GENERAL FINDINGS OF THE COMMITTEE ON STATE INSTITUTIONS
RELATING TO THE CONDITIONS AT FLORIDA STATE HOSPITAL
AND THE ALIEGED MISTREATMENT OF PATIENTS
The Florida Legislative council on January 31, 1961, authorized the continuation of Its Committee on State Institutions for the purpose of making a thorough study of the al1eged mistreatment of patients in the Florida State Mental Hospitals, and to report back to the Council at a later date with its findings and recommendations
An on the spot examination of conditions at Florida State Hospital began on February 1, 1961, and it has been conducted in accordance with the following prospective outline:
4. The actual investigation of statements. (they never did this step)
5. Findings of the Committee. (in this web page below)
6. Recommendations of the Committee. (in this web page below)
|The evidence by comparative analysis with the Committe's Investigation. The Florida Mental Health Association launched a massive PR campaign. The Committee's investigation dropped phase 4 - actual investigation. Reasoning that actual investigation more propertly belonged to the executive branch of government.|
The Committee has carried its investigation through phase three in the above outline. The Committee feels that an investigation as to the truth or falsity of particular statements and particular charges or particular acts is more properly a function of the executive department than of the legislative, and hence has made all portions of its records and files available to the Governor's office for such further detailed investigation by the administrative branch as it may find justified.From the great bulk of information received from both patients and attendants, there appears to be a strong indication
that some attendants have misused their responsibility. The hospital administration adheres to a strict policy of dismissing any employee responsible for handling patients improperly, and this policy is conscientiously enforced. Yet, because of the size of the hospital, the large number of employees and the round-the-clock. operation of three shifts, it is not always possible to detect every occurrence of misconduct. There are marry other factors involved in this problem which will be covered in greater detail below.
Although it appears certain that there have been instances of improper handling of patients, it is evident that there are other problems in the general condition of the hospital which have a direct bearing and may in part be re6ponsible for much o£. the difficulties concerning the treatment of patients. During t¾e past ten years, there has been a great improvement in the overall environment of the hospital, and it is' still continuing. Many of the old buildings have been torn down and replaced with modern facilities. The newer buildings house the receiving wards, the intensive treatment area, the hospital wards and the Park Trammel wards for the elderly. An inspection of these wards gives the impression that facilities are as up to date as any hospital facility in the country. The general atmosphere is relaxed; wards are "spic and span"; there is no overcrowding and patients appear to have ample attention from doctors and nurses. The overall impression of this area is that of being a model hospital. On the other hand, the buildings of the white Male Department and a number of the buildings of the-white Female Department are in a state of complete obsolescence. -
Some of these facilities were erected for use as an arsenal prior to Florida's admission to the Union in 1834. These buildings contain such outmoded facilities as toilet troughs used in World War I and are in such condition that they represent a serious fire hazard9 It is from these antiquated buildings where the white Male Department is located that most of the complaints of patients have evolved. There are approximately 1,000 patients contained in the white Male Department who are distributed among ten' wards where there is very little segregation as to condition of mental health, age, etc. Criminal patients, sexual psychopaths, elderly feeble and helpless patients and teen-age boys are all bunched together in crowded wards.1 The size of wards one through ten in the white Male Department range from the smallest of approximately 82 patients to the largest of approximately 192. In these wards there are approximately 350 "charge" patients, which refers to those patients pending trial by the Courts and includes also patients having been convicted of crimes ranging from the passing of small bad checks to such extreme cases as rape and murder. Because of these violent and criminal elements being. mixed with the innocent non-charge patients, the hospital is compelled to employ stricter security precautions throughout these wards than normally would be required. Consequently, the wards are maintained more as detention wards for inmates than are as hospital wards for the sick. This practice creates a
1. It does not appear to be in good character to bed down a 14-year old boy, who may have only a mild case of mental disturbance, next to an experienced,35 or 40-year old sexual psychopath or some other criminal or to have him placed next to someone who is totally incompetent mentally.
grave injustice to and many hardships for the innocent patient. The solution to this problem rests with the isolation of all "charge" patients from the patients not charged with crime and a program of replacement or remodeling of dilapidated buildings. There have been no complaints from the receiving and intensive treatment areas, which is ample proof that the investment made in improving the environment is paying off wish rewarding dividends. Patients are more contented in their pleasant surrounding they are being treated, staffed and returned home at a faster rate than ever before; and the attendants are mote satisfied because of better working conditions.
