The state will adopt new policies it hopes will better protect patients at its mental hospitals against sexual assaults as part of a proposed settlement with a former patient who was abused on two separate occasions, including by another patient with HIV.
After 20 months of negotiations with the victim's attorneys, the Department of Health and Mental Hygiene, which oversees the state's mental health facilities, agreed to develop a safety and protection plan, as well as conduct psychiatric evaluations for all patients.
The agreement requires that an outside entity would investigate all sexual abuse allegations rather than the agency's internal police. The department would also enact a standardized protocol to collect patient medical histories to identify those vulnerable to sexual assault.
The agreement with Disability Rights Maryland and the Venable law firm, both of which represented the patient, will be presented to a federal judge next week for final approval.
The patient, who was not identified in court records because she was the victim of sexual assault, was first abused in November 2011 at Clifton T. Perkins Hospital Center in Jessup, the state's maximum-security mental hospital, where she was sent after committing what her attorneys characterized as minor offenses. There she was assaulted by a male patient in a bathroom after both were able to leave a gymnasium where the staff was supposed to monitor them.
During the investigation, she was repeatedly questioned and accused of consenting to the sex. A psychiatrist later told state police that she did not have the cognitive ability to consent to sex.
She was released from Perkins in January 2012 but returned to state custody in October when she was sent to the State Secure Evaluation and Therapeutic Treatment facility in Jessup. There she was assaulted in a bathroom by another patient who was HIV-positive and had a repeated history of sexual assault. Another patient stood at the door as a lookout.
The man who assaulted the victim was supposed to be in a staff member's sight at all times because of his status. The victim was the only woman housed at the facility at the time. Investigators once again accused the victim of consenting to the sex.
The victim became suicidal and emotionally distraught after the incidents, and attorneys said she was not given proper follow-up care.
After the first assault, she tried to wrap a sheet around her neck. She also complained of pain and bleeding. After the second one, she said she was afraid to go to bed and had difficulty sleeping. She initially would not take medication to prevent contracting HIV because she said she wanted to die. One day she banged her head continuously against the bed, saying she wanted to die.
Attorneys for the victim said the hospitals failed to put protections in place despite knowing she had a history of sexual abuse, mental health problems and cognitive disabilities. An assessment by Kennedy Krieger Institute that looked at her intellectual and functional capacity found she had difficulty learning simple tasks, showed limited academic skills and did not understand much of what was said to her.
Her attorneys blamed employees who weren't trained properly but also said some simply failed to do their jobs.
Lauren Young, director of litigation for Disability Rights Maryland, said systemic change was needed.
"To its credit, the department examined this case and took it very seriously, so we had an opportunity to make comprehensive change," she said. "We wanted to do the best we could to make sure this doesn't continue to happen."
State health officials declined to discuss details about the settlement but expressed regret over the incidents in a statement.
"The 2014 incidents at the heart of this case were tragic," the statement said. "We are using it as an impetus to train our staff to better provide appropriate supervision, for the security of the patients we serve."
In addition to the systemic changes ordered at the state mental facilities, the victim will be awarded $400,000, the maximum allowed under state law, which will be set up in a trust after attorney fees are deducted. The state Board of Public Works approved that portion of the settlement last month. The state also will pay for the victim to live outside of the hospital on her own, as well as for a medical worker who will provide her daily care.
"She will get both the services she needs and a very significant pot of money that will go to provide any extra help that is needed for her in the future," said Mitchell Y. Mirviss, a Venable attorney who took the case pro bono.
In addition, another attorney, Sarah Rhine, has been assigned to help the victim make decisions in her best interest. Rhine approved the settlement along with the victim.
She "is a kind young woman who was clearly vulnerable to abuse but has shown incredible strength," Rhine said in a statement. "The fact that she entered our health system in need of treatment and was victimized in such a violent manner was a failure of massive proportion."
The sexual assault incidents were not the first time problems have been reported at one of Maryland's state mental hospitals. Changes were made at the Perkins after three patients were killed by other patients in 2010 and 2011.
One mental health advocate applauded the agreement.
"When psychiatric patients are in treatment facilities that are supposed to take care of them, which clearly didn't happen in this case, it is important to put in place procedures so something like this never happens again," said Kate Farinholt, executive director of the National Alliance on Mental Illness Maryland.