Tragedy follows landmark court win

ON a crisp afternoon last fall, a police officer responding to a 911 call pulled onto an abandoned military base on the eastern edge of San Francisco Bay. Six dreary naval housing blocks, converted into apartments for down-on-their-luck veterans, had been painted with labels meant to inspire: Hope, Resolve.

The door to Apartment B, in the building called Courage, was open. The man who had summoned police, Kanuri Qawi, was waiting casually in the doorway, a glass of soda in his hand.

Qawi invited the officer inside and began spinning a wild tale. Intruders, he insisted, had entered his apartment. They had robbed him of $300, then stripped him naked, strapped him to a flatbed truck and paraded him through the streets. As Qawi talked, incense burned, but it could not hide the smell. It was the smell, the officer knew, of decaying flesh.

The officer asked if he could have a look around, then pushed open the door of an empty bedroom. Qawi’s roommate, John Laird Milton Sr., was lying on his back, his body stiff, his face blue. His blood was splattered three feet up the wall. Next to the body were his glasses and one white sock. An autopsy would reveal that he had been stabbed seven times, once in the heart. He had been dead about a week.

Interviewed by investigators, Qawi was consumed by what he described as an elaborate conspiracy: how staffers at the apartment complex had called him a homosexual; how they wanted to kick him out because he had been “contaminated” by radiation during the Chernobyl meltdown.

Police quickly realized that Qawi, 46, was suffering from delusions. What they didn’t know that day was how long and hard he had fought for the right to have them.

Qawi was a notorious figure in California mental hospitals. His nine-year legal battle had taken him all the way to the state Supreme Court, where he had won the right -- for himself and hundreds of other mental patients -- to refuse to take the psychiatric drugs prescribed by doctors.

His case was a seminal chapter in the campaign to modernize mental health treatment and give patients more control over their bodies. And in key ways, it helped transform California’s mental hospitals, with a growing number of patients rejecting their drugs, suffering psychotic breaks and lashing out in violence.

At the police station that evening, investigators struggled to get Qawi focused on their case: When was the last time he had seen Milton? Had they quarreled? Finally, Qawi offered his theory: Probably, he said, the people who were out to get him had attacked Milton by mistake.

“Damn, man,” he said under his breath. “They hurt John.”

A solid student

KANURI Qawi started life as Kenny Washington, an average kid from an unusual family.

As if their 14 children weren’t enough, Kenny’s parents, Alma and Calvin Washington, also took in a host of foster children at their home in Arcadia, Fla.

Calvin Washington was a railroad man who laid track across the South. He was known in the community as “Granddaddy” and served as a church deacon. The family lived rent-free in road master houses and station houses owned by the railroad; Calvin Washington felt so indebted to government-sponsored New Deal work programs that he named one of his oldest sons Franklin Delano, as in Roosevelt.

“We didn’t hardly want for anything,” said Franklin, now 67 and a retired sheriff’s deputy.

Kenny didn’t have many friends but seemed like a normal kid. He developed into a powerful athlete, running track and playing high school football. A solid student, he read books about religion and listened to gospel music and rapper MC Hammer.

Kenny’s family began to notice that something was amiss in 1987, toward the end of his six-year career in the Coast Guard and Air Force.

Summoned to Florida, where Calvin Washington was dying of prostate cancer, the siblings were devastated -- except for Kenny, who was inappropriately joyful. Later, at the funeral, he was withdrawn, disconnected from reality, Franklin said.

Back at his military base in Turkey, Kenny changed his name to Kanuri Qawi. He told his siblings that he had turned to Islam because he was unfulfilled by Christianity.

Soon, Qawi was out of the military for good. Court records show that he began drinking heavily. Then, on a chilly night in the fall of 1990, his life took a sharp turn.

Robert Lakeman and Mary Miller were strolling home in downtown Oakland after a late meal at a deli. Miller felt dizzy and leaned on a wall to catch her breath.

Suddenly, there was Qawi, striding toward them across the street -- 29 years old, 6 feet tall, muscular, shirtless. According to court records, he said something about how blond women had caused the Vietnam War. He kicked Miller in the face, then turned on Lakeman. By the time bystanders could intervene, Lakeman was nearly unconscious. Miller’s nose was broken, her front teeth loose.

Qawi was taken into custody half a block away, his jeans and tennis shoes spattered in blood.

In prison, he became gripped by paranoia. He had a “magician” wife who bound him and injected him with cocaine. In a memo, he ranted: “I want diet special food hot.... I do not want special food hot made by the Black family gang.”

Twice, records show, he tasted freedom. Paroled in 1993, he lasted less than a month; police found him lying on the sidewalk and sent him back to prison after he spat on an officer. The next year, he was paroled again; this time, he was picked up after seven weeks on suspicion of stalking a clerk at J.C. Penney and threatening to place her under a “voodoo curse.”

