Shutting door to treatment

PSYCHOSIS: Rosa Cabral in May accompanies her son, Reny Cabral, 23, on his first shopping trip since becoming paralyzed in January. Last fall Reny began showing symptoms of an emerging psychotic illness. After a 10-hour stay at a county psychiatric facility in January, he was released and later attacked his girlfriend, holding a knife to her throat and choking her until she lost consciousness. As soon as the sheriff's deputies arrived, any chance of Reny getting proper mental health treatment dissolved. Audio Slide Show
PSYCHOSIS: Rosa Cabral in May accompanies her son, Reny Cabral, 23, on his first shopping trip since becoming paralyzed in January. Last fall Reny began showing symptoms of an emerging psychotic illness. After a 10-hour stay at a county psychiatric facility in January, he was released and later attacked his girlfriend, holding a knife to her throat and choking her until she lost consciousness. As soon as the sheriff’s deputies arrived, any chance of Reny getting proper mental health treatment dissolved. Audio Slide Show
(Robert Gauthier / Los Angeles Times)
Los Angeles Times Staff Writers

Torrie Gonzales stood at the stove, laughing with her boyfriend as she fried him some eggs on his 23rd birthday. Then she felt him press a flimsy blade against her neck.

Struggling on the floor, she pried a paring knife from Reny Cabral’s hand, leaving him curled up in a ball, sobbing and seemingly horrified.

“He said, ‘I don’t know what I’m doing. I’m so sorry,’ ” recalled Gonzales, now 25.


Twice more he attacked her, choking her until she passed out, then performed mouth-to-mouth resuscitation to revive her. Finally, he raised his arms with a look of panic and walked into the orchard adjacent to his parents’ modest rural home.

A neighbor, hearing Gonzales’ screams, dialed 911.

In the days leading up to the Jan. 6 attack, Cabral had been exhibiting symptoms of an emerging psychotic illness. He was held, briefly, in a psychiatric facility. But once Glenn County sheriff’s deputies responded to the 911 call, he lost any chance of being treated in the mental health system. He would now be dealt with as a criminal, with catastrophic consequences.

As the availability of acute inpatient services has diminished, rising numbers of the mentally ill are ending up behind bars. About 350,000 of the country’s 2.1 million inmates have been diagnosed with severe mental illness, said Dr. H. Richard Lamb, director of research for the Institute of Mental Health, Law, and Public Policy at USC’s Keck School of Medicine.

Some mentally ill people find themselves diagnosed and treated for the first time after being incarcerated. But jails and prisons -- never designed for therapeutic care -- often trigger deeper crises, Lamb said.

What happened to Cabral provides a stark illustration of just how wrong things can go. Today, Cabral is not only facing criminal charges and struggling with mental illness; he is also paralyzed from the mid-chest down, unable to walk, to dial a phone or hold a pen.

Arturo and Rosa Cabral immigrated to Orland in the late 1970s from the hills of Zacatecas in central Mexico. On the flat expanse of the northern Sacramento Valley, hard work was plentiful in orchards of almonds, olives and plums.


In time, they forged their own business as landscapers and had three sons, who helped from the time they were young.

None pitched in with as little complaint as Reny. “Conscientious,” “always respectful,” and “a cut above the outstanding” an array of elementary and high school teachers wrote of him in letters last spring to the Glenn County Superior Court.

He ran track and played basketball, baseball and football, all while making the honor roll. Photographs show him beaming as prom king.

At Butte College, he developed a passion for politics, trolling fraternity parties at Cal State Chico in 2004 to register new voters. At one such party, Cabral met Gonzales, a women’s studies major with laser-sharp wit. The following summer they moved in together.

“He was something different from everyone else who I met,” Gonzales said. “He wasn’t some drunk guy. That was refreshing.”

But by the fall of 2006, she recalled, he’d changed. “He would sit on the couch and just stare at nothing.”

He told her bizarre tales: that he worked for the FBI, that he’d been kidnapped and molested. He began using marijuana and alcohol in increasing quantities, Gonzales said, a common occurrence among people with emerging mental illness.

On landscaping jobs, the old Reny would lift his mother in the air and twirl her around until both were breathless with laughter. The new Reny was removed.

“His face was different. He talked to us differently,” said Rosa Cabral. “But we didn’t know what it was.”

ON Jan. 3, Gonzales walked through the open door of the Chico apartment she shared with Cabral to find tufts of body hair on the living room floor.

Meanwhile,in the city’s expansive Bidwell Park, police watched as Cabral bolted naked through traffic, dragging a roll of saran wrap behind him. Nearby, officers found 5 gallons of kerosene and his oil-drenched clothes.

A detached Cabral spoke of suicide to police and social workers and said he shaved his eyebrows for a “fresh start,” records show. Police had him transported to a local emergency room, and from there he was sent to Butte County’s 16-bed Psychiatric Health Facility on a 72-hour hold, police and county records show.

There, he was tentatively diagnosed with psychotic and depressive disorders, records show, and prescribed Risperdal, an antipsychotic drug most commonly used to treat schizophrenia.

