Patients Vs. the Public : Mental Case Law: Matter of Rights

When a psychiatric nurse at Woodland Memorial Hospital read a description of the suspect in the brutal bludgeoning of a University of California, Davis, physics professor two months ago, she was afraid she knew who the murderer might be.

And, indeed, a few days later, 24-year-old Jeffrey Gerard Jones, a former patient at the hospital, was arrested and charged with a series of claw hammer murders and attacks in Sacramento. He is the prime suspect in the killing at UC Davis, as well.

To nurse Kate Seiberth, the Jones case is a horrifying example of the weaknesses in the ability of California’s mental health system to hold seriously disturbed individuals for treatment. Only 17 months before the January slayings, staff members at the Woodland hospital had attempted such a commitment for Jones, who was hearing voices and was convinced that doctors had planted a radio inside his head.

Hearing Required

However, since Jan. 1, 1983, no mental patient in this state can be kept involuntarily beyond 72 hours without a hearing before an independent referee, who must determine whether the individual is a danger to himself or others, or so gravely disabled that he cannot provide food, clothing or shelter for himself.

Jones had such a hearing at the Woodland hospital in August, 1983, and the referee in the case released him. As Jones left the hearing, Seiberth said: “He turned to me and said, ‘I’ll get you.’ ”

Hearings such as the one that freed Jones from a psychiatric ward 18 months ago are the most recent addition to a series of proceedings intended to protect the rights of patients who are hospitalized against their will under civil commitment laws enacted in 1967. Under that system, the longer the commitment, the heavier the burden on the health professionals to show that the individual is dangerous, suicidal or disabled.

Hearings Needed

More than 72,000 times each year in California, individuals are held against their will for up to 72 hours for evaluation. Any longer involuntary stay requires a hearing, as well as an opportunity for the patient to take his case to court.

Today, many of the patients’ rights protections are under attack by psychiatric health professionals and by groups representing the families of the chronically mentally ill. They say that the state and the courts have gone too far in protecting the rights of patients, who all too often are unable to make meaningful decisions about their own care.

“The cases are handled in a typical legalistic fashion,” said a psychiatrist familiar with the Jeffrey Jones case. “They require proof of inability to provide, proof of dangerousness. The evidence must be very fresh, it must be persuasive to an attorney. The question of a person’s illness is not an issue. The question of a person’s competence to make a decision is not an issue.”

The same psychiatrist, who asked that he not be identified, spoke of a patient who was released, only to be picked up a few hours later when she was found eating garbage.

But patients’ rights advocates contend that present law represents a necessary balance of conflicting interests.

Something for Everybody

“There’s something in it for everybody and something in it to provoke everybody,” said Barbara Demming Lurie, patient rights director for Los Angeles County. “That may mean it is a good law, that everybody finds something to fire on.”

Lurie recently heard from a patient who had been held for 72 hours after a dispute with her husband. The patient, a successful businesswoman, said she was taken away last October at midnight by ambulance and locked up without ever being examined by the psychiatrist who signed the necessary papers or by any other health professional. The psychiatrist had simply accepted her husband’s version of her mental state, she said.

“I felt like I was living in Russia,” she said in an interview. “I felt all of my liberty and freedom was flushed down the toilet. I couldn’t make a phone call. I couldn’t post bail.”

As a result of the incident, the county in December warned psychiatric hospitals that they must evaluate all patients in person before holding them involuntarily, or risk losing county approval to make such holds.

Asking for Changes

But despite examples of what appear to be abusive commitments, such groups as the California Psychiatric Assn. are asking for changes in the law that would make involuntary commitments easier.

Critics of present commitment laws are not asking to turn the calendar back two decades to a time when patients could be held virtually indefinitely on the judgment of a psychiatrist. But they hope that changing standards will give treatment programs a chance to work.

While relatively few of the mentally ill are a physical threat to others, those who are become examples of the failure of the commitment procedures and state mental health system in general.

Despite changes in the law in the last few years to make it easier to commit potentially dangerous individuals and those who have, in fact, committed violent crimes, there is a growing concern that those laws are not working.

Governor Involved

Gov. George Deukmejian has said that he will sponsor legislation this year to make it easier to commit dangerous, mentally ill criminals, whose prison sentences are about to run out. The Department of Corrections has identified 150 to 175 violent, disordered individuals now in prison who are scheduled for release and cannot be committed for psychiatric care, according to Patrick Kenady, the department’s assistant director for legislation.

He said that the Administration is drafting a bill similar to one that Deukmejian backed when he was California attorney general. That legislation would have allowed the courts to commit violent offenders for up to two years at a time, either in a prison or a state mental hospital. The bill was vetoed in 1979 by then-Gov. Edmund G. Brown Jr. who said that “while the idea is lofty, all my experience tells me it won’t work.”

Civil libertarians and patients’ rights advocates already are attacking Deukmejian’s plan to revive the proposal.

Marjorie Swartz, an attorney and lobbyist for the American Civil Liberties Union, said that Deukmejian’s plan is unnecessary.

Numbers Decline

She points to a 1982 law that enables psychiatrists to use past history to show that individuals represent a “demonstrated danger of substantial physical harm to others.” But since its passage, the number of patients held has actually dropped--from 110 in the 18 months before the change to 86 in the 18 months afterward, according to a report by the state Department of Mental Health.

“I don’t know why they won’t use it (the new law),” Swartz said.

Sen. Robert Presley (D-Riverside) is proposing a bill similar to Deukmejian’s but he, too, is mystified as to why present laws are not working.

