Two young patients repeatedly attempted to kill themselves in a three-week span earlier this year at a leading Denver eating disorder clinic after a doctor told staff to ignore their behavior, a state investigation found.
The two patients — aged 11 and 14 — arrived at the nationally renowned Eating Recovery Center’s Spruce Street clinic in Denver within a day of each other in early June. Both had histories of self-harm and suicidal ideation, in addition to their eating disorders. As their behavior escalated, lower-level staff raised concerns that they weren’t capable of caring for the patients.
But the center’s leaders kept them anyway, in violation of the facility’s own policies, according to an investigation by the Colorado Department of Public Health and Environment. Top providers believed the patients’ behavior was an attempt to get out of treatment. They addressed the mounting suicide attempts via “therapeutic ignoring” and increased check-ins. At one point, one of the patients was left in a hallway for 10 minutes amid one attempt, until other patients rushed over and called for help.
After a different attempt in mid-June, the facility’s leadership emailed staff and acknowledged how “scary” such behavior can be. Still, they wrote, it wasn’t possible for patients to “seriously hurt” themselves by putting objects around their necks. If the patients tried, they said, they would likely just lose consciousness.
“At this time, we are OK with that,” the officials wrote, according to one investigative report.
The subsequent state investigation revealed that the two patients attempted suicide more than 15 times in the days after that email was sent, with one patient making 10 attempts in a single day. Investigators issued five citations to the facility, repeatedly criticizing it for keeping the patients in spite of its own policies and for instructing staff to ignore the patients’ self-harm and stated intentions. The state found that the physician directing the patients’ care was not actually a certified psychiatrist and that senior Eating Recovery Center officials failed to provide oversight of the facility and the care it provided.
The state is now “closely monitoring” the facility, health department spokeswoman Gabi Johnston said. After the facility submitted a corrective plan, investigators reviewed the facility again in September and gave it a clean bill of health. Typically, facilities aren’t penalized financially if they correct problems that the state found.
Dr. Anne Marie O’Melia, the Eating Recovery Center’s chief medical officer, told The Denver Post that the two patients’ treatment “goes against all of our policies and training.” She said she and other senior leadership only became aware of the issues when the state health department launched its investigation in August. She said oversight has increased and that there have since been leadership changes at the Spruce Street facility.
“Patient treatment care and concerns are our absolute priority,” O’Melia said. “When we found out that there were practices that were different than the standard of care, then we immediately worked to retrain staff and to make sure that the ways that we communicate, the practice of managing all behaviors, including unsafe behaviors, is more closely monitored by additional oversight outside of just that one facility.”
The state health department declined to detail any ongoing investigations into the Eating Recovery Center. The agency’s investigation into the suicide attempts was sparked by two complaints, Johnston said. She declined to provide those complaints or detail them. The two patients were both discharged, she said. It’s not clear what happened to them afterward.
The investigation comes amid heightened scrutiny for the Denver-based Eating Recovery Center, one of the most prominent eating disorder treatment providers in the country. Ex-patients previously told The Post that the company used tactics that felt punitive, like threatening to use feeding tubes or refusing to allow patients to go outdoors, to ensure compliance. Spurred on by those complaints, lawmakers earlier this year considered a proposal to tighten regulations for the company and its peers in Colorado. They later dropped those plans because of cost concerns.
Vincent Atchity, the president and CEO of Mental Health Colorado, called the state health department’s findings “starkly scandalous” and said they bolstered advocates’ calls for tighter scrutiny of eating disorder facilities in Colorado.
The Eating Recovery Center is considered a national leader in eating disorder treatment. Owned by two private equity firms, it operates four clinics in Denver, according to its website, and its presence here has helped make the city a hub for eating disorder care. The facility’s leadership has detailed stories of critically ill patients who successfully addressed their eating disorders under the center’s care.
But other patients previously told The Post that the Eating Recovery Center’s methods had increased their own trauma and, for some, intensified suicidal ideation, depression or anxiety. Several said staffing was typically tight and turnover was common, a complaint supported by former staff members who spoke to The Post.
O’Melia said the company had improved its staffing and retention.
Patients with severe suicidal ideation or uncontrolled self-harming behavior aren’t supposed to be at the Eating Recover Center, a therapist who worked at the center for two years told The Post. She spoke on condition of anonymity because she feared backlash at her current job.
But it’s not always possible to tell who’s going to get worse, and management has an incentive to admit as many patients as possible, she said.
The therapist said she didn’t feel staff had the resources needed to keep patients safe. When a patient attempted suicide, it would fall on the therapists to explain what went wrong. There was often no satisfying answer to give parents, she said, since she wasn’t allowed to tell them there weren’t enough staff to watch their kids.
“We weren’t able to provide the exceptional care they boast about,” the therapist said of the facility’s leaders. “I felt like someone would have to die in our care for the higher-ups to take our concerns seriously.”
“Therapeutically ignore”
The two patients who repeatedly attempted suicide spent fewer than three weeks at the facility in June. Each had shown a pattern of suicidal ideation and an intent to take their own lives before they were admitted, the state investigation found. Both should’ve been transferred away from the Eating Recovery Center to higher levels of care, according to the facility’s internal policies.
