Taking charge: FASTT program provides mental health services to low-level inmates

Sheriff Ken Furlong said getting help for mental health patients was something that had been pushed aside for a long time in Carson City.

Saying it was an issue that “needs to be resolved,” the sheriff and other community leaders have partnered with the state in a new program . . .

February 17, 2013  — Originally published in the Nevada Appeal. (All rights reserved)

PDF copy: Taking Charge (FASTT) Clip

Sheriff Ken Furlong said getting help for mental health patients was something that had been pushed aside for a long time in Carson City.

Saying it was an issue that “needs to be resolved,” the sheriff and other community leaders have partnered with the state in a new program.

The Forensic Assessment Services Triage Team, or FASTT, is a partnership between the state and local governments to bridge a gap in mental health services from when someone is arrested on a low-level offense to after they are released but fail to engage the state’s mental health services.

“With these low-level cases, they’re in and out so quick, that’s why we call it FASTT,” said Dr. Joseph McEllistrem, the Carson City Jail’s director of forensic health services.

“Many of these people are known. They’re known to law enforcement, they’re known to the mental health service system, but it was the breakdown between the two systems, or not a formal relationship between them, that really is the crux of it,” Richard Whitley said.

Whitley is the administrator of the Division of Mental Health and Developmental Services and the administrator of the Department of Health and Human Services’ Health Division.

Whitley has been one of the key players in so quickly organizing the FASTT program, Sheriff Ken Furlong, Partnership Carson City’s Kathy Bartoz and other participants said.

“The people that would qualify for the FASTT team intervention are going to be most readily identified by the arresting agent, the booking officer or the forensic health services team at the jail, because they’re now not seen by a judge for at least three days,” McEllistrem said.

McEllistrem said once someone who is in need of intervention is identified they fill out a referral form.

“We do that just to get some buy-in from them. Tell us what’s going on, help us quickly identify your needs. While they’re filling that out, Lisa Treinen is contacted.”

Triage Assessment Coordinator Treinen, along with psychiatric caseworker Kathleen Buscay, come to the jail and meet with the referral and do a clinical interview. Their findings allow David Ramsey, the jail’s nurse practitioner, to write prescriptions and to make sure clients make their first, and continuing, appointments with Carson Mental Health Center.

“In less than 24 hours, someone from Carson Mental Health and the FASTT team coordinator are on sight interviewing (the inmate,)” McEllistrem said. “Before they leave that interview, they have identified their needs, they have set an appointment with Carson Mental Health and developed a treatment plan.”

So far, 41 people have been interviewed, five people have voluntarily enrolled in the program.

“There are very few names I don’t recognize” from previous contacts, Treinen said. “These are people whom we know.”

McEllistrem has been seeing the same for many years. He is a clinical psychologist and known by most in the jail simply as Dr. Joe.

“We have been dealing with how to integrate community collaboration between mental health providers, law enforcement and family,” McEllistrem said. “We kind of knew if we would integrate these groups, we could really reduce the number of crisis calls.

“It was always reaching a crisis point before we were intervening.”


The problem everyone saw was the gap. When the jail released a low-level offender, usually arrested on a misdemeanor, an appointment had been made for the Carson Mental Health Center but the person rarely made it there. While the person was an inmate, he would be getting the proper medications but as soon as the jail bars closed behind him, he was left to his own devices. The gap in services had to be bridged.

An October meeting between state and local leaders was called to discuss the issue.

“They mobilized so quickly,” Whitley said. “I think it’s because they were seeing the problem anecdotally and individually. They knew the problem. We put a number to it and said, we’re a partner in this and in some ways, it was probably the state mental health system acknowledging the problem, quantifying it for ourselves and going to an existing forum in the community and saying, we’re in. We need to be a part of addressing this problem and it did move very quickly, I think.”

Bartoz praised Whitley’s bottom-up approach. “He’s allowing the community to take charge of our issues.”

Before, Ramsey couldn’t write prescriptions for longer than an inmate’s stay. With the FASTT program, he can write prescriptions to last a few more days, just long enough for the client, as Whitley calls them, to get to his appointment with Carson Mental Health.

