“Are they interested in our rehabilitation or just in punishing us?” 

– Anonymous, in a juvenile institution in Puerto Rico

On Oct. 15, 2020, a young man in the custody of the Department of Corrections and Rehabilitation (DCR), whom we will call José, attempted to commit suicide in his shared room in the Villalba juvenile prison.

There was no juvenile officer in the area, although minors must always be supervised, as the current federal court case related to poor conditions in juvenile institutions in Puerto Rico establishes. Other youths had to come to his aid.

The officer who was supposed to be supervising and was not, did not have a working radio transmitter, according to a report from the Office of the Correctional System Investigator (OISC, in Spanish). The minor received medical attention and survived, but the incident was not recorded on video, even though the institution has a 24-hour video surveillance system that should have been in place to deal with these types of emergencies.

That day, José was marking eight months since he was last able to see his family, as visits to juvenile institutions were canceled due to the COVID-19 pandemic. At least three different psychologists had been assigned to see his case due to   massive resignations of mental health personnel. He also had little social interaction, outside of his cellmates due to the measures against the virus, according to one of the reports on him by federal court assigned monitor, Kimberly Tandy. At the time, the young man was between 14 and 21 years old. The documents presented in court do not specify his age but establish that that was the age range of the inmates at that time.

We don’t know what happened to José after this incident, as the judicial system protects the identity of these incarcerated minors. However, it’s possible that after the incident, José was dressed in a paper gown as part of the anti-suicide protocol, put in a room with extremely cold air conditioning and not given a blanket to keep warm, which is the experience that several detained minors have told Tandy’s staff, assuring that the treatment is “abusive.”

José’s incident is one of 68 cases in which there were suicidal thoughts, signs or attempts or acts of self-mutilation registered in the two juvenile prisons of the Bureau of Juvenile Institutions (NIJ in Spanish) between July and December 2020, when there was an average of 90 juvenile offenders there. In 2019, of the 110 minors there were there at that time, 35% had suicidal thoughts, signs, or attempts. While in 2020, of the 90 minors who remained, 76% reflected the same circumstance. This happened during the COVID-19 pandemic and after irregularities in the processes of hiring mental health services for this population, a report of the Center for Investigative Journalism (CPI, in Spanish) found.

The numbers for suicide attempts and self-mutilation by youth come from Tandy’s quarterly reports submitted to the US District Court of Puerto Rico, in which she denounces the “mental health crisis” in juvenile institutions.

According to Corrections Secretary Ana Escobar Pabón, the crisis never existed, as she told the CPI. However, according to federal reports and the experts interviewed, the situation is critical and reflects structural, administrative, and economic problems in Puerto Rico’s juvenile institutions.

Between July and December 2020, the period when the mental health crisis was documented, the DCR failed to comply with having the minimum number of juvenile officers in the two institutions for minors and had serious deficiencies in providing health services, Tandy detailed in her reports for the third and fourth quarters of 2020. In addition, in that period, the DCR was in a legal fight with Professional Consulting Psychoeducational Services (PCPS), the firm that oversaw offering mental health services in youth institutions. PCPS sued the DCR for   irregularities with the contract of a new provider, Physician Correctional, a company with close ties to the governing New Progressive Party (PNP, in Spanish). During this period, PCPS also made massive layoffs of mental health professionals, affecting the treatment of the minors.

In 2020, 76% of minors in juvenile institutions had suicidal thoughts or attempts,
according to Federal Monitor Kimberly Tandy’s quarterly reports filed in Federal
Photo by Dennis Jones | Metro

These problems of contracting process irregularities related to the private mental health services company, such as staffing losses and deficiencies in services, happened under the tenure of former Correction Secretary Erik Rolón and his former assistant and successor, Eduardo Rivera Juanatey.

Rivera Juanatey signed the contract to change mental health services providers a week before leaving his post after the change in government administration.

The 9th most expensive juvenile system in the US

With an average cost of $780 per minor per day, or around $285,000 per year per youth, according to data provided by the Corrections Secretary, Puerto Rico’s juvenile institutions system is the ninth most expensive in the United States. The figure is almost three times the cost of a year at Harvard University and is 11 times higher than the average salary on the island. The number is also higher than the average cost of incarcerating minors in the United States, which is $588 per day per minor, according to the study “Sticker Shock 2020: The Cost of Youth Incarceration.”

