It's 4:30 in the morning, the sun still three hours from poking above Tallahassee's wintertime horizon. Shairi Turner's BlackBerry sounds its gentle tones anyway.
It has to, if she is to get even a few minutes on the treadmill or some quiet time to catch up on e-mails before her children wake and the day gets going for real. Once it does, there will barely be a moment for some microwaved veggies and rice, let alone solitude, in between meetings, conference calls, site visits, appearances before oversight committees, and on and on and on.
But that's your life when you're not just the chief doctor, but the only doctor, overseeing the medical care of some 8,000 troubled children in the custody of the Florida Department of Juvenile Justice.
So forget about preventative medicine and dealing with lousy nutrition and all the other things that might be done with a captive audience of predominantly poor minority teenagers. Shairi Turner, '91, has to focus on more pressing goals. Like keeping them alive.
Indeed, a child's death in custody in 2003—17-year-old Omar Paisley died of a ruptured appendix over a June weekend; detention center staff assumed he was exaggerating the symptoms of a stomach bug—was a big reason Florida finally decided to hire a doctor for the decade-old agency in the first place.
Florida is notoriously cheap with its social service programs—shockingly so for someone like Turner, whose professional life had been spent in Boston. In Florida, an entry-level detention center guard makes $8 or $10 an hour. “So when a Wal-Mart moves into a rural area, we lose staff,” she explains.
Because the majority of the residential programs that house juvenile offenders are run not by the state but by nonprofit and for-profit enterprises, the task of monitoring health care standards is even more daunting.
“Not to be morbid, but I feel like we avert death every day.”
She has not always succeeded. On her office bookshelves, among the volumes of Florida statutes and medical journals, are three thick binders, each bearing the name of a child who died in custody since she took the job, including 14-year-old Martin Lee Anderson, whose death at the hands of boot-camp guards in the Florida Panhandle made international news.
On the other hand, the woeful understaffing does at least provide Turner one clear metric for success: a good day is one in which no one has died.
January 5, 2006,was not a good day.
Turner's daughter, Aaliyah, then only 16 months, had a 103-degree fever, and her doctor wanted blood work to make sure it was nothing serious. So when Turner got a call that afternoon from a colleague about an injured 14-year-old who had been airlifted from a local hospital to Pensacola, she was relieved when it was agreed that she would not have to drive the two hours out to the military-style “boot camp” where he had collapsed. The department's inspector general could go instead.
That evening, though, Turner stepped out of her daughter's Tallahassee hospital room and called Sacred Heart Hospital in Pensacola. The emergency room physician there told her that the patient, Martin Lee Anderson, had disseminated intravascular coagulopathy—that is, his body was bleeding uncontrollably because of some unknown stress.
“I knew when he was in DIC that he probably wouldn't make it,” Turner remembers.
Martin died the next morning. He had been sent to Bay County's sheriff-run boot camp for violating probation after stealing his grandmother's car. He was, as is typical for children in agency custody, African-American; and while peninsular Florida is not really part of the South-with-a-capital-S, Bay County, in the state's Panhandle just south of Alabama, decidedly is.
Later that day, standing at her kitchen table, Turner took the notes that she would reduce to a memo, the one that would later grab headlines when the press got hold of it. Bay County medical examiner Charles Siebert told her that the boy's body would be transported to him, rather than being autopsied in the county where Martin had died. She reported his statement that such a thing was “highly unusual” in the memo, along with her medical observations in the case. And her amazement at Siebert's autopsy conclusion—that Martin died of sickle-cell trait (“I know my jaw must have dropped”)—helped make her a star witness for the prosecution when seven guards and a nurse from the boot camp were charged with Martin's death.
It turns out that he didn't die from sickle-cell trait. A second autopsy, performed in response to the outrage about the first, determined that Martin had asphyxiated after the guards, rather than waving an ammonia tablet under his nose, had held it there while they clamped his mouth shut.
The ammonia tablet became necessary when Martin passed out after guards pummeled him and kneed him when he refused to continue running. Most of that was visible on the videotape that the agency's inspector general was “walked through” when he visited Panama City that first day.
