Thursday, November 21, 2013
Good morning:
Why was Gus Deeds released by the mental health facility?
Austin “Gus” Deeds, 24, was released from a mental health facility on Monday after undergoing a mental health evaluation to determine if he were a danger to himself or to others. The evaluation occurred at the end of a prior emergency commitment.
He assaulted his father, Virginia State Senator R. Creigh Deeds, with a knife on Tuesday morning stabbing him in the head and upper torso multiple times.
Gus committed suicide by shooting himself with a rifle.
His father was airlifted to the University of Virginia Medical Center in Charlottesville where he is now listed in good condition.
The Washington Post is reporting today that,
officials initially said the reason he was not admitted to a hospital was that no bed was available. But multiple nearby hospitals later confirmed that they had available space but were never contacted.
The implication in this statement is that a mental health professional determined that he was a danger to himself or to others and would have been committed but for the lack of a bed.
Three issues are raised by this statement:
(1) whether a mental health professional (i.e., psychiatrist) evaluated Gus Deeds and concluded that he was a danger to himself or to others (the implication is that this happened); and would have involuntarily committed him to a secure mental health treatment facility, but for the lack of an available bed; and
(2) whether Gus Deeds was released without checking with other mental health facilities to determine if they had an available bed, which would be patient abandonment; and
(3) whether Gus’s father was warned that Gus was dangerous and if not, why not?
I have previously written about a mental health professional’s duty to warn others in Is the University of Colorado Potentially Liable to Holmes’s Victims? I said,
In Tarasoff v. Regents of the University of California, 551 P.2d 334 (1976), the California Supreme Court created a new cause of action in tort for the negligent failure of a mental health professional to notify the police and potential victim regarding a threat to harm or kill communicated by a patient to the mental health professional. Before Tarasoff, mental health professionals were prohibited by the therapist/patient privilege of confidentiality from disclosing threats to harm or kill others uttered by patients during treatment.
The unique facts and equities of Tarasoffcompelled a majority of the California Supreme Court to ignore legal precedent and create a new cause of action against mental health professionals founded in negligence to compensate victims of violence committed by a patient under the care and treatment of a mental health professional who failed to warn the police and the victim of a threat to harm the victim uttered by the patient.
See also: Holmes: Does the Colorado Statute Bar Recovery?. Note that Virginia will have its own statute that may vary from the Colorado statute.
Virginia Governor Robert F. McDonnell (R) has ordered the Virginia Inspector General to find out why Gus Deeds was released.
“We’re going to investigate the circumstances that led up to Austin Deeds’s release at the expiration of the emergency custody order,” said G. Douglas Bevelacqua of the Office of the Inspector General.
Finally, please read this comment by Gytannia, a reader who commented regarding the Washington Post article:
Speaking from experience when someone who is mental “flips out”. It can happen very fast from calm to extremely dangerous. Like a light switch. The son could very well have been seemingly calm and cooperative all day Monday. This tends to convince the family that maybe they don’t need to be hospitalized. Especially a politician wouldn’t want public to know, so would put it off possibly. Then, when something in a conversation flips that switch or even if he sees something online, it’s game over for self control or decent behavior. While attacking, who or whatever is closest, it’s like watching a movie that you can’t stop, even if part of your brain is screaming to stop. Often the shame afterwards of acting like that and causing harm or fear to your loved ones is too much to take. Every time it happens, it takes another piece of your self worth, of self confidence, and soon you think you don’t “belong” among the “normal”. anymore. And you don’t want to harm your loved one..again. At the time, your brain refuses to think consequences or any rational thought, and there seems to be no solution short of drugs to make you drool into oblivion. Hence the suicide following the outburst. It seems that suicide is always the first thought after a big mental outburst of violence on a loved one.
We will have to wait and see the result of the Inspector General’s investigation, but right now the assault and suicide appear to have been preventable, but for the negligence of the mental health facility that released Gus Deeds.
