Medical Probe

State medical officials are the latest to investigate the death of a teenage boy at the Arizona Boys Ranch. They're looking into the conduct of the nurse and doctor who examined 16-year-old Nicholaus Contreraz before he died of a massive infection.

Their inquiries come as a California report rips the quality of the facility's medical care. And state licensing and law enforcement officials are still investigating the March death.

Arizona's Osteopathic Board of Examiners (OBEX) and Board of Nursing have begun reviews of Dr. Virginia Rutz and Linda Babb. Rutz and Babb cleared Contreraz to work and exercise at the Arizona Boys Ranch, a last-chance facility for troubled youth. Despite being given a clean bill of health, Contreraz died on March 2 of a heart attack brought about by an infection that filled his chest with two and a half quarts of pus.

OBEX began its investigation into Rutz for "questionable care" in late May, three months after Contreraz's death. The nursing board opened a complaint against Babb at the end of June. Citing state confidentiality laws, board officials didn't release details about the complaints.

Rutz, the camp's physician, found nothing wrong with Contreraz in his entrance physical two months before he died. Babb repeatedly saw Contreraz during his stay at the ranch and repeatedly cleared him for physical activity.

However, a report released last week by the California Department of Social Services blames ABR's medical staff for contributing to Contreraz's death. The report concluded, "Recognition of Nicholaus' illness was not a challenging task. . . . The condition could have been treated if recognized early. . . . Nicholaus' medical needs were severely neglected."

Based on the findings of the report, California pulled all youth at Arizona Boys Ranch from the facility and barred future placements.

Dr. David L. Chadwick, a consultant on child abuse, reviewed the medical records of the Contreraz case for the California agency. He called Rutz's decision to clear Contreraz for physical activity at ABR "questionable practice." Noting that Contreraz had asthma, Chadwick said, "Putting an asthmatic into a situation where exercise is utilized for discipline and pushed without limit seems to be asking for trouble."

Rutz, an independent contractor to the Boys Ranch, was already on a five-year probation by OBEX for improper prescription of drugs.

Rutz says that she's responded to OBEX's questions about her care of Contreraz. "They believed that I had seen the boy just before he died. And I said, 'No, that's not true.' I can't be held responsible for something I didn't see . . . two months ahead of time," she says.

Rutz also says she can't answer Chadwick, because she hasn't seen the report. She says, "I didn't have an opportunity to review Nicholaus; certainly if I'd seen him again, and reevaluated his asthma and it couldn't be controlled, we would have sent him off the ranch and back to California."

But the report's most damning comments are directed at Babb, who until the current complaint had no record with the state nursing board.

When Contreraz saw the nurse the day before he died, she diagnosed his gasping for air as hyperventilating, and gave him a paper bag to breathe into. Chadwick calls this a "fatal error."

"She mistook the signs of impending respiratory failure for 'hyperventilation.' Differentiating between the two is not a challenging medical task," he said.

The "true nature" of Contreraz's problem might have been discovered much earlier, he added.

"The condition could have been diagnosed at any time during the 7-10 days prior to death if competent medical personnel had evaluated him," Chadwick said.

Chadwick determined that ABR's and the state's health-care standards "fall far short of national standards, and this flaw is likely to have contributed directly to the death of Nicholaus Contreraz."

The report is also studded with incidents where Contreraz saw the nurse, complaining of health problems, only to be put back to work.

Even on the day he died, when the nurse saw Contreraz "being supported by two staff," she apparently did not take any action. "She asked Nicholaus what was wrong and he replied that he could no longer walk and that he hurt all over," the report says. "Her advice to him was to slow down his breathing."

Babb was placed on administrative leave by the ranch after Contreraz's death, which is also the subject of an ongoing criminal probe. She did not return calls for comment.

Cassandra McCray of the Arizona Boys Ranch did not know Babb's current status with the company. She declined to comment on the California report or the medical care Contreraz received while at the facility.

Contact Chris Farnsworth at his online address: [email protected]