A System Gone Mad

Two agencies were supposed to be taking care of Donald Ellison. Instead, they were missing in action--and the mentally ill Vietnam veteran was left to die on the street.

Last February 6, after a week of freedom, Donald again was back behind bars on the assault and disorderly conduct charges.

County doctors blamed the relapse on a "substance-induced mood disorder"--booze and illicit drugs. But a blood test showed he hadn't been drinking or taking drugs.

His mind was malfunctioning on its own.
In previous years, several judges had committed Donald to the Arizona State Hospital as gravely disabled and incompetent to stand trial. Although Donald hated ASH, hated all forced treatment, his family always considered him to be at his safest there.

But ASH is far less often an option these days for people like Donald.
One reason is the Arnold v. Sarn "exit criteria" agreed to last November 13 by attorneys for the plaintiff SMIs and the defendants, the state of Arizona and Maricopa County.

Diverting patients from ASH and preventing "unnecessary and inappropriate hospitalization" of the mentally ill are linchpins of the agreement. The pact also discourages placement in supervisory-care homes "except in a unique situation." Again, the reasoning seems sound: Many boarding homes aren't even fit for animals.

Most experts agree deinstitutionalization is a noble concept, a compassionate way of freeing the mentally ill from the ghetto of government psychiatric incarceration.

But authorities couldn't find a "least restrictive placement"--short of the homeless shelter or the street--that would accept a degenerating Donald Ellison. He was far too sick.

The prime alternative to ASH and supervisory-care homes is called "community placement," which ideally includes intensive monitoring of clients in their own homes.

"The prevailing theory is that supervisory-care homes are in place only because there aren't good community-based services available," attorney Chick Arnold explains. "Discouraging placement in supervisory-care homes, the theory goes, is going to provide an incentive to the system to develop the kind of individual living services that are needed. Theoretically."

In truth, Donald was in limbo, caught between the lofty aims of Arnold v. Sarn and real life.

By last May, records show, ComCare inexplicably had dropped him as a client, despite his permanent status as a gravely disabled patient.

But a May 10 fax from ComCare to the Maricopa County Jail confirms its action: "Case closed, but can be reopened if he wants it."

ComCare reopened its file on Donald, though it's unlikely he knew what he wanted.

Jail records paint a disturbing portrait of a pathetic figure.
May 10: "Reeks of BM [feces] . . . Noted to be hoarding BM in Styrofoam cups."

May 28: "Screaming--threatening and out of control."
June 2: "Became loud, hostile, threatening, banging on doors. 'I want my Bible, my food and my bag of shit.'"

On July 3, authorities transferred Donald to the county psych annex at Maricopa Medical Center. It marked his 12th admission to the facility in less than a decade.

These days, the county hospital serves as a treatment "provider" to ComCare, the same as the private Samaritan hospitals and other area facilities. In effect, ComCare purchases a service from such providers, and ultimately decides who's admitted and who isn't.

But doctors retain the right to disagree with the ComCare clinical team's evaluation. This right--and responsibility, and how doctors in Donald's case failed to utilize it--loomed large in what was about to happen.

A few days after he arrived at the county hospital, Donald tried to fill out a questionnaire. "Why were you admitted to this hospital?" it asked.

"Paranoid schizophrenia, Donald Ellison, my illness," he scrawled.
Two of Donald's sisters from California visited him at the hospital over the July 4 weekend.

"It was really sad," says Alice Jackson. "He was very sick and he was slipping away from us. He said, 'You think you're so smart, but you don't know nothing on my life.'"

On July 9, Donald met at the psych annex with a ComCare case manager, who made notations after the meeting: "Discussed with [Donald] where he needed to go after discharge, and that it would be a place where staff can monitor his meds, and [Donald] agreed with this."

Toward the end of his three weeks at county, Donald did show slight signs of "stabilizing": He wasn't hoarding feces anymore, and he wasn't drooling as profusely.

But his sister Mary Howard wasn't convinced. She expressed her feelings during a July 17 meeting with his AVSC guardian/conservator Gary Warner, a ComCare case manager and county hospital personnel.

"I said Donald didn't seem to be snapping back like he had before," Howard says. "He seemed just sicker than ever to me."

No one, she adds, broached the possibility of moving Donald into his own apartment.

"We discussed the option of him going into New Life, a residential abuse program," a ComCare case manager wrote after the meeting, confirming Howard's recollections. "If he is not accepted in the program, he can come back to the hospital."

Mary Howard spoke with her brother for the last time shortly before she left for a family reunion in Texas.

"He told me, 'Buy me a ticket, sister,'" she says. "I told him it was too late. He said he was getting out real soon. I said I'd see him soon."

Howard wouldn't know how badly Donald's interview at New Life had gone until after he died and she got access to AVSC records.

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