Frederick Leatherman Law Blog 
http://www.nbcnews.com/video/nbc-news/53623576#53080265
Off topic, random music vid:
New post up:
Philip Chism indicted by grand jury today for first degree murder, aggravated rape and armed robbery
Having worked in a psychiatric hospital, I saw cases like this numerous times and am surprised that none of those patients have done what Deeds did. We have so many issues with our mental health system. We have the issues regarding a lack of communication as seen by this case. We have issues where families can and have seen members going down a bad path and not being able to do anything. We have patients who see themselves going down a bad path and not being able to get help. One of the saddest things that I saw was a patient who ran out of his medication for schizophrenia. Because he was going to a public hospital, he had to wait a few days for the county hospital to fill his script. He BEGGED for his script to be filled expeditiously. He BEGGED for an exception to be made for him. But the “one-size-fits-all” approach meant that he had to wait the requisite 48 hours to get his script filled. He was starting to have auditory hallucinations, but he was at the point where he could still realize that they weren’t real. Two days later he didn’t fill the script. Three weeks later, he was admitted to the hospital after being found by the police wandering around and talking to himself. He seemed nothing like the patient I saw 3 weeks prior. If someone would have just filled his script, that hospitalization didn’t have to happen. We have the fact that physicians don’t spend a lot of time in medical school learning about behavioral issues and once they graduate, they get no training in psychiatric issues because they are focused on their speciality. This is a problem because often physicians prescribe medications that feed the drug and alcohol addictions that all to often (but not always) go hand and hand with psychiatric problems. Often patients self medicate because they know something is wrong, but they don’t know what it is. So they turn to alcohol or drugs because those things actually help them feel better, even though it far from the optimal treatment. So we have doctors giving psych patients benzodiazepines feeding addictions. We have physicians prescribing Adderall in massive amounts that aren’t necessary because the patient may not have ADHD. They may have depression, anxiety, or bipolar. We have all of this going on in the midst of stigma associated with mental health. This stigma is not limited to patients, families and society as a whole, but there is still a strong element in the medical profession. I can go on and on about this subject.
OT, but Henry Butler was just convicted of Second Degree Murder in the killing of Everett Gant in Port St. Joe, FL:
http://www.wjhg.com/home/headlines/Butler-Trial-Testimony-Draws-Emotion-232750601.html
This was the case where Mr. Gant went to Butler’s door to ask him to stop using racial epithets against the neighborhood children. Butler shot him in the head, and Mr. Gant died 6 weeks later.
Reassuring to find out that at least one jury got it right in Florida . . . finally.
How did he get a gun?
FUCK the RKBA a since owning a gun is a menace to society.
My mom was a practicing Physician in the 1970’s & we would go to McArthur Park in LA & watch busloads of 10,20,30+ year institutionalized folks just pushed off the bus and into the park. To be fair, the legal costs of keeping these institutions open began to exceed their budgets due to the increased rights being forwarded to the patients. Fair enough, but no alternative was presented.
It’s never gotten better. Although I do believe those who can get care have much better options than the 1970s.
Malpractice. Straight up. They abandoned the patient, knowing he needed hospital admission. Big lawsuit, more than likely.
Agree
Professor, If you would take the time to look at this link and give your opinion of what impact you feel this will have on the topic we are discussing?
http://www.nbcnews.com/health/experts-praise-historic-mental-health-addiction-parity-rule-8C11565155
i know you were asking fred, but i think is great news. early intervention with affordable treatment could make a world of difference. the old system provided a bad cycle where treatment options were limited lead to less than desirable outcomes and then the downward spiral to joblessness, homeless …. and it just got worse from there.
fauxmccoy, While my comment was directed at the Professor, I do/always welcome others view points as well! I think this new action involving our health care is way past due, but I fear that in the rush politically to destroy the progress made by the passing of a health care (insurance) bill, will cause this to fall by the wayside… I’ve been asking those folks that I know that hate the ACA (ObamaCare) bill, and blame the rising rates for their personal insurance on that, if they actually think the insurance companies will lower their premiums if some how the bill is overturned. Most have no answer, but some think the insurance companies will drop the rates, when asked why they think that will happen, most simply say they heard they would on the TV or the Radio… I can only say if one truly thinks the insurance companies will lower their rates they need to buy a few ocean front properties in Iowa…
yeah, it’s a delimma. folks on the right offer up non solutions such as ‘tort reform’ or ‘selling insurance across state lines’. those to the left want ‘medicare for all’. bottom line for me, as one who has been bankrupted twice due to cancer (once as a young adult in college, second as a new mom of 2) no one else has offered up a solution that could possibly have passed in our current climate. i am simply on wait and see mode, but very heartened that no one will ever again experience the utter financial ruin that i did. folks really do not know what they have, until the lose it. sometimes, i’m all for the ‘hey, i know you don’t like it, but it’s ultimately better for us all, so suck it up, buttercup’ …. real mature, i know.
