In early September 2014, officers from the Department of Justice came to Schneider Regional Medical Center with a 19-year-old male patient from St. Croix. The patient, a former resident of the Youth Rehabilitation Center with a history of violent crime, was remanded by court order to the hospital’s Behavioral Unit for treatment.

Five months later, the patient is still there, in a unit ill-equipped to give him proper care, and no one is footing the bill.

“If someone had contacted us, we would have been able to explain our constraints,” said Schneider Chief Executive Officer Bernard Wheatley.

The situation resulted from a lack of protocol and inadequate communication between the territory’s health facilities, their physicians and the court system when it comes to remanding patients to the hospitals, according to Wheatley.

“The least we can do is have a professional dialogue to see whether or not we can accept such a patient,” he said. “To make such a determination without consultation by professionals at Schneider Regional, to me, is really unethical.”

Schneider cannot release the patient, whose identity they cannot reveal, until he is placed in a permanent inpatient facility, and until the court issues a written order following another hearing, according to an excerpt from an Aug. 28 Superior Court ruling provided by Schneider officials.

If Schneider violates the court ruling, the hospital could end up with criminal or civil contempt charges. It is now left with a patient that, in the opinion of Schneider physicians, needs a forensic psychiatry unit, not a behavioral unit.

“The treatment of those patients and the management of those patients are diametrically different,” said Luis Amaro, chief medical officer at Schneider. “This is forcing us to take care of a forensics patient on a psychiatric floor that does not have the means to do it. It would be very similar to forcing us to take care of your neurosurgical concerns when we don’t have the neurosurgeons.”

According to Amaro, the Behavioral Unit is equipped to treat patients with psychiatric diagnoses, but do not necessarily pose the same dangers as a forensics patient who might not have a psychiatric diagnosis.

The court ruling also said that after hearing testimony from Doris Hepburn, director of the Alcohol Drug Dependency Division in the Health Department, the court determined that the Division of Mental Health is “able to provide adequate and appropriate treatment for the ward,” causing Schneider officials to question why the patient was ultimately sent to Schneider.

According to Wheatley, there is also no provision in the court ruling that specifies who will foot the hospital bills. Per the hospital’s investigation, he said, the Department of Health recommended that the patient be sent to Schneider, so a bill totaling some $131,000 was sent to the Health Department in December.

The costs are now closer to $200,000, according to Wheatley, and will continue to rise at least until the court takes another look, and that hearing is not scheduled until Feb. 22.

Hospital officials said they were also struck by a provision in the court ruling that they consider dangerous – to make sure the patient continues on his current medication regimen.

According to Amaro, the ruling goes against their medical training, which emphasizes learning to know when to apply drugs, how to manage them and when to take patients off of drugs.

“To receive a court order that mandates that we cannot adjust the medications despite the necessity to do so for the betterment of the patient’s health put us now under pressure to abide by a court order versus follow our responsibilities as physicians,” he said.

“The court has now begun a process of being a medical physician, in a sense,” added Wheatley.

Staff safety is also a concern, according to Wheatley. He said when the patient was admitted on Sept. 2, the Justice Department left a two-man security team on guard. Two weeks later, he said, the two guards were pulled out because the department could no longer afford to pay the overtime.

This poses security issues for the Behavioral Unit, according to Wheatley, which only has two nurses on duty at any given time during the day, one nurse at night, and two psychiatrists on call. The hospital ended up posting its own security in the unit at the hospital’s expense.

“Since the DOJ has left, we now absorb the cost of basically watching this patient with our own security,” said Wheatley. “We have no choice; this patient needs to be watched.”

As for the right inpatient facility, Schneider physicians said that may not be found in the territory, which lacks a forensic psychiatry unit. This patient might have to be sent off-island to get the proper care, not at all uncommon practice in the territory.

“We do the best we can, and we’re always going to do at Schneider Regional what’s best for our patients and the people of the Virgin Islands, but at the same time that put us at a liability, and puts the patient at risk because they’re not receiving the care that they should,” Amaro said.