Mental Wards

A court commissioner has dismissed criminal charges against two men and is likely to drop many other cases because he says the agency providing mental health services to county inmates is failing badly at its job.

Commissioner Benjamin Vatz's recent rulings -- which followed six days of little-publicized hearings held in downtown Phoenix late last year -- directly attacked the conditions at Sheriff Joe Arpaio's jails, and also blasted the efforts of high-ranking officials with Correctional Health Services in coming to grips with chronic understaffing and underfunding.

Vatz is likely to drop charges in the coming weeks against Santos Silva, a Mesa man accused of murdering his wife, and against at least three people charged with sex offenses involving minors. Odds are he'll also be dismissing felonies against another 20 or so mentally ill inmates whose rights he says have been violated by a lack of timely, consistent and effective treatment by CHS.

However, the commissioner won't allow these inmates to go back on the street without months -- or much longer, in some instances -- of inpatient treatment at a county psychiatric facility.

For example, Vatz ordered one of the two inmates whose cases he dismissed to be involuntarily committed at Desert Vista Psychiatric Center. He did so because he became convinced that the inmate, 35-year-old Rafael Trujillo, poses a potential danger to himself or others, and may be "persistently and acutely" disabled by his mental problems.

Trujillo had been charged with aggravated assault before the commissioner's March 10 ruling.

Earlier, on February 24, Vatz had this view of the treatment by Madison Street Jail medical personnel of mentally ill inmate Robert Marstella:

"There is no excuse for the conditions under which this individual with obvious mental health needs was held. His lack of treatment, counseling, medication management and restoration [to competency] services was unconscionable . . ."

Added the commissioner in a seven-page ruling, "Severe overcrowding, unsanitary conditions, cockroach infestations, extreme noise, lack of air conditioning and bullying by professional criminals, including assaults, extortion and stealing medications, are typical of the conditions under which the mentally ill must live."

Vatz then dismissed a charge of possessing dangerous drugs against Marstella, a 26-year-old man diagnosed with a psychotic disorder. However, Marstella is still in jail on a charge of promoting prison contraband -- a sharpened wood tongue depressor and a medical reflex hammer.

CHS is responsible for providing health care to the county's 8,000-plus inmates. During the hearing, Dr. Janice Bray, who then was the county's medical director for mental health, testified that, as of last November, about 1,700 of those inmates were on psychotropic medications. More than 300 of those inmates had been diagnosed as "seriously mentally ill" (or SMI), a term reserved for society's most troubled individuals.

The legal principles Vatz had to consider at the hearing were twofold:

Had the defendants' due process rights been denied because of the jail conditions and the long delays in the start of their "restoration" treatments?

And if they were, what could be done about it?

The commissioner answered the first question with a resounding yes.

As to the "remedy," Vatz dismissed charges against both Trujillo and Marstella in such a way that prosecutors cannot refile the cases.

That was precisely what deputy county attorney Juli Warzynski had been arguing against during the hearing and in court documents.

"Dismissal of the charges here would unfairly penalize the state and create additional expenses and delay for both parties," she wrote last October.

"Dismissal and release back into the community might unnecessarily endanger victims or the defendant himself if, after restoration, he is found incompetent, not restorable and a danger to himself or others."

Says Kenneth Huls, a supervisor at the county Public Defender's Office, which has been representing the inmates in the ongoing litigation: "This was a very courageous ruling, no doubt about it. That said, we're not trying to get criminals set free to make a point. In fact, we brought up the state's public-safety interests in our own pleadings. But if we don't take care of our mental health population in jail, it ultimately becomes a public-safety issue because most of the people we're talking about here would be getting out of custody at some point, treatment or not."

Huls adds that he's gained respect during the litigation for several CHS front-line employees who work in very trying conditions.

Commissioner Vatz also praised the work of CHS employees who apparently stabilized Trujillo mentally for a time before he disappeared into the jailhouse void last summer for almost two months of no treatment, much less attempted "restoration" to competency.

"This case is a reflection of the best and worst that CHS does for its seriously mentally ill population," he wrote. "Notwithstanding the deficiencies noted in the psychiatric units, [Trujillo's] unit made progress in its efforts to treat and monitor [his] condition."

But Vatz also noted that Dr. Bray -- a controversial figure who left CHS a few months ago -- had failed to meet with her own patient, Trujillo, for 48 days after a judge had ordered him into the county's restoration program.

During that stretch, "no supportive counseling had occurred, [Trujillo's] medications had been reviewed and renewed on two occasions without any personal observations as to his progress, or lack thereof, by CHS personnel."

It became clear after Dr. Bray and a psychologist finally did visit the inmate, Vatz wrote, "that any progress made in the period immediately following [Trujillo's] incarceration had been all but lost. . . . Unfortunately, rather than follow-up services, [Trujillo] received nothing from CHS."

Vatz cited the testimony of Judy Pease, a CHS counselor in the maximum-security unit, who said she'd been working last summer "literally on her own."

No psychiatrist, psychiatric nurse or co-worker was available to assist her, Pease testified, and things got so bad, Pease testified, "that Dr. Bray was giving orders regarding renewing, changing or stopping medications without even seeing defendants. There was insufficient staff to see if inmates . . . were taking their medications or even coming out of their cells to get them."

The commissioner also wrote of Dr. Kevin Hoffert, a psychiatrist in the Durango unit who testified he was quitting CHS after 11 years of service because of "artistic differences." By that, Hoffert said he was referring to what he considered the gravely diminished standards of care to the jail's mentally ill inmates.

Bray agreed during the hearing that CHS has been underfunded and understaffed. But she testified that the inmates in question were receiving "reasonable" treatment under the circumstances.

Another longtime CHS psychiatrist, Leonardo Garcia-Bunuel, told Vatz of the harmful effects of Maricopa County's jailhouse environment on the mentally ill, and noted that inmates are "likely to experience increased symptoms of depression, paranoia and delusions."

Unfortunately, Garcia-Bunuel tells New Times, "things are not getting any better yet. The inmates are still housed in the same conditions. As far as getting them to a level of, quote, competency to stand trial, you can teach most of them to mouth the right words like you can teach a parrot to talk. But you still have not treated the underlying illness. I wish the public would understand that."

E-mail [email protected], or call 602-229-8433.

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Paul Rubin
Contact: Paul Rubin