The decision by Baltimore police to leave a suicidal suspect facing serious criminal charges unattended at a local hospital — before he went on the run and allegedly shot a teenage boy to death in June — broke with state guidelines issued eight years ago to prevent escapes.
Maryland's "model guidelines" call for at least one police officer to remain at all times with violent criminal detainees being treated at medical facilities. The detainees should be restrained, even when going to the bathroom, and the officer should maintain an unobstructed view of the patient, according to the guidelines.
Harford County Sheriff Jeffrey Gahler, who chaired the state task force convened in 2008 on the security of detainees who are patients, said in an interview with The Baltimore Sun that the guidelines were "warmly welcomed, but not broadly implemented" by departments across the state, leaving health care facilities vulnerable.
"The hospital — and the criminals know it — is a weak point in the system where they can probably be more successful than at any other point at escape," Gahler said. Police departments "would be wise" to give the guidelines more consideration, he said.
Baltimore police and hospital officials acknowledge that Anthony Jerome Clark Jr.'s release from the University of Maryland Medical Center exposed communication failures. Hospital officials say staff didn't know Clark was under arrest at the time of his admission and release, and police officials say they believed the hospital provides security when mental evaluations are performed.
Security and law enforcement experts who have developed best practices for the handling of criminal detainees in hospitals said Clark's ability to walk away from the hospital — and then avoid detection on two arrest warrants for weeks — is reflective of systemic problems in the way police departments across the country handle forensic patients.
"They're leaving violent people unsupervised in hospitals and clinics, and they're escaping and hurting people," said Joel Lashley, a health care security consultant and author of the book "Confidence in Conflict for Healthcare Professionals: Creating an Environment of Care that is Incompatible with Violence."
"This happens way too much," Lashley said. "Hospitals are struggling with it all the time."
The Baltimore Police Department's policy mirrors Maryland guidelines that say detainees in hospital settings should be monitored by at least one officer at all times. Officers on hospital detail are required to "keep the detainee within a direct line of sight."
"Hospital security officers shall never be left as the sole security for detainees," the policy states.
The department has another policy that governs police response to mental health emergencies. It states: "When custody of the evaluee has been assumed by the emergency medical facility, a member is no longer responsible for the evaluee."
T.J. Smith, the Baltimore Police Department's chief spokesman, pointed to that policy when asked about Clark's case.
But that policy also says that when the "evaluee also has criminal charges pending," the officer should follow the policy for detainees, which requires an officer to remain with patients at the hospital.
When asked to explain, Smith said: "We stand by the fact that we did not violate any policy."
Smith said Police Commissioner Kevin Davis met with top hospital personnel this month to address the issue, but that no policy changes were made.
According to court records, Baltimore police took Clark, 25, into custody May 26 after a standoff in a Reservoir Hill home that he had broken into after an armed robbery at a nearby gas station. During the standoff, according to the records, Clark cut his wrist with a box cutter before police hit him with a Taser and brought him under control.
Clark was taken to UMMC, where court records say he was admitted to a "secure wing" for psychological patients because he was considered suicidal. Smith said Clark was admitted under a petition for emergency evaluation — a legal tool used to involuntarily admit people in crisis to health facilities.
At that point, police left the hospital and asked hospital staff to inform them before Clark was discharged, Smith said.
Instead, Clark was allowed to leave the hospital — police and hospital officials would not say when — and disappear, despite the fact that officers were pursuing charges against him.
Within hours of Clark's admission to the hospital, a warrant was issued for his arrest on a burglary charge. A second warrant, for armed robbery, was delayed by a "widespread computer outage" at the Police Department that prevented officers from showing the robbery victim an array of suspect photographs, according to court records. That warrant was issued the next day.
With Clark nowhere to be found, however, the warrants went unserved until he was rearrested following a shootout with police the night of June 11 — about 10 hours after he allegedly shot and killed 13-year-old DiAndre Barnes. The double shooting also injured a 21-year-old man, who police believe was the target.
David Walsh-Little, chief attorney in the felony division of the Office of the Public Defender in Baltimore, which is representing Clark, declined to comment on the case.
