Piece of Mind

Jackson's mental health unit fails Miami.

When he arrived at the crisis unit, he was penniless, aggressive, and suicidal. He was "hearing voices and seeing unidentified flying objects," according to state reports. A doctor found no reason to hold the 24-year-old, even though he had been admitted to — and released from — Jackson's mental health center three times in the previous two weeks. Doctors discharged him a fourth time, around 5 p.m. Memorial Day, at which point he became irate.

Terronne Freiberg, an 18-year Jackson employee who was then nurse manager, recalls commotion. "[John] yelled, 'If you discharge me, I'm going to the parking garage and I'm gonna jump!'"

Nobody stopped him. John's release forms had already been signed and employees were busy dealing with dozens of other patients. At 5:45 p.m., a hospital security guard watched John's 176-pound body drop from the fourth floor of Jackson's Ryder Trauma Center east parking garage and crash into the pavement below. The fall cracked his skull, broke his ribs, and caused his brain to hemorrhage, according to the Miami-Dade Medical Examiner's Office. Fire-rescue rushed him to the main hospital, but it was no use. He was pronounced dead 15 minutes later.

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The suicide raises questions about hasty discharges in the understaffed, high-stress facility. A subsequent lawsuit also suggests that after the death, John's medical files were hidden and altered. His records went missing and an employee was later fired for falsifying the documents.

"They were churning out patients," says Freiberg, who still works at the mental health center as an associate nurse manager. "They tried to cover it up."

Jackson's mental health unit was created decades after the main hospital opened in 1918. The center strives to help individuals "gain control over their lives," according to the Jackson Health System website. Because of the hospital's affiliation with the University of Miami, it brings together clinical treatment, teaching, and research.

When Jackson was founded, mental illness meant long-term hospitalization in Florida. In 1971, the Baker Act changed that. Psychiatric wards could no longer involuntarily commit patients for more than 72 hours.

In 1975, a patient named Kenneth Donaldson sued Florida State Hospital in the U.S. Supreme Court, alleging he had been held against his will for 15 years. In the landmark case, the court decided mental illness alone could not justify an involuntary lockup. The ruling prompted a national deinstitutionalization movement. (Critics later blamed it for the spike in homelessness.)

Sharmin Dipnarine, who began working at the mental health unit in 1980, remembers the era as an effective time for psychological treatment. Patients participated in music and art therapy, stayed months, and received fewer psychotropic drugs than today. "It has changed tremendously," says Dipnarine, who retired last year as acting assistant director of nursing. "It became very financially driven."

By the late '90s, public funding had dwindled and hospitals felt a financial pinch. In just eight years, from 1998 to 2006, the number of psychiatric beds in the state halved to 22 per 100,000 people.

So public hospitals began to discharge mentally ill patients sooner. A person who once stayed months would now be out on the street in days. "The pressure is high to release," says Tim Coffey, mental health project coordinator for Miami-Dade County Circuit Court. "Unless someone is saying, 'I'm killing myself right now,' they are getting turned back out. You find they get arrested later for milling around the hospital. It's completely unacceptable."

Jackson was perhaps under more pressure than anywhere in the state. In 2005, the hospital received $76 million from Miami-Dade County to help balance its budget. Two years later, a mental health subcommittee of the Florida Supreme Court, appointed by Chief Justice R. Fred Lewis, released a report criticizing the "fragmented" and "unwelcoming" state of mental health treatment.

Miami-Dade Judge Steve Leifman, a longtime crusader for people with mental illness, was committee chair. He blames the problem on two things: less federal funding and the effects of a tough-on-crime campaign. "It's kind of perfect storm conditions," he explains. "The system is broken."

John Hampton's case is the best example of the dysfunction. At 10:30 p.m. on May 16, 2004, cops first brought him to the mental health center, where he checked in voluntarily. He was suicidal and homeless and had no health insurance. Hospital staff gave him a list of shelters and "discharged the patient to self," according to AHCA reports at 7 the next morning.

Two days later, cops brought him back, this time involuntarily. John was "hearing voices" and "wanted to commit suicide by jumping off a building." Less than 48 hours later, doctors let him go. "The patient... was to follow up with the community health center," AHCA reports note.

He didn't. An ambulance brought him to the hospital's main emergency room for a fractured left hand five days later. He was "physically and verbally abusive" and "wanted to harm himself." A doctor discharged him a third time, at 3:30 p.m. May 27.

The next day, City of Miami Fire-Rescue workers delivered him a fourth time. He was more violent — "homicidal and hallucinating" — according to reports. He stayed until May 31.

Forty-five minutes after he was released, he and a friend, who is not named in public records, climbed about 100 feet to the top of the boxy cement garage across from the mental health center, according to a Miami-Dade coroner's report. Below was a row of small palm trees, a bus stop, and a busy street. They planned to jump together, but security guards spotted the pair and subdued the unnamed companion.

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