“If they had tried to walk me through that tape? I would have told that whole room full of sheriffs that they needed to get an attorney, because they had killed that kid,” Turner says.
In the end, Turner's testimony, which briefly put her on Court TV, was not enough. All the guards and the nurse were acquitted. “Manslaughter in Bay County?” Turner says. “With not one black person on that jury? Ain't happening.”
Change, nonetheless, happens. A few months after Martin's death, Florida legislators voted to close the get-tough boot camps.
As a child, Shairi Turner (it's pronounced Sha-EER-ee, and means a song or a line of poetry in Swahili) contemplated caring for patients—of the sort named Spot and Fluffy. “She just loved animals,” childhood friend Natalie Ryder Redcross recalls. At age 15, Turner had begun to consider human medicine instead, when a bull terrier at the vet's office where she worked sealed the deal. The animal bit into her foot, and she had to drag it to a doorway and shut the door on its head. “It was bad. I still have teeth marks on my heel.”
She majored in biological sciences at Stanford, then spent a “boring” year as a research assistant before attending medical school at Case Western Reserve University in Cleveland, where she graduated in 1996. Next came a combined residency in internal medicine and pediatrics, a Harvard program at Massachusetts General and Children's Hospital of Boston.
During residency, Turner realized that while she loved treating patients, she didn't love the paperwork-intensive “hassle” of medicine. When the residency ended, she persuaded Mass General to put her to work in its multicultural affairs office and continued seeing patients at a walk-in emergency clinic in Chelsea. “I was a primary care refugee. I did not want to practice primary care, but I did not know what I wanted to do.”
Her fateful hint came as she struggled to write a final essay for a Harvard fellowship in minority health policy. A story came on TV about the high incarceration rates for black men—and it set Shairi Turner on a path.
She sat down and wrote about a close childhood friend whose abuse at home put him on the police-and-juvenile-hall treadmill until, at age 18, he was sent to prison. She wrote about how he got clean and earned both a GED and an associate's degree. And about how that still wasn't enough.
At age 35, after his third parole denial, “he committed suicide in his cell,” she wrote. “There are at least one million African-American and Hispanic men aged 18-40 years imprisoned and disenfranchised in the United States. Through any other sequence of events in their lives—an unbroken home, a non-alcoholic parent, attention in an uncrowded school system—these men could have been productive members of society.”
She was completing a second fellowship at Harvard in 2004 when her mentor, domestic violence expert Angela Browne, happened to be catching up with an administrator in Florida's Department of Juvenile Justice—who happened to mention that they were looking for a medical director.
“I told him: I have the person for you,” says Browne, who called Turner right then and there. “I said: I'm handing him the cell phone, and you two need to talk.”
Shairi Turner began her new job in Tallahassee that winter.
It's 9:15 a.m., and in her corner office decorated with photos of and artwork by her young children, Turner convenes a meeting with her top staff to go over the issues of the day. That she has a staff to convene is itself an accomplishment. When she started, she was essentially on her own.
“I was the leader, and I was also the doer,” she recalls, explaining how she finagled staff positions from nearby areas. “It's a little easier now.”
In a perfect juvenile justice system, Shairi Turner would make sure each child got a medical exam. Kids with mental health problems would get help; ditto kids with drug or alcohol problems. The children's families would be educated on how to help keep their kids out of custody in the future, and the residential homes would be small—no huge dorms—and generally not surrounded by fence and razor wire.
“It would be well-staffed,” Turner says. “It would really be what it's supposed to be.”
Of course, such a system would cost a lot more than Florida legislators have ever been willing to spend. At Turner's staff meeting, the faces grow somber when she talks about forthcoming budget cuts. These will be cuts, everyone knows, on top of cuts from previous bad years that were never quite restored even in the good years. “I don't know how we're going to function, to be quite honest with you.”
The meeting is about to break up, but a question arises about a cut an employee in the building suffered on her hand. The woman is concerned that it has become infected with methicillin-resistant Staphylococcus aureus.
What does this have to do with the care of children in state custody? Well, nothing, Turner allows. “When you're the only doctor in the building, you're also in charge of occupational health.”
