The place housing some of the most dangerous people in Arizona is falling apart. About 135 patients, mostly men, live at the Forensic Hospital, a collection of 10 buildings on the Phoenix campus of the Arizona State Hospital.
Most of them have been judged “guilty except insane” in criminal cases that included assault, child molestation and murder. They’ve been sentenced to lengthy terms in the hospital and their volatility makes them dangers to themselves or others. About 30 are in treatment to determine if they can stabilize long enough to stand trial.
With proper medication and therapy, many of them will improve and return to the community, while others may never get out. The severity of their crimes ranges from a mother who burned two of her children to death to a man who violated probation because he was homeless.
“Most of our patients are your typically seriously mentally ill patients who happened to get into legal trouble,” says psychiatrist Tariq Ghafoor, chief of forensic services. “But because the people here would not understand their rights, they would not get a fair trial.”
Regardless of their sentences or their prospects for recovery, their living conditions are increasingly more expensive for state taxpayers to maintain.
Lawmakers will decide in the next few weeks whether to build a new facility. Republicans and Democrats agree its needed; they just can’t decide how to pay for it.
“I think there’s sort of an active consensus that it’s well past its lifetime and it’s an unsafe facility,” Senate Majority Whip John Huppenthal, RChandler, said Friday during a break from budget negotiations.
Democratic Gov. Janet Napolitano wants $32 million to rebuild the forensic hospital, paid with bonds, a financing mechanism the GOP generally opposes. Huppenthal says lawmakers are talking about whether to pay cash, lease-purchase or privatize the hospital.
Just keeping the facility open is expected to cost nearly $4 million over the next five years due to major plumbing, electrical, security and roof repairs.
Four of the 10 forensic buildings are so badly deteriorated and contaminated with asbestos that they’re unusable. The remaining units, state health officials say, pose a security risk to both staff and other patients because of their design and condition.
And the daily irritation of just navigating the old place is taking its toll on doctors, nurses, therapists and other staff, mostly because it gets in the way of treating patients.
“It’s basically falling apart, and we are spending a lot of resources keeping it together,” Ghafoor says. “It’s affecting our ability to maintain patient care.”
Legislators know the Wick, Juniper and Granada forensic units are crumbling, because they’ve been told about it, in detail, for years. They even appropriated $11 million to renovate the 55-year-old buildings, but took it back several years ago because of a state budget deficit.
• Administrator John Cooper had to evacuate more than 20 patients from a Wick unit last fall when the galvanized pipes burst.
• Psychology staff evacuated when the modular building that held their offices began sinking into the ground.
• The first floor of the twostory Granada building has fallen into such disrepair that it can no longer house patients.
• An accused killer escaped by squeezing through a bathroom window, a slot measuring about the size of a briefcase. The windows have been retrofitted with additional bars, plastic glass and two-by-fours.
• A patient, enraged at another man, threw himself through a wall and began throttling the man.
• What Ghafoor calls the “bucket brigade” is deployed every time it rains to catch leaks throughout the Wick, Juniper and Granada units. Air-conditioning units break down regularly; some are so old replacement parts no longer exist.
• Hospital staff have been hit, kicked, tackled, scratched and otherwise accosted on hundreds of occasions, in large part, they say, because of the building design.
• Overtime costs have increased by 75 percent, to more than $600,000 last year, due to the need for additional security. That’s partly because there’s just one security station for five units and staff members must physically stand watch constantly over certain patients.
NOT A PROPER FACILITY
The state hospital was first deeded as the Insane Asylum of Arizona in 1885 on 93 acres at 24th and Van Buren streets. Its population swelled to about 1,500 patients in the 1960s, but the advent of “de-institutionalization” and budget cuts have reduced its numbers dramatically.
Today, it’s licensed for 338 patients, including 120 in the civil hospital and roughly 100 who have been judged guilty except insane or, under the old law, not guilty by reason of insanity. Another 30 or so people are accused of crimes and sent to the hospital to determine if they can be found competent to stand trial.
The campus also includes an intake facility for the state Department of Corrections and a separate building for about 120 sexually violent criminals with mental illnesses.
The forensic units, on the northeast side of the grounds, were retrofitted about 10 years ago from what was once a geriatric mental facility, “which is the exact opposite of what a forensic population needs,” Ghafoor says.
