As psychiatrist’s abuse case drags, accuser expresses frustration

For Ruben Macias, the memories arrive at unexpected moments. “Sometimes certain smells will trigger it,” he said. “When I close my eyes, I replay the whole scene.”

A decade later, the episode still unfolds in his mind with sharp-edged clarity: It was a Saturday morning. The psychiatrist locked the door to his office behind them. He wore a polo shirt and shorts. “And,” Macias added, “he didn’t have any underwear.”

Macias was 17 years old in 2005 when he said a judge ordered him admitted to Austin State Hospital for treatment. Diagnosed with bipolar disorder and schizophrenia, Macias had cut himself, abused drugs and attempted suicide four times. He’d been arrested. The hospital was supposed to be a safe place.

Instead, he said, his treating psychiatrist there, Dr. Charles Fischer, forced him to have sex. (The American-Statesman typically doesn’t print the names of alleged sexual abuse victims; however, Macias contacted the paper and gave permission for his name to appear.)

Macias is the first of Fischer’s alleged victims to speak publicly, but he hasn’t been alone in his accusations. Fischer’s 30-year career rapidly began unraveling in November 2011, when the Texas Medical Board suspended his license, citing nine patients who had accused him of having sex with them in psychiatric facilities in Austin, Waco and San Antonio. Months later, a Travis County grand jury indicted him on charges accusing him of having sex with five teenage boys — including Macias — under his care.

Since then, however, the case against him has moved only at a crawl, slowed by dozens of postponements and re-settings. Fischer’s next court appearance isn’t scheduled until April. By then it will have been just under four years since he was criminally charged with 23 offenses ranging from sexual assault to indecency with a child.

Fischer, who remains free on bail, has denied that any of the episodes of sexual abuse described by his patients occurred. His attorney, Gerry Morris, declined to comment.

Beverly Mathews, one of the Travis County assistant district attorneys working on the prosecution, said she couldn’t speak about the case. In an email she said that generally “in cases involving multiple victims and voluminous records with allegations spanning several years, it is not uncommon for a longer amount of time to pass before the case is brought to trial.”

Yet experts said the passing time can only hurt the case against the psychiatrist. “The older the case is, with very few exceptions, the harder it is to prosecute,” said Joshua Marquis, spokesman for the National District Attorneys Association.

Macias said he has grown increasingly frustrated by the seemingly endless delays and what he described as indifferent treatment from the state. In a recent interview, he said he now wants nothing more to do with the case against Fischer.

Even if he changes his mind, Macias himself illustrates the difficult path prosecutors face as they try to build a case against Fischer, who had been a well-respected and lauded physician before losing his license. Today Macias is borderline homeless. Mostly unemployed, he lives with relatives, occasionally leaving on a whim on open-ended trips, as he did recently to California. He said he hasn’t taken his powerful prescribed medications to control his hallucinations in more than five years, explaining that he doesn’t trust psychiatrists.

An investigative account of the Fischer case obtained by the American-Statesman from a source shows all of the psychiatrist’s alleged victims have severe mental illnesses. Several have spent time in prison, state records show; investigators struggled even to track others down. Fischer’s attorneys have sought psychiatric records from his accusers, suggesting they may raise questions about the alleged victims’ competency to accurately recall events from more than a decade ago.

“This is not going to be an easy one,” said Floyd Jennings, a Harris County attorney and former clinical psychologist who is considered one of the state’s top experts on mental health and crime. “It’s going to be a lot easier to defend than prosecute.”

Therapist alerts regulators

Court and regulatory records show various agencies had investigated allegations of sexual abuse from Fischer’s state facility patients as early as 1992, when a boy from the state-run Waco Center for Youth accused him of mistreatment. Documents from the Texas Medical Board state that seven Austin State Hospital patients between the ages of 13 and 17 made allegations against Fischer between 2001 and 2006.

Fischer denied all of the allegations, and none resulted in professional discipline or criminal charges. A 2002 grand jury scrutinized allegations against Fischer, but he was not indicted and continued practicing.

According to a confidential investigative report prepared by the Texas Department of Family and Protective Services, the current cases against Fischer began building in mid-2011, when a former patient told his private-practice therapist in Temple that he’d been molested by a psychiatrist who still worked at Austin State Hospital. The counselor told investigators the young man had mentioned the alleged abuse two years earlier, but she had insufficient information then to identify the man as Fischer.

She reported that her client still struggled with the alleged abuse: He “is desperate to get better yet continues to experience setbacks in the effects the sexual trauma has had on him.”

As DFPS investigators pursued the allegation, they noted the string of earlier unconfirmed allegations against Fischer from state hospital patients shared common elements. The patients were all teenage males with severe mental disorders. Each said the abuse occurred in Fischer’s office behind a locked door. Their descriptions of Fischer’s behavior and the sexual assaults, which typically involved fondling and oral sex, displayed additional patterns.

Over the next five months, according to the report, investigators reinterviewed the former patients they could find and their psychiatric caregivers. They tracked down old complaints and police reports. It was the first time regulators had reviewed the cases together.

