Click here                              for more information on AMERICAN CAPITAL'S buyout of THE MEADOWS of Wickenburg.

Known Inpatient Suicides at
THE MEADOWS of Wickenburg

MARCH 9, 1999 - Inpatient Denise Lee Dixon, age 26, died from suicide after only fourteen days at THE MEADOWS. She hung herself with her robe's sash in the bathroom of her hospital room.   Although admitted to THE MEADOWS for the treatment of an eating disorder (anorexia), staff  never searched for her when she failed to report for dinner that evening.  Per the official Wickenburg Police and Maricopa County Medical Examiner's Reports, Denise was last seen alive at 1655 hours ( or 4:55 PM ) that afternoon.  More than two hours later, at approximately 7PM, Denise was discovered hanging from the shower door guiderail by her roommate.  It is documented that Denise was "cool to the touch" when she was discovered.  No one knows how long Denise had been missing or the actual time of her death.  The shower guiderail from which Denise hung herself did not break away, as required by suicide prevention standards. While at THE MEADOWS, Denise was being treated for high levels of depression and anxiety:  two indicators for suicide.  Staff had knowledge of, and had repeatedly documented, Denise's suicidality in her records.  Most specifically,  Denise was at THE MEADOWS due to a prior suicide attempt (overdose)  one month earlier, in February of 1999.  Initially admitted to the psychiatric unit at St. Paul Hospital in Dallas, her family transferred her to THE MEADOWS after one week.  It was there, where they believed, she would receive the attention, care and therapeutic treatment she deserved and  required. 

Denise Lee Dixon
January 24, 1973 - March 9, 1999

NOVEMBER 28, 2004 - Inpatient Richard Matthew "Matt" Burne died from suicide after only four days at THE MEADOWS. Admitted without any background/previous treatment records, Matt  had reported to staff, his in-house psychiatrist, Dr. Stephen Brockway, and his Primary Counselor,  Earl Doug  Dodge, that he had suicidal thoughts of hanging himself.  On November 26th, after an initial 90 minute evaluation, Dr. Brockway was concerned enough to order a second opinion regarding Matt's suicidality yet, at the same time,  reduced Matt's observation level from Q1 hours ( i.e. hourly checks) down to Q4 hours ( i.e. one check every four hours) with no basis.  The second opinion was never done.  Additionally, and unbeknownst to his family,  Matt informed Brockway, Dodge and staff that he had (recently) purchased a rope for the purpose of hanging himself, and that it was in the basement of his home in Pennsylvania.  Despite knowing these facts,  no one at The Meadows thought to remove or confiscate Matt's belts.  Staff did, however, ask him to call home to alert family and have the rope removed from his  basement (2000 miles away) even though it wasn't an immediate risk factor:   he wasn't scheduled to  return home  for at least another four weeks.  Regardless, no one ever followed-up to ensure that Matt  made that phone call.  (He didn't.)  In the early morning hours of November 28, 2004 -  sometime between 3 AM and 6 AM -  Matt Burne  walked out of one of THE MEADOWS' numerous unlocked/unmonitored doors, unobserved, and hung himself with his own belt from a tree off premises on an adjacent horse farm.  Although documented repeatedly in his medical records as highly depressed, anxious and suicidal, no one knew Matt was missing from the Acute Care Wing of this Level 1 Psychiatric Acute Hospital for more than three hours.  Matt died early on that  Sunday morning (exact time unknown).  For the two days prior to his suicide, none of Matt's direct care nursing staff ever read   his   medical  records   and/or  charting  ( from Friday to Sunday ).    Per  The   Meadows'  internal policies, they  weren't required to do so.   A highly  educated  (dual degreed Johns Hopkins University graduate and M.B.A. recipient), accomplished and brilliant  young man,  Matthew Burne hand-picked THE MEADOWS from a myriad of other hospitals based on their marketed staff and (then) undisputed reputation in the field of mental health.

Richard Matthew "Matt" Burne
August 29, 1967 - November 28, 2004

Per THE MEADOWS' marketing:   "Treatment at The Meadows is personalized to meet individual needs.  A multidisciplinary team of psychiatrists, psychologists and professional counselors work cooperatively and consistently with dedication to the best interest of each patient."