fauxmccoy, Read this article, it goes a ways toward exposing the true problems that are inherent in our medical community and health care in general in this nation.. It shoots many of the words of those who oppose the PPACA right out of the ballpark and exposes the hypocrisy of their goals..
http://www.nbcnews.com/health/what-makes-u-s-health-care-so-overpriced-its-not-2D11582695?lite&lite=obnetwork
nice article, crazy, it sure typifies my own experiences as what could only be described as a heavy user of medical services through no fault of my own. i have so many autoimmune disorders (in fact, my first cancer was hodgkins, a cancer of the lymph system, my immune system will be forever compromised). treatment kept me alive, but then led to numerous other difficulties. at age 40 i was uninsured and uninsurable. i know that i am not alone. so yes, i am one of those chronically ill folks, luckily now on medicare.
my experience has led me to be huge advocate for ACA, only because i personally know the horror of exceeding annual and lifetime minimums within a matter of days. i think that ultimately, when the website thing is under control, that most people will like the new protections the ACA offers.
it’s easy for some to criticize it, but unless they are offering a viable alternative, i tune them out.
thanks for the article, i’ll bookmark it and look into it more in depth (yes, i admit to having read it quite rapidly 😉 )
I support the ACA requirement that mental illness should be treated the same as any other illness. I believe we would see fewer crimes committed by mentally ill people, if the cost of mental health counseling and medication were covered by insurance.
Professor, Thank you for your response. Now if we could just solve the problem of health care for many older citizens surviving on SS who have Medicare part A, but lack the funds to pay for Part B! There are a lot of people who live (?) on SS that don’t qualify for assistance with the premiums associated with Part B. Many don’t seem to realize that SS is not in any way security, it is in a lot of cases the only thing allowing them to even eat or have a place to sleep, much less pay in some cases over 10% of their income for a step up in their Medicare Insurance. Then if they do get sick, they have a difficult time getting admitted to a hospital because many of them are now requiring the deductible be paid up front in non emergency cases… Isn’t it amazing that we live in such a great and allegedly Christian nation that so many of our citizens don’t even have access to basic health care! I don’t think anyone could consider the treatment that one receives in an “Emergency Room” at the local hospital as truly health care…
It is so sad when mental illness causes so much pain that one decides to take their life.
I grieve for Gus and the pain he suffered with.
i know my father, even at his most unhinged, could always keep it together during a 72 hour involuntary hold. he’s not the only one, unfortunately. it was shortly after one of these temporary holds that he held a gun to me all night. even with that traumatic event on record, the county did absolutely nothing.
i do not long for the old days of family members being able to secure permanent involuntary commitment. i acknowledge that the mentally ill have rights. i do wonder though if we’ve made any progress at all in maintaining that delicate balance and tend toward the ‘negatory’.
Community based treatment for the mentally ill was supposed to replace locking them up indefinitely in mental hospitals, but there has never been sufficient financial support by federal and state governments to make that system work.
Now the mentally ill cycle in and out from jail to the street and back in a never ending cycle.
That’s how we “treat” our mentally ill.
yup, fred. at the time of my dad’s first breakdown, reagan was governor in CA. ‘deinstitutionalization’ was a topic around the dinner table when i was a youngster.
in many ways, he was fortunate. the IRS took full responsibility for his illness, because it was they who sent him to vegas to audit the mafia run casinos. his life and family were threatened routinely. even after a transfer back to their LA office, he was not able to escape his demons. he was put on early retirement, so he had a decent income. my mom also earned a good living as a nurse, but the whole family disintegrated when i was 17. if not for that federal retirement and the wise investments he had made as a stable CPA, things would have been much, much worse.
i am glad that i came to forgive him and that we could spend the last 20 years of his life enjoying each other’s company. it was not always easy, but definitely worth it. my children have nothing but wonderful memories him and that is priceless.
My father was fortunate to have been a veteran. While the VA system has many flaws, he at least had some backup with his bipolar issues and we were able to mostly enjoy him into old age too, but it wasn’t until his 40s that science had figured out what to do for it. Thanks for sharing your story.
