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DIGNITY LOST-Critics Slam Treatment As Jails Deal With Mentally Ill

By Deborah Circelli, Staff Writer 

Gas masks over their faces and clad in armor, four correctional officers storm Ciara-Paige Green’s cell, then push the naked young woman onto her bunk.
 In the video, Green gags from a chemical agent sprayed in her cell and repeatedly yells to the male and female officers, "I can’t breathe," as one officer holds her head and others appear to pin her on the bed for a few minutes.
 The New Smyrna Beach woman was 19 and at the Volusia County Branch Jail on charges of striking police and corrections officers when the video was recorded last year. She has several mental illnesses and has struggled with cocaine addiction.
 Wearing only handcuffs and leg irons, Green, in the video, is lifted off the bed by two female officers, then walked out of her cell. Another officer, aiming a handheld video camera, records the cell "extraction" while a supervisor looks on. Seconds later, Green is pushed against the wall for pulling away, according to jail reports. As the camera keeps rolling, the officers struggle to get Green, still fighting, up stairs. She’s then strapped into a restraint chair and a bed sheet placed over her.
 This example from October is one of nearly three straight days where officers held video cameras to record Green naked on and off for more than two hours in what inmates and attorneys call the "buck naked cell," for people on suicide watch. She was put in mental health lockdown or disciplinary confinement all but three days of her more than six-month jail stay and put in restraint chairs for hours at a time for threatening to harm herself and assault staff, officials say.
 Her attorney and family say if the jail’s psychiatrist had prescribed proper medications for her mental problems, she wouldn’t have been a danger. Her appointed lawyer says some of the methods used on Green were malicious, unnecessary and meant to degrade.
 "That’s not a way to treat an animal much less a human being," said her attorney, Assistant Public Defender Jay Crocker.
 Her case, according to the Public Defender’s Office, is not isolated and a prime example of the need for change in how inmates with mental illnesses are treated in the county jail. Other groups statewide want more services to divert people with mental illnesses from jails.
 Public Defender James Purdy and a local faith-based group are calling for the Volusia County Council not to renew its contract in October with a private health care company unless safeguards are in place for inmates to receive medication.
 Local officials are also seeking more community services.
 "There certainly are a lot of inmates in the Branch Jail that we would agree would be better off in other circumstances," said Volusia County spokesman Dave Byron. "We are sort of the repository."
 Families Wait For Change
 Meanwhile, family members like Green’s mother, Debi Green, 52, watch loved ones revolve in and out of jail, crisis units and hospitals — many for charges such as resisting arrest, battery on an officer or lesser crimes.
 Green, now 20, sits in a state mental hospital in Chattahoochee after being sent in February from the jail to a local crisis unit.
 She was found incompetent to stand trial for possession of drug paraphernalia, resisting arrest with violence and a probation violation for battery on a correctional officer.
 "God, the cruelty," Debi Green cried recently in her New Smyrna Beach kitchen, with her hand against her heart, as she watched the October video of her daughter. "They’ve stripped her of her dignity."
 About 1 a.m., after being video recorded naked in her cell over almost three days, Green rips her mattress with her teeth. Out of the material from the mattress cover, she makes a skirt and a top to cover her breasts. She is then placed in a restraint chair for fear of hurting herself with the material.
 Court reports from psychiatrists show Green’s mental illnesses, which include post traumatic stress from abuse, bipolar, schizo-affective and borderline personality disorders cause impaired judgment, erratic behavior and poorly controlled anger.
 Making Things Worse?
 Her attorney says the way she was treated in jail only aggravated her condition.
 "They were doing things to tweak her and try to set her off," said Crocker, who is a board member for the Mental Health Association of Volusia County. "You don’t have to invade somebody’s privacy especially when they are naked. It’s pretty outrageous."
 County officials said Green was given the standard paper gown and blanket, but damaged or refused to use them.
 Green wrote in letters to her mom that the jail wouldn’t give her a paper gown. One video confirms that officers did not give her a paper gown after making her remove her jail-issue orange pants and shirt.
 She asked for a blanket and was shown naked. They replied they would return with one.
 Corrections officers also testified that Green’s problems were behavioral, not mental. They said she’d kick and cuss at officers, pull hair and threaten to kill them and their families. She was in jail for battery on a law enforcement officer and a new charge of battery on a corrections officer.
 Her mom was not allowed to visit throughout her more than 180-day stay. Jail documents stated if Green improved her behavior, she could have recreation and visitation. But that never happened.
 County’s Side
 "This was a very troublesome inmate. This woman was a handful," Byron said.
