In 2013 Florida expanded laws to prohibit gun sales to those that may be a danger to themselves or others but the law has failed.
As doctors revived her mother from an overdose, a distraught Tampa Bay teen told police her mother believed she had a demon on her back, talked to herself of the end times, and vowed the two would die together in a suicide pact.
Less than a year later, Florida cleared the woman to buy a shotgun.
Within two weeks, she and the teen were dead, shot with that very gun.
The state's strategy has been two-fold. A decade ago, lawmakers banned gun sales to people who had been forcibly committed to mental hospitals. Four years ago, Florida broadened the ban to include those who voluntarily commit themselves for long-term psychiatric treatment.
Florida court clerks have struggled with the initial law, taking up to three years to input thousands of names into the database used for gun-purchase background checks and entering incorrect information for hundreds of others, state audits concluded.
Now doctors and hospitals are failing to flag the names of patients who should be prohibited from buying guns under the 2013 expansion of the law, the Sun Sentinel found.
"If you're a danger to yourself or others, you have no business getting out and being able to purchase firearms," said Marion Hammer, a lobbyist for the National Rifle Association.
"There is nothing wrong with the law. What is wrong is the system is not working, and people are not following the law."
The 2013 measure came in response to a growing outcry nationwide over gun violence and mass shootings. Advocates for the mentally ill, however, knew the greatest benefit could be keeping unstable people from killing themselves.
Two out of three gun deaths in Florida are due to suicide – far outnumbering those caused by murder or accidents, according to the most recent state statistics.
Despite the Legislature's efforts in the past decade, suicides by gunshot are up 23 percent per capita and homicides have not declined, statistics kept by the Florida Department of Health show.
Other statistics indicate a problem: Florida has far fewer entries than other large states in the FBI's index of mentally unstable people barred from gun purchases.
By the end of last year, FBI figures shows Florida submitted a total of about 140,000 records on people prohibited from buying guns because of mental health issues. Texas had nearly double the amount; New York three times the number, and California five times as many.
The FBI would not address disparities in state data, though in recent years many states have made large strides to gather and submit information that would disqualify a mentally ill person from buying a gun.
Numbers don't add up
Florida lawmakers recognized years ago that they needed to improve upon the law that barred gun purchases for people committed for long-term mental health treatment. That's because many of even the most severely troubled people are not involuntarily committed; more commonly their doctors persuade them to volunteer for long-term treatment. That meant that many who might be dangerously troubled would still be free to buy guns.
In 2013, the Legislature broadened the law to enable doctors and hospitals to add those people to the list of those who can't buy guns.
The Sun Sentinel reviewed data from the Florida Department of Law Enforcement and found the only county doing a credible job under the new law is Hillsborough, which had submitted nearly 3,500 names since July 2013.
In many other counties, the number of names doctors and hospitals have added to list since 2013 is low -- extremely low:
Miami-Dade, twice as large as Hillsborough and the state’s most populous county, entered just 273 names.
Broward, the state’s second-most populous county, has submitted about 640 names, with more than half of them in the first full year of the law and steadily declining each year since.
Palm Beach County, Florida’s third largest, has flagged 844 names.
Duval County, which includes the large city of Jacksonville, has entered only seven names total -- all in 2014.
Ten Florida counties reported no names at all.
It is not plausible that Florida's three most populous counties, Miami-Dade, Broward and Palm, had fewer eligible names than Hillsborough.
"Miami-Dade County has the highest percentage of people with serious mental illness of any urban area in the United States," said Miami-Dade County Judge Steve Leifman, a nationally-recognized expert on mental health and criminal justice.
Interviews with key figures involved with creating and carrying out the law reveal various breakdowns. They say doctors are unaware of or confused by the law, or unwilling or unable to declare a patient an "imminent danger" and file the paperwork with the local court.
Though they have to sign only one form, some doctors find the law too burdensome. Others complain it puts them in an awkward spot: Telling patients that if they agree to needed treatment, they risk losing their right to buy a gun.
Even when doctors do file, courts have rejected petitions because the paperwork is unsigned, incomplete or insufficient. For example: Miami-Dade courts rejected as insufficient 30 percent of the petitions filed so far this year.
"I think on a statewide basis we need to meet and look at how the law is working and look at changes that would make it work more efficiently," said John Dow, president and CEO of the South Florida Behavioral Health Network, which coordinates mental health programs in Miami-Dade and Monroe counties. "It needs the involvement of all parties: the courts, the judges, the providers -- particularly the physicians."
Wanted gun to "kill cops"
In Florida, mentally ill people can be hospitalized against their will dozens of times and still be free to buy a gun.