He was scheduled for parole one more time, in 1995. By then, though, his illness had made authorities nervous about freeing him again. Under state law, parolees with a mental illness that makes them dangerous can be confined against their will to a mental hospital rather than released to the streets.

Qawi was sent to Atascadero State Hospital, a mental institution north of San Luis Obispo, where he was diagnosed with paranoid schizophrenia and put on an antipsychotic drug called Mellaril, according to medical records introduced in court.

New drugs bring hope

When they first became available in the 1950s, antipsychotic drugs held immense promise -- even offering the hope of a cure for severe mental illness.

But it soon became evident that the drugs were not a panacea. Although for some patients they relieved the worst symptoms, they also came with debilitating complications that caused many to reject them.

Over the course of his confinement -- at Atascadero, then San Bernardino’s Patton State Hospital, then Napa State Hospital -- Qawi was given at least seven psychiatric drugs, records show. He complained about all of them and developed many side effects: muscle stiffness, sexual dysfunction, high blood pressure, high cholesterol.

Qawi responded with a barrage of lawsuits against the state challenging every aspect of his confinement -- his criminal conviction, his diagnosis, the juries that had kept him in the hospital. Mostly, however, he focused on medication. In 1995, just months after arriving at Atascadero, he argued that the drugs being forced on him represented a “sufficient intrusion upon bodily security” and a violation of his constitutional rights.

Although his doctors noted some improvement from the medication, Qawi focused on what he saw as an unacceptable bodily invasion.

“I suffered permanent nightmares, a swollen tongue and a hindrance of my thought process,” he wrote in his first court petition challenging the hospital’s right to medicate him against his will. “To what extent can a involuntarily committed patient be forced against his will to take antipsychotic drug for paranoid schizophrenia without due process of law?”

The first 17 cases Qawi filed, handwritten petitions that shifted between rational legal arguments and rambling conspiracy theories, went nowhere. But over years of representing himself, he began to refine his analysis. Embedded in his later filings was a studious review of the law. Qawi cited U.S. Supreme Court cases and deftly dissected the California statute that had led to his confinement.

A court petition in 2000 was rejected like the others. But when Qawi took the case to the 1st District Court of Appeal, a panel of three judges took particular note of a single sentence: “The hospital does not hold any due process hearing to determine if I can be medicated against my will.”

The next winter, the judges surprised the legal community by issuing a one-page order to the state asking why Qawi was not entitled to such a hearing.

Amid rising concern about psychiatric drugs -- and the contention that forced medication strikes at the foundation of constitutional rights -- a series of court decisions had given more and more patients a voice in determining the course of their treatment.

Now Qawi was arguing that the same principle should apply to patients like him -- who had been paroled to California hospitals from prison after committing violent acts. To state officials, that was going a step too far. They pledged to fight.

The state, argued Deputy Atty. Gen. Angela Bothelo, had a societal obligation to make patients like Qawi less dangerous. The purpose of Qawi’s drug regimen, she wrote in one court filing, “is precisely to avoid a recurrence of the violence that led to his ... commitment in the first place.”

But Qawi’s lawyer, Renee Torres, argued that just because Qawi had been involuntarily confined did not automatically mean he was incompetent to make rational decisions about medical care.

The appellate court ruled in Qawi’s favor. In 2004, the state Supreme Court weighed in: Qawi and other patients like him could be involuntarily medicated only if the hospital could prove that they were incompetent or sufficiently dangerous.

In a lone dissent, Supreme Court Justice Janice Rogers Brown lamented the likely consequence.

Without treatment, she said, patients would never get well, leading back to the “warehousing” system that mental health providers and lawmakers had tried so hard to dismantle. Indeed, in hundreds of pages of legal wrangling over Qawi’s rights, no one, not even his own lawyer, ever thought he would be released.

Refusing to admit illness

PATIENTS such as Qawi are not simply locked up forever. To keep him in custody, prosecutors had to prove once a year that he would pose a “substantial danger” if released. For years, when it came to Qawi, that was an easy case to make.

Though most experts agree that schizophrenia cannot be cured, they believe it can be controlled, provided that the patient acknowledges his illness. On that count, Qawi failed miserably.

Throughout his confinement, he refused to admit that he was ill. Graded at one point on his ability to recognize his disease or the violent behavior it had caused, he scored zeros. While other patients took part in exercise classes and attended relapse prevention groups, Qawi focused his energy on his legal challenge.