The cost per minor in Puerto Rico increased by 111% in the past 10 years, from $370 per minor per day in 2011 to $780 in 2020. In that period, the population of incarcerated minors decreased by 87.5%, from 496 minors in 2011 to 62 in 2021, and is expected to continue to decline due to “a decrease in the processing of youth” and a “reduction in the commission of offenses among the youth population,” according to the Corrections Secretary. In the same period, the NIJ budget was reduced, but not in equal proportion. It was down 66.5%, from $67 million in 2011 to about $22 million in 2021.

In the last 10 years, the NIJ closed five youth institutions (there were seven in 2011) and changed from an autonomous structure, with its own budget, to one under the DCR’s umbrella. It was in 2011 when Restructuring Plan No. 2 was approved to unify the former Juvenile Institutions Administration with the Correction Administration to reduce costs and consolidate certain administrative offices. This led to the NIJ’s disappearance into the DCR, which is why last year, the federal court ordered that the juvenile institutions’ budget be separated to be better able to see how the money is spent.

10 Corrections Secretaries and a 27-year fight in federal court

The federal government has kept a close watch on what is happening in Puerto Rican juvenile institutions since 1994. When Gov. Pedro Rosselló launched his “Heavy Hand Against Crime” policy, the federal government sued Puerto Rico for civil rights violations in juvenile institutions and assigned a federal monitor to keep the court informed.

During  27 years the case has been open, the population of incarcerated minors has dropped from 1,000 to less than 100 and 14 juvenile institutions have been closed. The case has been valid during the incumbency of 10 Corrections Secretaries, three federal judges and four monitors; it is the oldest consent agreement in the district of Puerto Rico. Tandy, appointed in 2018, wrote in her 2020 quarterly reports that the NIJ and DCR were still in breach of at least seven of the 30 remaining stipulations of the case, out of the more than 100 it had in its early days.

These non-compliant stipulations are training for direct service employees, number of direct service employees, “reasonable safety” for youth through supervision, enough staff to implement such adequate supervision, treatment for controlled substance abusers, in house mental health treatment program, and ongoing psychiatric and psychological services.

In 2021, some of those stipulations are in partial compliance. The Corrections Secretary said that “we only have 26 left to complete.”

After Tandy warned the US District Court of the mental health crisis in 2020, Judge Gustavo Gelpí, who presides over the case, created a panel of three judges to evaluate the possibility of releasing a minor to prevent his or her situation from worsening. No minor was released. In a court hearing on the case on June 17, the US Department of Justice (DOJ) noted that mental health services in juvenile institutions had “stabilized,” but expressed concern about the use of disposable paper gowns in the anti-suicide protocol when the air conditioning “is as cold as Chicago,” and using excessive force in the treatment of incarcerated minors.

Puerto Rico’s model is ‘unsustainable’

In the same court hearing, Tandy warned that Puerto Rico’s juvenile institutions system “is one of the most expensive in the country (United States)” and said that, with the constant population decline, the model must be changed because as it is, “It’s unsustainable.” She also said that services had been normalized with the new mental health provider.

Two weeks later, on July 2, the government of Puerto Rico and the DOJ submitted a joint motion to the federal court stating that “The United States doesn’t believe that there currently is a mental health crisis that requires the attention of a panel of three judges.” And on three sheets of paper, they dismissed the multiple incidents that occurred in juvenile prisons for decades.

But recently, the federal monitor again expressed her concern about the problems of the DCR in adequately reporting incidents with minors in prisons. The most recent case was on July 2, when a “riot” occurred in the Villalba juvenile prison, which was not reported until July 10, although it had to be reported to the monitor in less than 48 hours.

The incident happened when a youth services officer left a group of six minors unsupervised to look for cleaning supplies. The minors blocked the entrances, covered the security cameras, and started a “riot.” The NIJ requested the intervention of the Special Operations Unit, which used pepper spray to disperse the minors. The incident was not even referred to the OICS, prompting the federal monitor to warn the court of the irregularities and request an emergency hearing.

Almost a year to install protective acrylic against COVID-19

Some of the provisions of the federal case were in breach after the declaration of a pandemic in March 2020, when Puerto Ricans were recovering from the earthquakes at the beginning of the year and a state of emergency and lockdown was declared due to COVID-19.

Just when the minors thought that being closed in between blue and cream walls, all dressed in the same way — with a gray T-shirt, blue pants and tennis shoes or flip-flops — and with an icy air conditioning was a difficult situation to bear, then came the measures to prevent COVID-19 infections. The DCR banned visits to juvenile institutions, reduced physical activities and in-person educational and vocational programs, cut back on out-of-prison employment opportunities, and opted for virtual classes for those still in high school.

