Colorado legislators prep new regulations for eating disorder clinics

Colorado legislators will propose new regulations for providers of eating disorder treatment in the coming months, amid calls from advocates and patients to crack down on practices that one legislator labeled “barbaric.”

The coming legislation, which will debut early next year when state lawmakers reconvene, would require providers to follow specific requirements around weigh-ins, the use of feeding tubes and isolation, and to offer gender-appropriate accommodations. Legislators considered similar requirements earlier this year but dropped them because the new regulations would cost $870,000 to implement.

The resurrected proposal would task the Behavioral Health Administration with overseeing treatment facilities in the state. Colorado, and in particular Denver, has become a national hub for eating disorder care and has seen an increase in patients amid a national surge in disordered eating diagnoses. The state health department regulates eating disorder clinics as it does other facilities, without specific requirements tied to the type of care provided there.

Several patients, including some who’ve traveled hundreds of miles for care here, have described a punitive environment at major facilities in Denver, including being kept in their rooms for days at a time, threatened with feeding tubes and forced to stand, barely clothed, in line with other patients during weigh-ins.

“You can’t hear these stories and not be moved,” said Sen. Lisa Cutter, a Littleton Democrat who co-sponsored last year’s bill and plans to bring back the regulatory proposal next year, along with Democratic Rep. Chris deGruy Kennedy. “This is something that we can change, that we can help change, that we can have a fairly immediate impact on. Some of the practices and some of the stories we heard were just awful.”

Any new regulations could face headwinds as lawmakers decide how to prioritize limited funding. Much of the cost associated with implementing the bill comes from an aged information technology system within the new Behavioral Health Administration, advocates and Cutter said. Adding any new regulations to the current system “comes with a significant price tag,” Thomas Miller, the agency’s interim deputy commissioner, told legislators last week.

Advocates were leery of bringing the eating disorder regulation bill back — and asking patients to relive trauma to sell the bill to other legislators — if it was doomed to fail for similar cost concerns. But lawmakers and advocates decided to move ahead because of persistent complaints from former patients and because of a recent state investigation that found one prominent eating disorder clinic, the Denver-based Eating Recovery Center, intentionally ignored two suicidal patients in June.

That incident, which prompted a medical director to leave the clinic after he ordered staff to ignore patients who wrapped objects around their necks, came just weeks after lawmakers dropped their plan to more tightly regulate the clinic and its peers.

ERC and other providers have consistently maintained that they already face sufficient oversight. ERC’s chief medical officer, Dr. Anne Marie O’Melia, told The Denver Post that the company’s facilities were already monitored by state regulators at both the Colorado Department of Public Health and Environment and the Behavioral Health Administration, as well as by the Joint Commission, a national group that accredits health facilities.

The Joint Commission re-accredited ERC in July, before the state investigation into the treatment of suicidal patients at one ERC clinic. The state re-inspected that facility in September and gave it a clean bill of health.

“We welcome the opportunity to work with other eating disorder experts, organizations and lawmakers who are introducing this legislation,” O’Melia said. “We share the same goal: ensuring safe, effective care for people with eating disorders in Colorado.”

Though lawmakers dropped the proposed regulations earlier this year, they did pass two bills aimed at helping eating disorder patients. One seeks to coordinate research, outreach and prevention, while the other banned the sale of certain diet pills to underage Coloradans and eliminated an insurance provision that required patients to be at a certain weight threshold to be eligible for treatment.

But Vincent Atchity, the president and CEO of Mental Health Colorado, said in October that the “starkly scandalous” recent episode with suicidal patients at ERC shows that eating disorder treatment facilities need specific regulations to ensure vulnerable patients are treated appropriately.

“It just underscores the importance of returning to that aspect of the bill that didn’t make it through last year, and establishing some real expectations of patients’ quality of experience in these settings,” Atchity said. “…If they’re not having their health care needs met, it’s inhumane.”

“I’ll never come back here”

Since March, more than a dozen former Eating Recovery Center patients have described practices to The Post that they considered punitive, counterproductive and, at times, traumatic.

Charlie Gates, a 19-year-old nonbinary person, said they traveled from California to Denver in December 2021 for eating disorder treatment. It was an isolating experience, they said, and staff seemed uninterested in meeting patients’ needs, leading some to relieve themselves in corners when they couldn’t get someone to take them to the bathroom.

“The only thing I got out of ERC was weight restoration, and that was through coercion,” Gates said. “The part that kills me is I was one of the quote-unquote success stories, and ERC has no idea of the harm they caused.”

O’Melia, the ERC medical director, said that she couldn’t comment on individuals’ experiences because of privacy concerns, but that staffers are always available to take patients to the bathroom. Going alone isn’t an option for eating disorder patients because of concerns they could harm themselves, she said.

“No elements of treatment should be used as a form of punishment,” she said. “Our goal for each of our patients is to develop a collaborative and healing care relationship and to work together toward recovery. It is never OK to ignore patients’ needs or behaviors, and it goes against our policies and training.”

Ashley Zeckmeister, a former floor nurse and supervisor at ERC who left in July, said the company’s practices could be punitive. She said some patients couldn’t go outside the building for days at a time and that ERC only began limiting that practice in June, after a Post story described patient concerns. The company also stopped using mesh and paper gowns — which ex-patients said often exposed their bodies in common areas — in early June.

Zeckmeister, who said she reported the incident with the suicidal patients to state regulators in July, said patients often reported feeling traumatized by the company’s practices. One patient told Zeckmeister that she struggled to walk past a certain room at one of the clinics because it’s where she and other patients were forcibly given feeding tubes.

“She has said — and I don’t even know where she’s at (now) — but she had said, like, ‘I’ll never come back here. I would rather die than come back here for treatment again,’” Zeckmeister said.

MK Kidd, 16, said they were treated four times at ERC and still have post-traumatic stress disorder and significant discomfort with being touched or surprised. At one point, they spent a month in their room while ERC got a court order to place a feeding tube, they said.

Kidd said they don’t want ERC shut down, but they think it needs significant reforms. With better communication and more individualized treatment, it could help people, they said.

“I am alive because of what they did,” Kidd said, “but my quality of life has been reduced.”

A blurry line

Several patients and providers unaffiliated with ERC say the criticism the company has faced gets at the core of eating disorder care: Eating disorders are life-threatening diseases that also compromise a patient’s ability to think. Treating them is difficult.

Advocates and providers disagree about whether specific practices, such as nude weigh-ins, the use of feeding tubes and close observation of bathroom habits, are necessary for patients’ survival or if they’re gratuitously traumatic. By the time patients arrive at specialized eating disorder facilities, they may be near death, and some may require a feeding tube.

Some families are concerned that too much regulation could interfere with treatment.

A father whose daughter traveled from the East Coast for treatment at ERC in Denver said she was discharged suddenly during her second stay after making “suicidal gestures” by wrapping something around her neck. Her discharge in November came after media coverage and public interest in the state investigation into ERC’s treatment of suicidal patients. He spoke to The Post on condition of anonymity because of fear his daughter could be refused treatment in retaliation if she needs it again at some point.

The state’s report of that investigation noted ERC wasn’t set up to care for suicidal patients, which the father of the East Coast patient believes contributed to the facility discharging his daughter with little time to plan her next steps. The family couldn’t find a facility that could handle a patient who was in serious psychological distress and depended on a feeding tube for nutrition, so they took their daughter home for a “terrifying” week until she was sick enough to get care at an emergency room, he said.