ATLANTA — Lucretia Felder was 2 when social workers placed her in foster care. Soon she moved on: to group homes, to a residential school for children with intellectual disabilities, to a “retardation center” for adults. She spent time in one state psychiatric hospital, then another, then one more. She went to jail. Finally, she ended up in a medical prison, an inmate never convicted of a crime.

Georgia has institutionalized Felder for 42 years, acting alternately as parent and prosecutor, guardian and jailer. At 44, a ward of the state nearly all her life, Felder is both a prisoner and a product of a behavioral-health system that still faces significant challenges after a decade of federal oversight, an investigation by The Atlanta Journal-Constitution found.

The system came under scrutiny in 2007, when the Journal-Constitution reported on the deaths of more than 100 people from the state’s seven psychiatric hospitals. Some were neglected, others abused. Many received substandard medical care. All died unnecessarily.

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Under an agreement with the U.S. Department of Justice, Georgia promised to transform the way it cares for people with mental illness and developmental disabilities — in large part by moving long-warehoused people like Lucretia Felder from monolithic institutions to homes of their own.

Since 2010, Georgia has moved hundreds of people into group homes and other community-based facilities. But more than 200 people with developmental disabilities remain in institutions. Many, like Felder, have known no other life.

State officials recently told a court-appointed monitor that all 200 could live in communities — if only enough “appropriate” places for them existed. The monitor is looking into the state’s failure to recruit new service providers.

Felder’s case is especially complicated, and resolving it could test the limits of depopulating the institutions that have held people like her since the 19th century.

She is one of about three dozen people with developmental disabilities who remain in state custody as “forensic” patients. All either were found not guilty by reason of insanity or, like Felder, were declared mentally incompetent to stand trial on criminal charges. She was charged with assaulting workers at Central State Hospital in Milledgeville in 2005.

Although Felder can read and write and do arithmetic at basic levels, she possesses the emotional and psychological sophistication of a 5- to 7-year-old, a state psychiatrist determined a few years ago. “She doesn’t know how to run a vacuum cleaner,” said Barbara Fischer, who befriended Felder two decades ago and is now her fiercest advocate.

Most troubling, Felder has a history of aggressive and, at times, violent behavior. She has trashed hospital rooms, punched and cut caregivers, thrown feces onto guards and fought with other patients. State officials say she would require two caretakers at all times in her own residence.

Since 2007, Georgia has housed Felder in a private, for-profit medical prison in South Carolina. She remained there, year after year, even though for a decade no judge reviewed her confinement, as state law requires. She is lost in a system that either forgot or ignored her, allowing her to languish in prison for more than a decade.

“They just threw her away like a piece of garbage,” said her uncle, Eddie Felder, who lives in Colorado. “That girl is 40-something years old now. All she knows is an institution.”

She also knows exactly what she wants: to experience what she calls “my first life.”

Felder spoke to the Journal-Constitution in several recent telephone interviews. She also gave the newspaper written permission to examine her medical and psychological files, which usually are confidential. At times, she seemed wary: “Are you a good person?” she asked a reporter during one call. More often, though, a childlike joy infuses her conversations. When she recorded her name for the prison telephone system, it came out as an exuberant “Lucretia!”

“I want to know my surroundings,” Felder said in one interview. “I want to meet people and know people. Get a job. And live my life until I die.”

Bad behavior

She is a Grady baby, born in the Atlanta hospital in January 1974. The second-oldest of what would become 10 siblings, Felder was a toddler when her father went to jail on theft charges. When social workers visited the family’s home in DeKalb County, they deemed it “an abusive environment,” according to court records. Just 2 years old, Lucretia immediately went into foster care, and all her brothers and sisters eventually followed.

“Nine got out,” Felder said, “but I didn’t because I had behavior.”

From an early age, according to court records and other documents reviewed by the Journal-Constitution, Felder received an array of diagnoses: impulse control disorder and oppositional defiant disorder, conduct disorder and mood disorder, borderline personality disorder and organic personality disorder.

Some doctors lumped her issues into a single phrase, now considered offensive: mental retardation.

One state psychiatrist measured Felder’s IQ at 38, another at 49. A score of 70 or below indicates an intellectual disability.

Felder perceived the institutions where she lived as “dangerous and threatening,” another psychiatrist wrote in 2005, and she harbored “chronic hostility and anger.”

How she expressed those feelings often led to trouble.

In the late 1980s, Georgia arranged for Felder to attend a special school in Florida for adolescents with intellectual disabilities. She got so upset on the flight to Miami that she had to be lashed to a stretcher. The school expelled her for “disruptive behavioral problems” after she assaulted a staff member, her records show. She was 16.

In her 20s, Felder moved into a small group home in metro Atlanta. With just one roommate and one caretaker, it was the closest to independence she had experienced. She even got a job: cleaning the food court at a Walmart. But she had to enter a state psychiatric hospital four times to stabilize her moods. Then, Felder said, there was “an incident.”

