|
Death in the Family
Aided by advocates for the mentally ill, William Bruce left the
hospital -- only to kill his mother
By ELIZABETH BERNSTEIN and NATHAN KOPPEL
The Wall Street Journal
August 16, 2008; Page A1
On June 20, 2006, William Bruce approached his mother as she worked at
her desk at home and struck killing blows to her head with a hatchet.
Two months earlier, William, a 24-year-old schizophrenic, had been
released from Riverview Psychiatric Center in Augusta, Maine, against
the recommendations of his doctors. "Very dangerous indeed for release
to the community," wrote one in William's record.
William Bruce, left, with his father, Joe Bruce, who feared his son's
release from a psychiatric facility.
But the doctor's notes also show that William's release was backed by
government-funded patient advocates. According to medical records, the
advocates -- none of them physicians -- appear to have fought for his
right to refuse treatment, to have coached him on how to answer
doctors' questions and to have resisted the medical staff's efforts to
contact his parents. As one doctor wrote, William told him his
advocates believed he is "not a danger, and should be released."
William's father, Joe Bruce, obtained his son's medical records from
Riverview eight months after the killing. "I read through the records
and I just remember crying all the way through," Joe Bruce says. "My
God, these people knew exactly what they were sending home to us."
Helen Bailey, one of William's advocates, declined to discuss the
details of his case but says the handling of it was consistent with
her professional duties. "My job is to get the patient's voice into
the mix where decisions are made," says Ms. Bailey, an attorney with
Maine's Disability Rights Center in Augusta. "No matter how psychotic,
that voice is still worthy of being heard. I have not had the person
who is so out of it that they can't communicate what they want." She
added that the records reflect the doctors' perception of what
happened.
The story of William Bruce -- based on medical records made available
to The Wall Street Journal -- as well as interviews with relatives,
doctors, advocates and hospital administrators brings into sharp focus
the impact of a little-known government-funded advocacy program for
psychiatric patients.
Attempt to Curb Abuses
Congress created the national Protection and Advocacy for Individuals
with Mental Illness program, or PAIMI, in 1986 to curb abuse and
neglect of the mentally ill, primarily in institutions. In the 1960s
and 1970s, many abuses were uncovered at hospitals, where patients
were physically restrained, neglected or overmedicated.
The PAIMI program, operated by the Substance Abuse and Mental Health
Services Administration with a 2008 budget of $34.8 million a year,
funds protection-and-advocacy agencies in each state. Typically
nonprofits, these groups sometimes receive supplemental funding from
states. According to a 2007 SAMHSA report, the agencies served 19,000
people in 2006.
Some doctors, hospital administrators and mental-health veterans argue
that advocates are endangering the mentally ill and the public by too
often fighting for patients' right to refuse treatment. Many advocates
"have a strong bias," says Robert Liberman, a director of a
psychiatric rehabilitation program at the University of California,
Los Angeles.
"I don't know if they are doing people a service when they assert the
right of mentally-ill individuals to remain psychotic," says Ron
Honberg, director of policy and legal affairs for the National
Alliance on Mental Illness, an education, support and advocacy group.
Proponents of patient advocates say they're essential to protecting
the rights of the mentally ill. The National Disability Rights
Network, which provides lobbying and other services for the patient-
advocacy system, says advocates play a critical oversight role.
They cite the 2006 sentencing of the owners of a Kansas treatment
facility on charges that they subjected patients to forced labor and
involuntary servitude, and a class-action lawsuit alleging that female
patients of the Lincoln Regional Center in Nebraska were raped and
assaulted by a male staff member. The latter case was settled in 2007
with the hospital, which denied liability, agreeing to more thoroughly
investigate assault complaints.
The mentally ill are "very vulnerable," says Curt Decker, executive
director of the National Disability Rights Network. "There needs to be
an external, independent, legally based advocacy system to make sure
they are being treated fairly, equitably and safely."
John Morrow, senior public health advisor at SAMHSA, declined to
discuss the Bruce case. But he says advocates serve a very important
function, and that the organization has resolved thousands of cases of
abuse and neglect.
In recent years, there has been a wave of legislative efforts, many
inspired by violent crimes, to make it easier to mandate treatment for
the mentally ill. Advocates have blunted those efforts in California,
New Mexico and Michigan.
In Michigan, advocates successfully pushed for limits to a 2005 law --
proposed after a schizophrenic killed a young man -- mandating
outpatient treatment. "They have a left-wing, individual-rights-at-all-
costs agenda," says Virg Bernero, mayor of Lansing, Mich., who helped
pass the law when he was a state legislator.
"Our legal mandate is to protect the rights of individuals," says
Elmer Cerano, executive director of Michigan's PAIMI chapter. But, he
says, "rights are limited when it comes to safety."
Despite advocates' objections, Joe Bruce -- with the help of his pro-
bono attorney, Robert Owen of Fulbright & Jaworski LLP in New York --
successfully lobbied the Maine legislature to pass three bills. One
gives mental-health professionals greater leeway to disclose patient
information to those who may be affected by that person's conduct.
Another makes it easier to medicate involuntarily committed patients.
William Bruce grew up in Caratunk, Maine, a picturesque town of about
110 residents nestled in the state's northern hills. His father, a
rugged, talkative man, worked as a senior technician for the Maine
Department of Transportation. His mother, Amy, served as the town's
treasurer. The oldest of three boys, William grew up in a 100-year-old
farmhouse that sits on the banks of the winding, rock-strewn Pleasant
Pond Stream.
Even when Willy -- as he was known as a boy -- was young, "there was
just something different about him," his father says. Although cute
and energetic, William was hyperactive and deeply self-centered, his
father says. And he could turn suddenly violent: When he was four, he
pushed his younger brother down the stairs. At five, he broke the same
brother's leg, his father says.
As an adolescent, William was handsome, popular with girls and deeply
troubled, attempting suicide at 14. He would sometimes see therapists,
but would quit and stop taking any prescribed medication, Joe says.
William's behavior particularly pained his mother. Tanned and
athletic, Amy loved kids, often hugging her own and opening her home
to neighborhood children. But Joe says she was seldom able to
emotionally connect with her eldest son, and repeatedly blamed herself
for his problems.
After dropping out of high school, g
|
| |
| |
|