Karen Lancaster, a UMMC spokeswoman, declined to discuss security procedures for forensic and psychological patients, citing a federal law that protects the privacy of individuals' medical records.
"We follow applicable medical protocols in the delivery of care, and do not put our medical providers or other employees in the position of acting as law enforcement," Lancaster said in a statement.
Lancaster said the hospital "recognizes that this is a very tragic situation, and acknowledges related concerns regarding the series of events and the desire for answers." But she said hospital officials "will not waiver in our commitment to the protection of the personal health information of our patients."
In court records, police said they were "unable to accompany" Clark into the psychological unit where he'd been admitted. Smith said that officers "are not permitted to be armed in certain areas of the hospital while patients are receiving certain levels of treatment." And as a general rule, Baltimore police officers are required to be armed at all times.
"In mental evaluation cases, hospitals provide a different level of security," Smith said. "Routinely, officers speak with hospital security when patients are in need of mental health care. That is what we had in this case, although there was a pending criminal investigation."
Officials with the Maryland Hospital Association declined to comment on Clark's case, and spokesman Jim Reiter said officials have not heard of any other "out-of-the-ordinary problems."
Clark's release is not the first incident in Maryland to draw attention to the security of detainees and prisoners in medical facilities.
In 2006, an inmate at Roxbury Correctional Institution who was taken to Washington County Hospital for a self-inflicted wound managed to break free, steal the gun of the corrections officer watching over him and fatally shoot him, before being rearrested about an hour later after the vehicle in which he was fleeing crashed.
In January 2008, an inmate at Jessup Correctional Institution who was taken to Laurel Regional Hospital after complaining of chest pain overpowered two officers, stole their guns and fled in a vehicle before being killed seven hours later in a police shootout in Prince George's County.
A state task force convened in 2008 to develop model law enforcement guidelines for handling criminal detainees in hospital settings. The guidelines say that hospital security officers "shall never be left as sole guarding authority." The guidelines also address officers entering secure psychiatric units, saying they should use weapons lockers to secure their guns.
The guidelines do not provide exceptions under which detainees can be left without a police guard.
Gahler, who was a captain in the Maryland State Police at the time, said police departments in the state have been slow to adopt the guidelines.
Connie Packard, public safety director at Boston University Medical Center and president of the International Healthcare Security and Safety Foundation, said hospitals and local police departments typically have agreements that govern the handling of detainees in hospital settings.
Neither Smith nor Lancaster would confirm whether such an agreement existed.
Packard said national best practices call for police to assign at least one officer to guard a detainee suspected of committing a serious crime, such as armed robbery, while that person gets medical care.
"I make it very simple. The statement I give to people is, 'You are a prisoner before you are a patient,'" Packard said.
Hospital security officers at Boston University Medical Center may assume custody of a person if a crime is committed at the hospital, she said, but "we will never take over a prisoner of somebody else."
If a police officer told her staff that he was going to leave a detainee at the hospital and asked them to call when the detainee was ready for discharge, she said, "We would respond back, 'I can't guarantee that he won't elope.'"
Firearms are not allowed in certain areas of Packard's hospital, she said, but she understands that officers don't want to give up their guns for safety reasons. So accommodations are made in those situations, she said. In many cases, hospital staff find the patient a room in an area where the attending officer can be armed.
Lashley, the health care security consultant, said Clark's case in Baltimore is "a familiar story."
"It's common practice around the country for police to drop off prisoners at a hospital and say, 'Call us when he's good to go,' just assuming the hospital is going to be able to maintain security," Lashley said. "That's a glaring omission in terms of chain of custody for these patients, and needlessly places hospital staff in peril."
The families of Clark and DiAndre said they want answers — particularly as to why Clark was able to walk out of the hospital, given the circumstances under which he was admitted.
"That's the main question," said Clark's mother, who asked that her name not be used because she fears retaliation. She also offered her condolences to DiAndre's family.
Dwight Pettit, a local attorney, said his office launched an investigation on behalf of DiAndre's family. He believes police violated their duty — and their own policy — by failing to ensure Clark remained in custody.
"We don't think there's a question about that any longer," Pettit said.