Getting to the appointments, for many clients, can be more complicated than just continuing to take their medication. It’s about their life skills, some of which many members of the community take for granted.

“This isn’t just about people being mentally ill,” Bartoz said. “It’s about them not having the skills they need to function in society. It may be they can’t navigate bus systems or have a difficult time with their social interactions skills and turn people off, don’t get hired. It’s people who are having a hard time functioning.”

Those bridge medications, between the care they receive in the jail and the first appointment with Carson Mental Health, are a key part of the equation.

“David Ramsey will write bridge medications,” McEllistrem said. “Once we verify the appointment with Carson Mental Health, if they’re on meds, we want to keep them on their medications when they leave us, which in the past we weren’t able to do because there was no guarantee of follow-up, which was too dangerous. Now we’re able to supply these bridge prescriptions.”

Whitley sees bridging the gap in services to be part of his duty.

“I think it’s negligent if we don’t take an action to connect our systems because this is where the failure is occurring,” Whitley said. “These are our clients, so the fact that they were clients for out-patient mental health and now are coming into the criminal justice system, the question really is for us, on the mental health side, how is it that our services are failing and the client is having intervention from law enforcement. Unless we ask that question we can’t get at what we could do differently.”

Furlong, an enthusiastic partner the whole way through, said he, too, thought case management and proper hand-off are the key. Often, once a person was released from jail, they were really released not into the world or even back into Carson City but into “a dark hole.”

“That dark hole was really the problem. They went right back to the street,” he said. “Case management is a critical issue when it comes to mental health. We weren’t doing well at handing it off after they left the jail.”


Part of the new way of doing business is to break down the silos of care that existed, to build links and bridges and other sundry forms of transportation between service providers.

“We’re breaking down silos,” McEllistrem said.

The FASTT team is made up of people, of faces. When someone comes in contact with the law and is being held at the jail, the FASTT team member, either Treinen or Buscay or both, will meet with them before they are released. When the client comes back to Carson Mental Health, they will be seeing the same, familiar face and reconnecting with someone they’ve already met.

“Once you make that first contact, you take the mystery away,” McEllistrem said. Taking that mystery away, allowing a continuance of care, is one of the facets of the program.

“Before, it was Band-Aid care.” McEllistrem said. “Deal with the crisis, put a Band-Aid on it and you move on to the next case that’s burning on your desk. We just didn’t have that ability to follow up and insure somebody’s able to access the care they needed and said they wanted. In the end, it sort of already existed. We’re just pulling them together and having a team follow them through the system so they don’t fall through the cracks, so they don’t miss an appointment, so they don’t stop taking their medication. The barrier to successful treatment is really going to be addressed by the FASTT team.”

When it comes to the actual costs of the program and the expanded care, on Whitley’s end, it’s almost nothing.

“We’re just moving personnel” and duties, he said. “We’re formalizing the hand-off.”

Bartoz was more enthusiastic. “He’s taken existing resources and by moving them around and getting people to collaborate, get them all moved to the front-end of this problem, by doing the in-jail assessment, we have probably increased the success rate of these individuals three-fold without any additional money. It was just a matter of moving people around, getting them out of the silos, getting them out of their cubicles and saying, I’m putting you over here.”

A similar program is ongoing in Reno, with the hope to expand statewide.


Whitley came to Bartoz to help bring the local players together to bridge the gap in services he saw through the data his office had analyzed.

“What we did with Carson City was we looked at the jail data and our mental health data for Carson City to see how many people in the jail had been clients of mental health and really let data drive where we needed to put services,” Whitley said. “What was unique, I think, was the sheriff being such a willing partner and being willing to share the data.

“We had a meeting first with the sheriff (because) we’re concerned that we’re seeing a lot of people who are getting out of jail, not getting plugged in to mental health systems …” With the draft report on the overlap between mental health patients and frequent visitors to the jail in hand, Whitley called Bartoz.

