Unmasking "Dr. E"

This article will include general, non-graphic descriptions of abuse. Linked material may include outdated language, descriptions of abuse, and disturbing images; if so it will be labeled with a warning.

Behavior analysts are required to be instructed in ethics as a portion of their graduate training. Many are assigned an excellent book on the topic, Ethics for Behavior Analysts, by Jon S. Bailey and Mary Burch. In the first chapter, there is a baseline justification for ethics – whether laws, a code, or even personal values. One particular unethical event is used as an illustration of the need, and as a catalyst, for formalized ethics. This is typical in other fields; similar books in the field of medicine might include a story about the Tuskegee Experiment. An excellent (short) summary of many of these events, in medicine and in ABA, is here.

The story included in the Bailey & Burch book centers on Florida. It was the 1970s, and American society was vastly different in how it treated people with developmental disabilities. This was at the dawn of the deinstitutionalization movement; people with disabilities still often lived in large, state-run institutions. The quality of these institutions varied wildly, with some notable examples like Willowbrook (link includes a few disturbing images and descriptions) on Staten Island rife with abuse, neglect, and an utter lack of care or treatment.

The widespread practice of behavior analysis at that point was relatively new, with JABA being founded in 1968. At the same time, behavior change had been demonstrated in institutions for two decades. There was an excitement around the possibilities – people were once classified as “untrainable,” or “vegetative,” but were learning. There were also large groups of people, concentrated in specific locations, few concerns about consent, and an extreme need for compassionate treatment. However there was an utter lack of licensure, certification, or even qualification for “behavior modifiers.” 

Many people were, predictably, bad. Many people also did innovative and excellent work, but there was no standard per se.

We’re suddenly in a time where a huge, vulnerable population is available for an unstandardized treatment delivered by people of varying training and qualification. This brings us up to speed with Bailey & Burch’s story: Sunland Miami.

Sunland Miami was one of several Florida state facilities for people with developmental disabilities. Prior to the Sunland nomenclature, there was a single state-run facility, the Florida Farm Colony, in operation from 1921. Admissions to the original Sunland center began in approximately 1957, and the eventual demand for placement led to a high of six open centers with nearly 6,000 residents. Placement continued beyond the 1980s. Shortly after Sunland Miami opened on July 1st 1965, a series of scandals plagued the center, which was composed of 42 “cottages” with approximately 900 beds. In fact, scandals touched virtually all the Sunland centers throughout the state. All of the scandals were precipitated by either cruel and bizarre punishment inflicted upon the residents, or a general neglect. Bailey & Burch report that in 1969, the superintendent was pushed to resign after isolating two residents in a trailer (Bailey & Burch are incorrect and it occurred in 1967 – it appears they are repeating an error from the McAllister report on Sunland Miami). Strange, because the “cottages” themselves, as they were euphemistically titled, had “detention rooms.” And in 1972, Bailey & Burch describe, there was the wide-ranging inquiry that led to the ouster of a director, two employees, and one “Dr. E,” who was purported to be a behavior modifier and created a treatment plan that devolved into punishment-as-treatment. The punishments were cruel, inhumane, and shocking.

A blue-ribbon commission put the spotlight on these circumstances, exposed it for what it was, and soon after the Florida Association for Behavior Analysts formed and adopted an ethics code, and the Sunland centers closed. And that would wrap up the story, if not for the internet. 

The mystery that sent me down this wormhole in the first place: Why did Bailey & Burch disguise the name of “Dr. E”? A quick Google can lead one to contemporaneous accounts that one “Dr. Dennis Edinger” (warning: mild descriptions of abuse in this link) resigned after the investigation. According to Bailey & Burch (quoting from the McAllister report) he filed a grievance related to a work reassignment, which led to an initial investigation – which, while it found that he was reassigned without following official administrative procedure, also found that reports of abuse needed to be immediately investigated. Shortly thereafter a commission was formed, an investigation took place, and a report was issued. The McAllister report, and widespread knowledge of the abuse at Sunland Miami, sprung out of Edinger’s initial grievance. The year after Sunland Miami, Edinger appeared to be working at Western Illinois University (possibly until 1979?). In the late 70s, he was also working in an intervention program for rural children with special needs. Around 1979, Dr. Edinger got a teaching position at Morehead State University. When his contract was not renewed between academic years, he sued; he got his job back, but sued again when he was not granted tenure. He lost, then lost his appeal in 1990, and no further employment record is identified. He posted prolifically in a listserv about celeration, starting around 2004. He died in 2016.

