Mother sues facility in death of teen girl

ANGLETON -- A Brazoria County residential treatment center was criminally negligent in the death of a 15-year-old girl who stopped breathing after staff members restrained her, the girl's mother alleges in a lawsuit.

Leslie Brown, seeking unspecified damages, filed the lawsuit Friday on behalf of the estate of Latasha Bush. The girl died Feb. 27, three days after being restrained by staff members at the Daystar Residential Center in Manvel.

The Harris County Medical Examiner's Office ruled that the death was a homicide resulting from complications of mechanical asphyxia, a term that means compression of the chest or airways that prevents breathing.

Brown alleges that Daystar intentionally harmed the girl and acted with criminal negligence. Her lawsuit states that her daughter was developmentally disabled, mentally ill and had the emotional age of a 6-year-old.

On the morning of Feb. 24, Bush, who weighed more than 250 pounds, was walking barefoot and was told by a staff member to put on shoes or socks, the lawsuit states. She complied but became angry and refused to sit down.

"An employee of Daystar grabbed Bush and threw her face down on the floor, sat on her back and pulled both of Latasha's arms around her neck," the lawsuit states.

The lawsuit also alleges that two other employees held the teen's legs while the third sat on her back and refused to get off, despite her pleas that she could not breathe. They held her down until she quit moving and they then provided ineffective CPR after realizing she was not breathing, Brown alleges.

The girl died at Memorial Hermann Hospital in Houston.

"In lieu of proper behavioral care, defendants relied on an atmosphere of emotional and physical intimidation," the lawsuit alleges.

Daystar's attorney could not be reached for comment.

The facility is still operating but was placed on probation in July by the Texas Department of Protective and Regulatory Services, said agency spokeswoman Estella Olguin.

Olguin said the center must meet several regulatory conditions regarding staffing, training and use of restraint by December or lose its license.

The Brazoria County District Attorney's Office is still investigating the death.

Two other deaths involving teens at centers operated by the company that owns Daystar also are being investigated.

In 1993, Dawn Renay Perry, 16, a patient at the Behavior Training Research facility in Brazoria County, died from heart failure caused by exertion after being restrained by staff members.

Dr. Joseph Jachimczyk, Harris County's medical examiner then, ruled that the death resulted from natural causes.

The current medical examiner, Dr. Joye Carter, changed the ruling to "accidental" recently after reviewing the case because of the Bush case and another death.

In the other case, Stephanie Duffield, 16, died Feb. 11, 2001, after being restrained at the Shiloh Residential Treatment Center, a sister facility to Daystar.

That death was ruled an accident resulting from exertion caused by her being restrained.

Hanson, Eric. "Mother Sues Facility in Death of Teen Girl." Houston Chronicle, 28 Feb. 2002.

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Death at residential treatment center ruled a homicide

Authorities have ruled the death of a girl who died after being restrained at a mental health residential treatment center in Manvel a homicide.

The Brazoria County District Attorney's Office is investigating the girl's death, as well as the similar deaths of two other teens at treatment centers.

The Harris County Medical Examiner's Office ruled 15-year-old Latasha Bush died from complications of asphyxia, meaning her chest or airways were compressed and she couldn't breathe.

Bush died Feb. 27, three days after she was held on the ground by three staff members at Daystar Residential Treatment Center. She had a history of bipolar disorder and seizures.

Bush had been at the Southeast Texas treatment center less than two weeks when she became combative with Daystar employees, was held in a "basket hold" for five minutes and then became unresponsive.

"I already know how, but why? She's a child. She's 15 years old, and these are adults," Leslie Brown, Bush's mother, told The Facts, Brazoria County's daily newspaper, for its Thursday editions.

Bush's death was the third known restraint-related death.

A 16-year-old girl died last year at the Shiloh Residential Treatment Center, a sister facility to Daystar, and another 16-year-old girl died in 1993 at a facility that preceded Daystar, called the Behavior Training Research Facility. Both deaths were ruled accidental, caused by heart failure.

Daystar is a nonprofit, private facility that cares for children and teen-agers with mental disorders and behavioral problems.

Cal Salls, executive director of Daystar, declined to comment on the case involving Bush.

Mark Collmer, a Houston attorney representing Brown, said he plans to file a lawsuit this week alleging gross negligence.

"One of the goals is to get them to tell us truthfully what it is they did to her," Collmer said.

Brazoria County District Attorney Jeri Yenne said she wants to gather as much information as possible on all three deaths before possibly taking the cases to a grand jury.

"We want to make sure that we have all these children's records to see if there is a common factor," Yenne said. "The information is voluminous as to each case."

Estella Olguin, a spokeswoman for Child Protective Services and Residential Childcare Licensing, said it's still too soon to shut down the facility.

"We just really want to make sure we look at everything," Olguin said. "We don't want to shut down a place that could care for kids with such severe needs."

Since Bush's death, Daystar has implemented additional training for staff members, Olguin said. Physical restraints are still used but should be used only after verbal commands have failed, she said.

"Death at Residential Treatment Center Ruled a Homicide." My Plainview, 15 May 2002.

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Patient deaths raise debate over physical restraint

A 16-year-old girl dies after being physically restrained by staff members during a disruption in a Katy facility for troubled kids. Officials defend the control technique, called the "basket hold," and say it will remain in use.

Meanwhile, authorities look into possible criminal charges.