“We’re kind of a like a wedding planner,” Bartoz said of Partnership Carson City. “We bring all the resources together. He called us on (Oct. 17) to see what we could get done and, coincidentally, we had a steering committee meeting (two days later).”

Whitley came to the meeting and presented his ideas and then the snowballing group contacted McEllistrem.

The concept is not novel to McEllistrem, who had seen an earlier implementation of the Crisis Intervention Training program come and go as funding came and went.

“We’ve been here before,” McEllistrem said. “We’ve done this before. We could never maintain it or sustain it. We’re reworking a program from the past but now we have the support of the state.”

The Crisis Intervention Training program, too, is being brought back into full swing come March, when the first training is planned. Much like the FASTT program, the CIT program aims to bring those who need help into contact with the Carson City’s mental health resources, although its aim is broader.

“CIT is not just mentally ill. Your crisis could be schizophrenic but this person’s crisis is they just need shoes,” said Sgt. Daniel Gonzales with the Carson City Sheriff’s Office.

The problem has been here for a long time, Ramsey said. At 63, he’s been in and around the medical field for 20 years. He went back to college at 43, graduated, and then bounced around before finally finding himself at the Carson City Jail.

“This is kind of great,” Ramsey said. “Ever since we lost our mental institutions, those people were basically turned out onto the street and a big percentage of them ended up in jail. County jails have been the new mental institution. That’s how it’s been, so this is kind of a step in a new direction, which I appreciate.”

Whitley was impressed by Furlong’s own willingness to emerge from his silo. Furlong was the first sheriff to attend the meetings between the state and the local governments on the issue.

“He’s been directly involved,” Whitley said. “I thought it would be more challenging.”

“This has come together quicker than any dealing I’ve had with the state in 30 years,” Bartoz said.

DA files murder charges against Patrick Dunn

ELKO — Patrick Dunn told investigators he tried to dispose of the gun he used to shoot Erik Espitia during an altercation early on May 27, according to court records.

The narrative of the alleged murder of Erik Espitia was filed at the Elko County Justice Court Friday afternoon, including a narrative of events according to witnesses . .

June 02, 2012 —  Originally published in the Elko Daily Free Press

DA files murder charges against Patrick Dunn as a PDF

ELKO — Patrick Dunn told investigators he tried to dispose of the gun he used to shoot Erik Espitia during an altercation early on May 27, according to court records.

The narrative of the alleged murder of Erik Espitia was filed at the Elko County Justice Court Friday afternoon, including a narrative of events according to witnesses.

The Prelude

Two groups left two different bars shortly before 3:15 a.m. Sunday, according to the investigation by Elko police detective Dennis Price.

The group leaving Cantina La Hurrabura was composed of Erik Espitia, Salvador Espitia, Raul Perez-Munoz and Esther Espitia.

The other group, leaving the Tiki Hut, was composed of Patrick Dunn, Chance Creamer, Brandon Evans and Angela Evans.

Brandon Evans was flown to Salt Lake City for injuries he suffered during the alleged fight that followed, according to police.

The two groups walked toward their respective cars, in the downtown parking corridor near the 400 block of Railroad Street.

When the groups got near to each other, “words were spoken which eventually led to a confrontation between the two groups of people,” according to the court documents.

The view from the car

Angela Evans, part of the group leaving the Tiki Hut, told investigators that she was there when the fight started and at one point “she attempted to intervene in an altercation” between Patrick Dunn and another person.

She was thrown to the ground after attempting to intercede in the fight Dunn was involved in, according to court records.

Angela Evans then “took a seat in the rear driver’s side passenger seat.”

She then heard a gun shot come from the rear of the car.

From the side

According to Salvador Espitia’s narrative, he was fighting Chance Creamer and “at one point he had Mr. Creamer pinned up against a vehicle.”

Creamer and Salvador Espitia agreed to stop fighting and watched Dunn go to the vehicle and retrieve the .40-caliber pistol.

Salvador Espitia grabbed Dunn by the hair, according to court records.

