On early morning April 10, 2001, Alberto Serrano patient at the former Savannas Hospital, attacked several people, killing one woman instantly and injuring three others who died over the next three days.

Serrano reportedly told doctors that the people he attacked looked like animals and monsters and he had to attack them to defend himself. On June 11, 2002, Serrano was found not guilty by reason of insanity and committed to a state mental hospital.

Alberto Serrano

May 9, 2001 

A psychiatric patient in Port St. Lucie was indicted on four counts of first-degree murder for violently rampaging through a hospital.

The suspect, 6-foot-2, 230-pound Alberto Serrano was also indicted on two counts of attempted first-degree murder and one count of robbery. Attorney Mark Harlee said Serrano, a professional wrestler hopeful, was incompetent to stand trial.

Serrano was sent to Savannas Hospital on April 10 under a state law allowing officials to involuntarily commit people who are a danger to themselves or others.

According to a St. Lucie County sheriff's report, nurse Alda Ellington was left alone with Serrano who proceeded to beat her to death. Then he assaulted five elderly patients sleeping in their rooms. Three later died.

St. Lucie mental patient kills nurse, injures two patients

Associated Press

April 10, 2001

PORT ST. LUCIE, Fla. - A psychiatric hospital nurse was beaten to death and two elderly patients were injured early Tuesday in an attack by a man who was being checked in, authorities said.

Alberto Serrano, 33, was charged with first-degree murder in the death of Alda Ellington, 47, a nurse at the private Savannas Hospital.

Serrano also was charged with two counts of attempted murder in the beatings of two female patients. One, 75-year-old Olive Simpson of Wellington, was in critical condition at St. Lucie Medical Center. The other patient, 64-year-old Elizabeth Scott of Port St. Lucie, was treated and released back to the mental facility.

"I was shocked because I thought she was safe in a situation like that," said Elizabeth's husband Raymond Scott. "I felt so good that she was secure. Undoubtedly she wasn't."

In a separate incident, Serrano was arrested last Friday on a misdemeanor battery charge for punching a man in the face and back in the waiting room at New Horizons mental health center in Fort Pierce. He was released from the St. Lucie County Jail the same day on $500 bond.

Serrano's girlfriend, Nidia Pena, said he was taken to New Horizons by police after attacking on his family in the middle of the night.

"Not again," she told police when she learned of the latest incident. "He just did this at New Horizons and was arrested for battery two days ago."

While being processed, Serrano was alone with Ellington when he attacked and beat her to death at about 2 a.m., said Mark Weinberg, spokesman for the St. Lucie County Sheriff's Office. Serrano then attacked the patients, whose rooms were nearby, he said.

Ellington was found unconscious lying in a pool of blood. Simpson and Smith were lying in their beds with bloody faces.

"With his own bare hands and with no apparent provocation he committed these acts," Weinberg said. "We do not know of any precipitating factors."

Serrano was brought to Savannas after voluntarily admitting himself into the emergency room of Martin Memorial Medical Center in nearby Stuart at about 12:30 a.m., said hospital spokeswoman Pat Austin.

He was taken to Savannas under the Baker Act, which requires a person determined to be a threat to others to spend three days in a psychiatric facility for an evaluation, Weinberg said.

Serrano was arrested without incident after deputies found him sitting in a chair outside the building. He was drenched in water and his hands were swollen and cut. Detectives believe he may have washed himself in a pond on the property after the alleged attacks, the report said.

He was taken back to the county jail, where he was being held without bond in a medical cell until a Wednesday morning court appearance. He talked about the attacks during an interview with detectives after his arrest, Weinberg said.

By Teresa Lane, Palm Beach Post

April 12, 2001

PORT ST. LUCIE -- Four days before a mental patient fatally beat a nurse at Savannas Hospital, mental health workers at a second facility ignored a "routine procedure" that would have ensured immediate psychiatric care for the patient, law enforcement officials said Wednesday.

Although police took Alberto Serrano to New Horizons of the Treasure Coast early Friday for treatment, he never received any, records show. A punch to a fellow patient instead meant a trip to the St. Lucie County jail, where Serrano, 33, spent the night on a misdemeanor battery charge before his girlfriend posted $500 bond.

St. Lucie County Sheriff's Office spokesman Mark Weinberg said while it is routine for psychiatric hospitals to place a mental health hold on patients who commit crimes, allowing them to receive treatment after jail, that was not done in Serrano's case. Serrano's estranged wife says he is schizophrenic.

Three days after his jail release, the 6-foot-2, 250-pound Serrano began hearing voices again. This time, police say, 47-year-old Savannas Hospital nurse Alda Ellington and two elderly patients were the targets of his fists. Ellington, who was 5-foot-4 and weighed 135 pounds, died of massive head injuries. Olive Simpson, 75, remains in critical condition at St. Lucie Medical Center. Elizabeth Scott, 64, escaped with a broken nose, cut lip and broken dentures.

