This story was produced by Reveal from The Center for Investigative Reporting, a nonprofit news organization. Learn more at revealnews.org and subscribe to Reveal’s newsletters at revealnews.org/newsletter.

By the time the federal government started sending immigrant children to Shiloh Treatment Center in 2009, the warning flags were waving blood red.

Three children had died after being physically restrained at Shiloh and affiliated facilities in rural Texas run by the same man, Clay Dean Hill. A teenager from California died after running away and getting hit by a truck. Texas officials repeatedly had cited Hill’s residential centers for troubled youths after caretakers were found to have slapped, punched, and kicked children.

Yet nine years ago, the U.S. Department of Health and Human Services sent its first delivery of federal tax dollars to Hill, a one-time longshoreman-turned-millionaire entrepreneur specializing in the care of vulnerable children. The federal government wanted Hill to take immigrant children with mental health problems who were caught crossing the border without parents or papers.

The funding started a couple of months before a male caretaker in his 40s was caught preying on a 15-year-old girl from California, sexually abusing her at one of Hill’s all-girl dormitories, where he was assigned overnight. He’s now a convicted sex offender.

“It shows you how disgraceful the place was,” said the former resident, now 25, who told her story publicly for the first time to Reveal from The Center for Investigative Reporting.

The federal Office of Refugee Resettlement continued to send immigrant children to Hill’s care after another teenager was killed during a restraint and the state of Texas shut down one of his facilities, deeming it unsafe for children. And this year, after immigrant children said in court declarations that they were forcibly injected with psychiatric drugs, federal officials claimed there was no problem. In all, the federal government has paid Shiloh more than $33 million for the care of immigrant youths.

It took a federal judge to force the refugee office to take action. U.S. District Judge Dolly Gee ruled July 30 that the Office of Refugee Resettlement must remove children from Shiloh unless a licensed psychiatrist or psychologist determines they pose a risk to themselves or others.

It didn’t have to get to this point. The history of death and abuse at Hill’s rural outpost for troubled children was no secret. Hill, 69, has remained a go-to provider for the Office of Refugee Resettlement even after multiple exposés by Texas newspapers, calls by members of Congress for Shiloh to be shut down and warnings from the local district attorney.

The story of Shiloh shows just how bad it can get at a child care operation the federal government deems worthy of taxpayer dollars and acceptable for immigrant children. Reveal previously found that private companies operating immigrant youth shelters across the nation have racked up citations for serious lapses in care. A ProPublica analysis of police reports found hundreds of allegations of sexual abuse, fights and missing children at these shelters.

Hill and Shiloh employees have not returned multiple calls by Reveal seeking comment.

A July statement on Shiloh’s website says it has been investigated by various government agencies and “all of the widely distributed allegations about Shiloh were found to be without merit. The children have been found to be properly cared for and treated.”

Trump administration officials also maintain that the children are in good hands at Shiloh and other facilities paid to supervise immigrant children. Scott Lloyd, director of the Office of Refugee Resettlement, said in a June press briefing that his agency is “proud of its partnership with our UAC care providers,” using the acronym for unaccompanied alien children.

“I’ve witnessed firsthand the good work they do throughout the U.S. to ensure UACs receive proper care and services,” he said.

The government’s defense of Shiloh also points to a fundamental problem with federal oversight. In court filings this year, government lawyers made it clear that the federal agency responsible for the children puts much of its faith in state officials to monitor immigrant shelters such as Shiloh.

But Reveal has found that Texas licensing officials apparently failed to properly implement their own regulations when they shut down Hill’s Daystar Residential Inc. facility and allowed Shiloh to continue. The law should have stopped Hill from operating any residential child care centers for five years.

It was a far-reaching failure that let Hill salvage his operation. Just as Texas stopped sending its foster children to Hill, the federal government was tossing him a new source of money: immigrant children.

Former employees told Reveal that they loved working with the children but were concerned that Hill has been allowed to stay in business, taking in a vulnerable population after decades of problems. Four said they were disturbed by the abuse that happened there while management looked the other way. They also said they didn’t want to use their names for fear of retaliation.