Dunn pointed the gun at Salvador Espitia. Salvador Espitia let go of Dunn’s hair.

Suspect told police

Patrick Dunn told investigators he “became involved in an altercation” with Erik Espitia. Dunn told investigators he was either fighting three or four individuals or there were three or four individuals fighting.

Dunn said he was kicked to the ground and, at one point, got up and “lost his snap,” according to court records.

Dunn told police he went to his vehicle, grabbed his gun, cocked it and fired it at Espitia.

He said he did not remember he or Espitia speaking prior to him shooting the gun.

Tossing the gun

When the investigator asked Dunn where the gun was, he said he had “taken it ‘into the hills’ and ‘tossed’ it under a tree.”

Dunn went with the investigators and showed them the area in which he threw the gun.

Detectives found the gun and a nylon holster.

The aftermath

Elko District Attorney Mark Torvinen charged Dunn with open murder with the use of a deadly weapon, assault with a deadly weapon and attempted willful destruction of evidence of the commission of a felony.

He is not eligible for bail.

Espitia is survived by his wife, three children and unborn child, as well as brothers, cousins and mother, according to a message on a memorial in the downtown corridor.

A car wash in the Red Lion parking lot will be held today, from noon to 4 p.m., to raise money for his family and for his final expenses.


DA files murder charges against Patrick Dunn as a PDF


Jackpot JOP candidate sued for harassment

JACKPOT — An Elko County deputy, who had a temporary restraining order issued against him for two months, is being sued, along with other members of the Elko County Sheriff’s Office and Elko County.

Brad Hester, who is running for justice of the peace in Jackpot, is being sued for damages stemming from alleged stalking, an alleged “unlawful” search and alleged slanderous statements . . .

June 15, 2012 — Published in the Elko Daily Free Press

JACKPOT — An Elko County deputy, who had a temporary restraining order issued against him for two months, is being sued, along with other members of the Elko County Sheriff’s Office and Elko County.

Brad Hester, who is running for justice of the peace in Jackpot, is being sued for damages stemming from alleged stalking, an alleged “unlawful” search and alleged slanderous statements.

Hester won 53 out of the 99 total votes cast in the primary election for Jackpot justice of the peace.

Hester will still face Monica Burt in the general election come November, according to the county clerk’s office.

Richard Pike, the plaintiff, applied for the first temporary protection order against Hester on Nov. 15, and it was extended by Judge Al Kacin on Dec. 14, for two months.

Kacin concluded that Hester conducted an unauthorized and warrantless search of Pike’s workplace with a K-9 officer, according to court documents.

Pike filed a complaint with the sheriff’s office after the warrantless search. Once an internal investigation, prompted by Pike’s complaint, began, Pike testified, Hester began a “stop and stare” form of harassment.

“(Hester) began driving an Elko County Sheriff’s Office patrol vehicle, while in uniform, to (Richard Pike’s)” house and work, “over the span of several months,” seven times a day, often lasting for more than five minutes at a time, according to the lawsuit filed at the end of May.

According to Kacin’s ruling, “It is especially disturbing this conduct occurred after Pike contacted (Lt. Marvin) Morton in an effort to provoke an ‘internal affairs’ investigation of Hester.”

Deputy Sean Munson is also being sued by Pike for allegedly breaking into the Jackpot Recreation Center and searching Pike’s office with neither a warrant nor probable cause.

Munson allegedly conducted the search while acting as the field training officer for the sheriff’s office, while being accompanied by newly admitted deputies. Munson had no permission from the Recreation Center staff to conduct the search, according to the lawsuit.

Sheriff Jim Pitts, Rick Keema, the Elko County Sheriff’s Office and Elko County are being sued, partially because they “breached their legal duty to properly supervise” Hester and Munson, as well as for not properly disciplining them.

Richard Pike asked the court for a temporary injunction to put Hester and Munson on administrative leave without pay, enter an order declaring that Hester, Munson, Keema, Pitts, the sheriff’s office and Elko County violated his constitutional rights, and requested an award for various damages.

