Rosalie Crawford was found wandering around a men's bathroom at San Diego's Lindbergh Field last Aug. 8, saying that witches were after her.
The 58-year-old Long Beach grandmother was locked in the psychiatric unit at UC San Diego Medical Center, where doctors say she continued to be delusional for more than a month. Repeatedly, her attorney says, she asked to be released and refused to take medication. But she was kept locked up anyway, and was injected with psychotropic drugs when she wouldn't swallow them.
A judge finally ordered her release Sept. 21, and she went home to Long Beach.
Nine months later, on June 15, a San Diego County Superior Court jury awarded Crawford $52,778. The jurors concluded that the hospital falsely imprisoned her and committed assault and battery when its employees forced medication on her during the last part of her stay there.
The case has touched a sore point in the mental health community, and those familiar with the case are fiercely taking sides. The verdict is being lauded by some as a victory for the legal rights of the mentally ill in California. It is being lambasted for tying the hands of those who want to help the mentally ill.
It could be years, lawyers say, before a clear answer emerges to a difficult question: Are there circumstances in which it is proper for doctors to keep a mentally ill person locked up, even after the law says the person must be released?
"In a courtroom, 12 jurors said a mentally ill person does have stated wishes," said Evvy Garrett, a longtime San Diego activist for mental health rights. "To us it really signifies a slight turning in the thinking of the general population toward the mentally ill. And it's real significant."
Dr. Allan Adler, medical director at Alvarado Parkway Institute, a psychiatric hospital, is outraged by the decision.
"What it does is put the hospitals and the physicians in the position of really practicing with not looking at the interest of the patient, but looking at all these legal things," said Adler, who testified for the defense in the case.
"Theoretically, if a patient says, 'I'm going to go kill someone,' you can't stop him because the 14 days (that he can be held in the hospital) are up."
During the trial, UCSD had contended that, because of her paranoid schizophrenia, Crawford might be dangerous to other people as well as to herself.
Even those who take a less dramatic view of the case acknowledge that it illuminates a dilemma in state mental health law that in recent years has caused hospitals to sometimes hold the mentally ill longer than is allowed by law.
"I'm not condoning this practice, nor am I saying it's commonplace. But I've certainly known it to occur," said Barbara Lurie, the head of the office in Los Angeles County that is charged with protecting the rights of mental health patients.
"I think when facilities do it, they know they're on pretty shaky ground and they shouldn't be doing it, but it's like they have no real legal recourse, and it's a very unusual and compelling circumstance," Lurie said.
When patients are detained longer than is legally permissible, part of the reason is concern for the patient and part is concern over a hospital's financial liability if the person is released and harms himself or others, those familiar with the case say.
Lurie gives this reconstruction of what a hospital's lawyer might say:
"Look at your liability in both directions. Let's say we release this guy and he kills five people. We get all the accompanying horrible headlines and then we get sued by the families of these people. Then look at the other side--you'd be sued for false imprisonment. And how much is the jury going to award for that?"
In the case of Crawford, it was $52,778.02--which neither she nor her attorney, San Diego lawyer Michael Coleman, will see until the case goes through what could be a long appeals process. Crawford could not be reached for comment, but her lawyer says she has made it clear she wants to pursue the case.
"I'm not going after the money. I'm going after the principle of it," Coleman said. "It's frustrating that they still won't acknowledge that they did violate the law, and violated this woman's rights."
Under mental health reforms passed in 1969, the Lanterman-Petris-Short Act, mentally ill people in California can be held against their wills for 31 days.
This includes 72 hours on an initial emergency hold, followed by two 14-day periods that depend entirely on the person meeting specific legal definitions of being in grave need of treatment.
During the 31 days, a court can order that a mentally ill person be given a conservator authorized for up to a year to consent to treatment for the patient. Conservatorships can only be granted for a person the court deems unable to provide food, clothing and shelter for himself; being suicidal is not included as a reason.
Occasionally, a hospital will encounter a patient who has no conservator but who doctors feel should not leave the hospital, even though the 31-day involuntary treatment period has expired. Most commonly, it is because the patient is suicidal.
It isn't often that someone reaches 31 days without having a conservator, though. In San Diego County there were only 16 cases in 1989 of people for whom courts authorized involuntary treatment for the full 31-day period. Statewide, the number was about 250, out of 90,000 instances a year in which mentally ill people are initially held.
But, in such cases, hospitals and patient advocates acknowledge, a hospital may opt to keep the person beyond the 31 days and file a writ of habeas corpus on the patient's behalf--asking a judge to tell the hospital whether to release the patient.
During trial on the UCSD case, the county's chief patient advocate for the mentally ill, Richard Danford, was asked to sanction it.
"I think the counsel for the hospital wanted me to say that it's an accepted local practice to hold somebody without authority to do that, and then file a writ on their behalf. But I refused to say that," Danford recalls.