An autistic 23-year-old man dies after being restrained on the floor at a Missouri City special-needs facility. A lawyer for the facility terms the death accidental, but a criminal investigation begins.

Three teenage girls die in connection with physical restraints at youth facilities in a span of nine years. Two cases are recent, but one involves a 16-year-old in 1993. Her death of heart failure, first ruled natural, is revised later to accidental, rekindling criminal investigations into all three cases.

These five victims from the Houston area are examples of fatalities that occur nationwide year after year during or after the use of physical restraint at mental health and treatment facilities.

No state or federal agency aggregates deaths or injuries related to restraints -- a gap noted in 1999 in a report to Congress by the U.S. General Accounting Office. However, the Hartford Courant documented 142 deaths across the country during or after restraints performed between 1988 and 1998.

In Texas, Austin-based Advocacy Inc., a federally funded program serving the interests of the disabled, has counted at least 15 fatalities over the past three years in hospitals and treatment centers across the state.

All such incidents raise questions about the physical restraint of patients or residents who become violent. Proponents say restraint is a necessity in the clinical and institutional world where some confrontations can be handled no other way. Critics say the practice is barbaric and should be banned.

At the very least, say skeptics, the practice needs tighter controls and safeguards. They point out how many restraints seem to go wrong and to the lethal consequences.

The restraint method most commonly used today is the basket hold, so named because it serves to contain the patient in a more or less basketlike position. Dr. Jack Zusman, a professor at Florida Mental Health Institute in Tampa and author of a book on clinical restraint and seclusion, says a sort of consensus favoring the basket hold came about over the past generation or so.

"When I was in training, the accepted practice was the chokehold," he says. "At least we're past that."

In theory, the basket hold calls for a staff member, working from beside or behind the patient, to crisscross the patient's arms across the latter's chest and hold them firmly at the patient's waist. A second staffer is to hug the patient's legs.

The staffer behind the patient is to slump or fall backwards onto the floor, using his or her body to cushion the fall of both people. The leg-holding staffer follows them to the floor.

Finally, the arm-holding staffer is to roll the two together onto their side. Both restrainers should be verbally urging the patient to cooperate and calm down in order to be released. Afterward, the patient is to be released into a "quiet room" or other seclusion to regain composure.

The maneuver goes better with several restrainers working as a team, and often staff members are discouraged from initiating the restraint without someone to help out, according to Scott Lundy, executive director for foster care for Lutheran Social Services of the South, or LSSS.

He contends restraint is a necessary last resort for controlling youngsters whose violent conduct threatens others or themselves, then adds, "Almost every child we deal with has a history of violence to themselves or others. There's no way to work with these kind of kids and not do (restraints)."

After the death at the LSSS-owned Krause Children's Center in Katy, LSSS President Kurt Senske planned no change in the use of the basket-hold restraint at the organization's four facilities in Texas.

"We feel very strongly that this is the right type of restraint. We don't do mechanical or chemical (drug) restraint and believe the basket hold is the least harmful physical restraint possible."

But critics say the basket hold is too frequently connected with injuries and deaths to be regarded as anything but dangerous.

"In my opinion, it is not the least dangerous," says Zusman, who rates other measures, including drug restraint using new-generation tranquilizers and antidepressants, as far less risky.

"Even mechanical restraint, done right, is often better," he says, explaining how using arm (straps) and leg straps to subdue a violent patient face-up across a bed can work better than having staff members try to keep a grip on flailing limbs.

"There's still a struggle," he admits, "but tempers don't get so involved."

While some contend the basket hold can be OK if done correctly in the appropriate situation, others say it is far too susceptible to abuse or misuse, especially in understaffed facilities.

Jerry Boswell, president of the Citizens Commission on Human Rights in Texas, says his organization, founded by the Church of Scientology, opposes most drug-based psychiatric treatment and has been lobbying the Texas Legislature to ban physical restraint altogether.

"It's used too often for the convenience of staff or as a punishment measure," he contends. "How many kids have to die before it's finally done away with?"

Nevertheless, the ability to use physical control measures would seem a continuing need for staff members in facilities housing periodically violent youngsters or adults. Even small children can hurt themselves and others when they fly into a rage.

Zusman concedes the basket hold probably has its place but "should be used only very briefly ... when there is no other way to control the situation."

The goal of a basket-hold restraint is to get the patient subdued on the floor without impairing breathing or causing other harm, and then to let go as soon as resistance ends.

But hazards abound. One is the fall to the floor, which doesn't always go as scripted. Lundy, himself a former restraint trainer, says it's not unusual for staffers to suffer back and leg injuries from "takedowns" that go awry.

However, the more lethal risks are to the patient. Zusman says that application of too much force or improper leverage can squeeze the patient's chest, strain the heart and dangerously increase blood pressure.

A basket hold that winds up with the patient face down on the floor is doubly perilous because he or she can suffer breath-stopping rib damage, diaphragm constriction or aspiration of vomit, Zusman says.

Texas law prohibits face-down restraint, but incidents occur anyway.

In a Mason County wilderness camp northwest of Austin, a 17-year-old boy died on April 14 after a prone restraint in which no one detected that he had vomited. A final autopsy report is pending.

Even by-the-book restraints can include sudden wrenching movements by patients or staffers that can break bones or dislocate joints.

In every case there's a risk of psychological trauma, says Zusman. "It's unpleasant for everyone involved. It's rare for a patient to say thank you."