 He spoke for the county-run jail system after the jail’s director, Marilyn Chandler Ford, would only respond in writing for this story, and after her responses were reviewed by Byron. "Whether she was a danger because of her mental illness or whatever factor," Byron said, "it doesn’t change the fact that this was a dangerous person. It’s not the Mayo Clinic out there. We have a fiduciary responsibility to the taxpayers to balance humane care and cost of care."
 County officials also said Ciara-Paige Green wouldn’t take medicine prescribed.
 The inmate, in written complaints and in court, said she wasn’t getting psychotropic medication that stabilized her prior to going to jail and the jail psychiatrist kept switching her medications.
 Dr. Stephen Young, forensic psychiatrist for the 7th Judicial Circuit, who found Green incompetent to stand trial in March, defended jail psychiatrist Dr. David Hager, saying he cares about inmates. He said Green was a "complicated case" and had a large volume of medical records.
 Use Of Restraints
 Dr. Henry C. Weinstein, a psychiatrist and chairman of the American Psychiatric Association’s Committee on the Mentally Ill in the Criminal Justice System, calls practices such as restraint chairs "primitive." He says solitary cells and isolation only worsen an inmate’s mental condition.
 Byron said the restraint chair is used frequently for dangerous inmates. Video cameras are used when inmates have to be forced from their cells. But in Green’s case, Ford said the videos also were to document her behavior so mental health staff could conduct a thorough evaluation. But they also said some of the video recording of Green naked went on "longer than preferred."
 "Our point of view is this was handled in a professional manner," Byron said. "Was it a pleasant occurrence? No. Was it the way you would hope these situations work out? No. Is it common for people to be video taped naked? No."
 Ford also said in written responses, "Inmate Green was not injured during her incarceration — but our officers were," including an officer who jail officials said had some of her hair pulled out.
 "The general public, including the Public Defender’s Office, cannot even imagine what the correctional officer has to handle," Ford said.
 Dozens Complain
 Public Defender James Purdy and several other attorneys report dozens of local cases of inmates being kept naked and not given psychotropic medications. Green is one of 84 inmates defense attorneys documented during a two-year period ending in October who complained the jail took them off the psychotropic medications they were on before incarceration, which Purdy said interferes with their defense. More complaints are coming in, and the American Civil Liberties Union also is collecting information.
 "My concern is there are other ways to deal with people who are suicidal besides putting then in a cell nude and leaving them there," Purdy said.
 The jail health provider, Prison Health Services, also has faced criticism locally and nationally in lawsuits regarding inmates not receiving psychotropic medication. The county is also being sued. Hager would not comment and is resigning at the end of May to seek a job out of state. But company officials said inmates who need them receive psychotropic medications.
 "We are taking care of the mentally ill," said Rita Jorgensen, who oversees mental health services at the county jail for Prison Health. The company is open, officials said, to subcontracting out the mental health portion of the contract with Act Corp. County officials, meanwhile, say Prison Health Services is doing an "excellent" job and saving the county money.
 Circuit Judge Joseph Will, who handled Ciara-Paige Green’s case, said the numerous reports he’s heard from inmates about the suicide cell are "horrible," and "alarming," including being strapped for extended periods of time in a bed without clothing.
 "Are the reports true? I don’t know," Will said. "I know if it happened to me or one of my children, I’d be very angry — so it causes me great concern," he said.
 Act’s crisis unit uses two cloth hospital gowns for people on high-risk watch, and they are allowed to wear their underwear. Cameras are mounted discretely in ceiling corners. In state prisons, wrap-around garments for suicidal inmates are being phased out in favor of an over-the-head smock made of tear resistant fabric, not paper.
 County Chairman Frank Bruno said he plans to look into Green’s case and others that are brought to him.
 "We have got to treat people with all due humanity," he said.
 Too Little Too Late?
 For Ciara-Paige Green, her mom fears, it may be too late because experts say with each mental breakdown there is more brain damage.
 Debi Green has been fighting for several years to get her daughter into substance abuse and mental health treatment since a judge ordered her daughter into a program in 2004, but bed space was never available.
 "She needs mental health help, not punishment," her mother said. "I’ve been fighting for a long time and it hasn’t done any good. All I can do now is hope my fighting helps somebody else."
 When Ciara-Paige Green finally got sent to a substance abuse treatment program this past January, she walked out after just two days. When police caught her three days later, she was charged with possession of drug paraphernalia, resisting arrest with violence and a probation violation and sent back to jail.
 Court and jail documents said she was "extremely regressed" back at the jail, refusing to eat or drink and threatening suicide. Her attorney was able to get her transferred out of the jail at the end of February to Act Corp.’s crisis unit and March 20 to Florida State Hospital.
 Her mom wishes the jail had sent her daughter to the crisis unit or hospital earlier.
 Ciara-Paige Green has a history in and out of juvenile detention centers and a troubled childhood, including a turbulent custody battle between her parents and abuse as a child and adult, records show. She even had altercations with her mother.
