Staff members at Florida State Hospital failed to consistently comply with state health 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 in October to the secure facility in Chattahoochee, 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,” hospital 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,” McMillian said in the transcript.
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 in October to Florida State Hospital 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.
DCF Secretary David Wilkins said the Inspector General’s report showed numerous breaches in standard operating procedures and poor decision-making on the part of some Florida State Hospital 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.