The major complaints of both patients and attendants include briefly: Choking, beating and teasing of patients, stealing packages loss of mail, the use of punitive wards such as the "squad" which existed until a few months ago, prolonged confinement- in solitary "strip cells" and the lack of medical treatment and occupational therapy.According to statements made by many patients and attendants, it has been a common practice for years for attendants to "choke down" disturbed patients for the purpose of subduing them. Some well meaning attendants claim that this is sometimes necessary for their own protection, especially when there is no other attendant in the ward. The trouble with this argument is that it leaves the door wide open for an unscrupulous attendant to "choke' a patient completely out for any cause whatsoever, and at the same time, such an attendant can fall back on a fabricated alibi that the patient was violent. Hospital authorities agree that this crude method of
The beating of patients is uncalled for and never justified. Teasing of patients is a form of mental cruelty which can be more brutal than an actual beating. All patients, including the acute mentally unbalanced, know when they are being made fun of and teased. Teasing often stirs patients to the point of great anxiety which in some cases leads to very serious trouble. The matters of stealing packages and the loss of mail are self explanatory. Another major complaint deals with the use of punitive wards such as the "squad." The "quad," as it was called, was a portion of ward 8 set aside to provide closer supervision over highly disturbed patients and those who are constantly trying to escape. A substantial majority of the statements made by attendants and patients seem to indicate that the "squad" was used for purposes other than just closer supervision of certain patients. The above conditions should not be permitted to exist.
Solitary unfurnished cells, known as "strip cells," are in use either to protect a patient from other patients or to isolate a potentially dangerous patient for the protection of other patients in the maximum security ward. Prolonged confinement of patients in such cells has not worked to the advantage of the hospital nor to the benefit of patients. In 1960, there were two suicides. Through February of 1961 there were two more suicides,
one on January 1 and the other on February 12, and an attempted suicide. there are conflicting reports on these suicides and it is difficult to evaluate them. The medical staff has indicated that all white male patients have been moved from solitary cells to wards to minimize or completely eliminate further suicides.2
The morale among patients in the White Male Department is extremely low. During the interviews, a number of non-charge patients expressed feelings of total despair of ever being released from the institution. Patients having no one on the outside to accept responsibility for them are particularly prone to this type of frustration. Many feel they suffer from the loss of human dignity, the complete loss of freedom and the misfortune; of being trapped in their environment. One big problem in this department is that of providing for the release of patients reaching competency who has no one in society to accept them. The two overworked department doctors cannot afford to devote much time to patients 'in this category who have been cured or are treatable because their efforts can be more successful with patients who have a reasonably good chance of being "staffed'1 and discharged.
Attendants for the most part have little or no first aid training as
a prerequisite to caring for patients. Consequently, their duties are considered
almost exclusively custodial in nature. The attendant is the key to the
patient's welfare. He lives with the patients eight hours a day, knows
when patients are upset,
2 As an alternative to the use of solitary cells, one state uses small cheerfully colored and lighted rooms for the segregation 'of patients in a violently disturbed condition. A glass panel extends across the front of the room beyond the access of the patient so that the patient can be under constant observation by the medical staff and the attendants. Since this type of accommodation receives only limited use, the number of such units would be small and the cost would not be prohibitive.
when they are contented, and their changes in behavior. However, he is not a means of communication with the doctor who does, not have adequate time to devote to each patient.3 Since the duties of attendants are custodial and because 35% of the patients are charge patients, attendants generally adopt the attitude that they are charged with the responsibility of guarding and controlling the actions of their charges rather than that of aiding and caring for the needs of patients. This attitude has had the effect of lowering the attendant's concern toward the innocent non-charge patient's welfare to the same level it is felt justified for the management of the more troublesome charge patient. Under such conditions, the innocent noncharge patient does not receive the type of treatment and care he is entitled to.