Still, both Danford and Lurie say these legally questionable holds on patients do happen.
"If the facility just can't let the person out on the street, their hands are tied, they feel bad about it, this is like a real unusual occurrence and the facility really has a record of protecting patients' rights and is trying to act in good faith, we won't jump down their throats," Lurie said. "However, if we find that this is more or less a pattern then, yes, certainly we'll do something about it."
In Crawford's case, she was kept in a locked ward at UCSD Medical Center in Hillcrest, first on a 72-hour hold, then under a 14-day authorization. During that period, a temporary conservator was appointed until a hearing could be held on whether a one-year conservatorship should be granted.
Because Crawford lived in Long Beach before her hospitalization, a court hearing on the permanent conservatorship was scheduled in Los Angeles County. But Crawford's UCSD doctors believed that she was too ill to go to the hearing Sept. 15.
When she didn't appear for the hearing, the conservatorship proceeding was dismissed, and the hospital no longer had any authority to hold her, Coleman successfully contended in court.
But the hospital kept Crawford while it filed for a writ of habeas corpus on her behalf. Judge J. Perry Langford granted the writ, ordering her release on Sept. 21.
The judge "acknowledged plaintiff's need for hospitalization but lamented the lack of any further statutory basis for holding her," UCSD said in its trial brief.
Coleman noted that his client returned to Long Beach after being released and did not require hospitalization again for about four months. She is now living independently, with her daughter as her guardian, in Long Beach, he said.
It was in the six days between the time the conservatorship proceedings terminated and the time Langford ordered Crawford's release that she was confined illegally and made to take medication that she expressly refused, Coleman said.
The jury agreed. It named Dr. David Braff, Dr. Eve Dreyfus and the UC Regents responsible for assault and battery against her. Only Braff and the regents were judged responsible for the false imprisonment.
UCSD's lawyers unsuccessfully contended that Crawford was so ill that she could not take care of herself. In addition, they said, hospital officials weren't notified of the end of the conservatorship and, in any event, they were immune from suit because of the hospital's government ownership.
Now that the verdict is in, the hospital is considering asking Superior Court Judge Alpha Montgomery to rule UCSD immune from the suit, order a new trial or to overturn the verdict, said attorney Robert Cosgrove. If those avenues fail, it might appeal to a higher court, he said.
While Crawford's case appears to be a unique combination of red tape and muffed procedural steps, the issues it raises apply more broadly, mental health advocates say.
Holding a patient beyond the legally prescribed time will occur most commonly with suicidal patients, Danford said.
"The law allows for a suicidal person to be held against their will a grand total of 31 days," he said. "At the end of that time the law doesn't say what you're supposed to do. So, if you have someone who's on day 31 going to walk right out of the hospital and head right for the bridge, you've got a problem."
Alvarado Parkway's Adler has another scenario.
"From now on, when I have a case like this, I'll phone the court and say, 'This is my problem. You guys decide what I should do,' " Adler said.
"And, if they tell me to let her go, I will document that in the chart, and I will cover myself legally that way. Because, if she leaves and kills her next-door neighbor, her next-door neighbor's lawyer, I guarantee you, will sue us. And they'll probably win, too."
Danford said he thinks the UCSD case will make hospitals in San Diego, and perhaps elsewhere in the state, more cautious.
"I think they're going to pay closer attention to those situations where it doesn't appear that they have authority to continue to hold somebody--whereas prior to this they might have been more willing to hold them to see what happens," Danford said.
George Root, an attorney for many hospitals in the county, as well as for the county hospitals association, calls the case an unfortunate precedent.
"The case dealt with the part of the law that there's just simply no answer to," Root said. "Most of the facilities in town would have done much the same as University did to try to protect the patient."
UCSD spokeswoman Leslie Franz says doctors there are not operating under any new policies as a result of the case. They will continue to do what's best for patients, she said.
A UC system lawyer, Andrea Resnick, suggested that the solution is for mental health law to be changed. The law now gives responsibility for a mentally ill person to the person's home county, even if the person is hospitalized elsewhere. If Crawford's conservatorship hearing had been in San Diego instead of Los Angeles, Resnick said, there wouldn't have been a problem.
In the meantime, there will still be a few people doctors think belong in the hospital but who legally should be released, those involved say.
"You can draw a parallel with the criminal justice system," Lurie muses. "Sometimes, criminals who are very dangerous get released on a technicality, and you know that they're going to harm somebody else, but the courts have no recourse because a law is a law is a law. And the question is, should that standard apply to mental health?"
Says lawyer Coleman: "What's bothersome is that . . . facilities in San Diego County are just disregarding the law and getting away with it. They're basically saying, 'We're doctors and you're mentally ill patients, so we're going to do what we think is best for you, and tough.'
"Mental health clients are people, and they need to be respected as such, whether they're in the hospital or out."