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
jgrotto@MiamiHerald.com


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.”