Indictments Against AYA in Jensen's Murder

[Anonymous]

You are all being incredibly judge mental.   Were any of you there, do you know the people involved? What about if it comes out that the staff are not to blame ? Then good people will have been wrongly accused, and their lives ruined.

Hey.  I'm alll for due process, but this isn't a jury here.  Nothing said here (unless, arguably if it is factually false) could possibly affect the outcome of the life of the man in concern.  Opinions are protected speech, as are evaluative opinions where you state a conclusions based on facts and source them, which is happening here.  People do reach different conclusions and have different opinions on the basis of the same facts.

What if they're not to blame?  Then I'm sure the court will find them innocent.  Even so, there are many clear cut cases where a jury has found people innocent of the most heinous crimes against kids.  Look at the Martin Lee Anderson case, for example.

[Anonymous]

Utah doctor indicted in death
By Brian Maffly
The Salt Lake Tribune
Article Last Updated: 09/05/2008 08:55:36 PM MDT

Posted: 8:48 PM- A prominent Utah County physician stands accused of negligent homicide in connection with the death of a Salt Lake City teen in a southwest Colorado wilderness therapy program.
    But Keith R. Hooker, who has worked in the emergency department at Utah Valley Regional Medical Center since 1970, says he is innocent. And the indictment, which also accuses him of child abuse, contains no allegations about what he is alleged to have done or failed to do.
    Caleb Jensen, 15, died May 2, 2007 from a staphylococcus infection, which Colorado prosecutors contend went untreated despite glaring symptoms. The boy spent the last week of his life lying in his own urine and feces, in a remote field camp operated by Alternative Youth Adventures in Montrose County, court documents allege.
    Jensen had been sent to the camp by Utah juvenile justice officials. Colorado authorities shut AYA down two months after Jensen's death.
    Hooker, who served as the program's medical adviser, was indicted in July and related documents were unsealed Aug. 25. He was arraigned in a Montrose, Colo. court last week and pleaded not guilty. His next hearing is scheduled for Oct. 6.
    Reached at his Mapleton residence Friday, Hooker declined comment. His Provo lawyer, Mike Esplin, said he has not seen testimony given before the grand jury, but he believes
there is insufficient evidence to support the charges.
    "Doctor Hooker never examined Caleb. His role is an adviser to the program. We think it's an overshot," Esplin said. "He didn't give [AYA] any advice concerning this incident. We are in the dark. [Investigators] never talked to him."
    Montrose County District Attorney Myrl Serra did not return phone calls.
    Also charged are camp emergency medical technician Ben Askins, who faces a more serious charge of manslaughter; program director Jim Omer and the businesses, Alternative Youth Adventures of Colorado and its corporate parent, Community Education Centers Inc.
    The New Jersey-based company provides treatment to 6,000 juvenile and adult offenders a year, in seven states. A corporate spokesman said the company was in the process of closing AYA at the time of Jensen's death, but declined to comment further.
    No charges were filed against field counselors who tended to Jensen and later spoke to investigators.
    Jensen was admitted to AYA's 60-day program on March 28, 2007. He had undergone an initial medical exam in Utah, but the exam did not reveal any illness, court documents said. His symptoms began April 23 when "it was noted that Caleb had a small blister located on his right ankle," the indictment said.
    The teen wrote in his journal the next day that he was "burning up, vomiting and having trouble hiking."
    Suspecting Jensen of "faking" his illness, camp staff separated him from the group until he died eight days later, the charges allege. Staff ordered him to wear diapers and put him on suicide watch, but allegedly did nothing to treat the fatal infection.
    Askins checked the boy on April 26 after he complained of hip and knee pain. Jensen was given ibuprofen but none of his vital signs were recorded. Jensen was soon urinating and defecating on himself and fellow students expressed concern about his health, documents said.
    For the last three days of his life, Jensen was not eating and he rarely stirred from his filthy sleeping area. Counselor Tracy Hale noted that he would lie in the sun most of the day without attempting to move into shade, the charges said.
    Field staff repeatedly called Askins and Omer at the AYA base camp, but no staff responded and no additional medical attention was ordered, documents said. After Jensen died on the afternoon of May 2, a helicopter ambulance crew responded to Hale's call for help and pronounced the teen dead at the scene.
    Omer and Askins could not be reached. Jensen's mother, Dawn Woodson, declined to comment, citing the advice of her Salt Lake City attorney, Tom Boyle. "We are investigating the facts and circumstances," Boyle said.
    Hooker, who also advises Utah County search and rescue, remains on UVRMC's medical staff. "If in the course of the proceedings something comes up, then we would re-examine that," hospital spokeswoman Janet Frank said.
    Hooker's indictment is a shock to many who have worked with him in Utah's wilderness therapy industry. He helped found Loa's Aspen Achievement Academy and serves as medical director for Wilderness Quest in Monticello.
    He was inducted in 2005 into the Clan of the Hand, an industry hall of fame.
    "In my dealings with him, he has been very professional. . . . [He] has a great knowledge of young people in a wilderness setting and the types of protocols that need to be in place to make sure they are safe," said Mike Merchant, who runs an Arizona program and presides over the Wilderness Quest board.
    http://caleb-jensen. memory-of.com/about.aspx

