Falling Through the Cracks

On a sunny May afternoon last year, Marina Lynn Brandt hobbled up to the cinder-block entrance of the Union Rescue Mission in downtown Los Angeles’ skid row, asking for a bed.

She was thin and pale, her breathing heavy. Her only form of identification was a plastic hospital band on her right wrist.

Brandt told workers behind the glass contact window that she had been brought to the mission’s San Julian Street entrance by a hospital. One worker, Mary Witherspoon, said she thought Brandt looked too ill to have been discharged. An intake clerk began processing her.

Less than an hour after she arrived, Brandt, 45, collapsed on the floor near the front door. Paramedics tried to revive her, but she was pronounced dead that evening. The coroner later determined she had died of pneumonia.

“It was kind of devastating,” Witherspoon said. “I never had anybody that died like that. You know so little about them.”

Although local hospitals have denied dumping ill patients on skid row, several have acknowledged routinely transporting medically stable patients there if they have nowhere else to go. They have defended the practice, saying the area has the city’s greatest concentration of social service agencies.

But as Brandt’s story makes clear, some of the patients taken to skid row need more than social services.

The death made little news at the time, because it was a sadly routine occurrence on skid row. Like many who call the downtown streets home, Brandt was mentally ill, with a long history of drug use and the severe health problems that often accompany it. She had logged years on the streets of Southern California and been in and out of health facilities across the region.

But a closer look at Brandt’s story reveals how a patchwork system of mental health care and medical services for the indigent often fails some of society’s most desperate, virtually ensuring deaths like hers.

Traditional clinics and hospitals frequently are not equipped to deal with mental illness. Mental hospitals don’t necessarily have facilities to handle acute physical illness. At the end of her life, Brandt needed both.

“The health system does not work very well for such people,” said Marvin Southard, director of the county Department of Mental Health.

Marina Lynn Brandt grew up in a spacious ranch-style home in Westchester, with a badminton court and a pool in the backyard, the fourth of five children born to an aerospace engineer and his wife.

Brandt’s father, Ralph, could be loving and generous, said Laura Brandt, the youngest of the Brandt children. But he also suffered from bipolar illness, and his behavior could quickly turn frightening.

Sometimes, he set up a lawn chair in a busy intersection near their house, plunked down on it and opened a beer. Cars would have to swerve to avoid him -- and the police would eventually take him home.

“When he was stabilized, on his meds, it was great,” Laura said. “When the medication wasn’t working or it was time to get a dose adjustment, wow. It could be pretty scary.”

Marina earned A’s in high school and went to UCLA to study architectural drafting. But early in her freshman year, she began hearing voices while on campus. To her family, she seemed forgetful, distracted. They wrote off what they considered inconsiderate behavior as teenage moodiness.

Soon, though, they realized the problem was more severe. Marina tried to commit suicide by swallowing pills prescribed for her father. She wandered off for longer and longer periods.

On one occasion, a family-organized search party found her in downtown Los Angeles after a long absence. Her hair was matted. She was beaten and bruised. Her fingers had been burned.

Brandt dropped out of UCLA after the winter quarter of her freshman year. She was eventually diagnosed with schizophrenia, a chronic and disabling mental illness.

Downward Spiral

As the disease took hold, Brandt’s behavior grew more and more bizarre. She giggled in public, flirted with strangers who often had no idea of the depths of her illness. She was easy prey for sexual abuse.

She also became violent, lashing out at those around her.

Laura, who was 10 years younger than her sister, said Brandt would often get a crazed look in her eyes as the mania set in: “Her eyes would be dilated, glazed over. The adrenaline was pumping. She looked like a caged animal.”

Brandt got that look once at a family gathering just before she tried to choke her mother. It took three people to pin her down until authorities could arrive to take her in for psychiatric care.

She got that look again one evening, and her mother and sister had to flee the house to escape her rage. They returned to find the home ablaze with lights, the stereo blasting.

“I pretty much tiptoed” in, Laura remembered. “But she saw me -- she was still awake, and she came after me with two kitchen knives.”