The five Houston-area cases cited at the outset exemplify what can go wrong during restraints. All are being investigated as possible criminal cases but none has resulted yet in homicide charges against specific defendants.

The incidents have much in common:

· The most recent, on Oct. 12, involved Maria Mendoza, 16, who died moments after being released from a brief basket hold involving four staff members at Krause Children's Center, a Katy residential treatment facility for youngsters with behavioral problems.

Senske says two staffers applied the restraint, and one other may have assisted briefly while a fourth monitored the situation. He says LSSS policy calls for team restraints in order to prevent one-on-one problems.

However, Katy police investigated and recommended homicide charges be brought by the Fort Bend County district attorney. The staffers have been suspended with pay, and the prosecutor's office continues its investigation.

The Harris County medical examiner's official cause of death for Mendoza was "mechanical" asphyxiation -- blockage of the airway by external means.

· Just two months earlier, on Aug. 25, a 23-year-old resident of Jireh Home Care in Missouri City died after a restraint applied when he became aggressive, according to state investigators. Matthew Vick, who was autistic and mentally impaired, was restrained on a floor by one or more staffers, but stopped breathing afterward.

Missouri City police investigated the case as a homicide and, like their Katy counterparts, now await the findings of the Fort Bend County district attorney and action by a grand jury.

The Harris County medical examiner found that Vick died of asphyxiation "by compression" -- restriction of his chest to the point he could not breathe.

· In July, the 1993 death of Dawn Renay Perry, 16, a patient at the Behavior Training Research facility in Manvel, was changed from natural to accidental by the Harris County medical examiner. The switch has prompted a criminal investigation by the Brazoria County district attorney.

Perry, who was mentally impaired, became unresponsive while being restrained by staff. An autopsy found she died of heart failure.

· Brazoria County prosecutors already were looking into possible criminal charges in two other deaths at youth facilities run by the company that owned now-defunct Behavior Training Research.

In February 2001, Stephanie Duffield, 16, died at Shiloh Residential Treatment Center in what the Harris County medical examiner ruled an accident resulting from exertion during a restraint.

Almost exactly one year later, Latasha Bush, 15, died three days after being restrained by staff at Daystar Residential Center, a successor facility to Behavior Training Research in Manvel. The Harris County medical examiner cited "mechanical" asphyxiation as the cause of death.

While many lawmakers and mental health caregivers aren't yet convinced that physical restraint should be banned entirely, some are looking into tighter regulation and oversight of its use.

State Sen. Judith Zaffirini, D-Laredo, has prefiled a bill for the 2003 session of the Legislature to prohibit types of restraint that can restrict a patient's breathing by compressing the chest or diaphragm or that interfere with the ability to talk.

In addition, her Senate Bill 59 would permit physical restraint to be used only when other means have failed, and would require that a person trained in the restraint, but not engaged in the application, monitor the patient's condition.

Students of the problem suggest several alternatives, some of them high-tech products unproven in the real world, and others, new applications of older common-sense ideas.

Among possible options to physical restraint are external chemical agents -- for example, less noxious versions of pepper spray and a new aerosol product that shoots out a sticky, stringy, entrapping web akin to the popular Silly String toy for children.

Police already employ electronic devices, such as electric-shock stun guns and high-intensity strobe spotlights, which may hold potential for use outside of correctional settings.

But restraint critics also say staffers in mental health facilities should rely on prevention and de-escalation more than they do.

Zusman suggests a new focus on facility design and furnishings, "like ways for residents to work off steam -- punching bags, for example." He says staffers need to be more alert to volatile situations before they erupt and be better prepared to defuse them through talk.

Kliewer, Terry. "Patient Deaths Raise Debate Over Physical Restraint." Houston Chronicle, 24 Nov. 2002.

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Closure of center for troubled kids follows years of woes

State child welfare officials on Friday shut down Daystar Residential Inc., a home for troubled youth, one day after a foster child's recent restraint death was ruled a homicide.

"Today, we have revoked Daystar's license to operate, effective immediately. The DFPS investigation found that this facility is just not safe for children," said Anne Heiligenstein, commissioner of the Texas Department of Family and Protective Services.

The closure, which can be appealed, was precipitated by the death of Michael Keith Owens, 16, whose death in November was ruled a homicide on Thursday.

All Texas foster care children had been removed from Daystar, a facility once licensed to care for as many as 141 children, by Thursday. Five other children placed at Daystar by California authorities were moved elsewhere Friday.

The Manvel-based Daystar, in operation since 1995, has made millions of dollars over the years caring for some of the most troubled and mentally disabled foster care children in the state, many of whom were housed in trailers about 25 miles south of Houston.

It was one of 80 residential treatment centers, known as RTCs, across the state licensed to care for such children, who number about 1,600. Since 2006, RTCs have received more than $300 million to care for these emotionally disturbed or disabled foster care children.

History of problems

But Daystar's 15-year history has been problematic, particularly over the last year. In June, the agency confirmed that a 16-year-old mentally ill girl had been sexually abused by a Daystar staffer the previous January.

That same month, the Houston Chronicle and the Texas Tribune reported that Daystar staffers had urged developmentally disabled foster care girls to fight one another for a snack in 2008. It was one of 250 confirmed abuse incidents that occurred at Daystar and the other 79 residential treatment centers.