On February 23, 2006, American Capital Strategies Ltd. of Bethesda, Maryland invested $79 million dollars in a buyout of THE MEADOWS of Wickenburg, L.P., which represented approximately 88%of the company stock, on a fully diluted basis. At the time of the press release, American Capital Regional Managing Director, Darin Winn, stated, "We're supporting world-class management and clinical teams who have developed a well-respected treatment model providing high quality care to patients from around the World."

Click here                        for information on lawsuits recently filed against THE MEADOWS as well as BURNE vs. THE MEADOWS, the case filed by the family of Richard Matthew "Matt" Burne.

Click here                             for information on specific caregivers who have lost at least one inpatient to suicide while under their direct care.

PLEASE NOTE THESE IMPORTANT FACTS: 
Unbeknownst to the Dixon family and R. Matthew Burne and his family, THE MEADOWS (like other similar programs)  is an open campus and subscribes to a full, open campus philosophy.   What this means is - according to depositions taken during Burne v. The Meadows as well as periodic calls to the Intake Office at The Meadows - there are no locked doors or locked  Units at The Meadows.  Doors open freely from both the inside-out and the outside-in.   Patients can and do  leave at anytime through any door.  Only  the front door is consistently  monitored  by  staff.   The Meadows does not openly market this fact anywhere in their printed materials or on their web site.  Thus, those "at risk" are truly at risk.   It was stated in at least  one staff deposition ( Burne v. The Meadows) that patients have left the facility  during the middle of the night unobserved and been  found at the local convenience store.  Additionally, it was stated that patients  have been found there - at the convenience store - "buying booze."  Although licensed by the State of Arizona for the use of Restraint and Seclusion, staff testified that "they never use it" and have locked the doors only once to "test them."  Until Matt Burne's suicide, there were no motion sensors, convex mirrors, or monitored closed-circuit video cameras  in the Acute Care Wing but there were monitored cameras in the laundry room.   After Matt's unobserved elopement and suicide off premises, The Meadows added motion sensors to the Acute Care Wing. 

According to information obtained via Burne v. The Meadows, patients at The Meadows are housed in various units/buildings, some with no on-site, direct (continuous),  supervision during the evening/graveyard hours.  All nursing and support staff are assigned to the Nurses' Station located in the Kiva Wing/Acute Care. It was stated in one deposition (Burne v. The Meadows) that at times there have been only two nurses for 70 patients during the night/graveyard shift.  BTS knows of one incident, and has documentation,  where only one nurse was assigned to work the evening/graveyard shift for the whole facility.  At the time of her suicide, Denise Lee Dixon was housed in the Pima Building: one of the patient buildings out of view from the Nurses Station based in the Kiva Wing.

During an April 24, 2008 telephone call to The Meadows requesting detailed information about their program, a BTS member spoke anonymously with a Meadows Intake staffer named  "Julie."   At one point during the conversation, Julie was directly asked about  the safety record at The Meadows.  Said caller expressed a specific interest in The Meadows' ability to protect and keep their patients safe, particularly those suffering from depression.  Julie responded by stating (quote), "No one's ever left here unsafely in 31 years."  Then, when questioned about the information now available on the Internet regarding The Meadows' suicides, safety concerns,  and lawsuits, Julie replied,  "I know nothing about that."  When said caller  next  offered  to  share with her  the source  of  this  information  - namely the (Break the Silence)  web site address - Julie stated, "I don't care."  The anonymous caller that day was us:  Break the Silence.   Unbeknownst to Julie,  we tragically and first-handedly knew that the  information she provided to us about The Meadows' safety record was  untrue and wrong.

It is IMPERATIVE that  facilities such as The Meadows market  and disclose to the general public, referring doctors, therapists,  and prospective patients  truthful and complete information about their program and physical plant.  When asked about their safety records, precautions, and processes, it is imperative they disclose valid and factual information to the public.  This is one of our Missions at BTS and we will continue to watch, monitor, and test these facilities closely in an effort to improve  inpatient safety.

While at THE MEADOWS,  Denise Dixon had been required to wear around her neck a "NO HELP" sign that was affixed to her Meadows ID Badge.  At the time, family believed this meant Denise was to receive no help from anyone while at The Meadows.  Since then, they have learned this meant Denise was not to render any assistance to others.  It has been reported to BTS that other signs such as "DO NOT TALK"  have also been used in treatment at The Meadows.  BTS would like to know the therapeutic benefit/purpose of wearing such signs?   Is it possible they may do more harm than good to an already at risk patient?