The jailed minors could not see their relatives for more than a year, until April 23, when the DCR finally set up rooms for in-person visits divided by acrylic panels. Other measures taken for the pandemic are still in place, representing a double confinement for these minors.

During the same period in which the DCR could not install the acrylic panels, there was a staff shortage at the agency. From the second quarter of 2019 to the beginning of this year, the DCR failed to comply with the minimum number of personnel required for direct services to minors, so the juvenile services officers had to get used to 12-hour shifts or doubling shifts. This staff shortage and attrition has caused multiple incidents such as the absence of routine checks in the cells, attacks among youth, long periods of isolation as punishment, officers leaving their work area without warning and without being replaced, among others, according to Tandy’s reports.

In addition, two DCR employees who asked not to be identified for fear of reprisals, denounced that the officers have worn out old uniforms, damaged radio communicators and a camera system — in the Villalba juvenile institution — that has no assigned personnel, so there’s no ongoing surveillance. There aren’t enough supervisors either. The Corrections Secretary said she is still evaluating how to fill those positions since the supervisors available are not well distributed. 

Irregularities were found in the recruitment processes of specialists to provide
mental health services.
Photo by Dennis Jones | Metro

After the closure of the Humacao Social Treatment Center in January 2019 — the last juvenile institution that the DCR closed — the employees were transferred to adult prisons and not to the juvenile institutions in Ponce or Villalba, due to the distance that they would have had to travel. Humacao is on the East coast and Ponce on the Southwestern part of the island. It wasn’t until last year that the hiring of at least 62 new youth services officers was announced. These officers are already part of the DCR staff, the official said.

Mental health services chaos

Although she acknowledged that there were problems in offering mental health services in the two juvenile institutions in 2020, the Corrections Secretary said the crisis reported by the federal monitor “never existed.” She held minors responsible for the increase in cases of psychiatric emergencies.

“It was a poor adaptation that the minors experienced, it wasn’t a mental health crisis. It was a situation in which some of the minors realized that they could go out on weekends to receive services at a mental health hospital in Cabo Rojo where they interacted with other minors,” Escobar Pabón told the CPI, suggesting that the youth staged suicide attempts to leave the institution on weekends.

However, for social worker, criminologist and sociologist Víctor García Toro, everything that happened in the juvenile institutions in that period “could be considered a crisis.”

“It’s a crisis generated by a series of external stressors to the already difficult coexistence environment that is the structure of a penal institution. Of course, whoever runs a penal institution doesn’t want to talk about a crisis because they compromise themselves politically and compromise their superiors,” he pointed out.

While this mental health crisis was happening among incarcerated minors, a similar crisis was going on outside among young Puerto Ricans in general because of the pandemic and the traumatic events that Puerto Rico has experienced in recent years – Hurricane María and the earthquakes – that were combined with the closing of the only public psychiatric hospital for minors on the island, as a CPI investigation revealed in June.

According to the monitor’s reports, all PCPS psychologists resigned in September 2020 and one psychiatrist resigned in October. Hiring psychologists has been a challenge for PCPS, to the point that they have employed recently graduated and inexperienced professionals who leave their positions within days of starting and without providing adequate follow-up to the treatment of their patients. They also did not comply with the required service hours in several of the periods evaluated by the monitor. The documents also mention mental health incidents not properly reported to the mental health consultant, Miriam Martínez, who works with Tandy, and the case of a minor who had at least three different psychiatrists in one  month.

It was the former Corrections Secretary Erik Rolón who decided four years ago that the agency would no longer directly contract mental health service providers, but rather that a private company would run the service. In April 2017, he contracted PCPS, a company that had not previously offered mental health services, or services to the correctional population. The first three-month contract was worth $324,555.80, according to data from the Comptroller’s Office.

For the next three fiscal years (2017-2020), PCPS landed three contracts for $1.4 million, $2.3 million, and $2.6 million, respectively. Contract costs were on the rise even though the population in juvenile institutions fell from 249 minors in 2017 to 113 in 2020.

“I decided to combine all those contracts under a single entity so that I would have better control because it isn’t the same thing to have to oversee one contract than to have to supervise more than 50 contracts that, secondly, cost more and, thirdly, it was believed that it was harder for the Department to oversee it,” Rolón told the CPI.