Ideally, experts say, forensic hospitals should have thicker walls, solid doors, covered sprinklers and smoke detectors, security windows, even special screws, among other things, to keep patients from escaping or harming themselves or others.
The living quarters should be free of nooks and crannies, or structural defects, that allow patients to squirrel away contraband.
The building design should be open, with central security operations to allow clear view of sleeping quarters and meeting rooms, rather than the long hallways and remote security station at Wick and Juniper.
As it is, hospital staff members discover homemade shanks and other weapons, some made with metal from smoke detectors, tucked into dropped ceilings. Rubber baseboards have become hiding places for weapons and other contraband.
“These patients are very adept at making weapons out of everything,” says nurse unit manager Elizabeth Orris. “They can hide stuff, so for our security it is a constant struggle.”
The units are spare, dreary spaces, sporting peeling paint and chipped linoleum floors. Patients mill about a day room, or move up and down a single hallway with counselors or other staff. On a recent day, a card game at a central table served as therapy for a few patients, their counselor watching to see how they follow the rules and respond to others.
Patients sleep four to a room, their bunks bolted to the floor. Some of the 25-bed units are co-ed and, except for Wick 5, which houses 40 patients, the patients share a single shower room.
Staff members must carry a pocketful of keys and know the idiosyncracies of every lock. That can be dangerous.
A patient who saw Orris opening a door tackled the nurse as she struggled to wiggle the key out of the lock. He pushed her into the room, but security pulled him away before he could seriously hurt her.
There is one small conference room for individual therapy sessions, and much of the work is done in hallways or in the day room because there’s no other place to go. That means frequent interruptions and distractions, which staff members say compromises their work and hurts patient progress.
“You would have questions about kenneling your dog in that facility,” says psychiatrist Jack Potts, former head of forensic services for Maricopa County and vice president of the Arizona Psychiatric Association.
“It’s just very old and decrepit. It’s inhumane,” Potts says. “Most of these people are insane. They’re not criminal.”
MONEY COMES AND GOES
During a 2000 special session, legislators appropriated $80 million in tobacco tax funding to build a new civil hospital, for those involuntarily committed, and a 16-bed facility for adolescents and renovate the forensic hospital units.
The civil and adolescent hospitals were built, but funding for the forensic hospital was rescinded in 2003 to help plug a budget deficit.
The state Department of Health Services has requested funding for a new forensic hospital ever since.
This year, the agency asked for $37 million and the governor requested $32 million. Negotiators in both the House and Senate have included a $32 million forensic hospital in preliminary budget plans, but it could be paid for over time or contingent on a healthy economy.
Most agree that the window for renovating the 55-year-old buildings has passed.
The debate among lawmakers is not whether to replace the forensic hospital, but when. The financing mechanism also is a thorny issue; Napolitano wants bonds to finance construction while the GOP-controlled Legislature opposes bonding.
“Nobody’s saying ‘just fix it.’ Nobody is saying ‘we don’t need a new forensic hospital,’” says health department director Sue Gerard.
“It’s a liability issue. It’s an employee safety issue. It’s a patient safety issue,” she says. “And it’s a safety issue for the public.”
Huppenthal says he thinks it could be renovated, but admits he’s probably in the minority. He and other Republicans also like the idea of contracting with a private company to run the hospital.
“Obviously, by a lot of standards, you would say it’s time to replace it,” Huppenthal says.
Increasingly, criminals are plea bargaining to get into the state hospital. Mental health advocates want lawmakers or judges to forbid that, or at least separate those who are dangerous from those who are not.
In the meantime, they say, the state — and lawmakers — are liable for whatever happens next.
“It’s like a time bomb,” says Sherri Walton, executive director of the Arizona Mental Health Association. “Eventually, somebody’s going to get hurt.”
By the numbers
The Arizona State Hospital’s forensic units are home to mentally ill criminals and those charged with crimes who may be too unstable to stand trial. Here’s a sample of injuries to staff that required medical attention, from December 2005 through
60 Punched in face
21 Kicked in leg, stomach or head
20 Knocked to the floor
8 Back injuries
7 Twisted knees
5 Hair pulled
2 Cases of smoke inhalation
2 Cases of spitting
2 Broken ribs
2 Broken hands
1 Hepatitis C patient spit semen into nurse’s face
SOURCE: Department of Health Services