As a result, no new children had been placed at Daystar since July while DFPS investigated the home. The agency quickly hired Jeffrey Enzinna as a state monitor to report on Daystar practices. Once there, Enzinna found lax record-keeping and a one-size-fits-all type of treatment for children.

"From reviewing incoming documentation, my impression is that there was a frequent use of emergency personal restraint and emergency medications," Enzinna wrote last fall. "There also appeared to be no program-wide systems of analyzing the use of restraints or emergency medications."

On Nov. 1, after Enzinna left Daystar, the agency decided to place the facility on probation because of the confirmed sexual abuse allegation from the previous June.

Boy was holding pen cap

Four days later, the 16-year-old Owens, who had been diagnosed with a mood disorder, died after a Daystar staffer physically restrained him in a bedroom closet. Owens had refused to show the staffer what he was holding in his hand, which turned out to be the cap of a pen.

Ruled a homicide by the Harris County Institute of Forensic Sciences, the case has been sent to a Brazoria County grand jury.

In December, the Chronicle reported that information on restraints used on children at RTCs was paltry at best. At least 54 of the 79 RTCs provided DFPS with only partial information, and 17 of those had failed to submit any documentation at all.

This potentially dangerous technique has been used at least 44,720 times on Texas children living at RTCs from January 2008 through August 2010.

DFPS' letter to Daystar, which notified the home it was to close, cited the restraint issue as one of the key reasons, saying Daystar officials failed to monitor and apply physical restraints that "minimized the risk of harm to the child."

Phone messages left for Daystar administrator Cal Salls and the company's attorney, John Carsey, were not immediately returned. There was no answer at the home of Daystar owner Clay Hill.

3 other restraint deathsDFPS' letter to Daystar, which notified the home it was to close, cited the restraint issue as one of the key reasons, saying Daystar officials failed to monitor and apply physical restraints that "minimized the risk of harm to the child."

Phone messages left for Daystar administrator Cal Salls and the company's attorney, John Carsey, were not immediately returned. There was no answer at the home of Daystar owner Clay Hill.

3 other restraint deaths

Owens' death was the fourth restraint fatality to occur at Daystar or its sister agencies in Manvel and owned by Hill, of Sugar Land.

In 1993, 16-year-old Dawn Perry died of an apparent restraint applied at Behavior Training Research, a facility that voluntarily relinquished its residential license to DFPS in 1998.

In 2001, Stephanie Duffield, also 16, died at Shiloh Residential Treatment Center after restraints were applied. Today, that facility is still open in Manvel, owned by Daystar's owner, but does not house Texas foster care children.

In 2002, 15-year-old Latasha Bush died at Daystar after restraints were applied.

Langford, Terri. "Closure of Center for Troubled Kids Follows Years of Woes." Houston Chronicle, 7 Jan. 2011.

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Feds sent immigrant kids to dangerous Texas youth facility, despite serious warning signs

By the time the federal government started sending immigrant children to Shiloh Treatment Center in 2009, the warning flags were waving blood red.

Three children had died after being physically restrained at Shiloh and affiliated facilities in rural Texas run by the same man, Clay Dean Hill. A teenager from California died after running away and getting hit by a truck. Texas officials repeatedly had cited Hill's residential centers for troubled youths after caretakers were found to have slapped, punched and kicked children.

Yet nine years ago, the U.S. Department of Health and Human Services sent its first delivery of federal tax dollars to Hill, a onetime longshoreman-turned-millionaire entrepreneur specializing in the care of vulnerable children. The federal government wanted Hill to take immigrant children with mental health problems who were caught crossing the border without parents or papers.

The funding started a couple of months before a male caretaker in his 40s was caught preying on a 15-year-old girl from California, sexually abusing her at one of Hill's all-girl dormitories, where he was assigned overnight. He's now a convicted sex offender.

"It shows you how disgraceful the place was," said the former resident, now 25, who told her story publicly for the first time to Reveal from The Center for Investigative Reporting.

The federal Office of Refugee Resettlement continued to send immigrant children to Hill's care after another teenager was killed during a restraint and the state of Texas shut down one of his facilities, deeming it unsafe for children. And this year, after immigrant children said in court declarations that they were forcibly injected with psychiatric drugs, federal officials claimed there was no problem. In all, the federal government has paid Shiloh more than $33 million for the care of immigrant youths.

It took a federal judge to force the refugee office to take action. U.S. District Judge Dolly Gee ruled July 30 that the Office of Refugee Resettlement must remove children from Shiloh unless a licensed psychiatrist or psychologist determines they pose a risk to themselves or others.

It didn't have to get to this point. The history of death and abuse at Hill's rural outpost for troubled children was no secret. Hill, 69, has remained a go-to provider for the Office of Refugee Resettlement even after multiple exposés by Texas newspapers, calls by members of Congress for Shiloh to be shut down and warnings from the local district attorney.

The story of Shiloh shows just how bad it can get at a child care operation the federal government deems worthy of taxpayer dollars and acceptable for immigrant children. Reveal previously found that private companies operating immigrant youth shelters across the nation have racked up citations for serious lapses in care. A ProPublica analysis of police reports found hundreds of allegations of sexual abuse, fights and missing children at these shelters.

Hill and Shiloh employees have not returned multiple calls by Reveal seeking comment.

A July statement on Shiloh's website says it has been investigated by various government agencies and "all of the widely distributed allegations about Shiloh were found to be without merit. The children have been found to be properly cared for and treated."

