SALEM, Ore. -- Gino Puglisi, a patient in the Oregon State Hospital's program for the criminally insane, used pay phones to run up sports-gambling debts and to get escape help. He got a cell phone, $1,000 cash and hacksaw blades in the mail, according to a state police investigative report obtained by the Statesman Journal.

Puglisi, 39, escaped in February by cutting through a security fence with bolt cutters supplied by a hospital employee and was caught nine days later.

He wasn't done. And he wasn't alone.

In October, police arrested two people who drove to the hospital in a stolen car said to contain cutting tools and methamphetamine, apparently to help him escape again.

More: Two arrested for trying to help mental patient escape

He has since been transferred to the state prison system after conviction on drug charges stemming from the escape.

"He was a handful," said Maynard Hammer, the hospital's interim superintendent. "That last one took some doing."

The report says that in the last two years, a dozen forensic patients, some with extremely violent pasts, have escaped. Other patients have smuggled in drugs, weapons and other contraband. Some developed romantic relationships with staff members.

Most forensic patients are there because judges found them guilty but insane for crimes ranging from shoplifting to murder. The 460 patients in the ward exceed the budgeted limits by about 30.

Program managers and staff juggle dueling responsibilities in a cramped, outdated facility that is part prison, part hospital.

Hammer said nothing prevents patients from using phones to gamble or get contraband.

"They have phone privileges unless there's something particular that causes them to lose them temporarily," Hammer said. "We have some patients that tend to like to dial 9-1-1."

Few patients match Puglisi's talent, Hammer said, but said Puglisi was not unique.

"They're intelligent folks. They know the street. They know how to manipulate and organize things," he said. "Sometimes, they keep us on our toes."

On the night of his escape Puglisi persuaded a staff member to open a door leading to a fenced recreation area. Puglisi cut through the security fence and raced to a nearby getaway van.

A former patient identified as Mary Flynn became acquainted with Puglisi and played a key role in paying off his gambling debts and supplying him with contraband.

"Ms. Flynn said she would get instructions from Mr. Puglisi about what to do, what to buy and how to send it or who to send things to," a state police detective wrote.

Flynn said she paid off the gambling debts with money orders to the Philippines and Costa Rica. Flynn reportedly told investigators he threatened to send people to harm her if she did not comply.

Puglisi's bolt cutters reportedly were supplied by a former hospital employee who worked there for five months in 2004. He arranged for the getaway van by phone.

Last month Christopher Walker got away by closing a door on his staff escort while on supervised leave.

Walker, 46, with a history of murder and arson, slipped away from his guard while on a day pass to his mother's care facility in Portland.

He fatally stabbed his girlfriend almost 20 years ago during a drug-induced psychotic episode.

When he escaped, the guard called the state hospital but nobody called police for at least 45 minutes. He was caught the next morning.

"We're reviewing our own procedures to make sure we're following what we should be following," Hammer said.

As forensic patients undergo treatment, community outings play a role in preparing them for release, hospital officials said. In a typical month, they said, hundreds of patients take part to visit relatives and libraries, shop or look for eventual work.

There are few problems.

Richard Laing said he escaped because he was frustrated by futile efforts to win his discharge from the review board.

On Nov. 18, 2005, Laing failed to return from his unsupervised pass, ostensibly to visit a library. He was collared two years later in Portland.

Most escapees are caught within hours, or days.

After the Walker case hospital officials temporarily suspended pass privileges for many patients but continues them for patients scheduled for release.

Still, the clamp down prompted grumbling.

"It's like a concentration camp," Reynaldo Rios said, calling the Statesman-Journal from the forensic ward.

Hammer said Walker's escape seriously raised questions about staff diligence and one-on-one supervision.

"I had a question myself when it was reported to me: Why did we send him up there with one escort? That doesn't necessarily speak to how dangerous the patient is. It speaks to the fact that anything can happen with one escort."