[Ursus]

The panel consisted of: Dwayne Roberts, MD, CCFP, CCFP (EM), CAQ Sports MED, Director, Utah Valley Sports Medicine Fellowship, Utah Valley Regional Medical Center, Edwin Weigh, PA, Medical Consultant for the Catherine Freer Wilderness Therapy Expeditions; and Dr. Keith Hooker, sports physician, emergency room doctor, mountain climber, one of the founders of the Aspen Program, and a medical consultant for many wilderness programs

To begin the discussion, Dr. Hooker explained there is no cost-effective way of screening all the potential risk factors in applicants of wilderness programs; even major sports teams do not use expensive tests unless an applicant’s case history indicates the need for further testing.....

Edwin Weigh, PA (Physician's Assistant), was the person who ran the code, from OR, on our daughter, Erica Harvey, while she was dying in NV.  He was also described, by Freer personnel,  before and after her death as Dr. Weigh.  Took us at least a year to find out otherwise.

Some panel--was that at a NATSAP event or OBHIC?

It was the quarterly meeting of OBHIC in January of 2003 when they were discussing the screening of risk factors and also the relevance and use of the PPE…………..
...

ding, ding, ding... that's right who....
three years after OBHICs report claiming wilderness to be safer than normal teen activities,
and a few months before Catherine Freer's THIRD avoidable death.

I'm not sure that the program affiliations of that "panel of physicians" have been sufficiently highlighted. This panel specifically addressed the question, "Why do kids who pass physicals still die in programs? Are there things that we should be aware of that we don't currently assess?"

• Dr. Dwayne Roberts, Director, Utah Valley Sports Medicine Fellowship, Utah Valley Regional Medical Center, medical director at Redcliff Ascent

• Edwin Weigh, PA, medical consultant for the Catherine Freer Wilderness Therapy Expeditions

• Dr. Keith Hooker, Utah Valley Regional Medical Center EMR, co-founder of Aspen Achievement Academy, medical consultant for several wilderness programs

Here is the full summary of that quarterly OBHIC meeting, emphasis as per the original:

-------------- • -------------- • -------------- • --------------

Medical Risk Screening Among Topics Discussed at O.B.H.I.C. Meeting

[Summarized by Loi Eberle, M.A., Educational Consultant
& Editor-in-Chief, Woodbury Reports, Inc.]

On January 9, 2003, the quarterly meeting of the Outdoor Behavioral Health Industry Council included regular working committee discussions, as well as guest speakers who discussed their areas of expertise with OBHIC members. The content of these presentations will be summarized later in this article.

One topic that sparked a great deal of interest was the discussion lead by a three-member panel of medical doctors who worked with wilderness programs and/or sports teams. They discussed the purely medical causes of potential fatalities in the field, how to assess the degree of risk associated with various kinds of symptoms described in applicants' case histories, and what programs can do to reduce the risk of potential medical emergencies in the field.

