AIDS and Abetting

Prostitutes often frequent the parking lot of the Tempe Bowl on Apache Boulevard, so police keep a close eye on the area. When Officer R.M. Monteton cruised the lot on the evening of September 12, 2000, he got an eyeful.

Monteton saw a man and a woman having sex on the pavement. As he approached the pair, the officer recognized the woman, and was mortified. It was 28-year-old Danielle Adair, familiar to Tempe street cops as a homeless hooker who has plied her trade in the Apache corridor for years.

Monteton knew Adair is HIV-positive -- in fact, she has full-blown AIDS. Officer Steve Carbajal, who responded to the scene, told Adair's 31-year-old customer that she carries the deadly virus. The man said he'd paid her $10 for the sexual experience.

Prosecutors later would charge Adair with prostitution and reckless endangerment, and her "john" with soliciting a prostitute. But even as police arrested the pair, they knew there was little chance Adair would be held criminally accountable for her actions.

Tempe detective Dave Hubalik pointed out in a report written after the Tempe Bowl arrest that his agency had arrested Adair six other times on prostitution charges since September 1998. But she'd been convicted just once, and then only for misdemeanor possession of drug paraphernalia.

That's because Adair is seriously mentally ill, and mentally retarded. County judges have dismissed charges against her time and again, after finding her "incompetent" to stand trial.

In Arizona courtrooms, "incompetence" means an accused person suffers from a mental illness, defect or disability that has rendered him or her incapable of understanding what's happening in the courtroom. The law says a defendant who can't assist his or her attorney with "a reasonable degree of rational understanding" can't be tried for a crime.

Doctors repeatedly have said Adair is incompetent because of her serious mental illness. Most recently, she was diagnosed with a schizoaffective disorder, a disease whose symptoms are a mixture of mood disorders and schizophrenia. Officials years ago ruled her eligible for mental-health services under the state's class-action lawsuit Arnold v. Sarn.

In most instances, judges also have found Adair "non-restorable," meaning they don't believe her mental state will improve significantly within 15 months.

That said, Danielle Adair seems aware she shouldn't be putting others at grave risk by having unprotected sex with them. (She also has syphilis, and has been treated for cervical cancer.)

"I know it's a bad thing to do," she tearfully tells New Times in a jailhouse interview. "But when I get out of jail and stuff, I don't know what else to do. I smoke crack, and I eat, and I need money. So I have to do what I have to do."

It isn't certain if Adair has infected anyone with the virus that causes AIDS. Still, by any definition, she's a menace to society, as well as to herself. Adair not only can't stay out of harm's way, she is harm's way.

Certainly, this woman has no business being on the street, and those involved in her case know it. How could they not, given Adair's 24 arrests, and 10 hospitalizations at the county psychiatric ward since 1994?

Among those keenly aware of her situation are public-sector attorneys, judges, psychiatrists and case managers working for ValueOptions, the private firm under contract with Maricopa County to provide and oversee services for its seriously mentally ill.

But until recently, little of substance has been done to protect the public from Adair, or to protect her from herself. Even though authorities agree she fits the legal definition of a gravely disabled public health hazard, Adair continues to float in and out of custody, then back onto the streets.

Many familiar with Adair's case say she could and should be subjected to restrictions of her freedom. They cite a slew of Arizona laws and policies concerning civil commitment, guardianship, public safety and other safeguards designed to deal with situations such as hers.

But the safety nets that were designed to help Adair and others like her -- and to protect the public from her -- have failed dismally. She continues to cycle through a mental-health system that often releases ill people to the streets rather than paying to keep them hospitalized.

Speaking generally, ValueOptions' director of clinical administration Mary Jo Whitfield says, "The issue is, once a person is stabilized psychiatrically, is it good care to keep him or her hospitalized? It's not. Ideally, there's supposed to be a continuum, in which a person who decompensates back in the community moves back and forth to the hospital. Do things work 100 percent of the time? Of course not."

Adair also keeps passing through a criminal-justice system where judges, prosecutors and others proclaim that she's an acute danger to herself and others, then don't track her whereabouts.

But Danielle Adair hasn't "slipped through the cracks," an aberration in an otherwise well-oiled system. And her plight isn't necessarily because of lack of funding, another common excuse for systemic failure.

