For much of Cindy Mertz’s tormented childhood, temper tantrums were a reliable method for coping with starvation, filth and abuse.
But the screaming and foot-stomping that sometimes worked for a child have wrought terrible consequences for 21-year-old Mertz, who remains intellectually disabled. Three weeks ago, Mertz landed inside a locked Pasco County mental hospital. Her legal guardian has repeatedly demanded that she be released back to a state-funded group home where staff has learned to manage her behavior. The hospital has repeatedly refused.
When a family advocate accused the hospital of “kidnapping” Mertz, staff blocked the advocate’s email account. And when a behavior analyst who had worked with Mertz for three years complained that her stay at North Tampa Behavioral Health was making her condition worse, the facility blocked his email, too.
“What needs to happen for us to get her out and take her home?” Nikki Drake, a board member of the National Association for Mental Illness in Pasco, wrote in an Aug. 13 email to hospital staff. “She can't live there. You can't cure her developmental disability.”
Mertz’s ordeal underscores what some mental health advocates claim is a persistent problem with the state’s psychiatric commitment law. Despite an overhaul of the Baker Act in 1996 designed to stop the inappropriate commitment of frail elders and others who could not benefit from psychiatric treatment, abuses of the statute continue to occur, they say.
The Baker Act allows 72 hours to determine whether a patient meets the criteria for involuntary commitment. But the act allows a so-called receiving facility to ask a judge to allow it to hold patients much longer when they are considered a threat to themselves or others. The hospital has done that, and is receiving Medicaid dollars to cover the cost of treatment.
“The law guarantees patients the right to be served in the least-restrictive setting. And, unfortunately, locked inpatient psychiatric care is the most restrictive setting, and should only be used when other alternatives are not available,” said Martha Lenderman, a former mental health administrator who helped implement the Baker Act reforms and is considered the state’s foremost expert.
“People kept in the most intensive settings can actually suffer more harm than from being in a normalized setting. They need to be restored to their usual residence, with an array of outpatient services, as quickly as possible.”
North Tampa Behavioral Health’s director of business development, Abbey M. Brown, who had been dealing with Mertz’s family and advocates, declined to discuss Mertz’s case with the Miami Herald Tuesday, citing patient confidentiality. Mertz was Cindy’s surname before she was adopted. She now goes by a different name.
In December 2000, Mertz and her two brothers were sheltered by the Department of Children & Families when their birth father reported the family was homeless. The family had been the subject, records show, of about 10 abuse and neglect reports, running the gamut from domestic violence to truancy to reports that the three children — two of whom appeared to be disabled — wandered the neighborhood unsupervised. The children frequently complained that they were not fed.
The reports appear to have begun around 1999, when the Mertz family moved to Florida just as child welfare administrators in Kentucky were preparing to file a petition declaring the parents unfit. In a report obtained by the Herald, a DCF investigator described the girl’s father as “juvenile,” saying he had spent his first paycheck upon finding a job buying a three-foot python.
In September 1999, one of Mertz’s brothers’ had his hair set on fire by his uncle, a report said.
A July 2000 report said “there was no food in the home, and the children walk around with dirty clothes and no shoes. The home allegedly had broken-out windows and no screens.” Three months later, DCF was told one of Mertz’s brothers had been shot at, and was being beaten “on a regular basis.” The same brother, at age 6, was seen selling marijuana outside the family home.
“When I first met the children in , I was shocked by their behavior, their total lack of self-control and their language,” a DCF investigator wrote in an agency report. “Cindy, in the presence of her parents, reverts to a screaming 2-year-old, pouting, demanding, stomping her feet, getting totally out of control.”
Foster care did not stanch the torment. A foster mother in whose care Cindy Mertz was placed later was charged with smuggling drugs into the Pasco County Jail. Drake, Mertz’s advocate, who has worked with the woman for a decade, said the foster mother used Mertz as a mule during visits with the girl’s mother.
Cindy Mertz eventually was adopted by another family in August 2008, records show, and they became her court-appointed legal guardians when she reached adulthood. But the damage already had been done.