Even with medication, he suffered some delusions; he insisted that he had 9-year-old triplets, that he had a degree in virology, records show. But his most distressing delusions -- the vivid hallucinations that had caused him to act in the past -- seemed to be suppressed by the drugs. Closely monitored, his every meal and activity planned, he was withdrawn and guarded and spent his days watching football on TV or listening to music.

But on several occasions, according to court records, when Qawi “cheeked” his meds -- pretending to swallow his pills -- he deteriorated and began having paranoid hallucinations.

One afternoon at Napa State Hospital, he sought out a psychiatric technician to report that another staffer had stabbed him in the forehead with a scalpel.

“You can see the blood all over me,” he said, pointing to his head, which bore not the slightest scratch. “All you people want to do is cover up.”

Each year, in arguing to keep Qawi confined, prosecutors and doctors had dangled the prospect that he would surely discontinue his medication upon his release. In January 2004, his psychiatrist predicted during a hearing that if Qawi were released and stopped taking medicine, “he would be truly very psychotic” within three or four months.

Soon after that hearing, after the Supreme Court ruled on his case, the Court of Appeal ordered the hospital to quit forcing Qawi to take his antipsychotic drugs. With careful management the staff was able to keep him relatively stable during the months that followed.

Late that year, hospital officials asked the district attorney once again to make the case in court for Qawi’s continued confinement. But by then, prosecutors had a problem.

Qawi had been off his medication for nearly a year. His hospital caretakers had always warned that “if he doesn’t take this medicine, he’s going to blow up like Vesuvius,” said Deputy Dist. Atty. Scott Swisher, who helped run the unit in charge of mental health cases. “Well, they stopped giving him the meds,” Swisher said. “And there was no Vesuvius.”

The prosecutors, convinced that this time they could not win, refused to make the case that Qawi should be held for another year.

And so, on Feb. 17, 2005, he walked out of Napa State Hospital, a free man for the first time in 11 years.

Gets ‘mellow’ roommate

QAWI had big plans, or so he told his brother. At the end of 2005, he showed up at Franklin Delano’s door near Monterey and said he was headed to Ethiopia. He’d become fixated on the region, convinced it was the resting place of the Ark of the Covenant. With fanfare, he told his brother: “This is going to be your last time seeing me.”

Instead he landed at a shelter in Oakland and then, last summer, at the door of an organization called Operation Dignity, founded by a Vietnam veteran who struggled himself with addiction, mental illness and homelessness before sobering up 27 years ago.

According to police documents, the Department of Veterans Affairs, which provides some funding for and oversight of Operation Dignity, conducted the only assessment of Qawi’s mental health upon his arrival. It lasted 15 minutes; a VA social worker described it as “more paperwork than an in-depth evaluation.” Neither the VA nor Operation Dignity knew about Qawi’s history of violence and resistance to medication or the extent of his mental illness.

Operation Dignity routed Qawi to its least restrictive facility -- Dignity Commons, the complex at the decommissioned base in Alameda -- because VA social workers “felt like he was a good mix,” the documents say.

Dignity Commons was full of troubled souls: veterans, by and large, who believed that they had been abandoned by the country they served. Most residents were on medication for mental disorders.

“The common bond here is that we’re all veterans,” said Operation Dignity founder Alex McElree. “At some point we had discipline. And together we’re going to get it back.”

To build some semblance of independence and community, Dignity Commons tries to match roommates with complementary personalities -- “a stronger person with a weaker person,” McElree said, “so they can have some support when we’re not there.” Qawi was intense. John Milton, McElree said, was “mellow.” In July, they were placed together.

‘Pops’ and his struggles

JOHN Milton was born in the Midwest in 1946, the youngest of seven brothers. His teenage years were happy ones, centered on girls, cars and Motown. After high school he enlisted in the Army and made staff sergeant as an armored tank commander. Later, back in Fort Wayne, Ind., he married and commuted with his father-in-law in the predawn darkness to pour molten iron for General Motors crankshaft castings.

His marriage didn’t last, but he loved his son and daughter dearly and moved to Oakland in 1975 to be near them. He would later have two more children.

Known as “Pops,” he was even-keeled and tender, always “right there when we needed to talk,” said one of his sons, John Milton Jr.

In basketball games when John Jr. was young, Pops pulled out the stops to win. He’d crack jokes, step on his son’s toes, yank at his shorts. Be a provider, he told his son. Do right by the ones you love. Be strong.

But he could not always live up to his own standards. He struggled with alcohol and would disappear, sometimes for years on end, family members said.

In time, he turned to crack cocaine. He fell behind on his $450 monthly rent and was evicted from a high-rise that had been turned into a sober-living hotel.

Still, he was a fighter. At Oakland’s St. Mary’s Center, which operated a shelter, he found refuge. He wanted to clean up. He moved to Dignity Commons with high hopes.

