Piece of Mind

Jackson's mental health unit fails Miami.

By the time Shantavia was 17, she had seen the inside of six foster homes. "I always had anger inside me because of my mom," she says. "I started fighting a lot."

Her friend Carolyn Ware — a thin 47-year-old with red streaks in her hair — explains Shantavia began living on the streets. "She's got a good heart but a quick temper," says Ware, standing outside her run-down Miami Springs home. "Her craziness would flare up."

Around the same time, Miami-Dade Circuit Court Judge Sarah Zabel began hearing scary stories about the children's psychiatric unit at Jackson. Young patients complained staff pushed them around, screamed, and left them in shackles for long periods. And Zabel believed them. "These kids are bright," Zabel says. "You listen and they are all telling the same story. You have to believe something is going on."

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Indeed, an AHCA investigation that year revealed staff did not keep adequate records of restraints and that they passed out meds without "appropriate informed consent or court orders."

Two years later, Miami-Dade public defender Carlos Martinez watched as a troubled three-foot-seven-inch 11-year-old girl bound by her wrists and legs was led into court. "The emotional and psychological effects are scarring," he says. "When we shackle kids, we are telling them that they are bad. We are punishing them before we even know if they've done anything wrong." He pushed to have indiscriminate shackling halted in Miami-Dade courts and succeeded.

But it never stopped inside Jackson. In 2007, soon after inspectors discovered the hospital improperly restrained a suicidal 29-year-old, Shantavia was sent to the psychiatric care unit. When she learned she would be staying for months, she became indignant: "I was like, Hell, no."

Soon her life became regimented. She would awake at 5:30 a.m., attend class, take her pills, and eat a tasteless dinner. Medication made her feel sluggish, and she gained almost 100 pounds. Perhaps to rebel, she began having sex with her roommate, who was a "fine-ass Cuban girl," she says. In the first month, she attempted to escape and was caught.

No matter how well Shantavia behaved, each time she had to be transported, nurses would strap on the shackles, she says. "People would stare. Oh my God, that was embarrassing."

Lisa Burton had never seen the word shackles in a doctor's order until she arrived at the hospital near the end of Shantavia's stay. Burton — a principled 51-year-old brunette — was hired March 24, 2008. She had worked 25 years in the medical field, much of it in mental health, but had never seen conditions like those at Jackson.

Burton was hired as the associate director of patient care services, a $115,000 administrative position. She was impressed with the dedicated nursing staff but found administration encouraged "fear and silence." Within her first two weeks, while doing a safety inspection, she found decapitated birds and dead mice in the Highland Park unit. She snapped photographs and reported it to her supervisor. Her boss told her not to bring it up again, she says.

"When you're director, you're not complaining," she says. "You're investigating."

Adds co-worker Dipnarine: "Lisa Burton came in with fresh eyes. She had knowledge and energy."

On the evening of April 15, Burton discovered something worse: An order to shackle an adolescent girl. Federal mental health law states shackles cannot be used for punishment or convenience and should be used only in an emergency. But in this case, the orders were written five days in advance. "I was stunned," Burton says. So she asked a nurse to lock her into the fabric shackles in order to get a sense of how it felt. She then reviewed a chart and found the practice was widespread.

The next day, Burton was appointed to a higher-ranking position: acting director of patient care. She was given more responsibility and a pay increase. When she informed hospital regional director Melida Akiti about the shackles and safety conditions, the $168,000-per-year official "demanded Burton to keep quiet," the lawsuit notes. Burton was outraged and met with others who agreed to "cease the use of shackles" in the adolescent unit April 18.

Three days later, Akiti called in Burton and offered a severance package, according to the lawsuit. It included a confidentiality agreement. Burton declined and was escorted by a security guard off the premises. She later filed a whistleblower complaint with the county ethics commission and lost. (The reason, according to ethics commission documents: She had failed to file "a written and signed complaint" when reporting the shackling.)

Shantavia fared worse. After fleeing the hospital, she began selling drugs with a boyfriend. Since then, she's been arrested for throwing a rock through a window and aggravated assault with a knife. (In both cases, charges were dropped.) Of her time at Jackson, she says, "They think they're helping. Really, they fuck you up more."

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If you consider Shantavia Robinson nothing more than a miscreant who deserved shackling, consider the case of Jacqueline Crawford Joyes. Born an only child June 8, 1932, she grew up traveling the world with her homemaker mother and her stepfather, a military colonel. Her birth father died when she was 7.

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