Mertz lives in a state-licensed and funded group home in Holiday, near Tampa Bay, and has been under the care of a behavior analyst who has been specially trained to use incentives — instead of drugs or punishment — to control her difficult behavior. On July 29, Mertz was taken under the state’s involuntary commitment law, the Baker Act, to North Tampa Behavioral Health. Long email threads among Drake, Mertz’s guardian, her behavior analyst and hospital staffers begin on Aug. 3, and become increasingly frantic.
On Aug. 6, Mertz’s adoptive mother and guardian warned the hospital that Mertz was at risk of losing her group home bed. “There is absolutely nothing that your facility is going to do for her in terms of services that she does not have access to in her [Agency for Persons with Disabilities’] home. If it’s not clear now, Cindy is in jeopardy of losing placement that she waited years to get.”
She added: “I am furious that my daughter is in this situation and we just want to get her out.”
Drake wrote an email on Aug. 10 with the subject line “Discharge Cindy.” In it, Drake said “keeping her on an inpatient psych unit for this extensive period of time is in fact causing great harm to her. No one is trained on her regularly implemented behavior plan at your unit and she has not followed any of her routine for going into the 3rd calendar week.”
In a conference call two days later, Mertz’s psychiatrist said she was being kept at the facility because she had openly talked about suicide. Her psychologist, who is paid by the state and had worked with her for years, said Mertz often spoke of harming herself as a way to gain attention. He said the family would have explained that to the doctor had he returned phone calls.
The doctor apologized for failing to return several calls. “I’ve admitted I wish I’d called sooner,” he said. “I should have, and I didn’t.”
At the end of the call, the doctor assured Mertz’s guardian he expected to release the young woman the next day. But that day, Aug. 13, the hospital asked a judge to allow it to keep Mertz indefinitely. J. Rob Phillips, the hospital’s director of clinical services, wrote in an email that Mertz displayed “suicidal ideation and suicidal gestures” the night before. “We will be transporting her to court today for the purpose of maintaining her in our facility,” he wrote.
Drake wrote in an email that she had spoken to Mertz on the phone after the release fell through, and the young woman sounded “over-medicated” and that her speech was “severely slurred.”
The mental hospital is owned by Acadia Healthcare, which runs 225 facilities in 37 states, for a total of 9,190 beds. Acadia operates four programs in Florida, including the Wellness Resource Center in Boca Raton. The dispute between Mertz’s family and North Tampa Behavioral Health isn’t the first time the Central Florida hospital has been accused of refusing to release a patient.
In a report dated March 26, 2014, the Agency for Health Care Administration faulted the facility for refusing to release a woman who had admitted herself to the hospital voluntarily — and was, therefore, within her rights to leave.
The AHCA report said the woman, who is not identified, “was demanding that she needed to go home to her ‘baby,’ which turned out to be a teddy bear that gave her comfort. Later, when a family member or friend arrived at the hospital to take the woman home, that person was turned away.
“It was explained to the person and the patient that the physician would like her to stay longer. The patient was noted to be tearful and said she wanted to go home.”
North Tampa was faulted in the same report for several lapses in nursing care. One patient was supposed to be under strict observation to prevent him from molesting other patients. Yet the patient “inappropriately touched” a sleeping patient anyway. “Review of the record revealed no evidence the [nurse] was informed, no evidence the physician was notified, and no evidence any interventions were completed,” AHCA reported.
The state also criticized the hospital last year for failing to ensure patients were competent to admit themselves voluntarily, or competent to consent to treatment, as Florida’s involuntary commitment law requires.
About eight months later, in December, the hospital was faulted by the healthcare agency for failing “to ensure medication orders were accurate and medications were administered and ordered” for some patients.
One of North Tampa’s sister facilities has also faced scrutiny.
A healthcare worker at Park Royal Hospital, near Fort Myers, was arrested by the Lee County Sheriff’s Office in September 2013 and charged with sexually assaulting five patients of the mental hospital.
And last November, healthcare officials reported that Park Royal staff failed to complete 15-minute bed checks on a man considered at risk of killing himself — which he then did.
The man was found “hanging in the bathroom,” ACHA said.