, "just worrying about another kid getting hurt."
Miller said she eventually decided to approach authorities with her concerns. On Aug. 22, she called Anne Fox, a manager with the Department of Juvenile Services' medical division, who put nurse manager Kay Schoo on the phone as well.
In the phone call, Miller said, she told Schoo and Fox about the severity of Aur's restraint, about Sunday's reaction and other concerns. Fox instructed Miller to send a report to Schoo's attention documenting her allegations.
Miller did that on Aug. 26, records show. She did not hear back from the state.
"Not a single word," Miller said. "I didn't hear from them again until Isaiah Simmons died. Anne Fox called me the next day and asked me how I was doing."
When she asked Fox why no one had responded to her report, Fox said she was not at liberty to discuss it, Miller said.
Juvenile Services officials declined to make Fox or Schoo available for interviews yesterday.
Since Simmons' death, Miller said, she has been interviewed several times by Jeff Kessler, an investigator with the department's internal investigations unit. When she told Kessler about her complaints against Bowling Brook five months earlier, he said he had not been aware of them, she said.
Miller said she regrets she didn't do more to alert authorities about practices at the school, but she had believed the state would investigate her claims.
"I don't know what else I could have done," she said. "I thought they were taking care of it. They're the ones who were supposed to take care of it."
The state's new Juvenile Services secretary, Donald W. DeVore, agreed the agency should have done more.
"Clearly, this department should be following up and taking action on warnings from health professionals and to fail to do so is unacceptable," De-Vore, who was appointed to the post by Gov. Martin O'Malley last month, said in a statement. "We will not let warnings about the safety of children in our care just slip through the cracks."