“Some of these guys, they were just so rough and brutal,” said a former employee who worked for years as a caretaker at both Daystar and Shiloh. “They seemed like they just wanted to always provoke the clients and get them to act out, get them to fight each other. They would abuse them.”

Drugging kids

Clay Hill now faces a court order to stop drugging children without proper consent. Immigrant children, many traumatized by violence in their home countries, told of being threatened that if they didn’t take pills, they would be punished with more time in Shiloh. Some said they were held down and forcibly injected with medication despite their objections.

Parents of the children said they never were asked permission for the powerful drugs to be administered.

This should not have been a surprise. Medication problems at Hill’s facilities go back many years, Reveal found.

“If they get mad, they’re gonna get a shot,” said a former employee who worked with foster children at Daystar and immigrant children at Shiloh. “If they start talking like, ‘I’m not going to do this,’ they’re gonna get a shot.”

A Texas Education Agency review in 2015 cited Shiloh for requiring parents of special education students to consent “to the use of ‘emergency’ medications as a condition of acceptance.”

“Some parents stated to the district that they did not feel their concerns were being heard by the facility doctors,” the findings state. “It also was reported by some district representatives that they have observed a Shiloh staff member threaten to give students ‘a PRN (emergency medication)’ for misbehavior.”

Ten years earlier, the Texas Department of State Health Services issued a scathing report on medication practices at Daystar. A team of experts found a troubling pattern: "There was no evidence of documented, informed consent for prescribed medications."

The diagnoses and treatment plans were “canned” and often didn’t correspond to the patient, the report said. Children and their families were not being told why they were being given the drugs. Many children were developing weight problems and some as young as 10 years old had high cholesterol.

“In almost none of these children were the elevated laboratory tests addressed,” the review found.

Daystar’s psychiatrist at the time was Dr. Javier Ruíz-Nazario, a longtime fixture of Hill’s operation and the same man immigrant children at Shiloh said was giving them medication. In fact, all four psychiatrists listed on a 2007 organizational chart for Daystar also are named on Shiloh’s forms for dispensing medication to immigrant youths.

Still, federal officials assured a judge in May that Shiloh didn’t need more oversight.

Jallyn Sualog, deputy director of the Office of Refugee Resettlement, said in a court declaration: “To my knowledge, Texas state licensing officials have not reported any concerns regarding Shiloh's compliance with state guidelines concerning the administration of psychotropic medications” to detained immigrant children.

Sualog asserted that “the board certified child and adolescent psychiatrists” at Shiloh use “best practice guidelines.”

Ruíz-Nazario, however, hasn’t had board certification to treat children and adolescents for years, Reveal found. After Reveal’s story, Sualog filed a revised declaration acknowledging that.

Another federal official said in an April letter to attorneys for the children that the Office of Refugee Resettlement has a medical team that monitors treatment and has visited Shiloh. In a footnote, he admitted the agency “does not, however, employ child and adolescent psychiatrists who would have the training to scrutinize the specific medications prescribed by Shiloh experts.”

Over-medicating the children to keep them in line was common practice, said three former employees. Two said caretakers would ask doctors to boost the medications to make the children sleepy and easier to deal with.

Even if federal officials were not paying attention to the findings of Texas agencies, they should have seen the Houston Chronicle’s 2014 investigation of Shiloh, which raised questions about the use of psychotropic medications. The story prompted U.S. Rep. Sheila Jackson Lee, D-Texas, to call for Shiloh to be shut down.

Jackson Lee told Reveal that she reacted to the recent news of problems at Shiloh with “a combination of disbelief, disappointment and outrage.” She had assumed the government stopped sending immigrant children there after the previous outcry.

“I’m sure there are some nice people there, but the overall record makes it inappropriate to send traumatized children to this facility. So it is very much a great disappointment to me,” she said. “I’m kind of taken aback.”

Who is Clay Hill?

Clay Hill has a special education degree from the University of Houston and a teaching certificate, according to a deposition he gave in 2003. After college, Hill started working with an autistic child and later ran a treatment center in Dallas.