Early chart entries described him as “suspicious” and “guarded.” Entries at 2:45 a.m. and 6:15 a.m. found him restless.

But by 7:30 a.m., the tone of the entries had changed: Cabral promised he would not hurt himself. “I do need some help though,” he said. “I cannot do it on my own.” When, at 9:30 a.m., he said he needed “to spend time with my family,” the facility obliged.

His diagnosis was changed to “major depressive disorder,” and about 10:30 a.m. -- just 10 hours into his three-day hold -- Cabral was released.

The Cabrals, Gonzales and Julie Nasr, a close family friend, were waiting for Reny upon his release. Gonzales said Cabral that evening told the family he had been instructed by God to “cleanse the household” on his birthday. She said he burst into tears and told her: “The loved one” to be sacrificed “is you.”

Nasr had already placed several unsuccessful calls to the psychiatric facility, begging them to take Cabral back. Now she and Reny’s older brother, Art Jr., both called in a panic. But Cabral refused to return to the facility, and the family was reluctant to call police who might use force.

Butte County Behavioral Health officials declined to comment on the case. But Lamb, the USC psychiatrist, noted that as the availability of community beds for those with acute mental illness has plummeted statewide, there has been “a tremendous amount of pressure to keep the length of stay down.” Cabral’s bizarre behavior, however, made the need for more extensive treatment obvious, he said.

“We can say with 100% certainty that he needed the full 72 hours,” Lamb said. “We can probably say with 90% certainty that he should have had the full 17 days” that mental health officials could have authorized. If Cabral had been held for 72 hours, he would have been hospitalized on the day of the attacks.

The fact that Cabral was experiencing his first psychotic break, Lamb noted, would have greatly enhanced his chances of successful intervention had he gotten proper treatment.

On the Saturday after his release, Gonzales and Cabral made plans. They would cook breakfast, then walk the family’s corgi-basset hound mix. His worried parents went to work, arranging for Art Jr. to come to the house too. But when he overslept and didn’t show up, Gonzales wasn’t worried.

“I didn’t have the possible inkling that he would hurt me,” Gonzales said of Cabral. “I think we were all in denial because everything hit so quick. We were thinking of the Reny that was, the Reny that wouldn’t hurt anyone.”

The deputies who brought Cabral to the Glenn County Jail in Willows had heard about his recent psychosis from Art Jr., sheriff’s records show.

The jail also received a faxed copy of the police report from neighboring Butte County outlining the park episode and psychiatric hold. Nasr’s husband, a Chico pathologist, called to inform jail officials that Cabral had been prescribed antipsychotic medication and needed help.

But Cabral did not receive it.

The lone psychiatrist who contracts with the jail was on vacation, records show, so shortly after Cabral was booked on charges of attempted murder and domestic abuse, a jail nurse called Glenn County’s Mental Health Department to ask for a clinical assessment.

But when a social worker called the jail, a deputy told him Cabral seemed OK, county records show.

“The jail staff will advise us of any further desired services in this case,” the social worker wrote in a log of the exchange.

About 40 hours after Cabral’s arrest, deputies noticed urine seeping from under his cell door, according to county officials. They found him naked, drinking copious amounts of water and vomiting.

In his distorted mind, Cabral would later recall in an interview, he was transforming into the DC Comics hero Aquaman so he could travel down the drain “to be with my mom.”

When deputies entered to move him to the jail’s “safety” cell, he began throwing toilet water.

Willows Police Officer Jason Dahl, who responded to a call for backup, deployed his Taser, delivering seven 5-second shocks to Cabral’s chest, police records show. Writhing, Cabral splashed more urine and fecal matter from the toilet. Dahl reloaded and zapped again, then reached for his pepper spray.

“I emptied the entire 4-ounce bottle . . . on Cabral,” he wrote that morning in a document later filed in court.

Finally subdued at 3:50 a.m., Cabral was placed in a safety cell lined with a thin layer of hard rubber.

Paranoia raging, he believed he would be raped if he didn’t escape, he recalled, and so rammed his head against the wall.

In checks through a slit in the door every 15 minutes, deputies noted his posture. The last entry to record him standing was at 4:31 a.m.

“Laying on floor,” “Laying on stomach breathing,” “Laying on stomach,” subsequent entries in a jail log note. At 5:45 a.m., breakfast was pushed through the opening. Cabral did not rise.

Cabral claims he yelled for help steadily. “If they did answer, they said to ‘get up,’ ” he said.

The first log entry to note Cabral’s distress was at 10:11 a.m.: “Laying on stomach/yelling.”

At 11:10 a.m.: “alleges paralysis -- ‘broken neck.’ ” Without entering the cell to investigate, the deputy left a voicemail for a nurse, records show.

At noon, as Cabral pleaded for help, they served him lunch.

No one opened the door until the jail nurse arrived at 1:09 p.m. -- more than eight hours after Cabral was last reported standing.