"We are not a psychiatric organization; we're a criminal justice agency," Weinberg said. "New Horizons is well familiar with the mental health hold procedure, and it has been done many times in the past. I don't know why they didn't in this case."

An employee of New Horizons, a state-supported psychiatric treatment center, said he was unaware of the hold procedure and said his staff prefers to treat violent patients in jail. Unlike Savannas Hospital and a second private, for-profit psychiatric hospital in St. Lucie County, New Horizons can't turn away poor patients.

"I have a non-tolerance procedure for violence," said Ed Stein, director of nursing and emergency services at New Horizons. "If someone is actively assaulting people, I can't put my staff and patients at risk. Our psychiatric staff treats violent people in the jail."

Diagnosed as a paranoid schizophrenic, Serrano had been admitted to mental hospitals at least 10 times over the past decade, usually because he had stopped taking his medication, said estranged wife Kimberly Serrano, 31. He was sometimes admitted for two weeks at a time to New Horizons, but he had also been admitted to Savannas at least twice, she said. He also had been hospitalized once in Palm Beach County and at least once in his native Puerto Rico.

Serrano was committed to New Horizons under the state's Baker Act Friday after he punched three adults and an 8-year-old girl and kicked down a bedroom door, a police report said. The four were residents of the JCAHO Boulevard home in Port St. Lucie where Serrano was staying in the garage.

He had attacked hospital workers before, his wife said. A bodybuilder with rippling muscles, the former roofer didn't like to take psychiatric medication because it made him tired. Twice he had to be restrained by staff members who were punched while trying to give him medicine, Kimberly Serrano said. Neither incident was so severe it ended in arrest, she said.

"He never hit me or my children," she said.

Although Savannas Hospital has refused to comment on whether staff members followed written procedures in allowing Ellington to interview Serrano alone, another area treatment center said it never allows nurses to be alone with incoming patients. A Savannas nurse on duty during the attack said staff members have complained of lax security, to no avail.

An orderly left the two in a room alone for an initial interview, and a technician who was supposed to assist was on break, said the nurse, who asked that her name not be used.

"Somebody called me over to do CPR (on Ellington) and I couldn't ... I mean, I had to stay at (my) unit," the nurse said. "It was just me. Plus, he (Serrano) was on the loose."

Serrano confessed to attacking the women, saying he "killed the people by breaking their necks and backs and beating them in the face," sheriff's Detective Elmer MCP wrote in a report.

The state Agency for Health Care Administration is investigating the incident. The Department of Children and Families, which state law designates as the "mental health authority" in protecting patients, said it would not take any action until ACHE reports its findings.

Savannas Hospital stumbled on its last survey by the Joint Commission on Accreditation of Healthcare Organizations, the private not-for-profit agency designated by the state to inspect hospitals every three years for compliance with its standards.

After receiving an excellent rating in 1996, the hospital was told to make improvements in 1999, the last time a full survey was completed. The hospital's psychiatric services fell short in three areas: initial assessment procedures, implementing plans "to provide a safe ... environment of care" and use of medicines.

Of the 574 psychiatric facilities reviewed by the agency in 1999, fewer than 15 percent were deficient in initial assessments and safety plans, and only 8 percent were deficient in use of medicines. Overall, the hospital's psychiatric services scored 95 out of 100, placing it among 459 facilities that scored in the same bracket.

Charlene Hill, a JCAHO spokeswoman, said it has asked Savannas to submit a confidential report within 45 days on the circumstances and causes of the nurse's killing and patient attacks. If the agency finds the report "thorough and credible," and the hospital takes the proper actions to prevent the incident from recurring, it's unlikely the agency would revoke the hospital's accreditation, Hill said.

The report is kept confidential so the hospital does a thorough investigation, she said. "We've learned over time it's a systems error, not a people error." But the agency also accepts information from the public on its complaint hot line, (800) 994-6610.

The state has different staffing requirements for psychiatric hospitals than nursing homes and acute care hospitals. The standard simply requires at least one qualified staff person on each floor at all times, according to state officials.

Although Stein said New Horizons workers are sometimes left alone while new patients are being screened, Lawn wood Pavilion spokeswoman Beth Tutee said that's a cardinal safety sin at her 36 bed psychiatric facility in Fort Pierce.

Savannas executives have refused to comment since the killing, instead issuing a release that said "Even in the most restrictive settings, forensic hospitals, jails and state hospitals, incidents such as this can occur." The facility has treated more than 15,000 patients since opening on Walton Road in Port St. Lucie in 1987 and said it will evaluate the tragedy in the coming weeks "to assist us in learning from this traumatic experience."

Serrano was being held without bail in a medical cell Wednesday on charges of first-degree murder and two counts of attempted murder.

Staff writers Colleen Mastery, Molly Hennessy-Fiske, Jill Taylor and Snaggy Beat contributed to this story.

Thanks to the substantial settlement, Olive Simpson is assured that she will be able to live in safe surroundings and receive the medical care she will need during her lifetime.