Morale, in general, among the attendants is low. There appears to be
wide-spread dissatisfaction and unrest because attend4nts feel they are
receiving only bare subsistence wages which range from a minimum of $165.00
per month to a maximum of $192.50.' An estimated
take home pay for most white male attendants is approximately $1,700.00
per annum In order to meet living expenses, attendants usually supplement
their income by working on farms or any other available employment during
off hours. Most attendants are deeply' in debt and any emergency such as
a family sickness creates a substantial hardship on the family budget.
3-Patients complain of seldom seeing a doctor. It appears that there
is a critical need for a middle man, such as a trained male nurse or a
well trained attendant, to act as liaison between the doctor and the patient.
Such a person could report the progress of patients the doctor has not
been able to see.
The most often heard complaint in this regard is that the attendants at the Apalachee Correctional Institution allegedly receive from . $50.00 to $100.00 more per month than they receive. Another factor causing dissension among the attendants is the practice of some supervisors, who employ a significant number of attendants from the same family or community. Due to this practice, employees are not always hired on the basis of ability, experience and qualifications. Still another factor is that this institution, along with its three similar institutions, are the only ones of the State not on a 40-hour week and some dissatisfaction among its employees results from their 6bservation that the nearby Apatachee Correctional Institution is on a 40-hour week.
During the interviews and while filling out the questionnaires, many of the attendants manifested considerable outward fear. Attendants interviewed on the hospital grounds were reluctant to give any information for fear of possible repercussions on the job or the loss of employment. For the most part, it was necessary to meet with attendants off the hospital grounds before. the would disclose what they felt were the true conditions at the hospital. This latter procedure of interviewing attendants was extremely time consuming and inefficient. However, it was considered necessary to meet with some attendants away from the hospital in order to get them to speak.
The white Male Department is extremely short of doctors. At present, there are two doctors assigned to this Department, but during 1960 and prior to that time, there was' only one doctor responsible for the care and treatment of approximately 1,000 patients in wards one through ten and the maximum security building. Because of the shortage of doctors, it is not possible to
develop an adequate doctor-patient relationship or for any one doctor to see a sufficient number of patients often enough so that the progress of each patents mental at condition can be charted honestly. In addition to the excessive patient workload, doctors are compelled to devote a large portion of the working day answering court correspondence which must be accurate and carefully thought out. Also, doctors must answer the requests and correspondence of the families of each patient. One of the most frequently heard complaints of patients is that of not having received treatment or of not having seen a doctor for periods ranging from as high as six months to two or more years. Good psychiatrists are in short supply, difficult to acquire and when acquired, they are not easy to retain. The present hospital staff of doctors consist of twenty-five doctors who have an average workload of 252 patients. In the White Male Department, there are only two doctors to care for 1,000 patients. This represents a distribution of only 8% of the hospital's doctors to care for approximately 167. Of the hospital's most troublesome patient workload. Presently, there is only one white female registered nurse assigned to the White Male Department who visits only ward 3X. Since doctors are In short supply, it has been suggested that the Department's two doctors could be relieved of much of their workload, it several male nurses or medically trained attendants were provided.
Because of the large number 6f hospital employees, presently about 1,900, and low wage scales, the hospital, is bound to be confronted with personnel problems. The lack of personnel qualifications and standards for employment have resulted in the
employment's of some attendants who can neither read nor write and many others ill-equipped to adequately administer their responsibilities in the care and treatment of patients. The hospital, is considering the, possibility of hiring a personnel director to screen and select; prospective employees on the basis of qualifications and experience. This appears to be a step in the right direction. Such a director could help facilitate the hospital's intent to upgrade the quality of employees and enable, the hospital to have a more direct control over the number of employees from the same family being assigned to each department. The adoption of written rules and regulations will help to eliminate much of the confusion among attendants as to hospital policy, and it will assist in the restoration of confidence by attendants in their supervisor's.