Trump administration officials also maintain that the children are in good hands at Shiloh and other facilities paid to supervise immigrant children. Scott Lloyd, director of the Office of Refugee Resettlement, said in a June press briefing that his agency is "proud of its partnership with our UAC care providers," using the acronym for unaccompanied alien children.

"I've witnessed firsthand the good work they do throughout the U.S. to ensure UACs receive proper care and services," he said.

The government's defense of Shiloh also points to a fundamental problem with federal oversight. In court filings this year, government lawyers made it clear that the federal agency responsible for the children puts much of its faith in state officials to monitor immigrant shelters such as Shiloh.

But Reveal has found that Texas licensing officials apparently failed to properly implement their own regulations when they shut down Hill's Daystar Residential Inc. facility and allowed Shiloh to continue. The law should have stopped Hill from operating any residential child care centers for five years.

It was a far-reaching failure that let Hill salvage his operation. Just as Texas stopped sending its foster children to Hill, the federal government was tossing him a new source of money: immigrant children.

Former employees told Reveal that they loved working with the children but were concerned that Hill has been allowed to stay in business, taking in a vulnerable population after decades of problems. Four said they were disturbed by the abuse that happened there while management looked the other way. They also said they didn't want to use their names for fear of retaliation.

"Some of these guys, they were just so rough and brutal," said a former employee who worked for years as a caretaker at both Daystar and Shiloh. "They seemed like they just wanted to always provoke the clients and get them to act out, get them to fight each other. They would abuse them."

Drugging kids

Clay Hill now faces a court order to stop drugging children without proper consent. Immigrant children, many traumatized by violence in their home countries, told of being threatened that if they didn't take pills, they would be punished with more time in Shiloh. Some said they were held down and forcibly injected with medication despite their objections.

Parents of the children said they never were asked permission to administer the powerful drugs.

This should not have been a surprise. Medication problems at Hill's facilities go back many years, Reveal found.

"If they get mad, they're gonna get a shot," said a former employee who worked with foster children at Daystar and immigrant children at Shiloh. "If they start talking like, 'I'm not going to do this,' they're gonna get a shot."

A Texas Education Agency review in 2015 cited Shiloh for requiring parents of special education students to consent "to the use of 'emergency' medications as a condition of acceptance."

"Some parents stated to the district that they did not feel their concerns were being heard by the facility doctors," the findings state. "It also was reported by some district representatives that they have observed a Shiloh staff member threaten to give students 'a PRN (emergency medication)' for misbehavior."

Ten years earlier, the Texas Department of State Health Services issued a scathing report on medication practices at Daystar. A team of experts found a troubling pattern: "There was no evidence of documented, informed consent for prescribed medications."

The diagnoses and treatment plans were "canned" and often didn't correspond to the patient, the report said. Children and their families were not being told why they were being given the drugs. Many children were developing weight problems and some as young as 10 years old had high cholesterol.

"In almost none of these children were the elevated laboratory tests addressed," the review found.

Daystar's psychiatrist at the time was Dr. Javier Ruíz-Nazario, a longtime fixture of Hill's operation and the same man immigrant children at Shiloh said was giving them medication. In fact, all four psychiatrists listed on a 2007 organizational chart for Daystar also are named on Shiloh's forms for dispensing medication to immigrant youths.

Still, federal officials assured a judge in May that Shiloh didn't need more oversight.

Jallyn Sualog, deputy director of the Office of Refugee Resettlement, said in a court declaration: "To my knowledge, Texas state licensing officials have not reported any concerns regarding Shiloh's compliance with state guidelines concerning the administration of psychotropic medications" to detained immigrant children.

Sualog asserted that "the board certified child and adolescent psychiatrists" at Shiloh use "best practice guidelines."

Ruíz-Nazario, however, hasn't had board certification to treat children and adolescents for years, Reveal found. After Reveal's story, Sualog filed a revised declaration acknowledging that.

Another federal official said in an April letter to attorneys for the children that the Office of Refugee Resettlement has a medical team that monitors treatment and has visited Shiloh. In a footnote, he admitted the agency "does not, however, employ child and adolescent psychiatrists who would have the training to scrutinize the specific medications prescribed by Shiloh experts."

Overmedicating the children to keep them in line was common practice, said three former employees. Two said caretakers would ask doctors to boost the medications to make the children sleepy and easier to deal with.

Even if federal officials were not paying attention to the findings of Texas agencies, they should have seen the Houston Chronicle's 2014 investigation of Shiloh, which raised questions about the use of psychotropic medications. The story prompted U.S. Rep. Sheila Jackson Lee, D-Houston, to call for Shiloh to be shut down.

Jackson Lee told Reveal that she reacted to the recent news of problems at Shiloh with "a combination of disbelief, disappointment and outrage." She had assumed the government stopped sending immigrant children there after the previous outcry.

"I'm sure there are some nice people there, but the overall record makes it inappropriate to send traumatized children to this facility. So it is very much a great disappointment to me," she said. "I'm kind of taken aback."

Who is Clay Hill?

Clay Hill has a special education degree from the University of Houston and a teaching certificate, according to a deposition he gave in 2003. After college, Hill started working with an autistic child and later ran a treatment center in Dallas.