In their sparsely furnished apartment on Moonlight Terrace, Milton and Qawi seemed to steer clear of each other, spending most of their time in their respective bedrooms. Qawi would later tell police that Milton was just a “skinny old guy” and that the two had gotten along fine. Milton told friends that he was a bit wary; Qawi, he said, was a “nice guy” for the most part, but “had his days.”

There were signs, however, that Qawi was becoming more delusional. He made advances on women he barely knew, suggesting to several that they had recently been romantically involved. He was oddly territorial.

“He told me: ‘Clear out. I’m at the mailbox now,’ ” said another resident, Patricia “Moms” Price. “I said: ‘I’m here too, brother.’ But it was scary. He looked like he could break your neck.”

On Sept. 6, Qawi called Operation Dignity in a panic, according to police records. There was an assassination plot against him, he said, and apartment managers were in on it. Qawi had bought locks for the door to his bedroom -- a rules violation at Dignity Commons.

Believing Qawi had become psychotic, Dignity Commons asked a VA social worker to evaluate him, police records show. That still hadn’t happened a week later, when Qawi called 911, his roommate’s body decomposing in the next room.

Inquiries, soul-searching

TODAY, Qawi sits in jail, charged with murder and held without bail. He has not entered a plea. His lawyer, Deputy Public Defender Samuel H. Greyson, called the prosecution’s case “very circumstantial and rather thin,” but declined to elaborate.

It is entirely possible that Qawi did not kill Milton. A month after the attack, documents show, no witnesses had come forward and investigators had not identified the weapon used in the killing. A friend of Milton’s has told police that he saw another man pull a knife on Milton two weeks before his body was discovered. Regardless, the killing and the arrest have prompted investigations, finger-pointing and soul-searching.

“We lost two soldiers,” McElree said. “Everybody wants everybody to be free. And nobody wants the crazies to go crazy.” He wonders if “this could have all been avoided, simply by forcing medication.”

During his early morning drives to his job at an East Bay transit bus factory, Milton’s son cannot shake the images of the killing: his father’s swollen face, the blood-soaked floor he found when he retrieved his father’s old Whispers and O’Jays records from the apartment.

“You learn to pick up, and you learn to accept each day,” said Milton Jr., 38. “But something’s been taken from me.”

Qawi has long struggled to separate reality from delusion, and it is likely that no one will ever know what happened inside the building marked “Courage.”

“He didn’t do it,” McElree said. Even if Qawi wielded the knife, he said, the responsibility lies with “whatever was going on in his head.”

If Qawi is found incompetent to stand trial, he is likely to be sent back to a mental hospital. There, if the pattern holds, he will once again refuse to take his medication.

“The one stand he was able to take,” McElree said, “is the one that bit him in the ass.”

leora.romney@latimes.com

scott.gold@latimes.com

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(BEGIN TEXT OF INFOBOX)

A journey through the system

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Kanuri Qawi’s odyssey, detailed in hundreds of pages of documents, has taken him to jail, to hospitals, to freedom and back again.

--

After serving prison time for a 1990 attack on a couple in Oakland, Qawi was sent to Atascadero State Hospital when he became paranoid and delusional. In a memo, he said he feared an elaborate conspiracy:

“Breakfast frozen. Lunch frozen, dinner frozen. I want diet special food hot. I want it now. I do not want diet special food hot made by the Black family gang.”

*

Qawi was placed on medication and, although the drugs dulled his delusions, he began to suffer side effects. He launched his legal challenge, including a 1995 petition to the San Luis Obispo County Superior Court:

“I was forced against my will to take antipsychotic drug for paranoid schizophrenia.... Forcible administration of antipsychotic drug presents sufficient intrusion upon bodily security to give rise to protectible liberty interest.”

*

For years, prosecutors and doctors were able to keep Qawi confined by arguing that if released, he would not take his medication and would become dangerous. In a 2002 trial, Alameda County Deputy Dist. Atty. Danielle Hilton argued:

“The fact that he hasn’t hit anybody, the fact that he hasn’t kicked anybody, that is not definitive about whether he is in fact a danger now, because he is.... In controlled settings, he is delusional.... When he does not take his medication, those delusions get worse.”

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In January 2004, the California Supreme Court gave Qawi a limited victory, requiring the state to seek legal permission to force medication on an involuntarily confined mental patient:

“The coercive administration of such medication, with its potential serious side effects, imposes a significant additional burden on the [patient’s] liberty interest.”

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Qawi was released from Napa State Hospital in February 2005. Last fall, he was accused of killing his roommate. Alameda Police Officer Ben Meredith wrote in his report:

“I noticed a very foul odor coming from the inside of his residence. I asked Qawi about the odor, and he told me his roommate