In the first few years of Brandt’s illness, she racked up a string of hospitalizations, for both psychiatric and physical ills, as well as multiple arrests. By the end of 1983, it was clear she could no longer care for herself. She was put under a conservatorship, with the Los Angeles County public guardian’s office acting as conservator.

In a 1984 court filing, the deputy public guardian assigned to her case, Vaishie Lazaire, described the difficulty of overseeing Brandt’s care.

“She wanders the streets ingesting any and all drugs and alcohol offered her and is unable to obtain adequate food or shelter,” Lazaire wrote. “She has been repeatedly raped and beaten while wandering on the streets. She often refuses to eat for long periods of time because ‘voices tell her she is fat.’ ... Marina Lynn remains too psychotic to make rational decisions for herself.”

A Home in Pomona

In 1984, after years of struggling with his own demons, Ralph Brandt drowned himself in the family swimming pool.

In the wake of his death, the family established a special trust to help take care of Marina financially.

Her mother had pinched pennies for years to buy a string of houses, apartment buildings and land around Southern California. The sale of one of those properties, a house on Grimsby Avenue in Westchester, brought $121,000, which was put into a trust for Marina administered by the public guardian’s office.

That money, combined with a monthly disability stipend and occasional Christmas gifts of a few hundred dollars from Brandt’s mother, paid for nearly a decade of Brandt’s care, mostly at what was by then her full-time home, Landmark Medical Center in Pomona.

In retrospect, sister Laura said, the period at Landmark was the most stable in Brandt’s adult life.

But her stay was not entirely problem-free.

In January 1985, Dr. William E. Sigurdson, Brandt’s doctor, wrote that she was “confused and delusional. She frequently gets into fights, believing that people are talking about her. She ... could become violent, with resultant injury to self or others.”

A few years later, Brandt disappeared from the facility and wound up in San Luis Obispo; she was returned by Greyhound bus.

In January 1993, she was arrested in Glendale for public intoxication.

In 1995, the money from her father’s estate ran out. Soon after, she left Landmark. Laura Brandt said her departure baffled family members, but they suspected that her running out of money was a factor.

Rosemary Campos Kilby, Landmark’s administrator, said she couldn’t comment on the specifics of Brandt’s stay. But she strongly denied any implication that a patient would have been turned out for financial reasons.

She said that “most of the people who live here are on county funding.... If her money had run out, it would not have meant a difference to the facility.”

Regardless, life after her trust fund dried up proved far less stable for Brandt.

A String of Hospitals

After Landmark, the shuffle began.

Court records show that Brandt bounced around Southern California for the next nine years. She was in and out of mental hospitals, treatment facilities and regular hospitals across the Southland, including stops in Rancho Cucamonga, Whittier, San Gabriel, Venice and El Monte, among other places.

Family members tried to keep up with her movements but found it difficult, said Laura Brandt: “There were so many facilities, just too many to remember.

“Sometimes, the best night’s sleep I had was when she was in a locked, good facility,” she said.

The public guardian’s office recorded 70 addresses for Brandt in the time she was in its care.

Sometimes, the move from one facility to another came after Brandt got in trouble for drug or alcohol use.

Other times, she just walked out and disappeared for days or weeks at a time, unable or unwilling to return.

“That was a pretty common thing, where she would get lost from her own facility,” Laura said. “They moved her around so much, it would be easy for her to forget.”

In 2003, Brandt walked out of a Los Angeles facility, saying she preferred living on the streets. Almost three weeks later, she was admitted to a psychiatric hospital in Alhambra.

Later that year, she told workers at a Pomona board-and-care home that she was going out to a local 99 Cent store; the next day, they reported her to police as missing. She resurfaced a few days later at Kaiser Permanente in Hollywood.

As the years ticked by, Brandt’s physical health deteriorated. Life on the streets, between her stays in medical facilities, wore on her. She contracted HIV. She was diagnosed with breast cancer and in 2001 underwent a mastectomy. She suffered bouts of anorexia.