"For [Adair] to continue to cycle in and out of jail as a default to the inadequate care she's gotten is gross negligence," says Jack Potts, a psychiatrist who heads the forensics unit at Maricopa County Superior Court. "This woman needs protection, and the community certainly needs protection from her. She just doesn't have the ability to stop herself. On an emergency room level, this is a Code Blue situation. And her case is not unusual."

It's not as if officials have just ignored the life-and-death issues swirling around Adair. The public record holds statements from doctors who repeatedly have warned of the health threat she presents. Last November, for example, Dr. Potts wrote to a Tempe city judge that "[Adair] continues to remain a public health hazard . . . and she certainly needs a guardian."

She has repeated the cycle to which Potts refers for years. In short, Adair commits crimes -- some potentially life-threatening -- gets jailed, is shipped to the county hospital for a short stint, then is freed to the community. "Community" translates in her case to drug abuse and prostitution.

"She's seen by society as the lowest of the low," says Christy Dye, chief of the Substance Abuse Treatment and Prevention Services unit at the state Department of Behavioral Health Services. "She's a woman with AIDS who is a substance abuser and a hooker. She's constantly subjected to violence and bad things, and then the system can't find a place for her. That's not right."

Danielle Adair first came to the attention of Maricopa County's mental-health system in 1994. Coincidentally, that was the year criminal justice and mental-health professionals asked the Arizona Legislature to amend the laws about incompetence to stand trial.

The thinking was sound: Under the system in place then (and now, for that matter), authorities allowed mentally incompetent people, especially the mentally retarded, to commit crime after crime without being punished or placed under proper supervision.

The legislators passed a law designed to rein in some incompetent defendants, in part by "providing secure treatment alternatives, subject to legislative appropriation, for [those] who . . . are a threat to public safety and who are not in an otherwise safe and secure environment."

Then-governor Fife Symington signed the bill. But the law's key phrase turned out to be "subject to legislative appropriation." Seven years later, the Legislature still hasn't allotted a penny to build the "secure facility." Just a few weeks ago, in fact, the lawmakers put funding for the proposed facility on hold until at least 2003.

However, it's not as if the lack of funding left mental-health authorities with nowhere to turn when trying to care for the Danielle Adairs of Maricopa County. For example, Arizona State Hospital (ASH) has been a "secure facility" for decades. Its chief executive officer, Jack Silver, said recently that about 30 beds out of 335 are open at ASH for mental patients.

But the vagaries of present-day mental-health politics and economics mean that few new patients of Adair's ilk are sent to ASH. Instead, most chronically ill people whom the courts deem civilly commitable end up in jail, then are freed to commit new crimes against other people and property. And hospital officials at ASH's county counterpart -- the Maricopa Medical Center (MMC) -- indicate the average length of stay at the psychiatric ward there is only about two weeks.

So why have there seemingly been no institutional or programmatic options for Danielle Adair, who desperately needs one? Those inside the mental-health system don't have an adequate answer.

"The more I look into this case, the more I shake my head," says Vicki Staples, BHS bureau chief for Persons With a Serious Mental Illness. "So many systems should have been involved, and it's unclear why they haven't been. So many should-haves. . . . I don't think there are any knights in shining armor in this story."

Danielle Adair's first admission to the county psychiatric ward came in July 1994, after she allegedly attempted suicide by overdosing on aspirin. It happened shortly after her 2-year-old son died because of a respiratory illness. She was released 11 days later, after telling officials her life story.

Though details of her autobiography have changed over the years, Adair's life by any measure has been grim.

"I was always in the stupid classes," she tells New Times, referring to special-education classes she took while growing up in Mesa. "People always said that I'm stupid, but I'm not that stupid. I learned how to make it out there, and nobody helped me with nothing."

Though those words sound bitter, Adair actually is very congenial. She jokes with a guard about letting her have a smoke, then joshes with a visitor about chocolate bars he must have in his briefcase. When Adair is on medication, as she was during the New Times interview, she's fairly coherent, and is well-groomed. On the surface, she doesn't yet appear ravaged by AIDS, or her other serious maladies.

Depending on the account, Adair was born either in California or Arizona, the youngest of three sisters. She claims her family disowned her years ago, and says she's had no recent contact with them or her estranged husband. New Times was unable to locate any of her family members.

School officials placed Adair in special-education classes as a youngster after her IQ score tested out at 64. That's considered mildly mentally retarded.

