Top DHHS regulator defends agency’s oversight of N.C. wilderness therapy programs

CHARLOTTE, N.C. (WBTV) – A top regulator at the N.C. Department of Health and Human Services defended the agency’s sporadic inspection of a camp that advertises itself as offering wilderness therapy in western North Carolina after a WBTV investigation.

WBTV has been investigating Trails Carolina for months. In May, we first told you about the facility and talked with former participants and a former staff member who detailed their experiences.

By Trails Carolina’s own admission, in a letter to members of the N.C. Senate, participants only receive one to two hours of individual therapy a week.

The rest of the time, participants told us, is spent with staff guides who are not trained therapists, mostly in the wilderness.

“If I was a parent, I’d be pretty pissed to find out what the actually therapy that happens, when it does happen,” Jonathan Hyde, who worked at Trails for about six weeks last summer told WBTV.

“It’s on a scheduled basis but the time that they actually meet with a licensed therapist is very minimal.”

Hyde received three days of training before being sent into he woods to supervise participants. A lawyer for Trails told state senators staff receive five days of training.

Kathleen Reilly, who went to Trails in 2012, said she left the program with more emotional and psychological trauma than when she arrived three months earlier.

“There’s no real therapy that happens,” she said.

“It’s just not normal. It’s not humane and it’s just not… What it does do your brain, you still don’t even want to admit it.”

Reilly said she once went 17 days without being allowed to take a shower.

Previous: ‘It’s beyond cruel’: Inside an N.C. wilderness therapy program for teens

A second former participant, who spoke with WBTV on the condition he not be named, said he was not allowed to use the bathroom and defecated on himself. He said he was forced to wear the same pair of pants for two weeks.

A 17-year-old participant ran away from Trails in 2014 and was found dead nearly two weeks later. He had climbed up a tree and fell into a creek, where he landed on his back and broke his femur.

In an interview with DHHS investigators after the participant’s death, a sheriff’s deputy involved in the search said rescue crews would have had a better chance of finding the teen alive had Trails staff not waited until after dark to call and report him missing.

Trails was issued a $12,000 fine but otherwise faced no additional consequences. A DHHS spokeswoman previously defended the agency’s handling of the teen’s death by saying an inspection found the death was an isolated incident.

DHHS refused to make anyone available to answer questions on camera for our initial story.

That changed a week after the story ran, though, when WBTV had vowed to ask questions of DHHS leadership on camera whether the agency agreed to schedule an interview or not.

Last week, the agency made Emery Milliken, deputy director of the Division of Health Service Regulation, available for a Zoom interview.

Milliken defended DHHS’ regulation of Trails Carolina and the two other licensed wilderness programs in North Carolina by saying they were no different than any other facility they license.

“Except for the fact it’s in the wilderness, [Trails] is not that different than other facilities that also deal with high-risk youth,” Milliken said.

“I think regardless of whether the child is in a therapeutic setting at a campus or in the woods, in a very primitive setting, I think both are situations where, you know, the youth are high risk and, meanwhile, our regulations set for the time period that we are to inspect and that’s exactly what we do.”

State law requires DHHS inspect Trails and other licensed facilities every 12 months but allows the agency to take up to 15 months if necessary.

A review of Trails’ inspection records found most inspections taking place more than 12 months apart, with one inspect taking place nearly 16 months apart. Most took place in 14-month intervals.

The facility was not inspected at all in calendar years 2017 or 2020. Milliken said regular inspections were suspended during the pandemic.

But Hyde, the former Trails staffer, said enrollment at the facility increased during the pandemic.

The inspection records also show DHHS failing to conduct follow-up inspections to ensure cited deficiencies were corrected in some years.

Records show follow-up inspections were conducted after inspections found deficiencies in 2010 - the first year Trails was inspected - and after inspections in 2014, 2015 and 2019. Every other year deficiencies were cited and Trails submitted a plan of correction but not follow-up inspection was conducted to ensure the deficiencies had been corrected as promised.

Instead, the records show, the “follow-up” inspection was conducted at the same time as the next annual inspection, which took place anywhere from 12 to 16 months later.

During the interview, Milliken disputed the notion that DHHS did not conduct follow-up inspections after most Trails annual inspections found deficiencies, citing the instances when the facility had conducted follow-up inspections.

But in an email after the interview, DHHS spokeswoman Chris Mackey said there is no requirement for the agency to ensure a cited deficiency had been corrected.

“There is not a mandated time for NCDHHS to follow-up on the facility’s implementation of corrective action. Corrective actions for most standard deficiencies (the least serious type of deficiency that does not impact the health, safety and welfare of the clients and lacks the scope and severity to be cited at a higher level) are typically monitored at the next visit to the facility, which could be scheduled when investigating a complaint or as part of the annual inspection, both of which are unannounced,” Mackey said in an email.

During the interview, Milliken said her staff follows state laws and regulations when inspecting Trails and other facilities.

“When we’re going out on either our annual inspection or on a complaint investigation, we are looking to determine whether or not a facility is complying with those regulations which, if they are, should mean that children are getting the therapy that they need in a safe and appropriate environment,” she said.

Milliken said inspectors typically look at paperwork and participant treatment records to determine whether a facility is complying with regulations.

“What is DHHS actually doing to ensure that children in the woods are being properly cared for and getting the treatment they’re supposed to get, outside of looking at a treatment plan and showing up every 14 months?” a WBTV reporter asked.

“Is DHHS doing anything else to make sure that these children are actually safe?”

“Certainly, Nick, you have to respect the fact that we don’t actually run these facilities,” Milliken responded. “These are not our facilities, so we’re not in charge of the operation of the facility. We are a regulator.”

“So, you can’t actually tell me what you do to make sure children who are our in the woods are actually safe?” the reporter asked.

“I think I did just tell you that and I think the same applies whether they’re in the woods or in a different setting; in a, you know, psychiatric treatment facility or an acute psychiatric hospital or whatever the therapeutic setting may be,” Milliken said. “We are regulators and we regulate and monitor, oversee, we do not actually operate these programs.”

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