He published few things before separating from Morehead State. But apparently he had a small impact in precision teaching/celeration, mentioned in a 2007 blog post here; mentioned as helping collect celeration resources here; acknowledged in this 2018 book. Some comments from various PhD/EdDs on a memorial page here – including one that he “studied” at the University of Kansas with Ogden Lindsley. His PhD dissertation was completed in 1969 at the University of Florida, and Hank Pennypacker is thanked (and even quoted, opposite the table of contents), as is Ogden Lindsley. Bailey & Burch note that nobody would “claim him as his student” (p 20). But based on the internet trail, he at least “studied under” Ogden Lindsley (he claims Og personally taught him at least some things, but according to McAllister’s report Edinger was prone to exaggeration. Then again, here is Og himself recognizing Edinger.), earned a PhD at the University of Florida, and came in contact with Hank Pennypacker (here is Hank correcting an Edinger story, but the gist is that they knew each other at UF). I don’t think Og or Hank were responsible for Edinger (and perhaps they didn’t formally teach him at all per se), though I wonder about the expediency of disclaiming a relationship – or even if the McAllister report stretched the truth to discredit him. The oft-cited report by J.W. McAllister (1972) was not found on the internet; a contemporaneous summary is here (descriptions of abuse). The McAllister report (descriptions of abuse) was found after a request to the state of Florida, and is now posted and available for you to read. It is an interesting document but also well-summarized by Bailey & Burch.

Was Dr. E responsible for what happened at Sunland Miami? It seems that contemporary sources don’t question his culpability and subsequent resignation (under threat of termination). Yet he was not found guilty of a crime, nor did he face sanctions beyond his dismissal. All contemporary reports make it clear that he was not responsible for prescribing specific punishments; rather, there was a kind of extreme treatment drift from a recommendation of “natural consequences.” In fact, he did not personally design the token economy at all, and simply took over the program a year prior to the investigation. Reports often note that he designed the program, which seems to be an honest mistake arising out of two facts: Edinger was a “behavior modifier,” and there was a token system used. Most people seem to have made the logical inference that due to these facts, Edinger designed the token economy. He definitely should have recognized and corrected the flaws, but he was not the designer. Unfortunately, there does not seem to be a record of who designed the system, or who immediately preceded Edinger in his role. Changing a bad system is very hard and reports do not indicate that Edinger even made any efforts – but technically, it was designed and carried out by other people altogether. Perhaps he was simply the manager best suited to take the fall. The official report was never going to blame poor systems, as that would have made the case for closing Sunland centers.

But examining that 1972 summary (again, descriptions of abuse) or the McAllister report certainly reveals some damning facts: the punishments were typically recorded in a ledger. Part of the reason that the investigation found evidence was that it was written down in detail. The writing was even used as evidence to exonerate two employees who, it was argued, would have tried to hide their behavior if they knew it was wrong. And Dr. E had been at Sunland for more than 1 year – long enough that staff and parents witnessed abuse. “Times were different,” but by any standard, the punishments that were recorded were unquestionably abusive. At best, Dr. E seems to have been negligently uninvolved; at worst, he gave the impression that he approved of the practices. (One parent reports that Edinger threatened to harm her son if she did not help him get reinstated. This is simply a report and was apparently not investigated.) The same could be said of the superintendent, Arnold Cortazzo, who signed at least one logbook entry.

In a bit of an irony, Arnold Cortazzo (warning: mild descriptions of abuse in this link) was the superintendent during the 1972 investigation. Also in 1972, he published a manifesto arguing that superior outcomes in Sunland Miami were due to the innovative supervisory structure: rather than a strict vertical hierarchy focused on custodial care (e.g., “warehousing”), there were co-equal centers that focused on treatment and worked as teams. He even reports data showing improvements on assessments. He reports that they engaged in innovative staff training. Further, he examined whether staff liked the changes, and data showed that they found the system acceptable. Frankly, relying solely on these written reports from Cortazzo, Cortazzo’s system sounds excellent for that time period (Cortazzo system superior, claims Cortazzo). Ultimately Cortazzo bore responsibility for the failings of the system, but it’s a twist in the story to find that he was committed to effective treatment. At the same time, surely a fatal flaw in the system was a lack of coordinated and regular oversight – the very hierarchical system he claimed to be against. In the McAllister report, it is noted how the centers were “siloed” and evaded scrutiny by virtue of their independence. Strong coordination between the centers was deliberately avoided, but it’s clear in hindsight that this was a mistake.

