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Hernandez found it hard to believe Rodriguez would have been aggressive with staff. “That represented a departure” for the girl, he said. Hernandez had spoken with staff over the phone before the girl died, he said. “I was told that she was actually up and active and laughing, which is not consistent with what was documented” in staff notes, he testified. “I’m having a difficult time trying to figure out what happened here … I can’t figure this out from the documentation.”

Bankes, now in private practice in San Angelo, did not respond to calls for comment. Laurel Ridge’s chief operations officer would not comment, except to say, “Laurel Ridge takes the care, safety, and privacy of all clients very seriously.”

In depositions, both Hernandez and Bankes recalled an email Fernandez sent out months before Rodriguez’s death regarding Geodon. It told staff to use Geodon instead of Zyprexa, an atypical antipsychotic that is FDA-approved for treating bipolar disorder and schizophrenia in adolescents, for cost reasons.

“It (Geodon) was on the pediatric unit and readily available,” Bankes testified. “And, in the email that we got from Dr. Fernandez about using Geodon, it didn’t say anything about not on pediatric patients. I mean, if it was there and on the unit and doctors were using it, then I assume it had been approved by Laurel Ridge.”

While Bankes denied that complications from Geodon had anything to do with Rodriguez’s death, Hernandez admitted that the Geodon “led to a cardiac arrhythmia and a subsequent cardiac arrest and the subsequent death.”

Discussing the case last month, Brant Mittler said “nearly every check and balance in the system failed Jo Angel.” The lawsuit blamed the most blatant lapses on Laurel Ridge.

According to a survey of local court filings, no other psychiatric treatment center in town has the history of serious litigation Laurel Ridge has seen in recent years.

On the night of Rodriguez’s death, a nurse’s entry says the girl was ordered to be transferred to the emergency room at 11 p.m. Hospital records show another transfer order a half hour later. At 12:50 a.m., a nurse starting her shift found Rodriguez barely responsive in her bed, struggling to breathe. An ambulance showed up two minutes later and spent 14 minutes on the scene. The ambulance left Laurel Ridge with Rodriguez at 1:06 a.m., arriving at Methodist Stone Oak Hospital, about 3 miles away, at 1:25 a.m.

Jose Rebolledo, a local pediatric cardiologist who submitted an expert report for the plaintiffs in Rodriguez’s case, wrote, “So, according to their own records, paramedics spent 14 minutes on the scene and then took 19 minutes to travel by ambulance at night 3.2 miles.”

Rodriguez’s death occurred during a particularly troubling period for Laurel Ridge. Two years earlier, state investigators cited the facility for personnel shortages that led to patient neglect. On the heels of that, a Dallas Morning News investigation turned up complaints of teenage patients assaulting each other, of repeated mistakes in medication delivery, and squalid conditions. Texas Department of Family Protective Services records from the past two years include an incident in late 2012 when “staff used excessive force while escorting a child into seclusion room which resulted in bruising.” Another incident report stems from when investigators found unauthorized meds in one child’s bedroom. Other deficiencies noted in the past two years include failure to maintain child/caregiver staffing ratios, and lapses in records keeping.

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