Hialeah Police forced one such man into emergency mental health treatment nearly 30 times, police reports show. He clearly wanted to harm himself or others: In 2014, he texted his mother, asking that she buy him a rifle and handgun so he could kill himself; in 2015 he put a knife to his neck and held his mother hostage in a two-hour standoff.
This February, he again told her he wanted to fulfill a dream: to buy a weapon. Frightened but unable to stop him, she followed her 32-year-old son to a Hialeah gun shop, where she begged managers not to sell him a weapon and called police, according to Miami-Dade State Attorney's Office records.
It's a good thing she did – he was saying he wanted to "kill cops." Although her son had been committed to a mental hospital in the past, court clerks never sent the record to the database of prohibited gun buyers, according to an official familiar with the case.
Police took him to a hospital. And finally, the court ensured that his name was flagged in the background check system.
Even when authorities know a person is dangerously disturbed, they may be powerless or unwilling to act.
Police, doctors and welfare officials knew of Elizabeth Genthner's troubles long before she and her 17-year-old daughter, Simonne Say, were found shot to death in their apartment near St. Petersburg in Pinellas County in December 2015.
Police believe they carried out a double suicide but can't be sure Genthner did not help her daughter pull the trigger.
Genthner's mental health issues were known to child welfare workers, police and physicians at Largo Medical Center, but they either could not or would not block her ability to buy a gun.
In December 2014, Genthner overdosed in a suicide attempt and was hospitalized for emergency mental health treatment.
In a hospital waiting room, Simonne tearfully told a Largo Police officer her mother spoke of Armageddon and the demon that never left her.
The girl told the officer that "all this has been building up" and "we killed our cats for it."
She described how the pair had made a pact to die together by driving off the Grand Canyon or by shooting themselves.
Despite the disturbing portrait, police could not act to bar any future gun sale to Genthner. She'd have to have been committed by a judge to a mental institution or her name submitted to the court by a doctor.
State child welfare officials became involved with the family, too, briefly putting Simonne in foster care, knowing Genthner "demonstrated significant mental health issues," a report states. But child welfare workers do not have a role in entering names into the gun database.
A social worker who routinely visited the home after Simonne returned told authorities she is not even allowed to ask whether families have guns.
California in 2014 adopted a law that allows police or family members to petition the courts to temporarily prevent a fragile, mentally ill person from purchasing guns or ammunition. Florida has no such measure.
On Nov. 18, 2015, Genthner and her daughter went to a Clearwater gun shop and Genthner chose a shotgun. The background check at first came back as a "conditional non-approval" -- likely because Genthner had been arrested on drug charges in the past but never convicted of a felony.
Within a few days, however, the Florida Department of Law Enforcement approved the purchase, a police report states.
FDLE could not comment on its approval of the purchase or provide any clarification on its decision because, under law, any records on its review are confidential and FDLE has to destroy the records within 48 hours of relaying its decision to the gun dealer.
Genthner and her daughter returned to the shop and claimed the gun on Nov. 27, 2015 – Simonne's birthday.
A week later, they were dead.
In their home, police found drawings of tombstones on the living room wall, Led Zeppelin's Stairway to Heaven playing on repeat, and a note on the bedroom door that declared the act a double suicide and read: "We have said our goodbye."
Some states are stricter than Florida on gun purchases by mentally ill people
CONNECTICUT – Prohibits gun sales to anyone voluntarily admitted to a psychiatric hospital within the past six months. Psychiatric hospitals have to notify the state Department of Mental Health and Addiction Services of admissions. Those records are checked by a public safety agency when a person applies for a permit to buy a gun.
HAWAII — Requires purchasers to first obtain a permit from the Chief of Police and direct their doctors to release any mental health records. Anyone diagnosed with a significant behavioral, emotional, or mental disorder is barred from purchase unless they produce a letter from a doctor saying they are no longer adversely affected by the disorder.
ILLINOIS — Requires gun purchasers to obtain an ID card from state police, who can deny the card to anyone who has been a patient in a mental hospital in the past five years.
MASSACHUSETTS – Requires a person obtain a firearm license or ID card from local police to purchase or possess a gun. State police can suspend, revoke or refuse to issue a license to anyone they believe is not suitable and poses a risk to public safety. This can include anyone admitted to a hospital for an emergency psychiatric evaluation or because of actions or statements leading to the hospitalization, such as a suicide threat. People can challenge the decision in court.
NEW JERSEY — Requires a permit issued by the state police to purchase a gun. Applicants have to report whether they have ever been confined to a mental hospital for treatment or observation or whether they have been treated by a doctor on an outpatient basis for a mental condition. If so, police may deny the permit.