Florida's mental hospitals suffer from chronic understaffing, lose track of expensive medication and waste taxpayer money, the Auditor General found. LUCAS DAPRILE/TCPALM Wochit
The problems at the Treasure Coast Forensic Treatment Center are myriad. And there's plenty of blame to go around.
But the biggest challenge might be finding, and funding, a durable solution.
As detailed in a recent TCPalm investigation, the Indiantown facility — run by a private operator and serving more than 200 mentally ill criminal defendants from throughout our region — lacks staff, training, licensing and funding.
At least one patient has been killed and several staff maimed in violent episodes that might have been prevented with adequate staffing.
Drugs were administered in violation of state rules, and possibly state law.
The center, one of four state-run mental hospitals, deluged Martin County 911 dispatchers with 5,337 911 calls over a 10-year period, an average of one every 16 hours.
A loophole in federal medical privacy laws prevents many patients who commit violent crimes while in custody from being charged.
As a result of our newsroom's reporting, the state Department of Children and Families, which oversees the hospital, has launched an investigation into allegations the hospital failed to report assaults and employee misconduct.
The forensic center's job is to restore accused felons' mental health to the point where they are competent to stand trail, and to house those found not guilty by reason of insanity. It's neither a simple nor inexpensive task.
But some of the decisions made by the hospital's for-profit operators, and the actions — or inaction — of the state have arguably made this difficult and dangerous assignment even more challenging.
From 2007 to 2014, the center was operated by the GEO Group of Boca Raton; that firm spun it off to Correct Care Solutions of Nashville, which retained many of the same employees.
But regulators say neither operator retained enough staff. Since 2007, the hospital has been fined nearly $700,000 for violating minimum staffing levels established in its state contract.
Our investigation showed the private operators make more money keeping staffing low and paying fines than they would by hiring a full complement of workers, and paying those salaries and benefits.
In other words, the fines amount to a mere slap, easily ignored.
Then there's the fact that the forensic center, along with two of the state's other three mental hospitals, is not registered with the Florida Agency for Health Care Administration, as required by state law.
Why not? Because, according to the state Department of Children and Families, it would be too costly to bring them up to fire and building codes.
Because the hospitals are not licensed, they're not subject to annual AHCA inspections, which could result in fines of up to $25,000 for infractions that aren't remedied quickly.
The Florida AHCA also could levy additional fines for subsequent offenses, including a $1,000 daily administrative fine, and fines for understaffing. The TCPalm investigation found the forensics center could have been on the hook for more than $4 million in administrative fines alone since 2007 — which would have been a powerful incentive to address some of the hospital's problems.
But no AHCA registration means no fines, and no compelling fiscal reason to address any deficiencies.
So there's plenty of blame to go around. Correct Care Solutions must staff the hospital appropriately and report all incidents of violence to the state. The state, meanwhile, needs to address the perverse economic incentives that all but encourage private operators to break the rules.
Florida officials also must insist the hospital be licensed by the AHCA, perhaps with the understanding that private operators would be given ample time to remedy any building or fire code violations.
These, however, are short-term fixes. The bottom line is more money is needed but not available. Florida ranks 49th for mental health spending, according to the Virginia-based National Alliance on Mental Illness' latest report in 2015.
Creative solutions are necessary. Yet efforts to expand alternative programs have died on the vine.
In downtown Miami, for example, the Miami-Dade Forensic Alternative Center operates on the idea that its inmates/patients aren't dangerous, just sick. It seeks to treat that illness rather than merely stabilizing a patient enough for trial. Wrap-around services like job training, case management and transitional housing mean patients spend 20 percent less time in the center and cost state and local taxpayers 30 percent less per day.
Yet the Florida Legislature declined to triple the size of this alternative program in 2011, and DCF officials subsequently declined to fund another alternative program.
Encouragingly, state Senate President Joe Negron told TCPalm he expects these issues to be raised again in the current Legislative session. We call on Negron, along with state Rep. MaryLynn Magar, who represents western Martin County, to make them a priority.
And though it might take a few more dollars, that money should be seen as an investment, funding that could save considerable tax dollars down the road — and help foster a safer environment for both the mentally ill and the people who treat them.
Editorials of Treasure Coast Newspapers/TCPalm are decided collectively by its Editorial Board. To respond to this editorial in a letter to the editor, email up to 300 words to TCNLetters@TCPalm.com.