Despite a damning 1972 report, the various Sunland centers remained open for years after, apparently without major changes. A committee report in 1974 claiming that all centers were overcrowded, and that some buildings were in need of replacement. A hepatitis outbreak in 1974, along with allegations of group assaults (warning: outdated language and descriptions in this link); during this investigation, conditions were found to be “poor.” Inadequate pharmacy records in 1975, making it nearly impossible to confirm if residents were given the correct drugs (originally flagged in 1972 and uncorrected 3 years later). The Fort Myers center buying animal-grade bran for residents in 1977. Due to a class-action lawsuit by Sunland Orlando residents in 1979 most of the centers closed by 1980, and yet some continued in diminished form. An ongoing battle over excessive tube feeding, even despite a court order, in 1983. The Jacksonville center with a death rate 5 times that of comparable facilities, due to understaffing, in 1984.

Sunland Miami was gone by 1982 – because it changed its name to “Landmark Learning Center” in an effort to change…the culture? The bad coverage? But in 1992, the director of Landmark Learning Center resigned due to unreported abuse that sometimes resulted in death, while housing less than half of the 1974 population. Another scandal in 1995, and another class-action lawsuit in 1999, and finally Sunland Miami was gone. In the year 2005.

Eventually, all but one Sunland center closed permanently. Many of the buildings were destroyed. The comfortable story of progress is that we discard bad actors, bad practices, and move forward in linear fashion. The report arrived, people were horrified, and the institutions folded under the pressure. 

The uncomfortable story is that all of the Sunland centers continued for more than 12 years after the publication of McAllister’s report, and Sunland Miami for 33 years. The successful 1979 lawsuit was based on issues at Sunland Orlando – the Miami scandal was not a factor. The 1999 lawsuit was based on Sunland’s failures, but decades after the McAllister report. Sunland Miami’s McAllister report was not the catalyst for closure. The bad actors were discarded, but things didn’t meaningfully change. There was no revolution, but rather a gradual shift in societal attitudes towards the people housed at Sunland. 

The McAllister report, and the Sunland Miami scandal, definitively did not lead to the closure of the Sunland centers, which was actually precipitated by later class action lawsuits. The McAllister report definitively did not trigger the formation of the first ethics code in behavior analysis, which was released in 1988. But if you look long enough into this abyss, you may see: Sunland Miami almost definitely did lead indirectly to the first ethics code in behavior analysis. It brings us back to Jon Bailey.

The name of the primary dormitory in the Sunland Miami scandal was Flagler cottage, with some unspecified participation from Leon and Desoto cottages, and termed by Edinger “Achievement Division.” At first glance this sounds like a bizarrely ironic euphemism – but surely this is a reference to the Achievement Place, a famously successful experiment that created the teaching family model and strongly influenced Boys Town. Achievement Place was an early demonstration of the power of the token economy in an institutional setting. Edinger must have been aware of the experiment while he was at Kansas with Og Lindsley. Jon Bailey would have been familiar as a fellow student at Kansas, as he himself worked on the Achievement Place. And Bailey, just a few years after Edinger, also traveled from Kansas to Florida, where he taught at Florida State. Then in Florida, reported in all the major newspapers, a peer from UK using all the terminology of behavior analysis and being involved in this ethical violation – this must have made an impact on Bailey. And in 1988, when FABA creates their first ethics code, Bailey is the purported author. Perhaps the Flagler cottage incident was not a catalyst to close Sunland, but it surely stood out in the memory of at least one Floridian, 16 years later.

Perhaps the Sunland Miami scandal didn’t result in direct action in 1972. Perhaps it did strongly influence the FABA, and later BACB, ethics code. There is a streamlined retelling of history that is not uncommon – the assassination of Archduke Franz Ferdinand was the single catalyst for WW1, for example. There are many reasonable criticisms of how history is shaped, but ultimately a story will be told, and often it will necessarily be simplified. My own critique, alluded to earlier, is that the simplified story elides important details in a way that allows the reader to feel relieved and superior. Dr. E was responsible, he was eliminated, and things improved. I believe that Dr. E was not solely responsible, but was a part of a dysfunctional system. After he was eliminated, things did not improve. Personal ethics cannot overcome a significant system. Society has not moved past the problems of Sunland Miami. The McAllister report was created by a system that found it expedient to blame individuals without criticizing the system, which became the official primary documentation of history. The full story, decades later, can never be told – but perhaps this is one step closer.