After work one day, she discovered that her roommate had rummaged through her belongings, looking for money. She punched the woman in the face, the police came, and Felder sat in jail until she calmed down.

That ended her community placements.

Felder’s caseworkers moved her to Central State in 1998. Georgia’s oldest psychiatric hospital had once housed more than 10,000 patients at a time. Many were confined for decades, from childhood to death.

The facility’s population had dwindled by the 1990s, but harsh conditions persisted. The Journal-Constitution reported in 2007 that 42 Central State patients had died under suspicious circumstances during the previous five years. During the same period, the state corroborated more than 190 instances in which hospital employees beat, choked or in some other manner abused patients.

Felder’s behavior at Central State was marked by “poor impulse control escalating to violence,” a psychiatrist wrote in her file. At one point, the hospital forced Felder to live in a gymnasium, alone, until she could control her outbursts. But the isolation provoked even worse conduct. She destroyed so many electrical and water fixtures that the hospital’s police force filed criminal charges.

A series of altercations in 2005 made Felder’s stay at Central State untenable.

That June, while trying to force her way into a treatment room, Felder slammed a door against an employee’s knee and foot. A month later, she threatened to kill a hospital worker and threw hot sauce into the woman’s face. Arrest warrants said Felder used the door and the hot sauce as weapons.

In November 2005, Felder cut an employee’s ear with glass from a broken mirror. Felder said the staff had taunted her after a contentious visit with her family. But a warrant said Felder “maliciously” tried to disfigure the employee.

Hospital police officers booked Felder into the Baldwin County Jail on charges of aggravated assault and making terroristic threats. She faced as much as 20 years behind bars.

A state psychiatrist determined that Felder was incapable of understanding the charges or participating in her defense. So, on March 17, 2006, Felder went to court with a plea that could help her avert prison time: mental incompetence.

The prosecutor, Stephen Bradley, reluctantly agreed to let the state hold Felder in a mental-health facility rather than prison — with, he said, “one specific condition.”

“It will not be in Baldwin County, Georgia,” Bradley told the judge, according to a transcript of the proceedings. The banishment, he added, was “a nod to the victims who have worked a long period of time at Central State Hospital (so) they are not required to face Ms. Felder any longer.”

Judge William A. Prior Jr. ordered that Felder be “transferred to and detained in a state mental health facility” outside Baldwin County. She would remain there, Prior said, “for the foreseeable future.”

Prior ended the hearing by addressing Felder directly: “Good luck to you, ma’am.”

He never offered her a chance to speak for herself.

Commitment

The court file for Georgia v. Felder sits in the public defender’s office in Milledgeville. Along with court transcripts, a grand jury indictment and other official documents, it contains an unsigned, undated, handwritten note: “Needs annual commitment hearing/review.”

The note acknowledges a key protection in state law for people deemed mentally incompetent: While the state may hold and treat them in psychiatric facilities, a judge must reexamine these arrangements, known as civil commitments, at least once a year.

The requirement for an annual review took effect in July 2007. State officials should have taken Felder’s case back to the judge in 2008, then again in 2009 and 2010, and every year since. Instead, with no judicial oversight, the state Department of Behavioral Health and Developmental Disabilities placed Felder into increasingly punitive settings.

At the Gracewood Developmental Center near Augusta, Felder was assigned to a small house with others so severely impaired they could not communicate with her — “low-functioning consumers,” as Felder put it recently. Frustrated by the social isolation, she hit a staff member with a computer and threatened to use a gas stove to blow up the house. She knocked out a window and ran away, but the police caught her on nearby railroad tracks and took her back.

Next, she moved to East Central Regional Hospital in Augusta, her third state psychiatric hospital in a decade. There, she punched a doctor in the nose and cut another employee’s face with a piece of broken glass.

In 2007, about a year into her civil commitment, state officials tried a different approach: They would pay a private prison hospital in South Carolina to take Felder off their hands. Neither the state nor her lawyer notified the judge in Milledgeville, court files show.

Felder’s public defender, John Bradley, referred questions to the Georgia Public Defender Council. A spokeswoman for the council would not elaborate on the case.

In a statement, the state behavioral-health agency declined to comment “out of a concern for privacy” — even though Felder signed a release that authorized officials to disclose information about her.

On April 26, 2007, Felder entered the Columbia Regional Care Center, the only for-profit hospital of its kind. It also is very much a prison. A fence encloses the 374-bed hospital complex, topped with razor wire. It accepts patients — inmates, to be more precise — from across the nation. Some are mentally ill or have intellectual disabilities. Others have physical illnesses, such as heart disease, cancer or AIDS. Many have been convicted of violent crimes in their home states.

Columbia assigned Felder to a floor that housed many of the most violent inmates. From the start, she got into altercations with roommates, other prisoners and staff members. During one fight, in 2013, Felder threw chairs, flipped over other furniture, spread feces on the floor and walls, and destroyed a smoke detector. Later that year, though, Felder stepped in to help a guard break up a fight between two other women.