In the 1990s, Hill founded Daystar and Shiloh, building a sprawling campus out of trailers and houses off country roads south of Houston. He created a variety of interrelated corporate entities, but Hill was behind it all.

He took in the most vulnerable children: emotionally disturbed foster kids, nonverbal autistic children and special education students school districts couldn't handle. Many were from Texas, but some were sent there from California and Guam.

The operation thrived because he would accept children no other facility would, former staff members said. Some were extremely disturbed and volatile, at times attacking caretakers.

Hill set up Daystar as a nonprofit at the suggestion of state officials, to allow for the use of federal tax dollars, according to his deposition. Daystar then leased the land, buildings, furniture and vehicles and contracted services from Hill's for-profit entities.

Hill even served as president of the now-defunct Daystar Pharmacy, a for-profit that provided drugs to his programs. Years ago, the pharmacist there got caught using fake prescriptions to steal some 15,000 pills, including more than 7,000 doses of opioids, according to state records.

Daystar and Shiloh sat near each other, sharing some staff and leadership. The children living at Daystar often went to school at Shiloh. At one point, their administrative headquarters were different parts of the same trailer.

At the same time, Hill created a baseball team for elite high school players that claims big-leaguers Josh Beckett and Matt Carpenter as alumni. Hill ran a nonprofit called Texas Tournament Baseball with a former banker who went to prison for fraud and later worked at Hill's treatment facilities. Ex-employees said ballplayers without experience caring for troubled children would sometimes work there, too.

Former employees said Hill seemed to care more about making a profit than improving the lives of children.

Hill took in compensation of $680,000 in 2006 and $720,000 in 2007, the most recent years he reported the amount in public tax filings. That was down from a salary of more than $1 million that he reported in 2001. Meanwhile, children had limited facilities for recreation, former workers said, and lived in buildings sometimes cited by state regulators as grimy and dilapidated.

"It was all about money with him," said Caroline Laifang, who worked as a special education teacher at Shiloh for several years in the 2000s. "If you're trying to explain to him this is not in the best interest of the students, he'll let you know – this is a business."

Hill, for his part, said he was constantly working for Shiloh and Daystar.

"I think I work 24 hours a day, seven days a week because I'm on call all the time," he said in his 2003 deposition, "and I respond to every call."

Dangerous restraints

In October, David, a 13-year-old boy from El Salvador, didn't feel safe at Shiloh Treatment Center.

Fearful of employees who screamed at him, David packed a bag to escape. When he tried to open a window, he said in a court declaration, a supervisor threw him against the door and pinned him against the wall.

"This made me feel like I was choking and it was hard for me to breathe. I told the supervisor to stop because I couldn't breathe," David's declaration states. "I briefly fainted. As I recovered consciousness a staff person violently threw me on my bed and this caused my head to bang against the wall."

It was eerily reminiscent of scenes described in medical examiner reports when U.S.-born children died in Clay Hill's care.

Dawn Renay Perry had been struggling with depression, aggressive behavior and low mental function when she was placed at Hill's Behavior Training Research facility, in the same area outside the town of Manvel where Shiloh sits now.

In April 1993, the 16-year-old was held face down on the floor by four people, records show.

"After restraint was applied multiple times, the decedent relaxed and rolled up into a ball as she usually did when she quit fighting," medical examiner records state. Then she vomited, turned blue and stopped moving.

Stephanie Duffield was also 16 when, in 2001, she became upset that a Shiloh staff member didn't escort her to the bathroom quickly. There was a struggle, and the assistant held her down, face to the carpet, putting her weight on Duffield's shoulders, according to medical examiner records.

Duffield protested, saying she couldn't breathe. Then she did stop breathing. The medical examiner called it "sudden cardiac death following hyperactivity and physical exertion during restraint," ruling it an accident.

Hill said in a 2003 deposition that he didn't think his staff did anything wrong.

"I thought it was just another horrible, horrible incident," he told a lawyer representing Duffield's family. "I happen to be – considered myself a friend of Stephanie's, had worked with her two days before. She bit my hand and scratched it and all the things that she could do. And we were friends. It – it broke my heart to see the kid die."

"So, you know, I thought she died of a heart attack," he said. "I didn't think the length of the restraint had a lot to do with it."

He didn't see a pattern when, a year after Duffield's death, 15-year-old Latasha Bush also died following a restraint.

The girl, who was diagnosed as bipolar with the emotional age of a 6-year-old, had told her one-on-one caretaker, Tisha White, that she wet the bed at night because she was afraid of her.

White said in a deposition that Bush was restrained by other caretakers after it appeared she was going to throw a flashlight and then threw herself against the wall, cracking it, and repeatedly asked to be left alone. White said the employees put Bush on her side, but a youth in the house said one of them was sitting on Bush and she was screaming that she couldn't breathe.

The medical examiner called it homicide by asphyxiation. State licensing officials said she suffocated as a result of being restrained with excessive force. The district attorney told The Dallas Morning News in 2003 that she considered prosecuting but lacked hard evidence of criminal intent.

Hill called Bush's death "a horrible tragedy" but saw no fault in his operation's methods.

"Based on the information we had, we felt like the restraint was done the way it was supposed to be done," he told a lawyer for the Duffield and Bush families, who ended up settling their lawsuits.

"I'm not willing to agree that the restraint caused the suffocation," he said.

Those deaths had been well publicized by the time federal officials awarded Shiloh $480,000 in May 2009 to start sheltering immigrant children.