In the 1990s, Hill founded Daystar and Shiloh, building a sprawling campus out of trailers and houses off country roads south of Houston. He created a variety of interrelated corporate entities, but Hill was behind it all.

He took in the most vulnerable children: emotionally disturbed foster kids, nonverbal autistic children and special education students school districts couldn’t handle. Many were from Texas, but some were sent there from California and Guam.

The operation thrived because he would accept children no other facility would, former staff members said. Some were extremely disturbed and volatile, at times attacking caretakers.

Hill set up Daystar as a nonprofit at the suggestion of state officials, to allow for the use of federal tax dollars, according to his deposition. Daystar then leased the land, buildings, furniture and vehicles and contracted services from Hill’s for-profit entities.

Hill even served as president of the now-defunct Daystar Pharmacy, a for-profit that provided drugs to his programs. Years ago, the pharmacist there got caught using fake prescriptions to steal some 15,000 pills, including more than 7,000 doses of opioids, according to state records.

Daystar and Shiloh sat near each other, sharing some staff and leadership. The children living at Daystar often went to school at Shiloh. At one point, their administrative headquarters were different parts of the same trailer.

At the same time, Hill created a baseball team for elite high school players that claims big-leaguers Josh Beckett and Matt Carpenter as alumni. Hill ran a nonprofit called Texas Tournament Baseball with a former banker who went to prison for fraud and later worked at Hill’s treatment facilities. Ex-employees said ballplayers without experience caring for troubled children would sometimes work there, too.

Former employees said Hill seemed to care more about making a profit than improving the lives of children.

Hill took in compensation of $680,000 in 2006 and $720,000 in 2007, the most recent years he reported the amount in public tax filings. That was down from a salary of more than $1 million that he reported in 2001. Meanwhile, children had limited facilities for recreation, former workers said, and lived in buildings sometimes cited by state regulators as grimy and dilapidated.

“It was all about money with him,” said Caroline Laifang, who worked as a special education teacher at Shiloh for several years in the 2000s. “If you’re trying to explain to him this is not in the best interest of the students, he’ll let you know—this is a business.”

Hill, for his part, said he was constantly working for Shiloh and Daystar.

“I think I work 24 hours a day, seven days a week because I'm on call all the time,” he said in his 2003 deposition, “and I respond to every call.”

Dangerous restraints

In October, David, a 13-year-old boy from El Salvador, didn’t feel safe at Shiloh Treatment Center.

Fearful of employees who screamed at him, David packed a bag to escape. When he tried to open a window, he said in a court declaration, a supervisor threw him against the door and pinned him against the wall.

“This made me feel like I was choking and it was hard for me to breathe. I told the supervisor to stop because I couldn't breathe,” David’s declaration states. “I briefly fainted. As I recovered consciousness a staff person violently threw me on my bed and this caused my head to bang against the wall.”

It was eerily reminiscent of scenes described in medical examiner reports when U.S.-born children died in Clay Hill’s care.

Dawn Renay Perry had been struggling with depression, aggressive behavior and low mental function when she was placed at Hill’s Behavior Training Research facility, in the same area outside the town of Manvel where Shiloh sits now.

In April 1993, the 16-year-old was held face down on the floor by four people, records show.

“After restraint was applied multiple times, the decedent relaxed and rolled up into a ball as she usually did when she quit fighting,” medical examiner records state. Then she vomited, turned blue and stopped moving.

Stephanie Duffield was also 16 when, in 2001, she became upset that a Shiloh staff member didn’t escort her to the bathroom quickly. There was a struggle, and the assistant held her down, face to the carpet, putting her weight on Duffield’s shoulders, according to medical examiner records.

Duffield protested, saying she couldn’t breathe. Then she did stop breathing. The medical examiner called it “sudden cardiac death following hyperactivity and physical exertion during restraint,” ruling it an accident.

Hill said in a 2003 deposition that he didn’t think his staff did anything wrong.

“I thought it was just another horrible, horrible incident,” he told a lawyer representing Duffield’s family. “I happen to be—considered myself—a friend of Stephanie's, had worked with her two days before. She bit my hand and scratched it and all the things that she could do. And we were friends. It... it broke my heart to see the kid die.”

