The suspicion that a few hospitals in the Tampa Bay area leak Baker Act patients like a sieve has bothered law enforcement officers and mental health advocates for years. Turns out they had reason to worry.
Most of the 32 acute-care hospitals in the Tampa Bay area appropriately restrain and treat troubled patients who are considered a danger to themselves or others. But four local hospitals, all owned by HCA, have repeatedly failed to meet this obligation.
Since 2003, more than 160 Baker Act patients have walked out of these four hospitals before being stabilized or evaluated, in violation of state and federal laws.
Community Hospital in New Port Richey and Northside Hospital and Heart Institute in St. Petersburg have had, on average, at least one Baker Act patient go missing a month for the past three years.
At Largo Medical Center and Brandon Regional Hospital, the numbers have averaged about one Baker Act disappearance every two months.
By comparison, Morton Plant Hospital in Clearwater, which is bigger than any of the HCA hospitals, has not had a single Baker Act patient reported missing since 2003.
Spokeswomen for Community Hospital and Northside say the issue has been resolved and no Baker Act patients have escaped since September. At Largo Medical, the last reported case was in June.
But there were walkaways from HCA's facility in Brandon in October and November, including a man who said he had overdosed on pills. His mother told officers her son had been Baker Acted "at least 11 times in the past" and "if he knew he was going to be Baker Acted, he would probably shoot himself or even at deputies."
Most patients who go missing are found hours or days later — at home, on the street, in one case at a Dunkin' Donuts. While family members are often frantic that a suicidal or potentially violent person has gone missing, local incidents so far have ended quietly.
But when something goes wrong, it can be catastrophic.
Last summer, Mark Rohlman was committed for psychiatric care to the HCA hospital in Fort Walton Beach, but he immediately bolted. Discovered by deputies in an alley behind a nearby barbecue joint, Rohlman was returned to the hospital, only to take off a second time.
Officers cornered the 47-year-old before dawn the next day, as he holed up at his family's home. When a SWAT team entered the house, Rohlman killed an Okaloosa County sheriff's deputy, then turned the shotgun on himself.
"We did everything right to help Mark, and we felt good that he was going to get the professional treatment he so needed," said his older brother Erik, who said the family had anguished over the decision to Baker Act their brother. "Now we feel like we signed his death warrant."
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Dozens upon dozens of police reports on escaped Baker Acts — called "elopements" by some in the trade — give a glimpse of volatile patients on the loose.
"(Patient) learned of the Baker Act and got up and walked out of the hospital. He made threats to harm anyone who tried to stop him," says a report filed in April at Northside Hospital.
"In hospital gown no shoes ... BA52 (Baker Act) just ran SB (southbound) on Vonderberg (sp) or Parsons,'' reads a bulletin about a patient who took off from Brandon Regional in October.
"Subj intox (subject intoxicated) and stated he wanted to kill himself with a gun," says a 2007 report on an escaped Baker Act patient from Largo Medical Center.
"(Patient) was placed in a room, he ran out of one of the unsecured doors into the parking lot," according to an August report from the New Port Richey hospital. The hospital waited 90 minutes before notifying deputies the man was missing.
These patients often are brought to a hospital ER after overdosing on drugs or alcohol and are Baker Acted because they are seen as a threat to themselves or others. Within 12 hours of having their medical condition stabilized, patients are supposed to be evaluated or transferred to a psychiatric facility.
The system breaks down when the patient leaves before being discharged and nobody stops them.
After the tragedy in Fort Walton Beach, an executive at the HCA hospital said it had little choice but to let Mark Rohlman leave. "We don't lock people up," Evelyn Ross, director of risk management at Fort Walton Beach Medical Center, told Northwest Florida Daily News.
But state officials say hospitals have not only the right to restrain Baker Act patients, they have the responsibility.
Martha Lenderman, the state's foremost expert on the Baker Act, acknowledged that there is a constant balancing act between a patient's safety and right to liberty. But the law allows hospitals to put Baker Act patients in restraints if the person is at risk of escape.
"I always ask hospitals whether they'd rather face charges of false imprisonment (for restraining a patient) or wrongful death," Lenderman said. "When you put it that way, they always get it.''
