DADE CITY, Fla. (AP) -- An inexperienced health care caseworker who visited a client at his home knew there was something that made her "very uncomfortable" about the 53-year-old man, even writing in his file that two people should visit him in the future.
Yet 25-year-old Stephanie Ross went alone to Lucious Smith's apartment Monday morning, and police said the ex-con with a history of violence inexplicably chased her down the street, stabbing her to death with a butcher knife.
Ross' death underscored the dangers of in-home visits by social workers and health care professionals. Some states have added safeguards to prevent attacks, such as pairing them up with another worker for home visits or assigning a police escort, but the additional measures are sometimes too costly for states and private companies.
"It may be if the risk is too high you don't send two people out, you ask the client to come in or meet in a different place or postpone the visit," said Tracy Whitaker, of the National Association of Social Workers. "Unfortunately, the money gets found after there's a tragedy."
Smith was being held without bail at the Pasco County jail on a first-degree murder charge. It is unclear whether he has an attorney.
Ross became a service coordinator for Maryland-based Integra Health Management in September and wanted to help people with chronic illnesses, the company said in a statement. She had been on the job for about a month when she first visited Smith in Dade City, a small city about 30 miles north of Tampa.
Afterward, Ross wrote about being "very uncomfortable" with Smith, according to Dade City police officer Brian Uppercue, who said authorities reviewed the file. It's not clear why Ross went there by herself Monday or what his illness was.
Smith was well known to police. Authorities had received "50 or 60 calls" about him since 2006, ranging from trespassing to battery to drunken, disorderly behavior, Uppercue said. Neighbors said he argued with nearly everyone around him and was banned from a nearby convenience store.
"She faced a real danger dealing with this man," Uppercue said. "He was a disagreeable guy."
He served seven years in prison for aggravated battery with a deadly weapon and was released in 2005. Smith lived in an apartment complex with other people who had disabilities, said Victoria Farkus, 40, who lives across the street.
Farkus and her niece were home Monday when they heard someone screaming, "Help me, help me, help me." Farkus said she initially thought her Chihuahua had bitten someone, but looked out her window and saw Smith chasing Ross.
Smith stabbed Ross several times, Farkus said, and a motorist who happened to be driving by saw her bleeding and drove her to the hospital. Ross died a short while later.
"I'm still shook up," said Farkus, giving an uneasy glance at Smith's apartment building. "I don't think I'll ever be able to get that out of my head."
Smith just sat outside his apartment after the stabbing, she said, and a few minutes later, police arrived.
"We knew right away that he was involved," Uppercue said.
Ross worked at a central Florida high school before being hired at Integra, which says it provides "a more integrated, collaborative and comprehensive approach to managing the health needs" of an insurance company's "most costly and complex members."
"This is an especially tragic loss," Dee Brown, Integra's chief operating officer, said in a statement. "Stephanie joined Integra to improve the lives of disadvantaged people struggling in the community with chronic illnesses, and believed strongly in our mission and goals in serving these individuals."
Brown told the Lakeland Ledger that Ross visited Smith four times. Brown told the newspaper Integra staff members are trained that if they are ever concerned for their safety, they can have other staff accompany them on their visits. Brown wouldn't comment on Ross' specific case.
Advocates have long pressed for better security measures for social workers and home health caseworkers who are frequently sent into potentially dangerous situations. Some note that social workers go into homes armed only with clipboards and laptops.
In 2004, Teri Zenner was fatally attacked with a knife and chain saw while visiting a client in Overland Park, Kan., to make sure he was taking his medication. The attacker was later convicted of first-degree murder and sentenced to life in prison. In 2010, the state's governor signed a law requiring social workers to take six hours of safety awareness the first time they apply to have their license renewed.
In an email, Brown said the company was helping law enforcement.
"We take the safety and well-being of our employees very seriously and are committed to assuring ongoing compliance with existing safety practices and incorporation of measures that might further reduce avoidable risk to our employees," Brown said.
Kennedy reported from Miami.
Follow Tamara Lush on Twitter at https://twitter.com/tamaralush .