In another session, Mike Hylman, a regional USFS recreational use/outfitter permit manager explained ways to improve relationships between outfitters and land use agencies. Later, Thomas Garriga, President of Positive Control Systems (PCS) led a discussion about the therapeutic hold techniques that are taught in his system.

Keith Russell reported on the status of the research activities he has been conducting through the U of Idaho, sponsored by the Outdoor Behavioral Healthcare Research Cooperative, the research arm of OBHIC. He also presented a proposal for a second study in which new data would be collected from participating programs.

Other OBHIC business included approving the minutes from the previous meeting, discussing membership applications and fees, and scheduling future meetings. Membership information will be posted on the OBHIC website: http://www.obhic.org, which for the last three years has been hosted by Woodbury Reports at http://www.strugglingteens.com, and now will be hosted on OBHIC's own site, and administered by Mark Hobbins of Aspen Educational Group.

More detailed summaries of the topics discussed at the OBHIC meeting will follow.

Medical Doctors Describe Ways to Better Screen for Risk Factors

A panel of three physicians who are experienced in wilderness and sports related medical issues qualified in the field of sports medicine discussed the question, "Why do kids who pass physicals still die in programs? Are there things that we should be aware of that we don't currently assess?"

The panel consisted of: Dwayne Roberts, MD, CCFP, CCFP (EM), CAQ Sports MED, Director, Utah Valley Sports Medicine Fellowship, Utah Valley Regional Medical Center, Edwin Weigh, PA, Medical Consultant for the Catherine Freer Wilderness Therapy Expeditions; and Dr. Keith Hooker, sports physician, emergency room doctor, mountain climber, one of the founders of the Aspen Program, and a medical consultant for many wilderness programs

To begin the discussion, Dr. Hooker explained there is no cost-effective way of screening all the potential risk factors in applicants of wilderness programs; even major sports teams do not use expensive tests unless an applicant's case history indicates the need for further testing. Dr. Roberts then described a relatively simple initial screening form, used both for sports teams and extreme sports competitions, that is based on published medical standards. They feel this same examination form is an appropriate tool for medical screening of applicants of wilderness programs, since these programs are less physically demanding than high school or collegiate sports, and certainly less demanding than extreme sport competitions.

This screening tool, called the Preparticipation Evaluation, is described in a 33-page monograph with the same name, which states: "The PPE has been in place for decades as an integral part of competitive sports. In fact, of the 51 state high school associations governing interscholastic sports (50 states and the District of Columbia), only one does not officially require a medical evaluation before a student can participate in high school athletics... In 1996... an American Heart Association (AHA) consensus panel developed recommendations specifically concerning cardiovascular screening to be included in the PPE. This was a major step forward in that a leading national subspecialty association achieved consensus on specific recommendations to improve the detection of cardiovascular abnormalities during the PPE...a major goal of the PPE is to identify athletes at risk for cardiovascular catastrophe. This has proved to be difficult at best. The evaluation currently recommended by the AHA, consisting of certain historical information and findings of the cardiovascular exam, has the potential to identify some, but not all, athletes at risk." Further information about the PPE can be obtained at: http://www.physsportsmed.com/issues/199 ... glover.htm.

Although the monograph points out "the difficulty of detecting certain conditions that preclude sports participation," the doctors on the OBHIC panel explained that question #5 on the PPE is considered to be the most important, cost-effective way for becoming aware of possible undiagnosed cardiac problems. These potential cardiac problems could either be due to an incomplete development of the heart, or due to problems of conductivity, the electrical activity involved in maintaining the beating of the heart. Conductivity problems are particularly troublesome, since they do not show up on an autopsy, but could responsible for cardiac arrhythmias that are the cause of a death.

"Yes" answers on any of the subcategories of question #5 indicate the advisability of further tests before clearing an applicant for participation. It was also emphasized that it is important that the professional doing the examination is fully aware of the level of activity for which the applicant is being screened.