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By mid 2004, Baker Act elopements in Largo had become such a problem that the hospital hired off-duty police to patrol its emergency room around the clock. The hospital canceled that contract in September 2007; there have been at least five Baker Act elopements since.
In 2006, escapes were so routine at Northside that a nurse told a deputy "they lost another one." Lenderman, former director of the state Baker Act, author of the law's 1996 reforms and statewide consultant, said she has heard more complaints about runaways from Northside than any other institution in Florida.
Judy Turnbaugh, president of NAMI Pinellas County, a patient advocacy group, agreed. "Northside has been a continuous problem,'' she said. "Hospitals don't want these people, who often don't have insurance. So they turn a blind eye and hope they'll walk out. I think everybody's bottom line is money."
Gina Stiles, Northside's marketing director, said in a statement that the hospital "is committed to providing all of the patients we serve with the highest quality medical care."
Though adequately attending to Baker Act patients may cost hospitals money in extra manpower or security, they have little choice. Federal law requires hospitals to care for patients with a medical emergency until they are stabilized, regardless of their ability to pay. And Florida's Baker Act requires hospitals to hold onto these patients after they have been medically stabilized, until they are transferred for psychiatric care.
Last fall, the head of emergency services for HCA's West Florida division asked Lenderman to train his staff on Baker Act regulations and their obligation to prevent patients from leaving. An HCA spokeswoman declined to say if the session was in response to Mark Rohlman's elopement from the for-profit chain's hospital in Fort Walton Beach in July.
Lenderman, who lives in Pinellas Park and donates her services to hospitals in Pinellas County, said she told HCA staffers to put patients in a hospital gown, stash them in the bowels of the hospital, and use video monitoring or trained sitters to ensure they don't flee.
"The regulations require there to be some level of risk before restraints or seclusion are used," she said. "But you don't have to wait until they're out the door."
Expecting police officers who Baker Acted the patient to stick around the hospital is also wrong, Lenderman said. "It's not law enforcement's job to babysit. Once they make the handoff, it's the hospital's responsibility."
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HCA officials defend their record by saying many hospitals have a "challenge" caring for Baker Act patients, but no other local facilities have done as poor a job.
Even HCA's six other area hospitals do a better job of restraining Baker Acts than the four HCA hospitals with high numbers. Sun Coast Hospital in Largo, for instance, reported just one missing patient during the past six years.
St. Petersburg's Bayfront Medical Center has nearly twice as many beds and a bigger emergency room than Northside. Bayfront reported 16 patients missing for any reason since 2004. Northside had 15 Baker Act patients walk out in just the first nine months of 2008.
St. Joseph's Hospital in Hillsborough County had fewer than 20 missing persons reports of any kind since 2003. During the same period, Baker Act elopements from Brandon Regional, a smaller hospital, numbered 30.
Tampa General Hospital, the area's biggest hospital, had 32 Baker Act patients go AWOL from 2003 to 2006. But several changes in the past two years have eliminated the problem. John Dunn, hospital spokesman, said a new ER, opened in 2007, has isolation areas away from exits. TGH also hired staff to act as monitors, installed videocameras and put special colored bracelets on any patient at risk of leaving.
(TGH has had unrelated problems with patients admitted for psychiatric care. Last summer it nearly lost Medicare funding after two psychiatric inpatients committed suicide.)
The day after the tragedy in Fort Walton Beach, the Okaloosa Sheriff's Office said the HCA hospital there had reported 45 Baker Act elopements over the previous 18 months. That number stunned state officials, who said they were completely unaware of the problem.
"There has been no requirement for all hospitals to report elopements, but there ought to be,'' said Lenderman, who said only specially designated psychiatric facilities have reported escapes in the past.
"For every one of these incidents that ends in a death, a hospital may get away with it for 99 others. But it's a disaster waiting to happen."
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Confused, fearful or just plain bored, patients have climbed through ceiling tiles at the New Port Richey hospital and jumped from a second-floor window at Northside, leaving a bloody gown on the rooftop. Most of the time, though, patients just walk out.
At Northside, patients have slipped out while using the public restroom, a woman in a hospital gown flagged down motorists in front of the emergency room and a man "walked out of the hospital to get a cigarette and just kept going."