Four days before two other patients discovered the 11-year-old attempting suicide in a hallway, the 14-year-old patient had been found in her room in a similar state. A physician told staff “to take no action and therapeutically ignore the patient,” according to the state health department’s investigation, because he believed the patients’ behavior was an attempt to get out of treatment. The two patients were repeatedly taken to nearby emergency departments and then returned to the facility.
But they were not always taken to the hospital: A nurse wrote that after one of the patients attempted suicide 10 times in one day, she requested the patient be sent to a nearby emergency room. But “the clinical team denied this suggestion and implemented therapeutic ignoring,” according to the state’s investigation.
Staff said they raised concerns to facility leadership about the patients’ self-harm and suicidal ideation, according to the state’s investigation. But more senior providers said the patients’ risk of dying from their eating disorders outweighed the risk of their death by suicide.
The patients’ care was ultimately overseen by the clinic’s medical director, who, together with another official, sent the email telling staff they were OK with patients strangling themselves into unconsciousness.
The medical director was listed on the facility’s website as a psychiatrist. But state investigators determined the official was a pediatrician, not a certified psychiatrist, and criticized the facility for failing “to ensure the medical director’s credentials and privileges accurately reflected his education and training.”
After the state asked questions about the medical director’s background, the facility quickly updated its website and removed “psychiatrist” from the provider’s title. A spokeswoman for the Eating Recovery Center said the listing on the website was a “mistake” that was corrected. O’Melia, the chief medical officer, said facility leadership was aware the provider was not a psychiatrist and that he was still practicing within the scope of his expertise and licensure.
The state reports do not name any of the providers interviewed or involved in patient care and instead refer to them by their titles. According to an archived version of the facility’s website, Michael Spaulding-Barclay was the medical director in May. He is no longer listed on the Eating Recovery Center’s website. O’Melia confirmed Spaulding-Barclay oversaw the two patients’ care and that he was no longer with the center. She declined to say if he left voluntarily or if he was terminated.
Attempts by The Post to contact Spaulding-Barclay last week were unsuccessful.
O’Melia said the Eating Recovery Center has since improved anonymous reporting systems, so lower-level staff can raise concerns about treatment protocols to senior officials outside of specific clinics.
“A very fine line”
It’s unclear whether “therapeutic ignoring” is widely used across the company’s facilities, which span several states. Senior Eating Recovery Center officials told state investigators that ignoring suicidal patients’ behavior “was not an accepted practice at the facility,” nor was allowing patients to asphyxiate themselves. Those patients, O’Melia said, should’ve been removed from the facility and sent to a different provider.
Em Troughton, a former patient at the Eating Recovery Center who previously described negative experiences at the Spruce Street facility, said that therapeutic ignoring was a common tactic for noncompliant patients, including those with self-harming or suicidal behaviors. Troughton, who uses they/them pronouns, said that while other patients received therapy, Troughton was left in a hallway alone because they struggled at mealtimes.
Therapeutic ignoring wasn’t a general policy, the former Eating Recovery Center therapist told The Post, but each provider had to use their own judgment about whether a patient was truly in despair or was trying to accomplish something else, like getting attention. Staff were more likely to ignore relatively mild self-harm, such as patients scratching themselves, to see if the behavior stopped, she said.
“It’s a very fine line, and it’s hard to say,” she said. “A lot of kids think, ‘This is my way out of treatment.’”
O’Melia said it was never OK for staff to ignore dangerous behaviors and that the facility had retrained its providers to ensure they were appropriately directing suicidal patients to higher levels of care.
But she said ignoring patients’ actions can be useful for low-level behavior, like name-calling or yelling. She said the company’s internal policies have been reviewed and revised to make clear that doesn’t apply to self-harm.
Suicidal behavior is common among people with eating disorders. A 2019 study estimated about 25% of patients with anorexia nervosa had at least one suicide attempt in their history, as did about 23% of those diagnosed with binge-eating disorder and 31% of those with bulimia nervosa.
Dr. Mindy Westlund Schreiner, an assistant professor and clinical psychologist at the University of Utah, said it’s not appropriate to use therapeutic ignoring as a way to address self-harm. It can be an option for milder behaviors, such as throwing tantrums, because the child eventually realizes the tantrum isn’t going to get them what they want, she said.
The danger is that children will almost always escalate their behavior before abandoning it — throwing a more violent temper tantrum when the parent ignores behavior they might have caved to before, for example — and when the child is injuring themselves, the risk they’ll do serious harm to themselves is too great, Westlund Schreiner said.
In addition, she said, if a child hurts themselves and sees that no one seems upset, that can reinforce any feelings they’re having that no one cares about them. The better response to self-harm, in addition to keeping the patient safe in the moment, is to help them work through what function the behavior is serving and come up with better ways to meet their needs, she said.
“There’s a time and place for (therapeutic ignoring), but the time and place is not when there could be harm to the patient,” she said.
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Originally Published: November 13, 2023 at 6:00 a.m.