Both the medical panel and the PPE monograph described "the (medical) history as critical in identifying athletes who may require further, more directed examinations." In addition to the answers to question #5 on the PPE, knowledge of the applicant's medical history, along with that of the mother and father is considered to be the most effective screening method for ruling out risk factors; 90% of potential medical problems can be identified in this way. This information is particularly important, it was explained, because even expensive tests like the echo-cardiogram do not show all kinds cardiac conductivity problems, though a "stress-echo" can be used to show some conduction problems.

The standard of practice is that if the PPE indicates potential cardiac problems, then a cardiologist needs to clear the person for participation. Also, the parents may need to sign a release of liability. It was felt that the parents should have to prove that a child is safe to go on expedition, if problems show up on the form; it should not be the responsibility of the program to conduct further tests in these cases.

The panel explained this screening is especially important because other factors can cause physical interactions. Stimulants, both prescription, such as Ritalin or Adderol, and non-prescription, such as methamphetamines, as well as antibiotics, can interact with anxiety and a high level of physical activity to increase the risk of cardiac arrhythmias, especially in the presence of undiagnosed cardiac problems. They also identified triptolines, a form of anti-depressants, as having a potentially dangerous interaction when these other factors are also present.

Emergency drugs used in the field can also cause dangerous interactions, especially when undiagnosed cardiac rhythm problems are present. It is important for programs to consult the same type of charts that pharmacists consult, if they need to administer emergency medication in the field to someone who is on prescription medication.

Dr. Hooker stated that in addition to cardiac problems, a few other conditions that would not be acceptable in the wilderness include: Seizure disorder, orthopedic problems that would keep the applicant from hiking, "sugar" disorders, such as diabetes and hypoglycemia, and asthma. Also, if there is a history of mononucleosis within the past year, it could have infected the heart or brain, causing further risk with increased physical activity. The presence of long-term alcohol problems in adult wilderness program participants can also greatly increase the risk of medical problems in the field. It was also pointed out that there might be different exclusions for sports than in the wilderness, because the wilderness is less of a controlled setting. Also, if there has been "heat stroke" or cold injuries in a person's history, their system is damaged forever, and close monitoring is advised.

Another potential problem is being extremely overweight. The Body Mass Index (BMI), based on a ratio of height and weight, is a very simple measure that has a high correlation with risk for various conditions, as well as being a performance indicator. For example, the "IRON MAN" data shows that if a person's BMI is just above average, there is no chance of that person being among the top one third of the finishers in that competition.

Another cause of potential medical risk in the field is electrolyte imbalance, which was identified as being more problematic than dehydration, and takes longer to reestablish proper balances. Electrolytes are especially needed for endurance events. If a person is complaining of dizziness, nausea, lightheadedness, they are kids at risk. The advice is to listen to them, and back them off from activity. It is a "salt issue." Various forms of effective electrolytes were discussed, from tablets, bouillon cubes, Gatorade, to V8 juice. Also, it takes a period of hours to restore imbalances, so it is important to monitor electrolytes, as well as water, to keep hydrated. The observation was made that kids who get in trouble from a medical standpoint are the ones who are pushing themselves too hard. An important medical history question is to ask whether they have ever been treated for being dehydrated? Also, having an infection with a fever puts a person at risk, because they can't control their body temperature well.

In terms of complications resulting from drug use prior to entering the wilderness, it was pointed out that the most dangerous time is the first 72 hours. The acute withdrawal phase can be dangerous, and must be closely monitored. Hiking hard and low hydration in combination with stimulant use all create risk, though the first 24 hours are considered the worst risk. After that, it has moved out of the system.

In addition to some simple guidelines, for example, "exercise is almost as good as prozac for depression, so is being an appropriate weight," they concluded by stating that outdoor behavioral healthcare is rewarding, but risky work, yet statistically is pretty safe; by far safer than letting the kids remain on the street, doing their usual activities.

Permits and Outdoor Use Issues

Mike Hylman, USFS regional manager, described ways to develop good relationships with land management personnel, and potential changes the permit process. One major recommendation was to invite the local USFS administrators into the field, so that they can see what OBH programs are doing and why. At very least, he recommends that programs get to know well, the district administrator and the person to whom they are required to report.