He assured that this decision saved the agency 10% of the cost of those contracts, which was a requirement of the Fiscal Control Board, but it is hard to tell if this really happened because the budget for Juvenile Institutions is included in the DCR’s. He explained that although PCPS had no experience with mental health services, it had worked with DCR providing educational services in early 2010, when Rolón was legal counsel at the agency.

“The fact that they don’t have experience in treating the prison population doesn’t mean that they don’t have experience in providing services, because they did provide them in the free community… Just because the services are in prison doesn’t mean they’re different from those that people receive in the free community. The important thing is that there’s a staff member who has the certifications,” he added.

He also said that the cost of the PCPS contract increased because “services were provided in areas that had been unattended. It wasn’t to pay the company more,” he said.

The company also got two other contracts for “educational, training and orientation services” for a total of $630,000. And a seventh contract for “technical services” and “non-medical laboratory services” between 2019 and 2020, for $1.1 million.

“As someone who has been involved, the turning point was hiring a private company to provide mental health services. Private companies make money, that’s their goal,” Taraneh Ferdman, a lawyer who worked for 10 years as a consultant to the DCR in the juvenile institutions federal case, told the CPI.

“I don’t know if [the PCPS executives] had experience providing health services. It wasn’t clear from their documents. What they offered in terms of amount of pay and quality of services didn’t make sense. So, they ended up losing many of the providers who had been [at DCR] for years,” she added.

García Toro agreed. “They hire private companies that charge much more than if you had the professionals within the institution working for these minors,” he said.

After June 2020, PCPS began receiving monthly contracts because DCR decided to open a request for proposals process for NIJ mental health services to minors. After the DCR notified PCPS that they would not be contracted, they sued the agency over notification issues. This paralyzed the new provider’s contract for a few months, until the DCR changed the bidding process to a professional services contract, which caused the Court of Appeals to lose jurisdiction.

The CPI contacted PCPS on several occasions, but they were not available for comments.

Meanwhile, Primary Physician Raúl Villalobos, president of Physician Correctional, said they had gotten the contract after a formal bidding process. When the CPI told him that the contract was for professional services, he was surprised.

“The truth is that I did not know you were going to bring that up. It was proven in court that the award had been correct,” he said.

The Physician Correctional contracts were signed by former Secretary Rivera Juanatey on Dec. 23 and 30, 2020, days after the general elections changed the  administration, and just after the Supreme Court decided that the contracting could be done without a bidding process. The first contract, for $508,018.10, was for “professional mental health services in the juvenile institutions program” and the second, for $626,896.60, was for “professional mental health services in the rehabilitation and treatment program.” The CPI got a copy of the contracts without the attachments, and the Comptroller’s Office has not made them public on its website because the DCR has not submitted all the documents.

Former DCR secretary Rivera Juanatey, who oversaw the agency amid the mental health crisis, also did not respond to several requests for an interview from the CPI.

Physician Correctional already had a five-year contract with the DCR, awarded by Rolón, which began Oct. 1, 2018, and expires Sept. 30, 2023, to manage the correctional health system and provide medical and mental health services to the entire correctional population, including juvenile offenders.

This $54 million contract was also challenged by the previous contractor, Correctional Health Services (CHS), which at the time sued the DCR and reported irregularities in the contracting process like those reported by PCPS. In the Court of Appeals, the lawsuit was dismissed for lack of jurisdiction when the DCR went from a bidding process to a professional services contract.

The CPI asked Rolón about these “irregularities,” and he said the change in the contracting method was due to “the rush we were in to be able to comply with the fiscal plan as far as Corrections was concerned.”

“Unfortunately, we were forced to cancel the process to evaluate proposals, it was done and there was an evaluation of proposals, but it was done at the level of direct professional services,” he insisted.

“The proposals that the two companies submitted were evaluated by a committee created for that and the committee believed that the proposal that best served the Department’s interests at that time and the fiscal scenario we had, was Physician Correctional,” he added.

Who is Physician Correctional?

Physician Correctional is a company owned by doctors and brothers Raúl and Javier Villalobos Díaz, who together have donated more than $20,000 to the New Progressive Party (PNP, in Spanish) and at least $6,500 to the Popular Democratic Party (PPD, in Spanish) in the last two elections, according to records from the Electoral Comptroller’s website. 

