Caught In A Legal Labyrinth

By Sherri Ackerman, Tampa Tribune, Fla.

Jan. 6–CLEARWATER — A mentally ill inmate — unfit to stand trial — waits months in jail without treatment before the Department of Children & Families transfers him to a state hospital.

There, he takes medications to help convince doctors he is competent. DCF returns him to jail, where he legally can refuse treatment.

Without medicine, the inmate’s condition worsens until the court finds him incompetent again and DCF finds him another bed.

“They’ve played that game for a long time,” Pinellas-Pasco Public Defender Bob Dillinger said. “Sending them back frees up beds.”

The game leaves inmates suffering terribly, mental health advocates say. They want newly elected Gov. Charlie Crist and his hand-picked DCF chief, Bob Butterworth, to make the issue a top priority.

The state’s lack of beds for mentally ill inmates in treatment centers in Chattahoochee, Gainesville and Miami is at the heart of statewide legal battles. The shortage also is at the center of an emergency meeting of lawmakers set for Wednesday.

The Legislative Budget Commission, at the urging of former Gov. Jeb Bush, will consider shifting $16.6 million in unspent budget money to house 373 inmates in the spring.

The move, expected to be approved, is a temporary fix for the 295 inmates waiting for treatment statewide. The money runs out when the fiscal year ends in June.

A long-term solution that prevents the mentally ill from entering the jail system in the first place must be addressed quickly, said Sara Romeo, a former legislator who oversees Tampa Crossroads, one of the Tampa Bay area’s first programs for mentally ill inmates.

The Blame Game

Romeo blames the crisis in part on Bush and lawmakers, who continually slashed DCF’s funding during the past five years.

DCF documents show legislators denied requests from the department in 2004-05 and 2005-06 for nearly $30 million earmarked for mental health services, including more residential treatment beds and case management to divert people from state hospitals.

Sen. Nan Rich, D-Sunrise, defended lawmakers last month, saying DCF never alerted them to the severity of the situation.

“They told us they didn’t know, that this caught them by surprise,” said Rich, co-chairwoman of the Health and Human Services Appropriations Committee.

Florida ranks 48th in the nation for its funding of mental health care, according to a report from the National Alliance for the Mentally Ill.

“It’s pretty striking,” said Katharine Lyon, vice president of the Florida Council For Community Mental Health in Tallahassee.

The state’s lack of funding for such programs directly correlates to the increase in the number of mentally ill people landing in jail, she said.

“They’re not getting their needs met,” Lyon said. “They end up engaging in low-level misdemeanors for the most part, but once that happens, it’s hard to break the cycle.”

Brandon Hitteman of St. Petersburg has become a poster boy of sorts for such a cycle. His criminal history began with misdemeanors and ended with an arrest in 2002 in the beating death of his girlfriend.

Since then, Hitteman has shuffled between the Pinellas County Jail and Florida State Hospital in Chattahoochee three times. The state seeks the death penalty against the 25-year-old, who was found incompetent in May 2003.

“His incompetence is the result of delusional beliefs suggestive of schizophrenia,” a psychologist wrote in court documents, and Hitteman had a previous diagnosis of schizoaffective disorder.

At least five other psychologists have interviewed Hitteman. The most recent review in September again determined that Hitteman was incompetent. He continues to wait in jail without treatment, said his public defender, Violet Assaid.

Meanwhile, his condition is worse and his life is on the line, she said.

“It’s like a revolving door,” Assaid said. “Nobody’s taking care of him.”

Jail ‘Is Not A Treatment’

A recent study published by the federal Department of Justice found that more than half of prison and jail inmates, including 64 percent of local jail inmates, have a mental health problem.

The majority have issues related to substance abuse, followed by bipolar and psychotic behavior, mental health providers say. While jailed, the inmates seldom receive treatment on par with what is available at psychiatric facilities.

In Pinellas County, the inmates routinely and legally refuse medication, said Maj. Kirk Brunner, who oversees the jail. An average of 20 inmates a day wait there for DCF to transfer them to one of the state’s three psychiatric hospitals.

“These people really need to be out,” Brunner said. “The holding facility [in jail] is not a treatment. They’re not getting any better here.”

At the county’s expense, Brunner must have a deputy on duty 24 hours a day for mentally ill inmates, who can deteriorate quickly while waiting for a state bed to open.

They often try to commit suicide or mutilate themselves, as one inmate did recently when he gouged out his eye.

“We have to pay for that, too,” Brunner said of the inmate’s emergency care. “Taxpayers have to pay for that.”

A 30-year veteran of the jail system, Brunner said the sheriff’s office is researching whether it can start billing the state for the extra costs associated with overseeing DCF’s clients. He doesn’t have a tally, but he estimates it costs the county about $350,000 a year just for the special surveillance of DCF’s wards.

Cure And Return

Inmates ordered into DCF’s custody are sent to one of the state’s three psychiatric facilities with one goal: to get better so they can return to court and answer their charges.

It usually takes about four months for the state to make that happen, officials said. Some inmates remain hospitalized for two or three years. About 10 percent are sent back to jail, only to return to the hospital.

To prevent inmates from becoming incompetent again while waiting in jail for court, DCF in November increased the number of days the state provides them with medication from seven to 30. The law, however, allows inmates to decline medications.

“If inmates refuse meds, then there’s nothing that can be done,” DCF spokesman Al Zimmerman said. “And it does contribute to the problem of some of them returning.”

The department plans to propose legislation this session that allows DCF to provide psychotropic treatment without an inmate’s consent under specified circumstances.

Sometimes, the waiting game isn’t DCF’s fault, Zimmerman said.

As of Friday, there were 52 inmates whose competency was restored, yet they were waiting 25 days on average for the county jails to come get them, he said. “These are people tying up 52 beds that could be used for other inmates.”

Butterworth, who officially took his post as DCF secretary this week, plans to investigate the department’s situation before announcing any sweeping changes.

The agency is struggling with too little money and too many obligations — child safety, foster care and adoptions, the abuse hot line and mental health care, he said. Butterworth vowed, however, that he would not allow the department to continue breaking the law.

Florida requires DCF to take custody of the inmates within 15 days of receiving their commitment orders. Yet for years, DCF has not followed the law until judges threatened the department with fines or contempt charges.

The issue exploded in November when Pinellas-Pasco Circuit Court Judge Crockett Farnell grew so infuriated with DCF that he held the department’s then-chief, Lucy Hadi, personally responsible. He fined Hadi $80,000 and threatened her with jail for leaving 10 mentally ill inmates languishing in the Pinellas County Jail.

Hadi left her DCF post Dec. 28 with plans to work for the Department of Education. She is scheduled to appear before Circuit Judge Robert Morris Jr. in Clearwater on Thursday.

Hadi’s private attorney, hired by Bush, has filed motions to delay the case pending the outcome of a DCF appeal.

Researcher Catherine Hammer contributed to this report. Reporter Sherri Ackerman can be reached at (813) 259-7144 or sackerman@tampatrib.com.

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Copyright (c) 2007, Tampa Tribune, Fla.

Distributed by McClatchy-Tribune Business News.

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