MIAMI HERALD WATCHDOG
Sex predator facility failing to treat inmates
Breakdowns in healthcare and state oversight have left a treatment center for sexual offenders starved of resources and its neglected inmates in dire need of proper care.
BY JASON GROTTO
ARCADIA – Holding the razor in his mouth, Ernest Contrillo ran the blade over his right wrist seven times as blood flowed from the crooked wounds. It wasn’t the first time he mutilated himself inside the Florida Civil Commitment Center. A year earlier in the center, Contrillo, 52, lost his left arm to a gangrene infection he coaxed along by severing his flesh. State records show that for four decades Contrillo had sought comfort in pain, yet he managed to obtain razor blades and cut himself numerous times in what’s supposed to be a secure mental health facility for Florida’s most menacing sexual predators. Since it opened in 1999, the center — created to treat men for their sexual disorders after serving prison terms — has struggled to meet its most basic mission, let alone deal with the medical needs of men like Contrillo. After his arm was amputated, he spent 10 days in the hospital because caregivers did not keep him on antibiotics. In fact, a four-month review of monitoring reports, court cases and internal documents show so many breakdowns in medical and mental care that drugs often were dispensed without doctors’ approval, men languished without treatment, and in some cases, those with severe psychological disorders were forced into solitary confinement — some never getting treatment for sexual problems. Gaps in care were often noted during state reviews, but problems continued. One man was given a powerful antipsychotic drug even though he was not diagnosed with a mental illness. Another was left in an infirmary for days while urine in his bedpan collected mold. ”All I ever heard from everybody was that they were sexual predators. But they’re also human,” said Beverly Babb, a former nurse who quit the center in 2004 after a year. Said Douglas Shadle, a psychiatrist who left because of conditions: “This is an asylum-era institution that has no place in this century.” Despite problems, state lawmakers repeatedly refused requests to adequately fund the center. But they waived laws that require the civil commitment facility to meet state medical and mental care standards. Seven years later, those decisions have exposed the state to a class-action lawsuit that places the entire program in jeopardy and exposes taxpayers to millions in potential court fines, a Miami Herald investigation has found. Consider: • For years, medical care has been plagued by shoddy record keeping, failure to provide basic checkups, delayed treatment of serious illnesses and potential violations of state and federal laws. • Crucial medications, such as powerful psychotropic and cancer drugs, were often not available or provided to residents without proper documentation. • Records show the center’s use of solitary confinement defies state and federal guidelines. • As the facility began filling up with mentally ill men, the private contractor hired to run the center, Liberty Behavioral Health, asked the state five times for more money and staff to provide psychiatric care. Each time, the state balked. • As the center’s population grew by more than 300 percent, its funding increased just 46 percent, leaving it to operate on a budget that’s less than half of those found at other mental health facilities in Florida. • The facility’s staffing levels are now less than half of similar programs in other states. ”Anytime offenders are put in the position where they can pretend to have the moral high ground, then we have done something very stupid,” said Don Ryce, the father of 9-year-old Jimmy Ryce, whose 1995 abduction, rape and murder led to the creation of Florida’s civil commitment law, known as the Jimmy Ryce Act.
BLAME GAME With Liberty’s contract set to expire June 30, the Florida Department of Children & Families — the agency that runs the program — has the difficult job of cleaning up a treatment center it allowed to deteriorate during the past seven years. DCF lays most of the blame for the center’s woes on its Pennsylvania-based contractor and has decided to manage the center until January 2007, when the international corrections company GEO Group is slated to take over the contract. But Liberty, which holds similar contracts in four other states, says the agency’s decisions and the state’s refusal to adequately fund the program caused it to falter. ”[Now] that the Department of Children & Families has chosen to publicly denounce our company and turn Liberty into a scapegoat for a legacy of its own poor decisions, we are prepared to speak out,” Sue Nayda, Liberty’s vice president, wrote in a 9-page letter to The Miami Herald on June 9. Liberty says that since the program began, the DCF ”abdicated its responsibilities to establish formal, fundamental administrative rules, regulations or standards to govern the program,” leaving Liberty to fend for itself as it struggled to treat offenders with a shoestring staff.
CLASS-ACTION SUIT Florida now faces a class-action lawsuit that claims the center is failing to provide constitutionally adequate care. One other state with a similar program, Washington, has racked up $10 million in court fines after losing a similar class-action case in 1992 — and it spends twice as much per offender as Florida. Already, the center in Northwest Florida lost one state case over its disciplinary methods. Four offenders at the facility filed suit in DeSoto County Circuit Court in 2002, claiming the center violated their rights by placing them in confinement without telling them why or allowing them to contact lawyers. Ruling in favor of the offenders, DeSoto County Circuit Court Judge Vincent T. Hall found the center not only broke rules governing mental health facilities, but also state prisons and standards set forth by the U.S. Supreme Court. Tucked in a corner of a rundown former prison compound, the Florida Civil Commitment Center’s infirmary is a one-story brown building with filthy walls and water-stained ceilings. Inside, a meager nursing staff with little support and virtually no oversight is charged with treating a myriad of maladies. The nurses work amid stacks of medical files that have been badly kept. The shoddy medical records have contributed to inadequate care at the facility — a challenge the center still faces, and one the DCF acknowledges in its own reports. Last year, one resident who complained of weight loss and rectal bleeding had no current weight in his file and no evidence of an examination, according to records. Another man in the infirmary suffered from chronic lung disease and asthma but there was no documentation of follow-up for his conditions. He complained of blood in his stool, a lack of appetite, vomiting, blood and weight loss, but there was no record showing those symptoms had been explored, the DCF report stated. Meanwhile, the man was prescribed a powerful antihistamine without documentation while the nurse on duty ”did not know why he was receiving the medication,” the report said. A review of nearly a dozen medical records by The Miami Herald found folders stuffed with loose leaf medical charts dating back years that were out of order and nearly impossible to follow. Worse, the state knew records were incomplete, yet never bothered to ensure the system was fixed. Five years after the center opened, DCF finally took a hard look, and found widespread problems, but two years later, medical care still remained ”a grave concern” largely because of incomplete and inaccurate medical files, reports stated. Only three of 23 files examined met state standards.