Insufficient income appears to be the major cause of discontentment among the attendants. The present wage scale does not provide an adequate incentive for improved and higher quality service from attendants. There are too many who are more interested in their small pay check than they are in giving dedicated service to the sick charged to their care. An attendant can be employed for fifteen years or more, do a good job, and still not receive more than the maximum salary of $192.5O per month unless such a person is' unusually fortunate and can be promoted to one of the few supervisory jobs which may 3b.e vacated because of death, retirement, etc. of one of his superiors.
Since the examination of Florida State Hospital began, a number of improvements have taken place. The two or three week
training course for attendants has been re-established, but is still highly inadequate. Patients and attendants aver that the treatment of patients has greatly improved; doctors are visiting patients more frequently, and the patient rate of discharge in the White Department has increased substantially in recent months. Much of this improvement is attributable to the addition of another doctor in the White Male Department. The number of patients contained in the Maximum Security Building has been reduced from 67 patients on February 1, 1961, to a low of 23 as of March 22, 1961. Due to conditions in the Colored Male Security Building, all colored patients have been vacated from that building to the bottom floor of White Maximum security Building. Also, all white male patients have been removed from solitary cells. These cells, however, are still being used for colored patients.
May 1, 1961.
FINDINGS AND RECOMNIENDATIONS
1. Finds - that there is no central employment policy at the administrative level for the selection of new employees on.. the basis of qualifications and experience. Department supervisors employ new attendants as vacancies occur which often results in. the employment of incompetent personnel.
Recommends that there be established a personnel director and staff in: each State Mental Hospital, with a director directly responsible to the Hospital Superintendent.
2. Finds - that the salaries of attendants are highly inadequate. The low salary scale is responsible for poor morale and the lack of incentive among attendants; it also discourages competent personnel from becoming dedicated career employees.
Recommends - that a personnel position classification plan for employees be established, that a 40-hour week be established and that satisfactory pay scales be instituted.
3. Finds - that many of the difficulties arising in the white Male Department at Florida State Hospital can be traced to the circumstance that patients convicted of or charged with, crimes are commingled with innocent non-charge patients.
Recommends - that all patients convicted of or charged with crimes be removed from Florida State Hospital at the earliest possible date.
4. Finds - that a large number of attendants in the white Male Department have less than a high school education. Some can neither read nor write. Many attendants have little or no knowledge of the fundamentals of first aid and they are ill-equipped for the responsible care and treatment of patients.
Recommends he that all attendants be required to complete successfully an adequate orientation and training course in the fundamentals of first aid and in the care and treatment of patients.
5. Finds - the White Male Department at Florida State Hospital does not always have a sufficient number of relief attendants available on all shifts to substitute for absentees because of sickness, vacations and time off during the month. As a rule two attendants are assigned to a ward. In some case when an employee is off, the remaining attendant must bear
the responsibility of the ward by himself, which may, in some instances, place such an attendant in a predicament he is not prepared to cope with.
Recommends - that it be mandatory that no less than two attendants be on duty on each ward at all times.
6. Finds - that there are a number of non-charge patients who have been recommended for discharge by the medical staff but must remain in the continuous treatment wards for as long as six months more until they are discharged; This practice tends to deteriorate the morale of such patients as time progresses.
Recommends - that non-charge patients who have been recommende4 for discharge and are ready for discharge be housed in Separate quarters than those where patients requiring continuing treatment are. quartered
7. Finds - there are a number of patients who are well or may be curable but the doctors are reluctant to spend much time with them because there is little or no chance of their being discharged because there is no one in society to accept responsibility forthem, Consequently, doctors concentrate their efforts or' other patients who have a much better chance of being released.
Recommends - that some suitable outlet be found for noncharge, patients who are otherwise eligible for discharge but cannot. be released because there is no one in society to accept responsibility for them.
8. Finds - that patients in the White Male Department at Florida State Hospital are confined to the wards with too many leisure hours with nothing to do. Such long periods of confinement indoors in a congested environment tends to depress patients and affords them innumerable opportunities for getting into mischief.