Willows’ tiny Glenn Medical Center concluded Cabral was quadriplegic. Three more hours passed before he was taken to Enloe Medical Center in Chico and given medication to reduce spinal cord swelling, according to a legal claim Cabral filed against Glenn County. The county rejected the claim, and Cabral’s civil attorney said he is now preparing to file a lawsuit.

His paralysis might have been mitigated by more prompt treatment: Steroids to reduce swelling must generally be given within eight hours of trauma, said Dr. Geoffrey Manley, chief of neurotrauma at San Francisco General Hospital and Medical Center. “Time is critical for the nervous system,” he said.

Cabral emerged from surgery “a C6 complete quadriplegic,” Dr. Jeffrey Mimbs wrote in a document submitted to the criminal court. He could elevate his arms and flex his elbows, but could not use his hands.

Because of the civil claim alleging negligence, malpractice, battery and civil rights violations, county officials have declined to discuss details of Cabral’s stay at the jail. But Glenn County Sheriff Larry Jones conceded that his staff -- whom he notes are “not mental health clinicians” -- are increasingly overwhelmed by inmates in psychiatric crisis.

Just two weeks after Cabral broke his neck in the safety cell, officers repeatedly used a Taser on a mentally ill inmate who was dipping his shredded articles of clothing in toilet water and eating them, according to a Sheriff’s Department document. Unlike Butte County, Glenn County has no psychiatric facility, instead leasing beds in Yuba City for $600 a day. Jones has declined to send inmates there because the facility insists that guarding officers check their weapons at the door -- a requirement that Jones said would leave his officers “emasculated.”

A recent Glenn County Grand Jury report, while not mentioning Cabral’s case specifically, acknowledges inadequate inmate mental health care, spreading blame among the jail, the county Mental Health Department and the hospital, citing several cases in which mentally ill inmates did not receive any care.

For the Cabrals, it has been a year of pain and adjustment. “Before this, I maybe saw my dad cry once,” Art Jr. said. “Now it’s a regular occurrence.”

Dozens of friends, relatives and former teachers have packed Cabral’s court hearings along with longtime landscaping customers who have pitched in to defray legal costs, shouldered primarily by the Nasrs.

At a March arraignment held at the physical rehabilitation center where Cabral was recovering, he was released on his own recognizance pending trial.

After six months at a Chico nursing home, Cabral returned this month to his parents’ now heavily mortgaged home, equipped with ramps and climate control financed by a $65,000 loan.

His position must be frequently adjusted to relieve pressure. Tight gloves compress his hands at night to create a claw-like reflex that may help him perform simple tasks.

Cabral is taking a dose of Risperdal that quiets his mind, leaving him with a slight slur of speech and a gentle insight into his schizophrenia diagnosis.

“It’s something I’m committed to do -- to stay on the medication,” Cabral said from his bed one evening. He longs to be at work with his parents, hearing “the rustle of the leaves, the wind in the trees.” But along with a maddening desire for independence has come reflection.

“You know,” he told Nasr one night as she read aloud to him from Ray Bradbury’s “Fahrenheit 451,” “I’m looking forward to what my life as a quadriplegic will bring me. I think it will be a more intellectual life than I would have otherwise had -- now that I don’t have my body.”

His relationship with Gonzales has taken new shape, punctuated by Best Friends Forever bracelets. In May, she returned for her first visit since moving to her parents’ home in Riverside to grieve and rebuild.

Both were nervous. But the hug came naturally. For days, Gonzales sat by Cabral’s side, feeding him, stroking his arm, playing Uno.

At night, amid the inhale and exhale of the leg pressurizing machine, they cried and talked -- about the shattered romance and Cabral’s looming criminal charges.

Twenty-seven California counties have mental health courts for adults whose crimes are linked to illness, offering flexible treatment and a reduced or nonexistent criminal record. Glenn County is not among them.

Prosecutors there continue to press their case, even as community members have pleaded for leniency. Gonzales’ early statements to law enforcement form the backbone of the prosecution’s case, despite her desire to see the charges dropped.

Conviction on triple attempted murder charges could mean many years in a state prison system in which care of the mentally -- and medically -- ill has been deemed so poor as to be unconstitutional. It could also jeopardize Cabral’s chances of accessing public housing for the disabled, and frighten off potential employers.

Cabral’s other option -- a mental health defense of not guilty by reason of insanity -- raises the specter of indefinite institutionalization in the state mental hospital system, which is under federal oversight for a history of poor patient care.

Cabral’s defense attorney, Dennis Latimer, first sought to leave the mental health issue out altogether, arguing that Cabral’s attempts at resuscitation and Gonzales’ superficial injuries indicated no intent to kill. But Cabral’s actions are hard to explain without context.

On Aug. 25, Cabral and his family once again entered a Glenn County courtroom.

Inside, Cabral softly entered his plea: Not guilty by reason of insanity. Latimer hopes prosecutors -- or a jury -- will see fit to reduce the charges.

“Do you understand that this could mean a lifetime in a state mental hospital?” the judge asked Cabral.

“Yes,” he answered, as his mother wept.

One in a series of occasional articles on California’s troubled mental health system.