DRUG ABUSE ”The medical care is a mess because they don’t want to spend the money on proper care,” said Babb, the former nurse who quit. In a facility already rife with drug and alcohol abuse, documents and interviews show that for years the center dispensed powerful medications without proper safeguards. Former nurses claim they often were intimidated by residents who demanded everything from painkillers to cough syrup. When the nurses refused, they said some of the men threatened them or threw violent temper tantrums. ”They would come up maybe four times a day for narcotics, and if you didn’t have them, they would intimidate you,” said Marjorie Ranger, a nurse who worked there for three years before quitting in 2004. Even worse, Ranger says, the center’s administration often forced nurses to fill prescriptions without a doctor’s signature or continue doling out drugs even after a doctor’s orders expired — both violations of state law. ”Every nurse working there knows her license is on the line,” Ranger said. ‘Xanax, Ativan, all kinds of medications were going out of there like they were candy. I would look at the charts and find doctors’ orders were not signed. They were written up by nurses without signatures.” Those claims are backed up by the DCF’s own reports, which state in 2005 that “Medication and other treatment are too often ordered without adequate explanation or records support.” Last year, a resident — who had no diagnosis of mental illness — was given the powerful anti-psychotic medication Zyprexa after experiencing fear, suicidal thoughts and paranoia when the center changed his dormitory, according to the DCF’s own report. In other cases, drugs that doctors properly prescribed were not available. One case noted by the DCF in 2003 found an offender waited nearly a month for cardiac medication. In other cases, the agency found psychotropic drugs prescribed by doctors were not available for seven to 10 days.
ATTEMPTS AT SUICIDE Joseph Myers, 32, was first arrested for a sex crime at age 7. Diagnosed with schizophrenia and borderline personality disorder, Myers was hospitalized twice for attempted suicides before going to prison on sex charges in 1997. Confined to the treatment center since 2001, Myers has slit his wrists with a plastic knife and attempted suicide there many times. In November 2005, he was forced into solitary confinement for having sex with another resident — though Myers filed complaints saying the man had been stalking him for months. Records from his psychiatric file, which Myers let The Miami Herald examine, show that he complained of hearing voices telling him to kill himself after he was placed in confinement. But to this day, the only psychiatric counseling Myers receives inside the center are sessions with a contract psychiatrist about once a month. Contrillo is in the same boat. Diagnosed with borderline personality and bipolar disorders, he has been placed in psychiatric hospitals nearly a dozen times since the age of 11. He has mutilated himself repeatedly inside the center, which contributed to the infection that caused him to lose most of his arm. The only help he receives is psychotropic drugs and occasional visits with a contract psychiatrist.
TREATED `LIKE A DOG’ ”My brother has mental and emotional problems, but they treat him like a dog,” Contrillo’s sister, Sue Alexander, told The Miami Herald. While holding at least 125 men like Contrillo and Myers, the center had no stand-alone mental health program until 2004, when the DCF admitted the need for an additional 25 staff members to create a special unit after repeated requests by Liberty. Yet the agency never bothered to provide funds for its own recommendation, forcing Liberty to divert staff from its sexual offender treatment program — the facility’s primary mission — which already suffers from staffing shortages and provides as little as two hours of therapy a week. So far, the special therapeutic unit is not even run by a psychiatrist. It is overseen by a man who holds no mental health license in Florida. Mental healthcare for men like Contrillo and Myers is at the heart of a federal class-action suit against the state. The case, filed in federal district court in Fort Myers, claims the program is failing to provide constitutionally adequate mental healthcare in what is supposed to be a mental health facility — not a prison. Other facilities are guided by laws guaranteeing adequate care, but DCF waived those rules for the treatment center on Feb. 5, 2001. ”It’s more evidence that it is providing constitutionally inadequate care for these people,” said Kristen Cooley Lentz, the lead attorney in the class-action suit. When the U.S. Supreme Court upheld civil commitment for sexually violent predators in 1997, it said the conditions should mirror those found in state mental institutions. Yet the state spends more than twice as much at other mental health facilities as it does at the Florida Civil Commitment Center, records show. ”It’s remarkable what is going on over there,” said Robert Bellino, a psychiatrist who worked at the center for 4 ½ years. “But nothing is going to change, because no one is going to spend the money.”