Department of Health threatens to suspend Daybreak Youth Services license after treatment facility failed to cooperate with patient safety investigation

One of the only residential treatment centers for youth in Eastern Washington, Daybreak Youth Services, could lose its license after the facility failed to cooperate with a Washington State Department of Health investigation, the agency announced Tuesday.

The Department of Health issued a notice of intent to suspend Daybreak’s license after the facility refused to cooperate with an ongoing investigation into patient safety concerns.

Daybreak, founded in 1978, offers trauma-focused addiction and mental health treatment for youth ages 12 to 18 statewide, with inpatient and outpatient services. The Spokane inpatient facility, at 628 South Cowley St., can treat up to 36 girls at a time and is a mirror to the Vancouver area clinic that treats young boys. Daybreak also offers outpatient co-ed clinics and counseling in Spokane Valley.

In March, the department began investigating allegations of misconduct as a result of “patient boundary issues” with a staff member that were reported to the department, according to a news release.

Daybreak failed to provide information requested by the department despite repeated efforts, the Department of Health said. The facility has 28 days to request a hearing on the license suspension before it takes effect. Requesting a hearing would postpone the suspension until an administrative law judge reviews and makes a decision on the case.

Tom Russell, Daybreak’s Chief Executive Officer, said Daybreak fully cooperated with the investigation and that the organization plans to appeal.

“Clients have a right to file a complaint,” Russell said, but patients often perceive interactions through the lens of their trauma.

“That’s their reality and so we have to look at that,” he said of complaints.

If the license is suspended, Daybreak must transfer all patients and cease operations.

Critical shortage of inpatient treatment facilities

There are very few inpatient behavioral health and substance abuse treatment facilities for youths in Eastern Washington making Daybreak a “key provider,” said Linda Thompson, executive director of the Greater Spokane Substance Abuse Council.

“It is a devastating loss,” Thompson said.

The notice to suspend Daybreak’s license was made months after Daybreak staff raised alarm bells about skyrocketing rates of mental health issues and fentanyl use.

“We have kids dying on our waitlist from fentanyl,” Sarah Spier, director of external relations at Daybreak, said Wednesday.

Patients will travel from all over Eastern Washington to be admitted at Daybreak, Thompson said. Losing those treatment beds will strain an already tight system, she said.

“The overall access to treatment right now is very tough,” Thompson said.

Often it can be a difficult road to get people to the point of seeking treatment and long wait times of weeks or months is another barrier, Thompson said.

“Immediately getting people into treatment is critical,” Thompson said. “The addiction is so strong that you’ve got to reach them when they are open to treatment.”

The investigation

Multiple complaints to the Department of Health allege that a skills coach hired in November 2021 acted inappropriately toward teenage girls in the program almost immediately after he was hired.

On Dec. 8, the man came to the facility to “hang with the girls” on his day off, the complaint alleges. Daybreak counseled the staff member after the incident.

Later that month, a patient filed a grievance that the worker used “prison sign language” to say he loved her. In January, another client complained the man engaged with her on social media.

The staff member asked patients for hugs and talked to them about their bodies, one complaint alleges. When a patient rebuffed his attempt to hug her, the staff member became confrontational, the document said.

The worker also was “slut-shaming” patients by commenting on their clothes, the complaint alleges. In response to the grievances filed against him by patients, the worker bullied and retaliated against patients, the complaints allege.

When asked about the employee’s alleged conduct, Russell noted there was no harm to a patient and that patients in the program all have traumatic backgrounds that shape how they experience the world.

In this instance, Russell said a patient wasn’t adhering to the facility’s dress code and misinterpreted attempts to enforce the policy.

The Department of Health isn’t asking questions about the context of the incidents, Russell said.

Daybreak opened an internal investigation into the worker in January. While the investigation showed a pattern of misconduct, the facility concluded he hadn’t violated Daybreak’s code of ethics and continued to employ him and allow him access to the facility’s teenage patients, according to the Department of Health.

Daybreak didn’t report any of the complaints or concerns to the Department of Health.

The Idaho Department of Health and Welfare stopped referring teens to Daybreak over concerns of poor quality of care and management at the facility, the notice of intent to suspend says.

In February, the Department of Health received a complaint from the Washington State Department of Children, Youth and Families about staff violating patients’ boundaries. A similar complaint was filed by the Spokane Police Department in March, according to the notice of intent to suspend. Spokane police received a complaint from the Caldwell Police Department and since Daybreak is out of its jurisdiction, the department forwarded the information to the Department of Health, said Julie Humphreys, a department spokesperson.

The Department of Health opened two investigations into the facility based on the complaints. Daybreak was cooperative during two site visits in March and April, providing staff records and allowing the worker to be interviewed.

Then in May, Daybreak stopped responding to requests from the Department of Health, specifically for copies of the grievances and complaints filed against the staff member.

In June and July, Daybreak argued that the department’s request for records was “overly broad” and refused to provide patient records requested by the department.

Daybreak prevented the department from interviewing patients, the department said. During staff interviews Daybreak Chief Operating Officer Richard Reathaford told staff to only answer questions about policies and procedures and wouldn’t allow staff to respond to what he called, “he said, she said” questions, according to the intent to suspend.

Reathaford continued to interrupt investigators in an attempt to limit the scope of their questions despite the Department of Health having broad authority to investigate licensees, according to the document.

Staff members have the right to have someone with them when being interviewed by the Department of Health, Russell said. He said Reathaford’s interjections were likely meant to clarify questions and scope, not as interference, like the Department of Health described.

Daybreak understood the investigation to be focused on whether staff members were keeping appropriate boundaries with clients, Russell said.

While Daybreak did provide client records at the end of the last facility visit on July 19, the facility only provided records it deemed to be within the scope of the department’s investigation, the department wrote. Russell denied that claim and said Daybreak provided the complete records for patients who made complaints about the employee but questioned whether records of patients who did not make complaints were releasable under federal law.

Daybreak requested multiple meetings with the Department of Health to discuss the investigation and clarify miscommunications, but the Department of Health did not respond to those requests, Russell said.

Due to Reathaford’s alleged interference and the lack of complete records, the department found the facility to be uncooperative and issued the notice of intent to suspend the license on Aug. 1. The employee voluntarily left Daybreak in June, Spier said.

Prior investigations

In 2018, the Department of Health investigated Daybreak’s inpatient facility in Brush Prairie, just outside of Vancouver, after allegations the facility was unsafe due to numerous unreported altercations and sexual assaults.

The Clark County Sheriff’s Office investigated why staff weren’t reporting the assaults and ultimately charged, Michael S. Trotter, Daybreaks’ former vice president for compliance, with three counts of failure to report child abuse or neglect. Court records indicating the outcome of that case were not immediately available Wednesday.

The Department of Health threatened to revoke that facility’s license but an appeal kept the facility open. Daybreak settled with the Department of Health in 2019 and agreed to improve staffing, training, security, and reporting policies.

In the settlement order, the Department of Health said Daybreak’s failure to meet standards “placed its residents at an unacceptable risk of harm.”

The nonprofit said it made significant changes following the investigation, including hiring Russell as CEO.

The Brush Prairie facility’s license was in good standing as of Wednesday.

While Russell said the complaints should be thoroughly investigated, he has no worries about the care being provided at Daybreak in Spokane.

“I know that what Daybreak is doing today is providing excellent care to the kids that are there,” Russell said.