Shairi Turner is the daughter of a playwright mother and an actor-director father. She is a Stanford and Harvard graduate, a medical doctor, and a top official at Florida's Department of Juvenile Justice.
She is also black, and that somehow is never far removed.
Growing up in the Bronx, she attended the elite Fieldston School in Riverdale, where she was one of only 20 or so nonwhites in her graduating class of 118. It was not the easiest thing, she remembers, and accounted for her decision upon choosing Stanford to live in Ujamaa, the black theme dorm.
“It was, wow: a place where I could be with all black people,” she says. “It was kind of like going to a black college at a white college.”
Nearly a generation later, race is a factor her children are starting to confront. “My son came home one day from school and told me, 'My hair is very bunchy,'” she says of her 5-year-old, Khari. “Not only were they all white kids, they were all white kids with straight hair.”
Khari and 3-year-old Aaliyah, though, attend a top-notch preschool, and have a physician mother and an electrical-engineer father who lavish attention upon them. Turner worries far more about the children consigned to the state-run detention centers, where they await trial, or the contracted-out residential treatment centers, where they serve sentences as long as several years.
The system, from the police to the judges to the centers' administrators, is overwhelmingly white. Their young charges, just as overwhelmingly, are not. And that, Turner has decided, is why they need her.
“No, I didn't come from a family in crisis, not at all. But I recognize that I come from a community that's in crisis. I come from a culture that's in crisis. And I cannot separate myself from that,” she says.
“I'm a voice for them,” she adds. “They're not commodities. They are salvageable. They are somebody's children.”
It's 10:05 a.m., and Turner and two colleagues huddle around a speakerphone. At the other end are officers from a private contractor that gets state money to house and teach delinquent girls who are pregnant or have just had babies.
The program received enough funding for 14 slots, but at the moment has only five mothers with babies and four girls who are pregnant. The program operators worry that legislators will see the low enrollment and slash the funding in the coming session. Their proposed solution? Modify the contract—quickly—to let them accept girls who have had their babies as much as a year earlier.
Turner is dubious. She knows a bottom-line-driven treatment idea when she hears one. Several times she presses the mute button to share her amazement with Laura Adams and Katrina Weatherspoon from the residential contracts office: “Are they serious?”
After getting a WINGS (Women in Need of Greater Strength) director to walk her through a typical day in the life of a young mother, Turner asks the speakerphone: “Who's supervising them supervising their kids?”
The voice explains how staff members watch and coach the girls as they feed, diaper and otherwise care for their infants. Turner mutes the phone and tells Adams and Weatherspoon that she does not want to make any changes until she has the chance to go to Miami. “I would prefer to go down there and look at this place.”
This is not good news for the women from WINGS, but Turner is firm, noting that since the person actually in charge of the contract is out sick anyway, an approval that day is simply impossible.
Turner shakes her head as she coils the extra cord to put the phone away. “If something happens to one of those babies in this program, we're toast.”
In a town where compromise for the sake of compromise is lauded as high virtue, Turner's readiness to speak bluntly makes her an unusual sort of bureaucrat. More than once, she says, she has headed to work with the feeling: “Okay. Today is the day I get fired.”
It's something that makes her former mentor at Harvard proud. “Shairi in that way is very nearly fearless,” Browne says. “She's a lot of fun to be around. She has one of the world's biggest laughs. She is very loving. But she will speak out on what she believes is important.”
This can take the form of facing off against lobbyists for the many private providers that run youth jails and group homes. When providers and their legislative supporters push to streamline regulations and “cut red tape,” Turner has been known to call it an attempt to dodge oversight and increase profits.
It's 1 in the afternoon, and Turner sits quietly in the front row of a committee room in the basement of the House Office Building. The committee chairman wants to help the private-sector contractors and their lobbyists reduce some “red tape.” That contractors are so embedded in the system goes back to its creation some 14 years ago.
The idea of a juvenile justice department came to Florida following a string of murders by teens. In the most widely publicized one, four children, aged 13 to 17, shot a British tourist couple in their rental car at a highway rest stop.
