The nurse who examined a 16-year-old boy in the weeks before he died at the Arizona Boys Ranch says she is not responsible for the teen's death since he showed no signs of an infection.
In her first interview since the boy died on March 2, the nurse, Linda Babb, tells New Times, "I just want to set the record straight that I am not the cause of this child's death."
Babb, a registered nurse who worked at the Boys Ranch Oracle facility until shortly after the incident, says Nicholaus Contreraz showed no signs of distress before he died of complications from an infection that had filled his chest with two and a half quarts of pus.
Contreraz was sent to Boys Ranch, a boot-camp-type facility for troubled teens, by California juvenile authorities.
Babb's comments come in response to investigations by several agencies. In the wake of Contreraz's death, the California Department of Social Services issued a scathing report on the quality of medical care at Boys Ranch, and California officials have said they will no longer pay to send kids to Boys Ranch.
In addition, Arizona's Board of Nursing has opened an inquiry into Babb's treatment of Contreraz. The death also remains under scrutiny by the Pinal County Attorney's Office and the state Department of Economic Security, which regulates Boys Ranch.
In an interview at her home outside Tucson, Babb says she was to meet with investigators from state Child Protective Services on Monday.
An autopsy done on Contreraz, who was ordered to Boys Ranch in January, shows the infection took weeks to develop. Dr. David Chadwick, an expert on child abuse retained by California officials, wrote in his report that diagnosing Contreraz's infection should not have been "a challenging medical task."
Babb, who worked as an intensive care nurse and nursing instructor before her time at Boys Ranch, came under direct criticism in the report. She made a "fatal error" when she diagnosed his gasps for breath as "hyperventilation," Chadwick wrote.
However, Babb says that the reports don't tell the whole story.
"It's like that armchair quarterback; it's really hard unless you were actually there," she says.
Babb's account of Contreraz's last days differs greatly from previous reports, which rely in part on her nursing notes and statements she made to Pima County investigators.
Babb confirms that she only listened to Contreraz's lungs with a stethoscope once and only took his temperature with a thermometer once, about a week before his death. But before he died, she says, he could control his breathing and his skin was cool to the touch.
She says that the last time she saw Contreraz alive, just a couple of hours before he died, he showed no signs of a fever or discomfort. Contreraz was with two staffers, and refused to walk, Babb says. The staffers asked her if they could carry him, and Babb said yes. The staffers put the boy into a fireman's carry, she says.
"He said he was fine. He wasn't panting. He wasn't grimacing. His breathing was normal. His color was normal," she says.
There was no "really outward thing" to tip off the nurse to Contreraz's illness, Babb says. "That Monday morning [the day Contreraz died], he was out there doing work crew and moving rocks. I had lunch with the child and he ate everything on his plate. At 3, he just didn't want to [walk]. He was fine up until that point. . . . He was fine, basically he was fine, and it's not like he never had the opportunity to tell somebody."
While the DSS and sheriff's reports say Contreraz was constantly complaining of pain and illness, Babb says the teen clammed up in her office. Aside from general reports of fatigue and aches, Babb says, Contreraz never told her he had a fever or difficulty breathing in the days before he died. "He never complained to me," she says.
Babb claims Contreraz protested to her when she made him sit out from the camp Olympics five days before he died. "He was furious with me," Babb recalls.
Contreraz could always get his breathing under control, Babb says, which is why she diagnosed him as hyperventilating.
"He was able to control it [his breathing]. If he was in respiratory distress, he could not have stopped [gasping]. If you're not able to breathe, you're not able to breathe all the time," she says.
Babb believes that the mass in Contreraz's chest was contained, and didn't become critical until it burst. This made it impossible for her to see any symptoms, she says.
"You can have a rotten egg that's closed in there, but you don't know it's rotten until it's broken open," she says. "And something broke open this encapsulated infection, and when that happened, then all the other stuff happened."
Chadwick, California's expert, rejects Babb's explanation.
"Nothing burst," he tells New Times. "There was no evidence on the autopsy of anything rupturing."
Contreraz's death was caused by the steady pressure of the accumulation of fluid on the lung, he says.
And Chadwick reiterates that Babb should have caught on when Contreraz had difficulty breathing.
"Even a person in respiratory distress can exercise some control over it [breathing]," he says. "If you're going to apply a term like hyperventilation, you should know how to recognize it."
Still, Babb maintains she never thought Contreraz was faking or "malingering," as some other Boys Ranch staffers have told investigators.
"Whenever those kids came into my office, I took them all seriously," she says. "My office was like a safe area. If there was a problem, they could come to me. They trusted me. . . . They were not shy to let me know they were hurting," she says.
In the ranch's atmosphere, Babb says, Contreraz seemed normal.
"We had kids with real problems, and they were taken care of," she says. "We also had kids who would often go and stick their finger down their throat to throw up. If they didn't show other symptoms, and it wasn't, you know, a one-time shot, then I wasn't worried."
Even the fact that Contreraz had to be carried by staff wasn't unusual, she says.
"That's not always that uncommon," she says. "They'd sometimes have sit-down strikes if they didn't want to go do something."
Babb says her treatment would have changed drastically if she'd been aware of what Contreraz was going through.
"If we had known what every staffer knew and what every kid said in the reports, things would have been done a lot differently," she says.
She says Boys Ranch staff never told her about Contreraz's almost constant vomiting and defecation. Before he died, Contreraz was made to carry a pail with the clothes he'd soiled, and every time he threw up or defecated on himself, he'd add more clothes to the bucket.
"I didn't know this stuff until I read the police reports, that he had diarrhea all the time, that he was carrying a bucket to throw up into, stuff like that," she says. "I didn't see him with a bucket. I didn't know that this was a big problem."
Although Babb does not blame herself for Contreraz's death, she says it still weighs on her. "I wish I could have stopped whatever happened to that point that we weren't able to fix it," she says. "It still hurts."
Babb's life has changed since the incident at the ranch. She was fired when she refused to resign, after being placed on a two-week suspension by Boys Ranch administrators, she says. (Boys Ranch CEO Bob Thomas says that Babb came to a "mutual understanding" when she left the company.) She is now working at a local clinic.
She says she is hounded by reporters who leave phone messages on her unlisted number and pound at her door. She says she has also filed police reports about being followed.
Babb also recently responded to the first inquiries from the state Nursing Board, and she knows that the questions will keep on coming.
However, she's certain that even if a lawsuit is filed by the family of Nicholaus Contreraz, she'll be exonerated.
"I have relived his last week a lot, and I don't see anything that I missed," she says. "I would have done everything the same because there were no outward symptoms."
Contact Chris Farnsworth at his online address: firstname.lastname@example.org