THE CAPITAL, TALLAHASSEE, June 1, 2012......

Staff members at Florida State Hospital failed to consistently comply with state heath care regulations and procedures surrounding the care of a pregnant patient whose baby remains on life support after an emergency delivery in December.

The patient, who was committed to the secure facility in Chattahoochee in October, called the Leon County Sheriff's Office 911 service twice during the evening of Dec. 23, saying she was in labor and not being properly cared for, an internal investigation by the Department of Children and Families inspector general concluded.

Despite the calls, staff at the facility assured emergency responders that the patient was fine.

"She's not going into labor," FSH senior supervisor Eddie McMillian told the dispatcher, according to a transcript of the call. "This is a mental hospital. I called the nurse and everything and they can't get an ultrasound today. Today is Friday. She says she's going into labor. She's not going into labor."

Within two hours of that call, she was on a helicopter ambulance to Capital Regional Medical Center. Shortly after, the patient would be at Tallahassee Regional Medical Center, where her child remains on life support.

The Department of Children and Families on Friday released copies of the inspector general's investigation, an 89-page critique of procedures that led to the decisions made in December at Florida State Hospital, the oldest mental-health facility in the state. The hospital, which cares for people who have been committed through the Baker Act and people who have been charged with crimes but are incompetent to proceed to trial, has 1,924 employees.

Overall, the report, much of which was redacted, found staff at the state-run mental health facility didn't consistently follow established protocol and failed to respond properly after the patient, in her 38th week of pregnancy, told them she was going into labor.

Instead, staff told the patient to go back and lie down and called for assistance only after she began bleeding profusely after being sent to the institution's emergency room.

As a result of the episode, McMillian was terminated March 13. Another-direct care supervisor, Maryland Clopton, resigned Feb. 1, while licensed-practical nurse Kathryn Cottle received notice last month of the agency's intent to dismiss her. Senior physician Rosalee Peckoo was placed on administrative leave Jan. 6 but has since returned to her job.

The investigation shows the patient had made repeated calls to hotline numbers after being involuntarily committed by court order to the Tallahassee Memorial Behavioral Health Center, where she was initially being treated.

Diagnosed with schizophrenia, mania and depression, she was transferred to FHS in October after staff at the behavioral health center determined they could no longer safely treat her.

A criminal investigation into the incident continues, said Jenn Meale, a spokeswoman for Attorney General Pam Bondi. .

Last week, DCF Secretary David Wilkins said the IG's report showed numerous breaches in standard operating procedures and poor decision making on the part of some FSH staffers.

"The investigation, I believe, proved that certain people did not come close to meeting our standards,'' Wilkins said.

DCF spokesman Joe Follick said Friday nothing has changed to alter Wilkins's assessment.

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Tallahassee, FL -- May 24, 2012 --

A child is on life-support and two Florida Hospital employees are without jobs after DCF says the child's mother was neglected while at the hospital.

"Our job is to investigate this, understand what happens and really demand a higher level of care for situations like this," says David Wilkins from the Department of Children and Families.

It's a situation officials with The Department of Children and Families say has put a child's life in jeopardy and cost two Florida State Hospital employees their jobs. All after DCF claims the hospital neglected one of its patients.

"In our business, we unfortunately have to deal with a lot of tragic situations, but particularly in this situation there are a lot of questions in terms of how the process was managed and who was involve ed with what," says Wilkins.

Those questions arose last December 12-23-11. That's when DCF says a pregnant patient at the hospital expressed concerns over her pregnancy. She was flown to Tallahassee Memorial Hospital and gave birth to her son. He was placed on life-support and is gravely-ill', according to DCF. While DCF won't say exactly how she was neglected. It says its employees 'did not meet our high standards'.

"Any time we have a tragedy it's unacceptable. Sometimes they're unavoidable. This situation may have been unavoidable as well. But you have to learn from it and just keep trying to do better, " says Wilkins.

The report from DCF is on its way to the Attorney General's office. That report will be available to the public next month.

In addition to the personal changes, DCF has added new protocol such as 'Labor Awareness Training' and created the position of medical services director to oversee the physicians.
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Tallahassee, FL -- May 24, 2012 --

With a baby on life support, suspicions that a pregnant woman received negligent care at Florida State Hospital have cost at least two employees their jobs and led to a criminal investigation and a possible lawsuit against the state.

David Wilkins, secretary of the Florida Department of Children and Families, said Thursday that the agency began investigating after the woman was taken from the state hospital by a helicopter ambulance to a Tallahassee hospital on Dec. 23 and gave birth to a boy who was placed on life support.

The woman, who had been admitted to Florida State Hospital through the state's Baker Act because of mental illness, had earlier expressed concerns about her pregnancy. While details of the baby's condition were not made public Thursday, a document provided by the department described him as "gravely ill."

Wilkins said he could not provide a detailed explanation of the woman's care because of patient-privacy laws. But he said the agency's inspector general has finished a report that could be made public as early as Friday.

"The investigation, I believe, proved that certain people did not come close to meeting our standards,'' Wilkins said.

Florida State Hospital, which is in the Gadsden County community of Chattahoochee, is the oldest mental-health facility in the state and has 1,924 employees. It cares for people who have been committed through the Baker Act and people who have been charged with crimes but are incompetent to proceed to trial.

The pregnant woman was admitted to Florida State Hospital in October and was in a ward designed to handle higher-risk patients. Wilkins said it is rare for pregnant women to be admitted to the state facility.

As a result of the episode, direct-care supervisor Eddie McMillian was terminated March 13, according to the department. Another-direct care supervisor, Maryland Clopton, resigned Feb. 1, while licensed-practical nurse Kathryn Cottle received notice Thursday of the agency's intent to dismiss her. Senior physician Rosalee Peckoo was placed on administrative leave Jan. 6 but returned to her job Thursday.

Wilkins said the agency asked the Attorney General's Office to take part in the investigation and requested that the Department of Health help determine whether hospital staff members met proper standards of care. Possible charges could be related to criminal negligence.

State Attorney Willie Meggs, whose office prosecutes cases in Gadsden County, said the Attorney General's office has been leading the criminal investigation. Charges, if any, would be filed through Meggs' office in Gadsden County.

The woman's family also has filed a notice of intent to file a civil lawsuit, a required step in cases against the state.

Along with the investigation, Wilkins said DCF has made changes at Florida State Hospital to try to improve care. For example, he said it has added a medical services director to provide more oversight of doctors and nurses.

Also, longtime hospital administrator Diane James recently announced her retirement and was replaced by Marguerite Morgan. But Wilkins said James did not step down because of the incident involving the pregnant woman.