In addition to this general advice, Dr. Rob Cooley of the Catherine Freer program suggested joining America Outdoors, to lend support to that group's activities regarding the permit process. America Outdoors is active in promoting the Outfitter Policy Act, RS2477, which is opposed by some environmental groups because it would require non-profits to go through the same permit process as commercial outfitters and would allow motor access in some areas not currently permitted. Mark Hobbins suggested, and it was agreed by the OBHIC members, to join and contribute to America Outdoors.

The benefit of "fee retention" was discussed, which involves requesting a small percentage of the permit fees to stay in the district. The Missoula, Montana forest service district demonstration project was described, in which $900,000 of permit fees is spent locally on trail maintenance. In the past the concern has been that fee retention would create more local bureaucracy, but it was emphasized it could be used for trails. "Flat fees" were also advocated, which could be based on use, though it was pointed out that "low end" outfitters would probably have their fees raised in this case. Flat fees are easier to maintain and plan for. The feeling was the group should support flat fees and fee retention, and Mr. Hyleman implied the forest service could agree to this policy if it was requested by enough of the wilderness industry.

Mike Hylman also announced the availability of a variety of Forest Service utilities that are either for sale, or rent, many with surplus government structures. Further information can be obtained through the forest wide and region wide lists maintained by the Forest Service Engineers, starting with the local forest district.

Outdoor Behavioral Healthcare Research Cooperative (OBHRC) report:

Dr. Keith Russell informed the steering committee, chaired by Mike Merchant of the Anasazi Foundation, of the importance of the recent publication of the initial OBHRC study in a top tier journal. Now it can be stated that there IS published research on the benefits of this approach. Considered a "seminal piece", the article was published under the title: "Perspectives on the Wilderness Therapy Process and Its Relation to Outcome," by Russell, K.C., & Phillips-Miller, D. (2002) in the Child & Youth Care Forum, 31(6), 415-437. According to the abstract, "Findings indicate that physical exercise and hiking, primitive wilderness living, peer feedback facilitated by group counseling sessions, and the therapeutic relationship established with wilderness guides and therapists were key change agents for adolescents. These factors helped adolescents come to terms with their behavior and facilitated a desire to want to change for the better."

In addition to running further regressions on this data for future journal articles, he is also conducting 24-month follow-up calls on the study participants. He also presented his proposal for another study, to test the relative effectiveness of Outdoor Behavorial Healthcare as a treatment model. His proposed study will address several hypotheses regarding "expected relationships between treatment, circumstances-motivation-readiness-suitability to treatment (CMRS), level of depressive symptoms, treatment intensity, aftercare intensity and outcome variables that focus on the reduction of substance use and depressive symptoms. Research methods include self-report questionnaires administered to adolescent clients and pre-and post-treatment, and at 6-month follow-up periods."

Russell also emphasized the importance of developing a manual of OBH treatment that adequately describes the similarities of approaches used by various OBH groups in a way that is acceptable to each of them. While acknowledging that there were many variations in how various groups accomplish each of these recognized elements of OBH, by finding a common description that adequately describes this approach, they will make strides in being recognized as a treatment modality.

He summarized his remarks by emphasizing the need for the industry to continue to inform the public about the research that is being conducted and published. This is an important way for the effectiveness of Outdoor Behavioral Health to become more widely recognized.

CORRECTION: DR. DWANE ROBERTS IS MEDICAL DIRECTOR AT REDCLIFF ASCENT
(Feb 19, 2003) Loi Eberle, M.A, Educational Consultant and Editor-in-Chief, Woodbury Reports wishes to apologize to Redcliff Ascent Wilderness Experience 800-898-1244, Enterprise, Utah, for neglecting to identify Dwayne Roberts, MD, CCFP, CCFP (EM), CAQ Sports MED, Director, Utah Valley Sports Medicine Fellowship, Utah Valley Regional Medical Center, also as the medical director at Redcliff Ascent. Redcliff Ascent was instrumental in arranging Dr. Roberts' role in this excellent discussion.


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