Nicholaus Contreraz
By Rhonda Bodfield
The Arizona Daily Star
A California doctor recently determined that an Arizona Boys Ranch nurse made a ``fatal error'' by failing to diagnose a 16-year-old boy's lung infection.
The day before Nicholaus Contreraz died, the nurse thought he was hyperventilating and gave him a paper bag.
Distinguishing between the two conditions ``is not a challenging medical task,'' said Dr. David Chadwick, director of the Center for Child Protection at San Diego's Children's Hospital.
Chadwick said the lung infection probably built up over a period of two weeks and ``would have been diagnosed at any time during the seven to 10 days prior to death if competent medical personnel had evaluated him.''
If detected early enough, the boy's condition could have been successfully treated, Chadwick said.
California's Department of Social Services asked Chadwick to review the March 2 death of Contreraz, who was placed at Boys Ranch for a joy-riding conviction.
California administrators based their decision in part on a finding of abuse and medical neglect in the Contreraz case, as well as a pattern of abuse at the Oracle camp where Contreraz died.
Boys Ranch President Bob Thomas has not responded to individual findings in the California report. He closed the Oracle camp in June after finding some staff members violated disciplinary policies.
Thomas said he also is planning changes in the medical program, and has sought input from the American Medical Association and other organizations.
In his report, Dr. Chadwick questioned whether Boys Ranchnurses should have more independence from correctional staff members.
The National Commission on Correctional Health Care Standards and the American Academy of Pediatrics support keeping health care providers at correctional facilities separate from other employees, Chadwick's report stated.
``The circumstances point out a probable policy which made the nurse responsible to the (Arizona Boys Ranch) staff and administration, rather than to an independent health care authority,'' he determined.
The day before he died, Contreraz complained to nurse Linda Babb that he hurt all over and had tingling in his fingers and toes.
Some staff members thought Contreraz was faking and continued to force him to do exercises until moments before he collapsed and died.
A Pima County autopsy following his death determined 2 1/2 quarts of pus in his chest cavity caused his left lung to almost collapse. The right lung showed signs of pneumonia and chronic bronchitis.
His death may have been hastened by the forced exercise and inhaling of foreign material into his working lung, Chadwick said.
Vegetable and meat material consistent with Contreraz's stomach contents were found in the lung.
Chadwick determined the boy inhaled the material after being forced to do push-ups near or over a bucket containing his vomit and excrement-soiled clothes.
Babb could not be reached for comment. Her public nursing file shows she was in good standing since her 1981 certification to practice in Arizona.
But last month, Babb contacted the Arizona State Board of Nursing to report the incident, asking for an investigation in order to clear her name.
In interviews with Pinal County investigators, Babb said she believed Contreraz was making himself hyperventilate because he would stop taking shallow breaths when she talked to him.
She said she did not listen to his lungs with a stethoscope the day before his death or when she saw him again hours before he died.
She also did not take his temperature, but said she did feel his skin. The only record of his temperature ever being taken was on Feb. 23 when he complained of a fever and chills, the California investigative team found.
The Pinal County Sheriff's Department is continuing its criminal investigation into Contreraz's death and other abuse reports at the Oracle camp. Arizona Department of Economic Security officials are reviewing whether to renew Boys Ranch's license.
California's Chadwick questioned whether Contreraz should have been admitted to the program because of a pre-existing asthma condition severe enough to require treatment, but not hospitalization.
A medical clearance form for Arizona Boys Ranch filled out in December, just weeks before he arrived, shows a doctor checked ``no'' to a question whether the minor had any medical problem that would have limited his participation in strenuous exercise.
Youths with asthma have not been ruled out of the program in the past.
``Providing medical clearance for Nicholaus Contreraz to be sent to a program in which vigorous exercise was required and was used as discipline was questionable practice because asthma may make vigorous exercise impossible at times,'' Chadwick said.
He added: ``Putting an asthmatic into a situation in which exercise is utilized for discipline and pushed without limit seems to be asking for trouble.''
Copyright The Arizona Daily Star
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