Angellika Arndt died May 26, 2006 after being physically restrained. Earlier in the day, Angellika was put in a "control hold" for gargling with her milk.

A state investigation into the death of 7-year old girl put in a control hold for 2 hours before she lost consciousness and died has produced a lengthy statement of deficiencies against the Rice Lake Day Treatment Center.

Center client Angellika Arndt, of Ladysmith, was airlifted to Minneapolis Children’s Hospital, where she died May 26, the day after she was put in the control hold.

“We expect facilities to protect the health and safety of people in their care, and what our investigation found is that they failed Angellika,” said Department of Health and Family Services spokesperson Stephanie Marquis.

According to the statement, the DHFS found that the center staff had not provided Arndt with the proper care required for someone with her diagnoses.

Staff used physical control holds for other than emergencies, such as gargling milk on the day of the control hold that led to her death, according to the statement.

“What we did not find in the center’s medical records was evidence as to why the hold needed to take place,” said Marquis.

The center, operated by Northwest Counseling and Guidance Clinic with main offices in Frederic, has been banned from using restraint holds in all of its facilities unless there is an immediate physical danger to the client or the staff and then only until police arrive, Marquis said.

Center officials must respond to the state’s statement of deficiencies with a plan to correct the violations in 30 days.

The state then approves, modifies or rejects the plan, Marquis said. If the plan is approved, an unannounced visit follows, she said. The state has the authority to suspend or revoke the center’s certification, she said.

She said DHFS authorities will meet with center staff next week to discuss the center’s plan of correction.

The clinic, which provides a day program for children with mental health disorders, has issued a press release stating its disagreement with the state’s findings.

“We have read the DHFS site review released on June 22 and have expressed concern with what we find to be errors of fact, incomplete context and misapplications of statute references,” stated the release issued June 23.

Meanwhile, Barron County District Attorney Angela Holmstrom continues to review Rice Lake Police Department investigative reports of the incident.

She said she won’t make a decision as to whether to press criminal charges against any center staff until at least mid-July.

Fatal control hold

Arndt was born in Milwaukee. She became a ward of the state and was placed in the Ladysmith foster home of Dan and Donna Pavlik in January 2005. The Pavliks have declined to comment on the case.

Arndt’s diagnosis included reactive attachment disorder, mood disorder, anxiety disorder, and attention deficit with hyperactivity disorder.

Clinic board of directors president Denison Tucker has said that the 2-hour control hold Arndt was put into on May 25 involved her being held on her stomach on the floor as one staff member gripped her ankles and another held her shoulders down.

According to the state’s findings, Arndt was placed in 18 documented time-outs and nine documented control holds in the span of 31 days from April 24-May 25.

In each instance, the control holds lasted between 1-2 hours.

Complaints from Arndt during the holds included dizziness and pain in her legs, ankle, thighs and eye.

Arndt was offered medication to control temper tantrums and agitation in April. She did regain composure following administration. However, the medication was not offered during the six control holds in May, which could have prevented or shortened time used for the control holds, stated the DHFS report.

Also, center staff interviewed by DHFS reported that the times for control holds depended on the behavior of the client and was not subject to time or other factors such as age, medical condition or medications, the DHFS reported.

During her last control hold, Arndt became unresponsive and went into cardiac arrest. She was given cardiopulmonary resuscitation and then airlifted to Minneapolis Children’s Hospital, where she died.

The Hennepin County Medical Examiner ruled Arndt’s death a homicide caused by complications of chest compression asphyxiation leading to cardiopulmonary arrest while restrained by another person.

The staff members who restrained Angellika have been placed on paid administrative leave by the clinic.

DHFS findings

In the 17-page statement of deficiencies the DHFS found that the clinic staff:

• Failed to properly identify the proper level of care for Arndt, who had behavioral and emotional issues that required care beyond what they were giving her.

• Failed to provide nursing or other medical services required which subjected clients to medical triage and evaluation by staff untrained to provide this service.

• Did not document the administration, effectiveness or side effects of psychotropic medications given to Arndt.

• Failed to provide documented evidence that a multidisciplinary team reviewed the number of control holds placed on Arndt or of alternative strategies for behavior interventions.

• Failed to seek and obtain approval from the DHFS for use of physical restraint as part of Arndt’s treatment plan.

• Failed to demonstrate that the behaviors that led to any of the control holds met the definition of an emergency.

Deficiencies related to staff included that the center failed to provide direct clinical review and assessment of employees and failed to document basic mental health training and techniques for nonviolent crisis management.

In a public letter issued this month, Tucker wrote that the center has reformed some of its policies since Arndt’s death.

That includes retraining center staff and establishing standards for holds and procedures for assessing risks posed by patients.

A monitoring system will now record all action taken by staff, he wrote.

The DHFS has authorized a psychiatrist to review Northwest Counseling’s entire program, including Arndt’s medical record, Marquis said.