A Tragic Result of a Failure to Act

This report chronicles Disability Rights Wisconsin’s investigation into the circumstances leading to and surrounding the death of Angellika Arndt  in Rice lake Wisconsin, from complications of chest compression asphyxia while at the Rice Lake facility of the Northwest Counseling and Guidance Clinic on May 25, 2006. When she died, Angie  was only seven years old.

Disability Rights Wisconsin (DRW) is the federally mandated Protection and Advocacy System for individuals with disabilities in Wisconsin. DRW is authorized under state and federal law to investigate incidents of abuse and neglect in settings that serve people with disabilities.

Independent investigations into Angie’s death were conducted by the Rice Lake Police Department, Barron County Child Protective Services, the State of Wisconsin Department of Health and Family Services Bureau of Quality Assurance** and the Wisconsin Department of Justice.

Additionally, the Office of Medical Examiner of Hennepin County Minnesota conducted a post mortem examination. In order to examine potential factors which contributed to her death, DRW’s investigation reviewed the results of these investigations and reports, along with information gathered from Angie’s foster family, Rice Lake Day Treatment Center policies and records, Angie’s public school records, and her mental health clinical records.

In the many months since Angie’s death DRW, along with other advocates and concerned parents have engaged the Department of Health Services in discussions regarding the circumstances and policies that allowed such a death to occur. During the course of these discussions advocates have presented DHS with many of the recommendations contained in this report. Unfortunately, the DHS response has been neither sufficient nor timely, nor with enough sense of urgency or importance to adequately safeguard against this type of death happening again to another Wisconsin child. DRW believes that the policies and conditions remain sufficiently unchanged so as to allow such lethal restraint practices to continue in this state, thus making it potentially only a matter of time until there is another tragedy.

In issuing this report DRW hopes that the lessons learned from Angie’s tragic death will translate into increased use of positive behavioral supports, a decrease in the use of seclusion and restraint with children and a prohibition of the use of restraints that have the potential to cause serious injury or death, as well as changes in the provision and oversight of day treatment services for children in the state of Wisconsin.