Felder’s aggression slowly subsided. The hospital changed her medications — and made sure she took every dose. She attended individual and group therapy sessions. She took classes on reading and spelling and counting money. She worked in the hospital’s horticulture shop and discovered a gift for gardening.

The violent outbursts didn’t stop, but they occurred less frequently.

“She has had a good year,” a Columbia psychologist wrote in a March 2017 evaluation. “Patient is ready for discharge back to Georgia.”

For the first time in Felder’s life, the unimaginable became possible: She might be able to move into her own home.

Broken promises

Felder was a patient at Central State when she met Barbara Fischer, a statewide coordinator at the Georgia Advocacy Office, which represents people with disabilities and mental illness. Nearly 20 years later, Fischer is retired and living in Macon. What began as a professional relationship with Felder has developed into a deep friendship.

Every month, Fischer drives 200 miles to visit Felder in Columbia. She picks up lunch for Felder on the way: pizza or sub sandwiches, sometimes hamburgers or fried chicken. She also deposits money into Felder’s prison bank account to pay for telephone calls and other incidental expenses.

Felder calls her “mama.”

“You just fall in love with her,” Fischer said. “She is an amazing human being.”

They have become so close, Felder wants to move to Macon so they can live near each other. Felder is largely estranged from her own family, except for her uncle in Colorado. He has offered to take her in, but Colorado is too far from Macon — and from Fischer.

State officials in 2015 identified five private agencies that might provide services to Felder in Macon. They chose a non-profit organization called The Arc of Macon, which agreed to assign two caretakers at a time, 24 hours a day, seven days a week. Officials also found Felder a psychologist and a psychiatrist. They worked out behavior plans and crisis-intervention plans. They rented a house near Fischer’s where Felder would live alone, supported by caretakers.

“There was furniture in the house, food in the cabinets, sheets on the bed,” said Renee Pruitt of the Georgia Advocacy Office, who visits Felder with Fischer most months. “It just needed her.”

Then the delays set in. State officials, Felder’s advocates, her service providers and her doctors scheduled a meeting for October 2016, but someone had a conflict. The meeting was rescheduled for November, but the new date was Veterans Day and someone else couldn’t make it. Thanksgiving, Christmas and New Year’s complicated everyone’s schedules. The meeting didn’t take place until February 2017.

By then, someone had realized Felder’s new psychiatrist was in Milledgeville — a problem, since she is still banished from Baldwin County. Her service provider, the Arc of Macon, wanted the state to pay more for Felder’s care. A judge needed to sign off on her release from custody. And in May, the Arc’s executive director, Katrina Spooner, sent an email with an ominous subject line: “Concerns Related to Transition.”

The organization’s board was worried, Spooner wrote, because of a February 2016 incident that ended with Felder strapped to a chair. The episode, Spooner said, “showed a greater fluctuation in behavior patterns than previously discussed.” Board members apparently did not want to be held liable if Felder acted out in her new home.

“I am facing an uphill battle with asking them to support me with this transition,” she wrote, “one that holds the greatest risk for exposure.”

The Arc soon formally backed out of providing services to Felder. Spooner did not respond to repeated requests for an interview.

It was left to Fischer and Pruitt to drive to South Carolina and give Felder the news.

Felder greeted them with a question, Fischer said: How soon would she leave the hospital?

Fischer said she reached across a table and took Felder’s hands. Take three deep breaths, she said.

“Honey,” Fischer began, “some people have broken their promises, and you aren’t going to be able to come to Macon now.”

Fischer began to sob.

“Mama,” Felder said, “please don’t cry.”

As she left, Fischer asked Felder to be her “best self.”

“OK, Mama,” Felder said. “I promise.”

A perfect world

One day last May, upset that she was not leaving Columbia, Felder broke a sprinkler nozzle and flooded her room. Two days later, she threatened to kill herself and scuffled with hospital employees. She wound up in handcuffs.

“They told me I was leaving and they lied about it,” she said. “I don’t like a liar.”

The altercations and her rationale for them underscore what may be the greatest challenge for someone like Felder to thrive outside an institution. Life can be messy, but Felder expects perfection. She assumes that if she finally gets her own home, she’ll find a job, get married, have children — just like in the programs she watches on television.

“She has no sense of reality about what it’s like to live in the world,” Fischer said.

The transition from institution to community often is difficult. In 2016 and 2017, Georgia released fewer than 10 forensic patients with developmental disabilities, and four returned to state custody within three months.

For the past year, Felder has kept her self-destructive impulses in check. No violent outbursts. No fighting. No smashing hospital property. Nothing that might imperil her eventual release.

But she is stuck. Although the medical prison says she no longer needs to be in an institution, Georgia officials have found no service provider willing to oversee her care. Her reputation, it seems, overshadows her reality.

And yet, Felder remains hopeful.

“I see people leave here,” she said one recent day on the telephone from her prison. “I see people leave here and come back to this place. When I leave, I ain’t coming back.”

© 2018 The Atlanta Journal-Constitution
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