Recommends - that the occupational therapy program be expanded to include all interested patients able to participate in such a program.
9. Finds - that there are no attending nurses in the wards of the White Male Department other than the infirmary ward. After 5:00 P. H. there is no doctor or nurse on duty in the Department. Should a patient develop an illness or some other physical ailment, he is usually referred to the medicine attendant
Recommends - that several white male practical nurses or other suitable well trained medical attendants be assigned to the White Male Department at Florida State Hospital.
10. Finds - that the buildings of the White Male Department are completely obsolescent and are critically in need of being refurbishe,4 or replaced.
Recommend - that a priority plan be developed to replace or refurbish all antiquated facilities as funds are made available for this purpose.
11. Finds - that Florida State Hospital is several times as large as is recommended by various state and national authorities for hospitals of this nature. The Committee also finds that the establishment of additional hospitals throughout the State has failed to accomplish the intended effect of reducing the size of Florida State, Hospital.
Recommends - that continuing study be made toward steps to reducing the size of Florida State Hospital. Certain categories of patients may be easily identified as those susceptible to transfer to another institution or for the processing necessary to discharge.
12. Finds - that the continuous treatment wards in the white Male Department at Florida State Hospital are inadequately segregated as to conditions of health. Insufficient attention has been given to medical classification of patients, brought on largely because of dumping of all categories of long term. patients into one area. This results in the odd mixture described in the report.
Recommends - that administrative procedures be developed for the most effective treatment of patients by classification toward the end of securing the most humane result for each. individual patient and contemporaneously reducing the size of Florida State Hospital.
S. Chesterfield Smith
Chairman, Committee on
Subcommittee on Mental Health
This Subcommittee was created by the Legislative Council's Committee on State Institutions on January 8, 1960, at Sarasota Beach, Florida. The Subcommittee was instructed to coordinate its activities with the Interim Committee on Mental Health and develop its own pro gram. During the 1959-61 biennium, the Subcommittee met with the Interim Committee at hearings in Sarasota, Marianna, Fort Lauderdale, and Boca Raton, and in addition visited several State institutions. Institutions included in the Sub-committee's study activities were: mental health, mentally retarded, alcoholic rehabilitation, child training centers, and tuberculosis hospitals. After a preliminary review of the overall problems of these institutions, the Subcommittee agreed that its efforts would be concentrated in areas of greatest need where the Interim Committee was least active.
Due to the increasing decline in the number of patients in tuberculosis hospitals during recent years, the Legislature in the 1959 Appropriations Act, authorized the Board of Commissioners of State Institutions to assign and transfer one of the hospitals and all the appurtenants thereto for other institutional use of the State when said Board finds that there was no reasonable need for the continued use of all tuberculosis hospitals. Shortly after the close of the 1959 Legislative Session, the Florida Tuberculosis Board notified the Board of Commissioners of State Institutions that they could give up the tuberculosis hospital at Orlando. The Board of Commissioners instructed the Directors of the Division of Mental Health and Child Training to make a survey to determine the best use to be made of this facility. Since the Sunland Training Center in Gainesville had some 1,300 patients on the waiting list for admittance, it was evident that additional facilities were most critically needed for mentally retarded children. The Orlando Tuberculosis Hospital was turned over to the Division of Child Training Schools in December of 1959, and on January 26, 1960, the first crib type non-ambulatory retarded children were admitted to the newly created Orlando Training Center. The Center had $1,000,000 to operate the hospital for the remaining eighteen months of the biennium.
When the Subcommittee visited the Orlando Hospital, it found that the old four hundred bed tuberculosis hospital had been converted to a mentally retarded hospital at very small expense to the State. The walls had been ripped out so the newly arranged wards could accommodate an average of between 40 to 45 patients, which increased the hospital capacity from 400 patients to 600 patients. When the last of the tubercular patients was moved out in December 1959, the Center began to receive patients at the rate of about 40 a week until its capacity of 600 had been reached. The Orlando Air Force Base furnished buses twice a week to transfer patients from the Gainesville Center to the Orlando Center.