What they didn't know was there would be another.

In November 2010, Michael Owens, a 16-year-old battling depression and behavioral problems, gasped for air in a closet smeared with blood. Daystar employees had taken him to the floor, pulling his arms behind him, when he began "huffing and puffing," medical examiner records show.

He died from asphyxiation, the medical examiner found, also noting "blunt impact trauma of face, torso and upper extremities." Like Bush's death, it was ruled a homicide.

His death was one too many for the state of Texas. Officials stripped Daystar of its license, cut off its multimillion-dollar contract and moved out all the children who lived there in 2011.

Texas' foster care agency wouldn't send any of its own children to Shiloh, either. In response to concerns from the district attorney, the Department of Family and Protective Services wrote in a 2011 letter that it "has no intention of contracting or placing any CPS children with Shiloh, Inc. and staff has been instructed accordingly."

But Hill got a big break from the state. Licensing officials kept Shiloh open for business, and that was good enough for the federal government, which was ramping up its delivery of immigrant children and millions of taxpayer dollars.

A month after Owens' death, the U.S. Department of Health and Human Services awarded $1.8 million to Shiloh to take in detained immigrant children. The address on federal funding records is the same as the one on Owens' autopsy report.

Problems continued. In 2011, state officials found a Shiloh caregiver restrained a child without justification, causing "an injury to a vital body area." He had lifted up and then dropped the child to the ground, records show, putting his body weight on top. Within two months, the federal government awarded Shiloh $2 million more.

With the influx of immigrants, state investigators started finding a new twist on an old problem: Shiloh didn't always have employees present who could speak the child's language.

A Honduran boy was bleeding from his mouth and screaming in Spanish that he was in pain while being held down in 2013, according to witness accounts described in state records.

One of the employees restraining him admitted that he did "not speak Spanish and he would not be able to understand if (the boy) was complaining."

The federal Office of Refugee Resettlement and its parent agency, the Department of Health and Human Services' Administration for Children and Families, declined an interview and did not respond to repeated requests for comment.

Slapping, punching and kicking

In November, an 11-year-old girl said in a signed declaration that she'd rather live on the streets in her native Honduras than stay at Shiloh.

"On at least two occasions staff members have tried to hurt me," she stated. "One time a staff member put her two thumbs up to my throat and her hands around my neck. It hurt and I was gasping for breath. The staff member said she was just 'playing' but I felt scared."

Such testimony should come as no surprise to government officials.

On several occasions over the years, Texas investigators found that employees at Hill's facilities slapped, hit and kicked children. In one case, an employee bit a child during a restraint. In two others, employees punched children in the head.

An employee bathing a 16-year-old resident caused severe bruising to the teenager's buttocks. Another child, a nonverbal 8-year-old boy, was found with multiple marks to his lower back and bottom. Years later, a cellphone video surfaced showing a Shiloh employee slapping a nonverbal autistic child.

At one point, a Daystar supervisor and another employee instructed seven developmentally delayed residents to fight, using snacks as a reward for the winner. The staff "laughed and cheered as the residents fought," leaving multiple injuries, according to state records.

Former employees said there were people working there who were doing their best. But they also told of abuse by co-workers that they couldn't forget: the ones who beat up a foster child, the one who frightened an autistic boy with sexual comments, the one who offered to teach how to choke children to "put them to sleep."

A former Shiloh caretaker said other employees would antagonize children to get them to act out, prompting a painful restraint.

"It was just like they got a kick out of it," said the former worker. Some of them were longtime employees, and no one would get in trouble, she said. She ended up quitting because, she said, "I didn't want to be a part of any of that."

Even in the early years, getting beat up was a part of life at Hill's treatment centers, said Brielle Gillis.

"It was to a point where you got beat so much that you felt like you deserved it," she said.

Gillis arrived in the 1990s as an 11-year-old foster child, removed from an abusive home, she said. Now 35 and transgender, she went by the name Jeremy Keith Gillis at the time. Gillis spent her adolescence at Hill's facilities until she got out in 2001.

One time, she said, three caretakers ganged up on her.

"They was holding me down, folding me like a pretzel, and they was stomping and kicking me," she said.

An adult witness to the beating confirmed it to Reveal and said nothing came of it.

Any complaints would get back to the caretakers, who would punish the children, Gillis said. In any case, she said, kids were written off as troubled liars.

Many years later, after a state investigator determined that Shiloh employees used excessive force in restraining a 14-year-old Honduran boy who had been abandoned as a baby, Hill defended his staff.

"Mr. Hill stated the kids can be very manipulative and will make up stories to get staff in trouble," the investigator wrote in 2013. "He stated he trusts his staff in doing the right thing."

'Controlling persons'

Texas has a law to prevent someone such as Clay Hill from running another child care facility when one gets shut down.

The state warned Daystar that its "controlling persons" – those determined to exercise control over the facility – would be barred from running another residential facility for five years.

If there was a person in control at Daystar, it was Hill.

Hill said it himself in his 2003 deposition when the family of Latasha Bush sued Daystar. He said he was the ultimate authority in terms of hiring, giving raises, training staff and accepting patients, though he delegated some decisions to underlings. The executive director of Daystar, Carroll "Cal" Salls, reported to Hill, he said.

State licensing officials should have known as much. A 2007 organizational chart in state files lists Hill at the top of Daystar. And state records list Hill as a "controlling person" at Shiloh.