“So, you know, I thought she died of a heart attack,” he said. “I didn't think the length of the restraint had a lot to do with it.”

He didn’t see a pattern when, a year after Duffield’s death, 15-year-old Latasha Bush also died following a restraint.

The girl, who was diagnosed as bipolar with the emotional age of a 6-year-old, had told her one-on-one caretaker, Tisha White, that she wet the bed at night because she was afraid of her.

White said in a deposition that Bush was restrained by other caretakers after it appeared she was going to throw a flashlight and then threw herself against the wall, cracking it, and repeatedly asked to be left alone. White said the employees put Bush on her side, but a youth in the house said one of them was sitting on Bush and she was screaming that she couldn’t breathe.

The medical examiner called it homicide by asphyxiation. State licensing officials said she suffocated as a result of being restrained with excessive force. The district attorney told The Dallas Morning News in 2003 that she considered prosecuting but lacked hard evidence of criminal intent.

Hill called Bush’s death “a horrible tragedy” but saw no fault in his operation’s methods.

“Based on the information we had, we felt like the restraint was done the way it was supposed to be done,” he told a lawyer for the Duffield and Bush families, who ended up settling their lawsuits.

“I'm not willing to agree that the restraint caused the suffocation," he said.

Those deaths had been well publicized by the time federal officials awarded Shiloh $480,000 in May 2009 to start sheltering immigrant children.

What they didn’t know was there would be another.

In November 2010, Michael Owens, a 16-year-old battling depression and behavioral problems, gasped for air in a closet smeared with blood. Daystar employees had taken him to the floor, pulling his arms behind him, when he began “huffing and puffing,” medical examiner records show.

He died from asphyxiation, the medical examiner found, also noting “blunt impact trauma of face, torso and upper extremities." Like Bush’s death, it was ruled a homicide.

His death was one too many for the state of Texas. Officials stripped Daystar of its license, cut off its multimillion-dollar contract and moved out all the children who lived there in 2011.

Texas’ foster care agency wouldn’t send any of its own children to Shiloh, either. In response to concerns from the district attorney, the Department of Family and Protective Services wrote in a 2011 letter that it “has no intention of contracting or placing any CPS children with Shiloh, Inc. and staff has been instructed accordingly.”

But Hill got a big break from the state. Licensing officials kept Shiloh open for business, and that was good enough for the federal government, which was ramping up its delivery of immigrant children and millions of taxpayer dollars.

A month after Owens’ death, the U.S. Department of Health and Human Services awarded $1.8 million to Shiloh to take in detained immigrant children. The address on federal funding records is the same as the one on Owens’ autopsy report.

Problems continued. In 2011, state officials found a Shiloh caregiver restrained a child without justification, causing “an injury to a vital body area.” He had lifted up and then dropped the child to the ground, records show, putting his body weight on top. Within two months, the federal government awarded Shiloh $2 million more.

With the influx of immigrants, state investigators started finding a new twist on an old problem: Shiloh didn’t always have employees present who could speak the child’s language.

A Honduran boy was bleeding from his mouth and screaming in Spanish that he was in pain while being held down in 2013, according to witness accounts described in state records.

One of the employees restraining him admitted that he did “not speak Spanish and he would not be able to understand if (the boy) was complaining.”

The federal Office of Refugee Resettlement and its parent agency, the Department of Health and Human Services’ Administration for Children and Families, declined an interview and did not respond to repeated requests for comment.

Slapping, punching and kicking

In November, an 11-year-old girl said in a signed declaration that she’d rather live on the streets in her native Honduras than stay at Shiloh.

“On at least two occasions staff members have tried to hurt me,” she stated. “One time a staff member put her two thumbs up to my throat and her hands around my neck. It hurt and I was gasping for breath. The staff member said she was just ‘playing’ but I felt scared.”

Such testimony should come as no surprise to government officials.

On several occasions over the years, Texas investigators found that employees at Hill’s facilities slapped, hit and kicked children. In one case, an employee bit a child during a restraint. In two others, employees punched children in the head.