Missing patients trigger costly and time-consuming hunts by law enforcement agencies, who use everything from canine units and helicopters to track the missing. In Hillsborough County, law enforcement has chosen to add another layer, reporting each "endangered'' missing adult to the federal Department of Homeland Security.
The potential for disaster permeates the police reports. A suicidal patient who raced out of Largo Medical's ER was found by police after "barricading himself inside his home."
An escaped Baker Act patient from the New Port Richey hospital was found in bushes nearby. Naked and unarmed, the man told the officer, "I will f------ kill you." Before he was subdued, the patient punched a policeman and was Tasered twice.
Police stayed with the man while he had the Taser probes removed at the hospital. Rather than being treated for his psychiatric problems, the man was arrested for battery and taken to jail.
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Though emergency room doctors can evaluate Baker Act patients and release them if they no longer need psychiatric help, Lenderman said nonpsychiatrists usually take a pass.
"There's fear of liability. They want somebody else to do that," she said. "But they create part of the problem by failing to release people who no longer meet Baker Act criteria. I've heard stories of people stuck in the ER for 48 to 72 hours. They get backed up like cordwood."
Lenderman urges hospitals to call the state if they can't find the Baker Act patient a bed in a psychiatric facility. "The state needs to know if there's a backup so they can look at the receiving facilities,'' she said, referring to specially designated centers like PEMHS in Pinellas County and Harbor in New Port Richey.
For some patients, any delay can be too much.
Last February, a man Baker Acted with a head injury ran off the same evening because Northside staff "left him sitting for over an hour," his wife told deputies.
Another Northside patient, a young woman Baker Acted after an overdose in July 2007, said she was stuck in a room and ignored. "The psychiatrist didn't come in to see me after the first day," said the woman, who was also treated for diabetes. "I kept asking when I was going to be moved, but nobody would say."
After nine days of no answers, she tucked her clothes under the hospital gown, walked past the nurses' station, down an elevator (twice, the first time she forgot her slippers) and into a public restroom by the emergency room. She changed into her clothes, tossed a heart monitor in the trash and walked out the ER doors to her grandmother's car. An IV was still sticking out of her arm.
"I'd had friends walk out of Northside before so I knew it could be done,'' said the woman. "The staff couldn't care if patients walked or if they stayed."
Though she escaped the hospital, she couldn't outrun her drug problems. A year later she ended up back in Northside, again overdosed and Baker Acted. This time she was moved within two days to a psychiatric facility. She has been drug free since.
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Mark Rohlman, a law-abiding businessman who became mentally unhinged after his father died and a land deal went bad, never got another chance. When Okaloosa deputies came looking for him in late July, he went out shooting, just as his brothers warned he would.
"If Mark had been held, if not the first time, at least the second time, I'm convinced he would have received treatment and been alive today,'' his brother Erik said. "When you entrust somebody to a hospital and they receive funds to administer a standard of care, you trust that's going to occur."
The family, which has not filed any legal action against HCA, had prepaid the Fort Walton Beach Medical Center $4,625 for Mark's care.
The five surviving Rohlman brothers are haunted by the fact that Mark killed Deputy Anthony Forgione, a 33-year-old father of two, before taking his own life. Referring to the predawn shootout at the family home, Erik said, "That young cop shouldn't have been in that room and Mark shouldn't have been in that room. They were two innocent victims in a chance encounter that was totally preventable."
Still grieving and trying to make sense of the tragedy, Erik, general manager of a Toyota dealership in Spartanburg, S.C., said he has made a point of visiting hospitals in his area, seeing what they do to make sure troubled patients don't leave without treatment.
"They looked at me like they couldn't believe there would be a hospital out there with those kinds of problems,'' he said.
Erik said he was glad to hear that two HCA hospitals in the Tampa Bay area say they have taken steps to stop Baker Act elopements.
"If Mark's death can prevent this from happening to others, we can derive some peace from that," he said. "That's all we can hope for."
Times researchers Shirl Kennedy and Carolyn Edds contributed to this report. Kris Hundley can be reached at firstname.lastname@example.org or (727) 892-2996.
How we did the story
We sought data from law enforcement agencies on the number of missing persons reports filed from Tampa Bay area hospitals 2003-2008. We then requested copies of the incident reports from hospitals with the most missing persons to identify those related to Baker Act patients. Hospitals not listed above had few missing persons reports of any kind.