 In a Daytona Beach News-Journal interview with Ciara-Paige Green two years ago, when she was at home stable for three months on medication, she said she wished she could "be normal" and not take medicine. She hoped to go to college, but was having problems concentrating to take the placement exam.
 She later stopped taking her medicine and ended up in jail last July for twice elbowing an officer, police said, while trying to flee Halifax Health Medical Center. She was taken there by police to be examined for excessive use of cocaine.
 What’s Next For Ciara?
 Green is at Florida State Hospital until doctors and a judge say she’s competent to stand trial. She likely will then be sent back to jail to face criminal charges. But her mom and attorney fear the cycle will start over again and she won’t receive the same medications.
 Crocker said Green could face 11 years in prison for various charges that he said are "attributable directly to her mental illnesses."
 Last weekend, Debi Green drove to the state hospital for Parents Day. Ciara-Paige Green is back on medication she took prior to her jail stay, her mom said. During the visit, at times she was delusional, talking about people who don’t exist, Debi Green said. But at other times she was in good spirits, visiting with other clients and their families. It was a big change, her mom said, from her daughter talking in the third person and not making sense more than a month ago.
 She said she’s still holding out hope for her daughter to lead some semblance of a normal life.
 Ciara-Paige Green wrote in a Jan. 6, 2008, letter to her mom while in jail that she’s optimistic.
 "I am in need of God’s help and I’m tired of being locked away," she wrote. "I’ve spent most of my life in lock up — so many family days I missed, years never to be able to be celebrated again, but like you wrote me a while back. There is light ahead."
 — Staff Writer Jay Stapleton contributed to this report.
 [Note: The following are unedited excerpts from Ciara-Paige Green’s handwritten letters to her mother and formal requests during her jail stay.
 To Her Mom
 • Sept. 26, 2007: "I’m sorry for putting you thru hell. Please don’t feel lonely and depressed cause I swear I feed of how you feel even when we’re not together, so smile, be happy. I’m still alive & drug free.
 • Oct. 9, 2007: "They put me in the chair. I urinated on myself and they left me sitting like that for four hours, that’s what happened and Sunday Oct. 7 I was in the chair and Sunday night I went to CWI." (Constant Watch — housed separately in a single cell) "I’ll make it through, whatever doesn’t kill me only makes me stronger. Ya feel me?"
 • Oct. 12, 2007: Talking about a friend of hers outside jail that just died of an overdose. "That could have been me that day I shot (up) that cocaine, thank God it’s not. God has helped me several times. Him and his angels."
 • Nov. 12, 2007: "Yes I have been being on my P’s and Q’s. They don’t give us paper gowns. I don’t know why not. Once I was given one. But their was lots more time that I or any other I/M on "CWI" was not."
 • Nov. 27, 2007: "I was in the (restraint) chair from 3:45 p.m. to 9:40 p.m. I thought I was going to die. Friday I went on CWI (Constant Watch). Saturday I went to 15 (I) witch means I get my clothes. While on CWI (two seargants) told me I could not have a paper gown."
 • January 2008: "I’m a very different person. Mom you won’t like me, I know, cause I don’t even like me. I spit on people, fight them. Most of the time they provoke me, but some times I do it cause theres no hope, not for me, not in this world."
 To Jail Officials
 • Oct. 11, 2007: "I do not agree with Dr. Hager in choices concerning my medication. I am diagnosed with schizophrenia and bipolar and he refuses to give me psychotropic medication that I was taking before my incarceration."
 • Staff response: "You are receiving the medication that Dr. Hager feels is appropriate for your care."
 • Oct. 12, 2007: Green asked the then director of corrections, Cynthia Clifford, how long can she be kept from having a visit from her mom. "I have been here since July and have not received nut nan visit."
 • Clifford responded Green can receive all privileges allowed "by following the rules and regulations of the institution."
 • Dec. 4, 2007: "I want off this behavior plan immediately. I’m not taking prescribed meds. N-E-No! Got it. Get it. Good. I have no bible until phase 3/C?" She said the behavioral plan violated her freedom to practice religion.
 • Dr. David Hager response: "Your life pattern of choices according to your likes & dislikes has resulted unfortunately in repeated incarceration. Stopping the behavior program because you don’t like it is not therapeutically useful. This would remove an important chance to learn how to behave more functionally. You will be seen by me as already scheduled."
 • Dec. 8, 2007: Green requests jail staff give her back her extra blanket that was given to her because of the cold weather. "My ex. blanket was on my bed and, I was using it to cover up with," she wrote.
 • Jail staff said Green flooded her cell and the blanket was lying on the wet floor. "If I/M Green really needed her extra blanket, she would have had it laying on her bunk. Request denied."