I have a cousin and a son who tragically wander the streets at times because they won’t consent to much but minimal treatment and noone can commit them, and of course, they think that not much is wrong with them. It’s a widespread problem.
tragic stuff, two sides, that i know.
on the bright side, my husband and i knew we were meant for each other when one day, we began comparing leather goods that each of our respective bi-polar parent had made in ‘the nuthouse’ as jim’s mom called it.
in 18 years, absolutely nothing has shocked us regarding our in laws. nothing but love and acceptance, here.
LOL – my dad wove throw rugs in what he also called the “nuthouse” or “nervous in the service.”
oh dear, oh dear, oh dear
hello fellow traveler … how lovely that we can look book and find some humor in the whole thing. i cannot imagine life without humor, it’s what keeps me hanging on.
get this — my dad made holsters and rifle scabbards. yes, they let him make accoutrements for his arsenal. go figure. they are exquisitely beautiful, he was a gifted craftsman. it does make me question the validity of the doc’s license, in retrospect. oh, i do have a lovely western style, hand tooled handbag … so i got that going for me. i hope you have a throw rug or two.
peace be with you, friend.
Will we as an allegedly civilized nation ever accept that we have a problem with the lack of mental health treatment? I suppose it is easier to ignore the problem than it is to attempt to find a solution. Ok, that must have been a moment of complete insanity, how dare I think this nation should spend a little of the tax payers money for the benefit of the tax payers mental health…. Only when corporate America decides they can make unlimited money off this problem will anything be done….
Privatization of the prisons with contracts that impose fines on the states for failing to keep the prisons full is corporate America’s “solution.”
Our so-called civilized nation must first deal with the CAUSE of so much craziness before it deals with treatment.
We must acknowledge that the original “founders” of this country were the crooks and the unbalanced and the liars of their land of origin. There was probably a celebration when they left for “the New World.”
We must acknowledge that America was not discovered-it was stolen. The atrocities heaped on native Americans THEN have serious consequencs even to this day. Americans of African descent were stolen from their native land never to be returned again. Their language, their culture, their dignity, their sense of family, their freedom was taken from them. PTSD is real-but PTSS [Post Tramautic Slave Syndrome] is also real and has been passed down from generation to generation. For instance, I was not a slave, nor was my deceased grandfather-but his mother was. I had conversations with him decades ago about slavery and his anger/sadness/hurt was evident. He was a gentle man, and I had never seen him angry until we had these conversations. My father was a very angry man, and I was an angry person for the 2nd and 3rd decade of my life. i was saved from this anger because I learned that writing my truth was more powerful than violent behavior.
We must acknowledge that we are not a country whose government and policies exemplify our so-called Christian values of love, acceptance, and peace.
Lastly, we must acknowledge that we cannot be the role model to the world until we get our own house in order. We cannot tell other countries to respect us when it is obvious to them that for the last five years many Americans do not respect our duly elected President simply because he is Black. We must be truthful about our racism, sexism, classism, xenophobia and homophobia. Once we honestly acknowledge our deficits as a nation, we can start to solve our mental health problems-one person at a time, one household at a time, one neighborhood at a time, one city at a time, one state at a time.
I agree with most of what you say, but I don’t believe we must limit ourselves to a one-step-at-a-time approach to solving our problems.
Individuals can and should multitask. Those who are farther along the learning curve can work on improving themselves in multiple areas while teaching others to do the same by example.
We are NOT civilized. Never have been. We have lots of laws to oppress less than desirable people according to many in the majority race. Makes them feel all superior.
FUCK the USA. Evil in America is winning.
No
This is a sad case but the coverage of it because of who was involved may lead to reforms. Let’s hope so.
Sometimes it takes the death of a so-called “important person” to effect change.
Hopefully this case will make a difference. With many emotionally challenged people in my family, I’ve had lots of personal experiences with the US mental health care system. The statistics are shocking – the number of beds in mental health facilities has consistently shrunk year by year since the 60s. It’s difficult to get quality care even if you have the money to pay for it. This says a lot about the skewed priorities of our culture.
not to mention that health insurance for mental illness is a cruel joke in itself, should the sick person even have insurance. 20 visits a year is the norm and at much higher co-pays than for other diagnoses. i fail to see how this can even benefit those who are on the edge, but for whom immediate treatment could make a world of difference.