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The story behind Fractured, a WFAE investigation

Fractured series logo

The idea for this series sprung from a conversation I had in December of 2021. A relative who works in the court system suggested I look into the plight of defendants who are too mentally ill to go to trial. He suggested I speak with some of the people who work in the state hospitals.

I live in Morganton, the site of one of North Carolina’s three state psychiatric hospitals, Broughton Hospital. So it wasn’t hard for me to find people who’d worked there. What I heard astonished me. Defendants with severe mental health problems could cycle between the hospital and the jail multiple times before they get a trial. Sometimes they’d get sicker as they waited, with potentially permanent damage to their mental health.

A few calls to public defenders and doctors throughout the state confirmed that what I’d been hearing was a problem elsewhere. One attorney told me about a client who’d tried unsuccessfully to get mental health care before he went on a violent rampage. I never got to interview him. He’s now serving a life sentence.

Fortunately, my editors at WFAE thought these stories were worth pursuing. They contacted FRONTLINE, who was eager to support the investigation. So beginning last April, I started to reach out to public defenders across the state. Over the next several months, I heard about clients with severe mental illnesses who’d spiraled downwards after their first incarceration. I realized I needed to broaden my focus.

One public defender told me about people who cycle in and out of jail, largely because of their mental illness, in a downward spiral. Many ended up homeless. Another suggested I speak with a client with schizophrenia who’d just gotten out of jail and couldn’t afford his antipsychotic medication. On one occasion I tried to speak to a former inmate, only to learn he died before I could get to him.

One public defender introduced me to the Assistant Jail Chief Becky Cauthran, Gaston County’s jail administrator. When she learned what I was working on, she suggested I interview her. It was just another confirmation that people throughout the health care and criminal justice systems are deeply frustrated with their inability to change a deeply flawed system.

Over the course of the year, I spoke with well over 100 people: lawyers, jailers, sheriffs, judges, doctors, social workers, officials, lawmakers, family members, and academics. But the most compelling stories were those of the inmates themselves. They were the only ones who’d really experienced what it means when people said to me “the system is broken.”

These were all stories that occur in darkness because they occur behind bars. Those who live them are too poor, too sick and too disenfranchised to have a voice. I strongly believed they needed to be able to tell their own stories. But there were a lot of barriers.

Unlike prisoners who’ve already been convicted, those in pre-trial detention are especially vulnerable. So many attorneys worried I’d inadvertently hurt their cases. But I had no interest in asking whether they committed the crimes of which they were accused. I wanted to hear about their mental health issues and their lives. I also asked that an attorney or a family member be present whenever possible.

Then there are various laws that protect medical information, HIPAA among them. So even if defendants were willing to speak with me, I realized it would be difficult to obtain credible confirmation of their stories.

Fortunately the law on capacity to proceed helped me here. The constitutional standard for incapacity to proceed applies only to defendants who’s incapacity stems from a mental illness or what the law terms a “mental defect,” such as an intellectual disability. So the very fact that someone has been found incapable to proceed to trial, is partial confirmation. I obtained off-the-record confirmation that incapacity stemmed from mental illness rather than another mental disability when necessary.

My WFAE and FRONTLINE editors and I gave a lot of thought to another obstacle: The ethics of interviewing someone who is seriously mentally ill or incapable. I knew from conversations with a mental health lawyer that there are different kinds of competency. An inmate can be legally incapable to stand trial, but still be fully capable of engaging in other activities, such as consenting to medication or even consenting to an interview. I tried as best I could to make sure that everyone I interviewed fully understood I am a journalist and that their story would appear publicly. I did not use interviews of inmates who did not appear to fully appreciate this.

I spoke only with people who were referred to me by their attorneys. The Gaston County public defenders’ office suggested I speak with Miguel Maldonado, who cycled in and out of jail for almost two decades. You will hear him in the second installment of this series. Mr. Maldonado waived his right to an attorney at the time of the interview. I later reviewed his interview with the public defender, when Mr. Maldonado subsequently requested an attorney.

Anthony Muckenfuss had been restored and was on house arrest at the time of the interview. He was mentally quite sharp, and he badly wanted to have his story told. He directed his attorney to share his medical records with me as well. We hear from him in our third story.

Dillon Ledford’s story is in our sixth story. His attorney suggested I speak with him, and was present at the interview. The Gaston County jail spoke with him to obtain his consent prior to the interview. Mr. Ledford was subsequently found incapable to proceed to trial.

The first time I met Erik Ramsey, who is featured in story seven, I was accompanied by his attorney. He had been restored to competency at the time. When I met with him again, he was on house arrest and accompanied by his brother.

The series starts with John. We didn’t give his full name to protect his confidentiality, and we never hear from him. He was charged with arson and attempted murder in June of 2018, but has yet to be tried because he’s been too ill to understand the charges against him. He’s been cycling between the jail and the state hospital for years. He doesn’t understand why, and according to his attorney, he blames everyone connected with the courts, including his lawyer. I’ve been trying to meet with John, with his attorney present, since last May. I hope he’ll be healthy enough to meet with me before this series ends.

This story is part of a collaboration with FRONTLINE, the PBS series, through its Local Journalism Initiative, which is funded by the John S. and James L. Knight Foundation and the Corporation for Public Broadcasting.

Dana Miller Ervin is a reporter at WFAE, examining the U.S. health care system.