The company is not registered under this name with the State Department, but rather as Grupo de Empresas de Salud de San Juan Inc. Other similar companies include GES-Grupo de Empresas de Salud-Clínica Dres. Villalobos Inc., Grupo de Empresas de Salud de Puerto Rico, Grupo de Empresas de Salud USA Inc., Raúl Villalobos Professional and Health Services Inc., GES Physician HMO Inc., and Physician HMO Inc. 

Villalobos told the CPI that the different company names are to “distinguish the operation.” So, the area that offers mental health services to incarcerated minors is now called Physician Behavioral, “but it’s the same Physician HMO.” He said, “there’s no preference or favoritism” in the contracts they got. 

“There was no irregularity,” said Villalobos. 

Rolón also insisted that the Villalobos brothers did not receive preferential treatment for being donors. 

“It wasn’t even my decision as Secretary. Any agency head in this type of process gets a recommendation [from a committee] and based on that, the contract is signed,” he said. He also said, “everyone has the right of free association and that includes political parties,” but that does not mean that government agencies make partisan decisions. 

However, after those contracts, then-Gov. Wanda Vázquez asked Rolón to resign, and the media reported it was due to multiple irregularities with the agency’s contracts. In this regard, Rolón only said he did not know why he had been fired. 

Physician’s first three government contracts, between 2011 and 2020, were with the Dr. Ramón Ruiz Arnau University Hospital for a total of $8.2 million. Some were awarded by former Health Secretary Lorenzo González Feliciano, who had been Chief Medical Officer of Physician. Villalobos said they had already been working with the hospital and “coincided” with the fact that González Feliciano was the Secretary of Health, but he got a waiver from the Government Ethics Office to work with them. That office told González Feliciano that he had to wait two years to work for the companies he had favored as Secretary, a term that ended in 2014. González Feliciano started with Physician in 2018. 

Meanwhile, although the company had no experience with correctional institutions before its first contract, Villalobos said they do have personnel who had worked with this population before and that they kept some health providers from PCPS, when its contract ended.

“Unlike the previous company, which had a shortage of psychology and psychiatry professionals, we’ve had the opportunity to offer many more services,” he said. However, the Comité de Amigos y Familiares de Confinados, an advocacy group for inmates, said in 2019, that under Physician’s term, there had been a “deterioration of mental health services” for the adult prison population and that the company had been “systematically reducing” those services. 

The future of juvenile institutions

According to the latest Profile of the Juvenile Offender published in 2016, Puerto Rico’s juvenile prisons mostly house youth with limited economic resources who come from the public education system (more than 80%), have been victims of abuse (40.6% of boys and 70% of girls), have been victims of sexual or drug abuse (21.8% of boys and 35% of girls) and have abused controlled substances (more than 80%). In addition, more than 60% have suffered from mental health problems before entering a juvenile institution. Physician is now updating this document, but the company stated it is not ready and does not know when it will be released.

Some of these minors will go back to jail, as 23.8% of adult inmates said they had been in a juvenile institution, according to the 2019 Inmate Profile.

The juvenile justice system has not been restructured for years and former Gov. Ricardo Rosselló vetoed a bill to reform it during his term (2017-2019).

A similar measure, Senate Bill 344, was introduced this term to finally try to reform the system. It is a multi-party initiative headed by independent Sen. José Vargas Vidot, which seeks to exhaust all administrative remedies before jailing a minor. It would also prevent minors under 13 from being prosecuted, youth would not be handcuffed in court proceedings, and mandates professional support for the minor and their family members during the proceedings.

“I want prisons for minors to disappear…The juvenile law has not been addressed for a long time and it still contains elements that are medieval, such as dragging chains to a trial,” said Vargas Vidot, who is working on the bill with “a lot of caution” in order to get the votes to pass it in a “conservative” Senate.

García Toro believes “jail isn’t a place for anyone.” The criminologist recommends changing the current system for “community programs, private programs or programs that the State runs in the communities,” directly with families and young people. They would be cheaper and possibly more effective.

Meanwhile, the Corrections Secretary supported a reform to the current system to keep youth “in the community so that they don’t have to enter the correctional system.” Although she was unaware of Senate Bill 344, she said she “would endorse any bill that is aimed at the non-criminalization of youth in prison.” However, she did not specify what plans she has to change the current system.

Despite all these initiatives implemented over almost three decades, at the end of the day, juvenile offenders in Puerto Rico remain trapped in silence in a costly dysfunctional system that robs them of the possibility of re-directing their lives.