The inquiry revealed a split portrait of Fischer. His accusers claimed he drew them into sexual activity with promises of computer time and candy. His colleagues said he was a reserved but professional caregiver with a dry sense of humor who loved his dog and maintained firm boundaries with his patients.

Fischer, who continued to work with adolescents during the investigation, insisted he never mistreated his patients and couldn’t explain the string of accusations. He hypothesized some boys may have turned on him because of their own previous sexual traumas. He confirmed he saw some patients in his office with the door shut to give them some privacy and explained that because he locked the door every morning out of habit it clicked automatically behind him during sessions.

Case spurs policy changes

A clinical psychiatric expert consulted by investigators, however, said it was “absolutely not” appropriate to lock the door during treatment. A sex offender therapist explained how those in positions of power target vulnerable victims and believe “their credentials will prevail in any situation where they are accused of molestation.” Hospital records showed none of the Austin State Hospital’s five other psychiatrists had ever been accused of abuse.

Fischer’s demeanor during his interview with investigators caught their attention as well. Although he appeared relaxed at the start, when an investigator read aloud a victim’s statement Fischer “sat upright in his chair and appeared to be taking very sharp, shallow breaths.” Later, “Dr. Fischer had his mouth open and teeth bared. … This was the most emotion that had been displayed during the course of this interview,” the report stated.

It also revealed how skeptical some of Fischer’s coworkers were of the allegations. An alleged victim’s mother told a DFPS investigator that when she reported her suspicions in 2003, a hospital social worker assured her that “Dr. Fischer would not do anything like that.” Then-Austin State Hospital Superintendent Carl Schock suggested during the 2011 inquiry that the alleged victims might have colluded against Fischer and that he “may have been targeted because it was rumored that he was a homosexual and the children may have been aware,” the report states.

The Department of Family and Protective Services informed state hospital officials in October 2011 that the investigation had confirmed two cases of sexual abuse against Fischer. He was placed on leave from the hospital and soon fired.

The case spurred Austin State Hospital administrators to make changes. Among them: The facility retrofitted 336 doors with windows; state officials began working more closely with the Department of Family and Protective Services to track abuse and neglect complaints to identify patterns; and caregivers who receive two or more allegations in a year now receive extra scrutiny.

Victim’s competence questioned

Prosecuting cases involving people with mental illness poses a variety of special challenges, said Patricia Gunning, special prosecutor and inspector general for New York state’s Justice Center for the Protection of People with Special Needs. Her office was created two years ago following a string of reports claiming widespread abuse of clients with developmental disabilities in New York.

Gunning said the cases typically demand the examination of voluminous complicated medical and psychiatric treatment records. Many jurors also don’t understand the complexities of mental illness and so discount victims’ stories — often prompted by defense lawyers who paint them as unreliable witnesses too mentally incompetent to understand what really happened.

That occurred in 2007 after prosecutors in Fort Bend, outside of Houston, charged Texas Department of Criminal Justice prison guards Kevin Brown and Anthony Monroe with beating a 36-year-old mentally ill inmate at the state’s Jester IV Unit. According to a case summary, the corrections officers would order the inmate to retrieve a yellow “wet floor” sign. Then they would beat him with it.

Just before the trial, the guards claimed that because of his mental state, the prisoner was legally incompetent to testify about what had happened to him, recalled Jennings, who worked on the case. Diagnosed as schizophrenic, the inmate had been in and out of psychiatric hospitals before being sentenced to 20 years in prison for burglary.

Jennings said he was able to overcome the claim — Texas law presumes all witnesses in a court case to be mentally competent, so defense lawyers must prove they aren’t. But he said that prosecutors in such cases must be prepared to confront the question. “Is it an issue? Sure it is.”

‘Who are you going to believe?’

Macias said that when he was admitted to Austin State Hospital in 2005 he barely saw Fischer. The psychiatrist prescribed him medication and their conversations were brief.

But one Saturday, Macias recalled, Fischer asked to meet in his office to talk about the teen’s upcoming discharge. When the doctor closed the door, “I got this gut feeling,” Macias said. “This doesn’t feel right. I’ve only seen you, like, twice, and now you want to take me to your office?”

He remembers Fischer standing up several times to open the door, peek outside, then shut it. Eventually, Fischer put his hand inside his own shorts and stretched out his waistband to show he wasn’t wearing underwear, Macias recalled. Then he grabbed Macias’ head and pushed it down. Macias said he later left the room and took a shower.

He said he didn’t tell anyone what happened until November 2011, when he read a newspaper story about the accusations against Fischer. “I figured, OK, someone told. So now I have an outlet and I don’t feel so much alone.”

Macias says he met with Austin police and was later interviewed by investigators from the Travis County district attorney’s office. They believed his story: In the indictment filed June 14, 2012, Macias and four other young men were named as Fischer’s alleged victims.

Still, he said he fears others won’t be so convinced. “He’s a doctor, you know?” he said. “Eight or nine years of schooling compared to a bipolar and schizophrenic. Who are you going to believe?”

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