An employee bathing a 16-year-old resident caused severe bruising to the teenager’s buttocks. Another child, a nonverbal 8-year-old boy, was found with multiple marks to his lower back and bottom. Years later, a cellphone video surfaced showing a Shiloh employee slapping a nonverbal autistic child.

At one point, a Daystar supervisor and another employee instructed seven developmentally delayed residents to fight, using snacks as a reward for the winner. The staff “laughed and cheered as the residents fought,” leaving multiple injuries, according to state records.

Former employees said there were people working there who were doing their best. But they also told of abuse by co-workers that they couldn’t forget: the ones who beat up a foster child, the one who frightened an autistic boy with sexual comments, the one who offered to teach how to choke children to “put them to sleep.”

A former Shiloh caretaker said other employees would antagonize children to get them to act out, prompting a painful restraint.

“It was just like they got a kick out of it,” said the former worker. Some of them were longtime employees, and no one would get in trouble, she said. She ended up quitting because, she said, “I didn’t want to be a part of any of that.”

Even in the early years, getting beat up was a part of life at Hill’s treatment centers, said Brielle Gillis.

“It was to a point where you got beat so much that you felt like you deserved it,” she said.

Gillis arrived in the 1990s as an 11-year-old foster child, removed from an abusive home, she said. Now 35 and transgender, she went by the name Jeremy Keith Gillis at the time. Gillis spent her adolescence at Hill’s facilities until she got out in 2001.

One time, she said, three caretakers ganged up on her.

“They was holding me down, folding me like a pretzel, and they was stomping and kicking me,” she said.

An adult witness to the beating confirmed it to Reveal and said nothing came of it.

Any complaints would get back to the caretakers, who would punish the children, Gillis said. In any case, she said, kids were written off as troubled liars.

Many years later, after a state investigator determined that Shiloh employees used excessive force in restraining a 14-year-old Honduran boy who had been abandoned as a baby, Hill defended his staff.

“Mr. Hill stated the kids can be very manipulative and will make up stories to get staff in trouble,” the investigator wrote in 2013. “He stated he trusts his staff in doing the right thing.”

‘Controlling persons’

Texas has a law to prevent someone such as Clay Hill from running another child care facility when one gets shut down.

The state warned Daystar that its “controlling persons” – those determined to exercise control over the facility – would be barred from running another residential facility for five years.

If there was a person in control at Daystar, it was Hill.

Hill said it himself in his 2003 deposition when the family of Latasha Bush sued Daystar. He said he was the ultimate authority in terms of hiring, giving raises, training staff and accepting patients, though he delegated some decisions to underlings. The executive director of Daystar, Carroll “Cal” Salls, reported to Hill, he said.

State licensing officials should have known as much. A 2007 organizational chart in state files lists Hill at the top of Daystar. And state records list Hill as a “controlling person” at Shiloh.

It was even more clear on the ground, said former employees and residents. From Daystar to Shiloh, Hill ran everything.

“He’s the one who runs the show,” said former employee Caroline Laifang. “No decision is made without Clay Hill knowing about it.”

But somehow, the state didn’t see it that way.

“In conducting its investigation, the state found that Daystar Residential and Shiloh Treatment Center did not share a controlling person,” said John Reynolds, spokesman for the Texas Health and Human Services Commission.

Still, the federal Office of Refugee Resettlement had plenty of opportunities to pull the plug. The Brazoria County district attorney, Jeri Yenne, wrote a letter to federal officials in 2011 “out of concern for the safety of children.”

“This is due to the fact that there have been a number of deaths over the years of minors placed on the property managed by Shiloh and its affiliate corporation Daystar Treatment Center,” she wrote. “I am requesting increased monitoring of Shiloh Treatment Center and that your agency review the same and consider limiting the number of children placed in Shiloh Treatment Center.”

Relying on state oversight

This year, an attorney representing immigrant minors at Shiloh wrote a letter urging federal officials to stop sending children there. It focused on the drugging problems, but noted Shiloh’s connection to Daystar and the deaths.

An Office of Refugee Resettlement official responded by making a point of distancing Shiloh from Daystar.