Brandt, who records show was 5 feet 5, weighed about 80 pounds in 2003.

The pace of her movement from one facility to another seemed to quicken late that year, six months before her death. She was admitted to Greater El Monte Community Hospital the first week of January 2004 to have an abscess in her chest drained. She told doctors she feared that her earlier cancer was returning, especially because her twin brother, James, had died of lung cancer in 1994.

After nine days, Brandt was moved to San Gabriel Valley Medical Center in San Gabriel, where she underwent psychiatric evaluation and treatment.

From there, she was moved to Brighton Convalescent Center, a long-term care facility in Pasadena. That stay was interrupted after six weeks, when Brandt started having seizures. She also was bleeding from her right eye.

At Alhambra Community Hospital, where she was treated, a doctor noted that in addition to previous ailments, she had multiple infections associated with methicillin-resistant Staphylococcus aureus (MRSA), an infection prevalent on the streets and in jails, and commonly seen in AIDS patients. She was severely anemic. She also had a shortage of all types of blood cells, including those that fight off infection.

Brandt was returned to the convalescent center four days later. But she was not a willing patient. She tried to refuse an IV from nurses. She wouldn’t wear a mask to limit other patients’ exposure to her infections. She threatened to leave the facility.

During this particularly difficult period in Brandt’s life, the public guardian’s office seemed to take very little role. Her file contains only two notations in 2004 before her death in May.

Citing privacy concerns, the office refused to comment on the specifics of Brandt’s case. But spokesman Chris Fiero said that dealing with mentally ill clients can be “extremely difficult.”

His office, he says, does “the best that we can to try to arrange appropriate living arrangements and appropriate care for all of our clients. But sometimes the needs of the client overwhelm our ability to adequately meet those needs.”

Residential facilities can also feel overwhelmed.

Steven Pavlow, the licensed operator of Brighton Convalescent Center, said in an interview that because Brandt had developed AIDS, his facility had no choice but to accept her as a patient when she arrived in February 2004. But he has doubts about whether centers like his are the best place for mentally ill patients.

“Under the federal guidelines, we have no choice,” Pavlow said. “And when there are psychiatric issues, you do the best you can.”

After changes in the laws about mental health care in the late 1960s, skilled nursing facilities like his, he said, “became sort of by default the facility for almost any kind of illness. We treat them medically, we have psychiatric consultations, but we have absolutely no rights as a skilled nursing facility to hold them.”

On April 12, 2004, Brandt left Brighton against medical advice.

Mysteries Remain

The final weeks of Brandt’s life are murky.

Late in the evening of April 29, she was admitted to the emergency room of Good Samaritan Hospital, west of downtown Los Angeles. She had a fever and difficulty breathing. By 2 a.m. she was back on the street.

Jess Beattie, a social worker in the emergency room, said the hospital provided Brandt with “medical care, food, new clothing and a shower” before discharging her.

“From my standpoint, the care was appropriate,” said Phil Fagan, director of the emergency room. “She was, on discharge, better than when she came in.”

Her whereabouts are unknown between then and 2:45 p.m. May 1, when she arrived at the Union Rescue Mission.

One intake worker there, Stephanie Davenport, says a man she thought might have been a taxi driver brought Brandt to the mission. Brandt said she’d been sent by a hospital and provided a doctor’s note, according to a mission log.

Mission officials say they don’t know what happened to that note, and the coroner’s office says it was not among her possessions.

At the time of Brandt’s death, her sister Laura was trying to locate her. In mid-May, Laura arrived home one evening to find a letter from the county coroner. Marina Brandt was dead.

She had died of lobar pneumonia, an ailment often associated with a compromised immune system. There was so much infection in her right lung that it weighed almost three times as much as her left. There were no alcohol or illegal drugs in her system.

Laura said she is appalled to think that a hospital might have abandoned Brandt at the time when she so clearly needed medical attention.

But the way the system worked, she said, “I am amazed that she lived to the age of 45.”