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By Dennis Wagner
Nicholaus Contreraz should have been in a hospital on March 2, instead of doing construction work, struggling with Arizona Boys Ranch staffers and dying, medical experts say. Dr. Philip Keen, medical examiner for Maricopa County, said that's the only possible diagnosis after hearing that Contreraz, 16, collapsed at the home for delinquents with a severe lung infection. "I'm astounded that you'd get that kind of disease process without making it to the infirmary," said Keen. Instead, Contreraz was forced to do calisthenics on the day he died. At one point, Boys Ranch staffers helped the boy do push-ups by grabbing his belt and pulling him up and down. At the time, says an autopsy by the Forensic Science Center in Tucson, Contreraz's lungs were filled with pus - the byproduct of pneumonia, bronchitis and strep and staph infections. He had been sick with empyema, an accumulation of pusin the lining between his left lung and chest cavity, for weeks. Finally, after a hellish day at the ranch near Tucson, his heart stopped beating for lack of oxygen. Bob Thomas, president of the eight-campus Boys Ranch network, said he, too, is concerned about the failure to diagnose Contreraz's lung ailment. "Our internal investigation is ongoing," said Thomas. "I'm as interested as everybody else. I don't want this to ever happen again. . . . What could we have done? What did we not see?" Dr. Bruce Parks, who conducted the autopsy, could not be reached for comment on what role the physical stress may have played in Contreraz's death. Keen said it is hard to imagine health experts missing Contreraz's ailment. "With that much empyema, the person should have been hospitalized," he said. Dr. David Baratz, a Phoenix pulmonologist, said empyema might be hard to recognize if the victim is suspected of malingering, because lethargy is the primary symptom. "They (patients) could just feel malaise - tired and fatigue," he noted. "If they didn't do a chest X-ray, it could get missed." However, Baratz added, alarms should have gone off during a basic stethoscope evaluation, a standard practice in physical exams. "You should be able to hear some sounds that say, 'I need a chest X-ray,' " he said. "The guy should have had some symptoms." Asked if death would be hastened for a juvenile empyema victim who was put to work, forced to exercise and then struggled with adults, Baratz said, "It certainly wouldn't help. . . . I can't imagine someone with empyema putting up a huge struggle." Thomas described Contreraz in terms similar to the boy who cried wolf: "His pattern was he lived in the nurse's office." In fact, Thomas said, Contreraz got a physical when he arrived at Boys Ranch eight weeks ago, visited a doctor twice, and was seen by nurses more than a dozen times. Thomas said he's been told that the infections may not have been readily detected because they were in the lining of the lung. He said Boys Ranch has not obtained Contreraz's medical records from California, but he has learned that the youth was cared for at an intensive-care unit twice in the recent past. Boys Ranch officials told state authorities that Contreraz was given a cursory medical exam two days before his death, noting that he "checked out OK." After Contreraz lay on the ground, refusing to work, he was checked again by a registered nurse who determined that there was "no reason why he could not work or complete any activity." After doing construction in the morning, Contreraz was assigned to leaf cleanup. When he balked, staffers ordered him to do calisthenics. When he refused again, they put him in an isolation barracks. When he fought back, they placed him in a "control position." When he defecated on himself, they carried him to a shower. When he would not get dressed, they put clothes on him and helped him do more calisthenics. Then the boy died. The medical examiner's report lists 71 external injuries - scrapes, cuts, bruises and punctures - found on Contreraz. His death is being investigated by the Pinal County Sheriff's Department and the state Department of Economic Security, which licenses Boys Ranch. Within hours after Contreraz died, a DES report says, ranch officials had conducted an internal probe that concluded there was "no wrongdoing on the part of staff." Thomas said some of the 71 external injuries resulted from efforts to resuscitate Contreraz after he collapsed, and others can be attributed to work and exercise in the rugged back country. Thomas emphasized that the Oracle home is an orientation program designed to prepare juvenile delinquents for the strict life at other campuses. However, he downplayed the amount of physical activity required of juveniles. "It's really not a boot camp," he said. "It's orientation, where you start a kid." Thomas said Contreraz was not forced to do calisthenics and "wasn't even exercising that day." He later confirmed that the boy was ordered to do "remedial calisthenics" but declined to say what those entail. Thomas said 90 percent of the problems encountered with Boys Ranch juveniles occur during orientation, when youngsters are most recalcitrant and have not learned to adjust. He said Contreraz was so obstinate that ranch officials nearly shipped him out, but were persuaded to keep trying. Thomas said sheriff's officials told his staff they are not conducting a criminal investigation. Mike Minter, a spokesman for the Pinal County Sheriff's Department, said detectives have not completed their investigation, which will be submitted to the County Attorney's Office. Jim Hart, a DES administrator, declined comment on an investigation by the division of children, youth and families.
Copyright 1998, The Arizona Republic
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