“We kept finding out that people were being released (from prison), who were obviously a danger to society,” Presley said in a recent interview. “There is a system that provides for that, but I’ve been told that the problem with that is that the Department of Corrections and the Department of Mental Health can’t seem to get together and work cooperatively and make it fly.”

Chaired Hearing

Last December, Presley chaired a Senate subcommittee hearing on the release of dangerous prisoners.

At that session, actress Theresa Saldana movingly described her own experience as a crime victim. Arthur Richard Jackson, convicted of repeatedly stabbing the actress, is currently being held in the psychiatric unit at the California Medical Facility at Vacaville.

Saldana testified that Jackson has sworn to kill her when he is released, which could come as early as Aug. 7, 1988, according to prison authorities.

“I can actually predict four years from today that Jackson will come out and murder me,” Saldana told the Senate panel. “And the people who make the laws and everyone who met me in the years before, will just shake their heads and say, ‘We knew all along he was threatening her, we knew all along that he exhibited psychotic, dangerous behavior in jail, and yet our hands were tied, we had no choice.’ But I’m still alive today and I think there is a choice.”

Sees Flaw in System

The state mental health director, Dr. D. Michael O’Connor, contended in a recent interview that insane prisoners are being transferred to state hospitals for commitment and treatment. But he admitted that the system may not be working as well as it could. New legislation, he said, “will clear the way, maybe even grease up the rusty gear . . . so that we can in fact maintain (dangerous offenders) in a secure treatment facility.”

At the same time, O’Connor and the department have placed a strong emphasis on patients’ rights in an effort to bring all the counties into compliance with state regulations.

“I feel that if we as a society are going to deprive people of their liberty, put them in a building and lock the door and tell them you can’t come out, and, in addition, we’re going to force upon them, and I mean force, the use of powerful medications . . . then we probably owe them a real due process.”

But O’Connor agrees that the standards of evidence are too rigid for keeping individuals who require long-term, involuntary hospitalization.

Particularly Dangerous

He described the case of a Napa State Hospital patient, Clarence Eugene McCutcheon, who was admitted involuntarily for 14 days in 1982, when O’Connor was director of the hospital. The staff at Napa felt that the patient was particularly dangerous and went to great lengths to commit him.

But to keep McCutcheon for a longer time required signed affidavits by eyewitnesses who had seen his dangerous behavior, and the witnesses, including a psychiatrist, refused to cooperate, O’Connor said.

The hospital was forced to release McCutcheon, who three weeks later, in an incident at a Eureka trailer court, murdered three people, including the sheriff of Humboldt County. McCutcheon was fatally wounded by police.

The problem, O’Connor said, is that the test for long-term civil commitments is similar to that used in a criminal trial--the court must be convinced beyond reasonable doubt that an individual requires institutionalization. O’Connor said he would like to see that standard eased so that a preponderance of evidence would be sufficient for longer commitments. And, he said, he would make it easier to bring in patient histories. “In almost any county in the state of California . . . you have to talk about how this person is today, what his abilities are today, while medicated today.”

Begin to Look Improved

After a few weeks of hospitalization, however, even the most severe patients begin to look improved, O’Connor said.

That was the case with Daniel Lee Young, the mentally disturbed man, who on the eve of the 1984 Summer Olympics plowed his car through a crowd of Westwood pedestrians, killing a 15-year-old girl.

Only a year earlier, Young’s family had taken him to the psychiatric emergency room at Harbor-UCLA Medical Center in Torrance, after Young had doused himself with gasoline in an apparent suicide attempt. He was transferred to what is now Hill View Mental Health Center.

Tried to Hold Him

The staff there attempted to hold Young for 14 days beyond the 72-hour evaluation period, on the grounds that he was both a danger to himself and gravely disabled. But a court-appointed referee found that there was no cause for keeping him, said Young’s psychiatrist, Dr. Jeffrey Weinberg.

“At the time of the initial evaluation, there were no indications that he was more dangerous than the average paranoid person who comes through here with a psychosis,” Weinberg said in a recent interview. “There are lots of people who look more threatening. The focus was on killing himself. There were voices telling him what to do.”

Many psychiatrists concede that mental health professionals have a poor record in predicting future violence.

Lurie and others point to a careful study of 967 patients released from two New York state hospitals for the criminally insane in 1966, after a U.S. Supreme Court opinion. All the patients were initially transferred to other state hospitals under civil commitment procedures. Four years later, one third of the group had been released from the hospitals.

In that period, only 26--less than 3% of the 967 patients--had committed acts that required them to be returned to the hospitals for insane criminals. Two of the returned patients had killed in that period.

Tricky to Predict

“It’s like predicting earthquakes,” said Sacramento County Deputy Dist. Atty. Albert Locher, who is handling the Jeffrey Jones prosecution.

Jones, who is now undergoing psychiatric examination to determine whether he is competent to stand trial, was under the care of psychiatrists as an outpatient at the time of his arrest for the claw hammer slayings, court records show.

Yolo County Dist. Atty. Dave Henderson is openly critical of both the psychiatrists who treated Jones and of the system that failed to hold him for treatment.

“The people who draft the laws believe there are a bunch of wicked doctors who want to incarcerate people forever on the ‘One Flew Over the Cuckoo’s Nest’ theory,” he said. “My experience is that doctors don’t want people to be there who don’t want to be there.”

One of the psychiatrists who had seen Jones before his arrest, Dr. Albert Globus of Sacramento, said that he has been advised by his attorney not to comment on the case. But he did say: “In a different age, he (Jones) would have been hospitalized.”

Next: The troubled system.