Pitts declined to comment and Julie Cavanaugh-Bill, representing Pike, was not available for comment by press time.

1. Jackpot deputy reassigned to Elko — December 20, 2011

2. Judge extends deputy protective order — December 15, 2011

3. Judge examines legal authority in deputy’s restraining order — December 14, 2011

4. Kacin to issue order on deputy — December 13, 2011

5. Jackpot deputy hearing Monday — December 9, 2011

6. Deputy reassigned, investigation under way — November 24, 2011

7. Jackpot coach files for protection against deputy — November 22, 2011



Kamaludeen to serve life without parole

Kamaludeen to serve life without parole

Friday, October 24, 2008

Jurors handed Mohamed Kamaludeen a life sentence without the possibility of parole Thursday after hearing testimony from Judy Calder’s family and a Canadian inspector investigating a 1993 stabbing that Kamaludeen was allegedly involved in.

Kamaludeen was convicted Wednesday of murdering professor Judy Calder on Aug. 18, 2007 and soliciting for her murder in 2006.

Kamaludeen is also wanted in Canda for the stabbing death of a garage owner in Canada for a ring, necklace and cash. The Canadian Inspector said Kamaludeen coerced a 17-year-old boy into murdering the man and that he told the box to cut the ring off his hand.

Judge Patrick Flanagan set the sentencing for Kamaludeen’s solicitation of murder charge and the two enhancements on his murder charge for Dec. 10.

Kim Calder, Judy Calder’s daughter, said the sentencing “in a sense makes us better able to go on.”

She told the jury during sentencing Kamaludeen took advantage of her mother’s trust. Sniffles reverberated through the audience and jury as Kim Calder continued to speak, her voice trembling when recalling her mother.

“She believed in people,” she said. “He used this very kindness to take advantage of her.”

“It’s nice not to have something hanging over our heads, like the trial,” Carolyn Conger, Calder’s sister, said.

Congertold jurors she had to receive a pacemaker shortly after the loss of Judy.

“This time has been so devastating, the stress so great, my heart has actually stopped working,” she said.

Kamaludeen said he forced the British embassy, which handles citizens of Kamaludeen’s native Guyana to extradite him to the U.S. for the trial. He maintained that he did not kill Calder. While addressing the jury, he kept his eyes locked on an empty witness box.

Detective David Fogarty said Kamaludeen lied to the jury. Kamaludeen planned to travel to Brazil and then walk to his home country of Guyana, he said. Kamaludeen tried to flee when he realized authorities wanted to capture him for extradition, he said.

Kamaludeen sentenced

Kamaludeen sentenced

Wednesday, December 10, 2007

“This is not a life sentence,” Judge Patrick Flanagan told the man convicted of killing Judy Calder today during his sentencing. After a calm composure and looks directed at the ceiling Flanagan looked at Mohamed Kamaludeen, raised his voice in contempt and said: “This is a death sentence. It is the intention of this court that you die in prison.”

Kamaludeen, who killed Judy Calder in his warehouse on Aug. 18, 2007, received 20 extra years on his sentence of life without the possibility of parole for killing Calder with a deadly weapon. He received another nine years for killing someone aged 60 or older. Calder was 64 at the time of the stabbing.

“But that knife, that large butcher knife, was wielded by the defendant in this case, plunged into the helpless breast of Judy Calder,” Flanagan said.

Kamaludeen received four to 15 years for soliciting Calder’s death in a 2006 attack at her Incline home.

Kim Calder, Judy Calder’s daughter, implored the judge to impose the maximum penalties.

“My mother was almost beaten to death,” Kim said of the 2006 attack. “She was afraid of everything . . . in the last year of her life,” she said.

Kamaludeen showed James Calder, Judy’s wife, the van he put her body in, hidden behind printers.

“The defendant acted as if he was a friend of the victim’s husband as he gazed into the back of the van where his wife lay dead,” Flanagan said.

Carlos Filomeno, a felon who worked as a laborer for Kamaludeen, said he helped him dispose of Calder’s body outside of Elko.