She says she dropped out of school after 10th grade, around the time she started using crack cocaine. Adair says she loves the jolting high, because it instantly makes her forget how ugly and stupid she thinks she is. She says she's never held a job for long, and turned to prostitution in her early 20s to make a few dollars.

"I don't do anything that good," Adair says, unconsciously rubbing a small, fading tattoo of a heart on her right hand. "When I get money, I buy drugs and I buy food. That's my life."

It's unclear when and where Adair met her husband, but the two had a son together in 1992, shortly before her 20th birthday. The child suffered from medical problems from the start, then died in 1994.

Adair again was briefly hospitalized at MMC in late 1994, after her addled mind continued to slip. But she quickly returned home after her condition allegedly "stabilized," a term of art in the mental-health field that usually means whatever those in charge of a patient desire.

In July 1995, a judge ordered her back to MMC after she allegedly struck her husband with a frying pan, then tried to burn his eyes with a cigarette. Again, authorities soon sent her home with an armful of pills and advice to seek counseling.

"I went crazy after my baby died," Adair says. "Things got real bad."

So bad, in fact, that Tempe police sergeant Leroy Betz says Adair became a sadly familiar face to him and his squad in the mid-1990s.

"It started out with domestic violence against her husband," he tells New Times. "Then she turned to prostitution and drugs. Then she turned out to have this illness [HIV], but she still was surviving on the streets. Our role was to keep arresting her for criminal violations. I know [Tempe city prosecutor] Geri Mattern was frustrated trying to find a mental-health facility for her. It's been years, and the mental-health profession still hasn't decided what to do with her, I guess."

On occasion, officials did try to find a place for Adair. They enrolled her in crisis shelters around the Valley, but she never stayed long before sneaking off to prostitute herself for drug money.

In September 1997, Adair's mental-health case manager wrote of "[Adair] complaining about being very tired. Out on street for days. Needs shelter, but kicked out of so many, does not know where to go." By then, county authorities had declared the woman "seriously mentally ill," which made her eligible for many services. She also was collecting social security disability payments of about $500 a month, which she says she would squander on drugs within days.

When Adair underwent yet another mandatory stay at the county psych ward -- this time for a week in July 1998 -- she tested positive for HIV. She says, "My husband told me he wouldn't have sex with me if I had it, and I had to get my blood drawn, 'cause I was out prostitutin'. And it came up positive. I don't use needles, so I guess I got it having sex."

Adair says her husband booted her out of the house, and she lived on the streets of Tempe and Phoenix when she wasn't in custody. Authorities by this time were on to her. A mental-health report in September 1998 said in part, "[Adair] presents as a danger to self and others by having unprotected sex in exchange for drugs, despite her HIV status."

Two days after Adair's "treatment" began that month, psychiatrist Stephen Borodkin wrote to the state director of Health Services. Dr. Borodkin's letter reiterated that Adair was a threat to public safety, and that authorities should monitor her closely.

Just two days later, however, on September 18, 1998, MMC inexplicably released the woman. Almost immediately, she returned to the only life she knew, as an HIV-infected, crack-smoking hooker.

Four days after that, according to Tempe City Court records, police arrested her on new charges of criminal trespassing. Less than a month later, Tempe police again arrested her for possessing a crack pipe. Prosecutors dismissed both of those cases because of Adair's continued "incompetence" to stand trial. On November 9, 1998, Tempe police arrested her yet again, this time on charges of possessing a crack pipe and for hitchhiking. Adair pleaded guilty -- it's uncertain why her attorney didn't play the "incompetence" card -- and served 90 days in jail.

Predictably, she started her destructive cycle anew almost immediately after her release.

In August 1999, Adair phoned her latest mental-health case manager from the county jail, saying she'd been arrested for prostitution and drug possession. That case wound up in Superior Court, where a commissioner considered whether Adair was competent.

In such instances, two court-appointed mental-health experts evaluate a defendant and opine about his or her competence. If the two disagree, the court often turns to Dr. Potts, who heads the court's forensics unit. (Judges may reject the experts' final recommendation, but rarely do.) One expert in this case said Adair seemed competent to stand trial; the other said she wasn't. Potts broke the tie after interviewing Adair, concluding she was incompetent, and posed a serious public-health risk.