“Notably, Shiloh RTC (Residential Treatment Center) is not operated by DayStar Treatment Center (DayStar), which is mentioned in your letter,” wrote senior federal field specialist supervisor James De La Cruz. “Even when it was still in business the licensure of Daystar was completely separate from that of Shiloh.”

The distinction is lost on former employees and residents. And Clay Hill wasn’t the only person who oversaw both institutions during their darkest moments. Kellie Pitts has been in charge of quality control at Shiloh since 1999 and also held that role at Daystar, according to Hill’s deposition. Tisha White, who was briefly suspended but cleared of wrongdoing in the 2002 death of Latasha Bush, appears to work at Shiloh, based on her Facebook profile and accounts of others. Pitts and White could not be reached for comment.

When lawyers representing the children asked a federal judge to intervene this year, government attorneys shot back that there is already plenty of oversight.

Federal officials argued that the court “should not conduct its own evaluation,” but rather “should rely on the State’s own evaluation.”

“Given this extensive level of oversight by the states,” the government’s filing says, “this Court can – and should – reasonably rely on the conclusions of those state licensing authorities.”

Yet state licensing officials, also responsible for the Texas foster care system, have been found to be dangerously ineffectual.

Federal District Judge Janis Graham Jack ruled in December 2015 that Texas was fundamentally failing to protect foster children. Among widespread problems, she found the state licensing agency was “failing its licensing and inspecting duties” and “almost never takes an enforcement action.”

She cited an internal review that found error rates of up to 75 percent in the state’s investigations of abuse allegations.

“This is staggering,” she wrote, “and it means that many abused children – for whom a preponderance of evidence indicated that they were physically abused, sexually abused, or neglected – go untreated and could be left in abusive placements.”

It is the same agency that investigated 30 complaints of abuse or neglect at Shiloh since October 2012 and ruled out every one of them, according to Department of Family and Protective Services records.

Texas, the judge found, “has closed one facility in the past five years, but it is a story of horror rather than optimism regarding enforcement.” She was talking about Daystar.

Texas authorities “allowed this facility – that was responsible for four deaths, numerous allegations of sexual abuse, and unthinkable treatment of developmentally disabled children – to operate for 17 years,” the judge wrote. “The Court does not understand, nor tolerate, the systemic willingness to put children in mortal harm’s way.”

In January 2018, the same judge issued a grim update: “Over two-years later, the system remains broken.”

Jack ordered continued monitoring of the state system by appointed special masters. Texas Attorney General Ken Paxton appealed the ruling to the U.S. Court of Appeals for the 5th Circuit, where it is pending.

“The ruling was arrived at by an unelected federal judge who misapplied the law, hijacked control of our state’s foster care system, and ordered an ill-conceived plan by the special masters that is both incomplete and impractical,” Paxton said in an April statement.

Former federal officials said they were doing the best they could.

“There was definitely a sense that the problems at Shiloh were problems that could be fixed,” one ex-official said. Given that Shiloh maintained its state license, “working to address the issues seemed like the right thing to do to keep the capacity on line.”

There weren’t a lot of other options for immigrant children with serious mental health problems, said the former official, who requested anonymity: “It is a specialized facility. We don’t have a ton of those in the system.”

Even one case of child maltreatment is unacceptable, but in a system housing thousands of children, it is also inevitable, said Maria Cancian, who was deputy assistant secretary for policy in the Administration for Children and Families, over the refugee resettlement office, from 2015 to 2016.

“Sometimes things are going to happen that shouldn’t happen,” she said.

The refugee resettlement agency tightened oversight, Cancian said, including increasing unannounced visits to shelters by field representatives.

“Was it enough? Almost certainly not,” she said. “There’s almost never a child service organization in this country that is adequately resourced.”

Cancian said she visited shelters that were “overwhelmingly staffed by people who were trying to do their best, and by and large, they were places that provided high-quality care.”

“The exceptions are absolutely not acceptable,” she added, “and it’s appropriate to shine a light on that.”

Reporters Aura Bogado and Vanessa Swales contributed to this story. It was edited by Ziva Branstetter and Amy Pyle and copy edited by Nikki Frick.