Orangewood Auditor Won’t Release Report

ORANGE —  A psychiatrist overseeing an outside audit of medication practices at Orangewood Children’s Home is refusing to hand over her report because she fears being sued for defamation if the report is made public, county officials said Wednesday.

Dr. Melinda Young of Torrance, hired in March along with two other auditors after Orangewood staff members complained that one psychiatrist was improperly medicating youngsters, says she will not turn over the report unless she can be assured it will remain confidential, said county Mental Health Director Timothy Mullins.

Mullins said he cannot guarantee the report will remain secret because he must make the results known to public officials who have an interest in the county-run home’s operations.

“I am stymied,” Mullins said. “I need her to finish the report. To start from square one is totally counterproductive.”

Young did not return repeated telephone calls from The Times.

“Join the club,” said Mullins, who said Young hasn’t returned his staff members’ calls either.

The new wrinkle in the review comes after the audit was delayed for months by the chaos of the county’s bankruptcy. The review originally was ordered by Supervisor William G. Steiner last November but did not begin until spring.

“The problem will not be resolved and there will not be closure until the findings of this medication audit are complete,” said Steiner, a former director of Orangewood, a 236-bed home for abused or neglected youngsters.

Besides being “embarrassing,” Mullins said, the impasse with the lead auditor is disturbing because the psychiatrist whose medication practices were questioned is still working for the county Health Care Agency and is treating children. The psychiatrist no longer works at Orangewood, however, Mullins said.

Mullins said he does not know what the audit concluded and has no reason to believe the findings are critical. But Steiner said the psychiatrist who is the subject of the review was at one point disciplined for “untimely charting practices” and placed on unpaid leave for three days.

Both Steiner and Mullins said they are confident that drugs now are being dispensed properly at Orangewood.

Young’s report has been complete since late June, mental health officials say. The two colleagues who assisted her, a psychiatrist who works for Los Angeles County and a pharmacologist at Camarillo State Hospital, have completed their portions, but the report will not be meaningful without the conclusions of the lead auditor, Mullins said.

Young, who was to receive as much as $10,000 for her work, has not been paid, Mullins said.

A memo from a county mental health manager shows that Young and her co-auditors raised concerns about “personal liability” for the results of the study as early as April. It is not clear what assurances they were given at that time.

But Young has since been assured she will be held harmless in the event of a lawsuit, said Teri Schultz, a staff member with the mental health agency who has tried to resolve the issue. “I have no idea why she should be concerned with that,” she said.

Several attorneys said no one is immune from lawsuits, but a state code applying to official government proceedings appears to protect a government contractor such as Young from liability. Some suggested that the county’s contract with Young may obligate her to hand over the report.

Auditors aren’t “retained just to give a favorable opinion,” said Michael H. Shapiro, a law professor and ethicist at USC. “They [aren’t] retained to say, ‘This is unfavorable and I’m not going to release it.’ ”

Mullins said he understands doctors’ traditional preference that peer reviews be kept confidential so that criticism is not stifled and reviewers can be as forthcoming as possible. In this case, however, the auditor’s concerns appear to be “overblown,” Mullins said.

A former staff member who initiated the complaints against the Orangewood psychiatrist said she is worried the troubles there will be covered up if the report is not released. Zaida Ramos, who supervised social workers and psychologists at Orangewood, said she was not satisfied with the way the audit was conducted, but does not want to see the results squelched.

“I think it’s a disservice to the children,” said Ramos, a licensed clinical social worker. “What they looked at and what they found should be made public.”

In a 10-page memo last November to Dr. Bernard Rappaport, who oversees children’s mental health for the county, Ramos complained that four children at Orangewood--ages 10, 9, 8 and 4--had been over-medicated and given possibly inappropriate combinations of drugs, such as antipsychotic medications mixed with antidepressants.

She suggested that some children were given the drugs without appropriate consent by parents or guardians and complained that the psychiatrist did not consult with other physicians on medication use or keep up with charting as necessary. She also said other staff members at Orangewood told her they suspected the psychiatrist was conducting unauthorized medication research.

Ramos said in her letter that she was informed by one doctor that boys under the psychiatrist’s care in an Orangewood cottage “are at times so sedated that they cannot stand up.” She voiced particular concern about the use of a new antipsychotic drug called Risperdol, which she said has not been tested on children and has potentially serious side effects.

Few psychiatric medications have been approved for use in children, and while such drugs may legally be dispensed to youngsters, there is some debate over which ones should be used and in what dosages.

Mullins said he took Ramos’ concerns seriously and ordered an outside audit because he wanted objective evaluators who were unconnected with the Orangewood psychiatrist.

“We’re still working under the premise that this lady [Ramos] had legitimate concerns,” Mullins said.

Ramos, who was laid off in April, alleges she was let go in retaliation for her complaints. County officials say she had been with the county for less than a year and was terminated as a result of the financial crisis brought on by the bankruptcy.