Commissioner Lindsay Ellis sided with the majority, writing in February 2000 that Adair "suffers from diminished cognitive abilities and bipolar disorder and that [she] is currently experiencing serious medical conditions that require immediate attention. . . . [Adair] is likely, without immediate or continued hospitalization, to suffer (or inflict) serious physical harm . . ."

Ellis ordered Adair's return to MMC for an evaluation as a danger to herself, to others, and for her "persistently or acutely disabled" behavior. But hospital officials didn't agree with the commissioner or the two mental-health experts. They dismissed the court-ordered treatment petition on March 3, 2000, and released Adair to her case manager. She'd officially been "stabilized," after less than one week at the psych ward.

Three months later, in June 2000, Adair spent a day at the hospital after she'd reportedly tried to hit her case manager -- it's unclear if it was the same one she'd been released to. That day, however, hospital officials decided Adair was competent to refuse medical treatment.

Actually, what she was was out of control, as she had been for years. Still, no one sought to have a guardian appointed -- the county's Public Fiduciary would have been a suitable candidate -- to look after her best interests.

HIV-positive Arizonans who pose ongoing health threats still aren't legally in the same "public health hazard" category as those with tuberculosis.

One law allows local health officers to detain anyone with tuberculosis "who endangers another person or the community, and the afflicted person fails or refuses to comply with voluntary examination, monitoring, treatment, isolation or quarantine . . ."

The law also orders the "receiving institution" -- it's not supposed to be a jail, however -- to provide suitable housing and care of the [tuberculosis] affected person." Arizona Department of Health Services (DHS) officials say they haven't tried to use that law in recent memory.

No such laws, however, govern those with HIV or full-blown AIDS. (DHS statistics show that 292 new cases of people infected with HIV were reported in Arizona last year, and 236 new cases of full-blown AIDS. That contrasts with 261 new cases of tuberculosis in 2000.)

But no one has sought to have Adair detained as a "threat to public safety," which authorities universally agree she is.

Did someone actually have to contract the HIV virus to qualify as one of Adair's victims?

No, Tempe prosecutor Geri Mattern concluded last September, when she charged Adair with prostitution and reckless endangerment in the Tempe Bowl case. The endangerment charge stemmed from Adair's unprotected sexual interlude with the parking lot customer, because she could be transmitting a fatal disease.

Adair remained incarcerated at the county jail from September 13 to January 19, during which time she took her medications, and apparently got better, both mentally and physically.

After the latest case got dismissed because of Adair's continued legal "incompetence," authorities shipped her in late January from jail to another familiar haunt, the county hospital. There, a social worker wrote January 24 that "the patient has been engaging in dangerous behaviors. She has been prostituting [in the community], despite the fact that she knows she is HIV-positive. When asked about this behavior, the patient states that voices at times tell her to prostitute."

Despite that damning notation, it became evident that history was going to repeat itself: Adair would be out on the streets again before long. Prosecutor Mattern says that was unacceptable to her and to the Tempe police officers with whom she works.

"It's easy to see why the county jail has become the biggest mental hospital we have," says Mattern. "If people like Danielle aren't supervised properly and helped with housing and all those things, they'll be back in jail in no time. This woman should not be out there doing what she's been doing. It's just not right, for the public or for her."

The veteran prosecutor knew Adair tends to vanish into the Valley's underbelly when she's not on anti-psychotic and other medications. As a stalling tactic, Mattern refiled the parking lot case in Tempe City Court. She also called BHS, where she spoke with Vicki Staples.

Staples says Mattern told her that Adair was about to be freed again, and New Times was going to write about it. Staples made several phone calls, imploring those in charge of Adair's well-being -- ValueOptions for one -- to find answers, quickly.

And, finally, they may have, though many close to the case are taking and wait-and-see posture. As of a few days ago, Adair remained in a locked ward at MMC, awaiting to hear if a small west Phoenix group home under contract with the state will accept her as a resident. The facility is said to be supervised 'round-the-clock, and is armed with buzzers that sound when someone enters or leaves.

ValueOptions' Mary Jo Whitfield points out that her agency recently formed a special team to look into the most difficult cases: "We're having more direct case consultation with our case managers concerning the very complicated cases. We want to teach them that no problem is impossible to solve."

Danielle Adair says she has the answer. "I know I belong in a hospital where they can take care of me," she says. "I like to sleep on real pillows and eat real food. It eats you up being in a jail cell for a long time. I don't want to go back to what I was doin'. They let me out, you know what's gonna happen, and so do I."


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