The Subcommittee finds that this 600 bed crib-type hospital is not adequate to furnish care for all of this type retarded patients. Patients range in age from a few months to 53 years, with the average age being approximately 10 years. Since mental retardation is an affliction for which there is no known cure,
the discharge rate is insignificant. Therefore, the need to expand this hospital is critical, especially in light of the ever-increasing length of the waiting list for admittance. The children at the Orlando Training Center are completely helpless bedridden patients who must have attendants to provide for their every need No private home is equipped to handle a case of this type, and any attempt to do so creates a tremendous burden on the family, creates hardships for the patient, and is detrimental to the mental well-being of other children of the family unit.
The staff has done an excellent job converting this hospital to an institution for the mentally retarded. With very little funds they have effected the conversion through the enlistment of outside assistance whenever possible. The Subcommittee wishes to commend the staff for the competent manner in which they handled the entire operation and the services they are presently performing. Through their initiative, the State of Florida could not have received any greater value for the dollars spent, and many helpless children are now being cared for who otherwise would not have been.
The Sunland Training Center at Orlando is requesting $877,966 in its 1961-63 budget to construct a 400 bed addition to the hospital, a laundry to replace the present obsolete inadequate facility, and a fence which is needed to provide privacy to patients from encroachments of housing developments resulting from population overflow in the Orlando area.
This Subcommittee is well aware of the progress the Orlando Center has made in spite of the handicaps it has had to face. The need for the additional wing to provide for 400 more patients is
most urgent, and the time has come when the institution can no longer be expected to continue its operations on exclusively make-shift arrangements. Therefore, this Subcommittee strongly endorses the budget request of the Sunland Training Center at Orlando and recommends that the 1961 Legislature provide the funds for these purposes.
Due to a complaint which was sent to an U. S. Congressman from Florida and relayed to the Legislative Reference Bureau through the Florida Attorney General's Office, the Subcommittee investigated the adequacy of Florida's mental health laws and found that they were quite adequate for present needs. However, this examination of the statutes revealed that some of the language was outmoded and tended to place an unfair stigma on patients. This outmoded language has been responsible for much misunderstanding of Florida's mental health laws. The Subcommittee recommends that Florida's mental health laws be amended so that all language such as lunatics, insane asylum, inmates, etc., be converted to the proper terminology now applied by the medical profession.
In recent months, one of the major State newspapers has been printing a series of articles strongly criticizing the brutal treatment allegedly being dealt to patients at the State. Mental Hospital. In the near future, this Subcommittee plans to make a complete investigation of these charges and will report back to the Committee on State Institutions with its findings.
As an over-all observation, it is noted that the several State institutions place a considerable amount of emphasis on the need for new buildings. New construction is justified in
many instances, but it is the consensus of this Subcommittee that the most pressing needs are the general improvement and upgrading of the quality of professional services. Therefore, the Sub-committee recommends that each institution be encouraged to make every effort to be more selective in the type of personnel employed so that the quality and standards of professional services will be upgraded.
At this time, the Subcommittee makes no recommendations on the Alcoholic Rehabilitation Center in Highlands County.
1. APPROPRIATE $877,966 TO CONSTRUCT A 400 BED ADDITION, A LAUNDRY AND A FENCE AT THE SUNLAND TRAINING CENTER AT ORLANDO, FLORIDA.
2. REVISE FLORIDA STATUTES SO THAT ALL OUTMODED LANGUAGE IN FLORIDA MENTAL HEALTH LAWS CONFORMS TO PRESENT DAY NEEDS AND USAGE.
3. INVESTIGATE THE NEWSPAPER CHARGES OF THE FLORIDA STATE MENTAL HOSPITAL.
4. ENCOURAGE STATE INSTITUTIONS TO BE MORE SELECTIVE IN THE HIRING OF PERSONNEL FOR THE PURPOSE OF EVENTUALLY UPGRADING THE QUALITY AND STANDARDS OF PROFESSIONAL SERVICES.
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