Rights of the Mentally Ill: Cases Renew Old Concerns

When California in 1967 enacted its landmark law to protect the rights of the mentally ill, critics direly predicted that hordes of dangerously disturbed people would roam the streets and perhaps harm others.

While that has not happened, two recent incidents in Los Angeles have raised new questions about the adequacy of the law, which also was intended to protect the public by allowing doctors to commit people they feel are a threat to society.

At the heart of the current controversy are the difficulties inherent in trying to balance the often conflicting needs and rights of individuals and society. But the law provides no easy answers, as the two recent cases show.

In the first incident, Joseph Edward Markowski, 29, was arrested June 25 and charged with four counts of attempted murder for allegedly selling blood that was tainted with the AIDS virus and for allegedly having had sex with a fellow transient.

Police had referred Markowski to psychiatric hospitals seven times since February, most recently on June 23 when he was held only one day at County-USC Medical Center, although legally he could have been kept under observation two more days without further authorization.

Release Called ‘Irresponsible’

Dist. Atty. Ira Reiner later lambasted county doctors for Markowski’s early release--despite a written warning from police that Markowski had sold blood contaminated with the AIDS virus. Reiner called the action “irresponsible” and said it had threatened public safety.

In response, Dr. John Ray, County-USC’s chief psychiatrist, explained that Markowski was released “because the law allows a person to be held only if he has a mental disorder and is dangerous because of that mental disorder, not because he has AIDS.”

Markowski is awaiting a mental competency proceeding to determine if, indeed, he is mentally fit and able to stand trial.

In the second case, David Columbus Hasson, 33, an unemployed auto mechanic with a history of mental illness, was hospitalized at Martin Luther King Jr./Drew Hospital on June 17 after his father and a friend told police that he was trying to run people down in his car.

Psychiatrists at the hospital held Hasson for 72 hours and then obtained legal authority to hold him 14 days longer. But they released him July 1, four days sooner than was required of them. Two days later, Hasson sped through an intersection, broadsiding a car and killing four of its occupants and critically injuring another.

Hasson was charged with four counts of gross vehicular manslaughter while intoxicated and felony driving under the influence of alcohol.

Under California law, people believed by police or relatives to be a danger to themselves or to others because of mental illness may be held against their will for evaluation and treatment for up to 72 hours. This evaluation is conducted in a hospital by mental health professionals. The law applies also to people who are unable to feed, clothe or shelter themselves--a category known as the “gravely disabled.”

If doctors decide that individuals in these categories need further observation and treatment, they may keep such patients an additional 14 days--but only after a Superior Court hearing officer grants permission. During these informal proceedings, the hearing officer must determine that there is probable cause to hold a patient.

If the additional 14 days is granted, the doctors may discharge the patient at any time during the 14 days or, after the two weeks, seek an extended commitment. They also may allow the patient to remain on a voluntary basis for as long as necessary.

In order to hold a patient up to 180 days on grounds of dangerousness, doctors must persuade a Superior Court judge or jury that the patient is mentally ill and, as a result, a danger to others.

‘Almost Impossible’ to Obtain

According to Ray, the County-USC psychiatrist, such proof is “almost impossible” to obtain. He said many of the patients brought to County-USC have chronic disorders that cause them to become assaultive, but only occasionally. For example, he said, alcohol or drugs or confrontations with family members may trigger the aggression, but then it will subside during the initial 72-hour or 14-day hold period.

Ray said the prospect of trying to persuade a court that such patients meet the law’s requirements often causes doctors to believe that such an effort is a waste of time and they simply do not bother.

An estimated 28,000 people were held for 72 hours in 1986, according to David H. Guthman, head of the district attorney’s psychiatric section. Of these, he said, 13,567 were granted 14-day holds, but county doctors filed petitions for 180-day commitments for only 10 considered to be dangerous to others. An additional 3,012 were found to be gravely disabled, and they can be kept indefinitely, although their cases must be reviewed annually.

Guthman said doctors may be reluctant to request the 180-day petitions because of the extensive medical documentation required and because many of them think these patients belong in jail, not in a hospital.

In 1983, the commitment law was amended in an effort to make it less difficult to commit a person for 180 days who is believed to be a threat to others. Before the change, such a person had to be in “imminent” danger of inflicting harm on others; now the law requires only that such a person has a “demonstrated” potential to be dangerous.

Despite the easing of the grounds for holding people against their will, Ray said that in practice “the court looks at what it sees at the moment of the hearing” when deciding whether the individual should be held longer. Doctors, he said, feel they could spend the time better treating patients than preparing the detailed affidavits required by the court, especially when they believe the time would be wasted.

Crowded Conditions Cited

Ray said the task of evaluating patients, which ideally should take place in a reasonably orderly environment, has become increasingly difficult because of crowded conditions caused by insufficient government funding.

He said there are times when 10 or 15 patients need evaluation, but there is insufficient space for them all. “They sleep on the floor or in chairs. There may be only one psychiatrist for 10 patients,” he said.

A report prepared last December by the county Department of Mental Health at the request of the Board of Supervisors found a need for 300 more beds for severely disabled people and an additional 300 beds for treating patients on 14-day holds.

The 1967 law was passed to correct civil rights abuses suffered by thousands of Californians annually who were committed to state mental hospitals by relatives or various government agencies who found it easier to have them committed rather than to provide them with the kinds of social or medical services they needed.

A legislative report that preceded the law’s enactment had said citizens “are often illegally detained in poor facilities . . . fail to receive adequate legal counsel and are committed indefinitely in 4.7 minutes” of court proceedings at which a “presumption of insanity permeates.”

According to the state mental health director at that time, 14,000 of the 22,000 admissions to state mental hospitals in 1966 had been ordered by the courts.

The remedial Mental Health Act of 1967 drastically reduced the number of people who could be committed while, at the same time, thousands of people were released from state hospitals into the communities.

Today, according to the state Department of Mental Health, only 5,000 mentally ill patients are in state hospitals and only half of them were ordered there by courts. (Most of the rest are convicted criminals who are mentally ill.)

Funding Level Criticized

The 1967 law, hailed as the “Magna Carta of the mentally ill,” was written with the intention that the supportive care, which many formerly hospitalized people continued to need, would be provided at expanded community mental health centers. Community mental health experts say that funding for these centers has not kept pace with the need.

Meanwhile, various interest groups that include psychiatrists, relatives of the mentally ill and patient groups are advocating changing the law again. One proposal would permit people to be committed before they have a psychotic episode and another that would lengthen the time that individuals may be held against their will. But not everyone is critical of the present law.

It represents a “delicate balance” between individual rights and society’s need to protect itself, said Sue North, consultant to Assemblyman Bruce Bronzan (D-Fresno).

“It’s very hard to strike more balance than is already there,” she said.

Times staff writer Terry Pristin also contributed to this story.