It was even more clear on the ground, said former employees and residents. From Daystar to Shiloh, Hill ran everything.

"He's the one who runs the show," said former employee Caroline Laifang. "No decision is made without Clay Hill knowing about it."

But somehow, the state didn't see it that way.

"In conducting its investigation, the state found that Daystar Residential and Shiloh Treatment Center did not share a controlling person," said John Reynolds, spokesman for the Texas Health and Human Services Commission.

Still, the federal Office of Refugee Resettlement had plenty of opportunities to pull the plug. The Brazoria County district attorney, Jeri Yenne, wrote a letter to federal officials in 2011 "out of concern for the safety of children."

"This is due to the fact that there have been a number of deaths over the years of minors placed on the property managed by Shiloh and its affiliate corporation Daystar Treatment Center," she wrote. "I am requesting increased monitoring of Shiloh Treatment Center and that your agency review the same and consider limiting the number of children placed in Shiloh Treatment Center."

Relying on state oversight

This year, an attorney representing immigrant minors at Shiloh wrote a letter urging federal officials to stop sending children there. It focused on the drugging problems, but noted Shiloh's connection to Daystar and the deaths.

An Office of Refugee Resettlement official responded by making a point of distancing Shiloh from Daystar.

"Notably, Shiloh RTC (Residential Treatment Center) is not operated by DayStar Treatment Center (DayStar), which is mentioned in your letter," wrote senior federal field specialist supervisor James De La Cruz. "Even when it was still in business the licensure of Daystar was completely separate from that of Shiloh."

The distinction is lost on former employees and residents. And Clay Hill wasn't the only person who oversaw both institutions during their darkest moments. Kellie Pitts has been in charge of quality control at Shiloh since 1999 and also held that role at Daystar, according to Hill's deposition. Tisha White, who was briefly suspended but cleared of wrongdoing in the 2002 death of Latasha Bush, appears to work at Shiloh, based on her Facebook profile and accounts of others. Pitts and White could not be reached for comment.

When lawyers representing the children asked a federal judge to intervene this year, government attorneys shot back that there is already plenty of oversight.

Federal officials argued that the court "should not conduct its own evaluation," but rather "should rely on the State's own evaluation."

"Given this extensive level of oversight by the states," the government's filing says, "this Court can – and should – reasonably rely on the conclusions of those state licensing authorities."

Yet state licensing officials, also responsible for the Texas foster care system, have been found to be dangerously ineffectual.

Federal District Judge Janis Graham Jack ruled in December 2015 that Texas was fundamentally failing to protect foster children. Among widespread problems, she found the state licensing agency was "failing its licensing and inspecting duties" and "almost never takes an enforcement action."

She cited an internal review that found error rates of up to 75 percent in the state's investigations of abuse allegations.

"This is staggering," she wrote, "and it means that many abused children – for whom a preponderance of evidence indicated that they were physically abused, sexually abused, or neglected – go untreated and could be left in abusive placements."

It is the same agency that investigated 30 complaints of abuse or neglect at Shiloh since October 2012 and ruled out every one of them, according to Department of Family and Protective Services records.

Texas, the judge found, "has closed one facility in the past five years, but it is a story of horror rather than optimism regarding enforcement." She was talking about Daystar.

Texas authorities "allowed this facility – that was responsible for four deaths, numerous allegations of sexual abuse, and unthinkable treatment of developmentally disabled children – to operate for 17 years," the judge wrote. "The Court does not understand, nor tolerate, the systemic willingness to put children in mortal harm's way."

In January 2018, the same judge issued a grim update: "Over two-years later, the system remains broken."

Jack ordered continued monitoring of the state system by appointed special masters. Texas Attorney General Ken Paxton appealed the ruling to the U.S. Court of Appeals for the 5th Circuit, where it is pending.

"The ruling was arrived at by an unelected federal judge who misapplied the law, hijacked control of our state's foster care system, and ordered an ill-conceived plan by the special masters that is both incomplete and impractical," Paxton said in an April statement.

Former federal officials said they were doing the best they could.

"There was definitely a sense that the problems at Shiloh were problems that could be fixed," one ex-official said. Given that Shiloh maintained its state license, "working to address the issues seemed like the right thing to do to keep the capacity on line."

There weren't a lot of other options for immigrant children with serious mental health problems, said the former official, who requested anonymity: "It is a specialized facility. We don't have a ton of those in the system."

Even one case of child maltreatment is unacceptable, but in a system housing thousands of children, it is also inevitable, said Maria Cancian, who was deputy assistant secretary for policy in the Administration for Children and Families, over the refugee resettlement office, from 2015 to 2016.

"Sometimes things are going to happen that shouldn't happen," she said.

The refugee resettlement agency tightened oversight, Cancian said, including increasing unannounced visits to shelters by field representatives.

"Was it enough? Almost certainly not," she said. "There's almost never a child service organization in this country that is adequately resourced."

Cancian said she visited shelters that were "overwhelmingly staffed by people who were trying to do their best, and by and large, they were places that provided high-quality care."

"The exceptions are absolutely not acceptable," she added, "and it's appropriate to shine a light on that."

Evans, Will, Lance Williams and Matt Smith. "Feds Sent Immigrant Kids to Dangerous Texas Youth Facility, Despite Serious Warning Signs." The Texas Tribune, 8 Aug. 2018.