Such a thing naturally upset business and political leaders in a state that depends heavily on tourism, and the legislature responded with a new agency carved out of the state's massive health and human services department.
The name itself, “Juvenile Justice,” made its mission clear. Justice, as in punishment. “Coddling” children was out, and boot camps were in. The actual operation of boot camps and other residential centers, meanwhile, would be contracted out to sheriff's offices and, later, to nonprofits and profit-making companies.
And this was the approach Turner was brought into in 2005—one with which she has fundamental disagreements.
“These are the kids that have fallen through the potholes of Florida, and they are in the final dumping place. Kids watch too much TV; we don't teach them to eat the right foods. We aren't a country that believes that kids are that important,” she says, the frustration boiling over. “Then you look at the privatization, the money that's being made.”
Although the funding structure is of continuing concern, Kristin Winokur, vice president of the Justice Research Center in Tallahassee, says Turner has improved the agency. The chief physician has formalized medical procedures in a comprehensive manual and has gotten additional funding for nurses and doctors who provide services at the residential centers. “She has really been able to bring together units and regions that really hadn't spoken to each other until she came in,” Winokur says.
Back in the legislative basement, other agency officials give presentations on various issues. Finally, Turner and some others are called to tables facing the committee members. A few of them are given time to speak. Not Turner, who utters perhaps 30 words in response to a question. She is told she will be invited back next time.
Still, sometimes a good result from a legislative committee is when nothing bad gets done.
It's 3:10 in the afternoon, and Turner is back in her office, meeting with each of her top staff.
With nurse Kathy Wilson, she discusses a 14-year-old boy at a Brevard County facility who is suffering seizures. Turner still finds it amazing that Florida could have built a juvenile justice system where most kids are locked up without at least a nurse on-site. “I was trained at Mass General, so the standards are very high. But I don't feel like we shouldn't apply them to these kids.”
They decide the boy should be transferred to Miami—200 miles to the south. At no point in the discussion does the location of the boy's family ever come up. That is a luxury they do not have.
At 4:07, nearly 12 hours from the time she awoke, Turner can't suppress a yawn as she and nurse Rosemary Erwin discuss priorities. They must finalize a plan to evaluate children as they enter the system, but make it reasonable, given that they have only one doctor and three nurses to cover the whole state. Then Turner glances at her watch.
Every month for a few days, her husband must make a pilgrimage to the main office—the price of working from home—and Turner must get out to the school before closing time. “Jimmie's coming back tonight,” she says. “Thank God.”
Behind this dynamo of a doctor and administrator is a quietly efficient husband and father without whose help, she acknowledges, she simply could not get it done.
Jimmie Lee Davis holds a doctorate in electrical engineering from the University of Massachusetts-Lowell and leads a $3 million, 25-member team investigating the use of GPS satellite data during aircraft landings for the military. His employer, MITRE Corp., is based in Bedford, Mass., and McLean, Va. But Davis mostly works from their 2,800-square-foot home in a sprawling subdivision at the southeast edge of Tallahassee. This lets him make breakfast and pack lunches for Khari and Aaliyah each morning, pick them up after school ends, and get dinner on the table by the time Shairi comes home in the evening.
Davis says this telecommuting and traveling arrangement isn't too bad for someone as hyper-organized as he is. (Turner asked him at the party where they met in 1996 if he had something to write down her number he had asked for. “I said, 'No, but I've got a really good memory.'”)
What's more, as challenging as it might be for him, he knows it's much harder for her. “I struggle with the toll that [her job] takes. It is not easy. I would wake up and she would be asleep on the floor, with her papers all around her.”
Turner similarly appreciates the wear and tear: “I don't know how much more of this my body can take.”
But whenever it seems overwhelming, she reminds herself about the children of other black and brown moms. She remembers Martin Lee Anderson's mom, almost the same age as she is.
“To me, these are my kids. And that's how I look at them. I will not let them write them off, in any way, shape or form. Not on my watch.”
S.V. DÁTE, '85, has covered the Florida government for a dozen years. His most recent book is Jeb: America's Next Bush.