As she described her third suicide attempt in ten days, Debbie Townsend didn't leave out many details.
Struck with "an overwhelming desire to be dead," she pulled a sheet from her narrow bed. She hung it over the door leading to her bathroom and climbed on a desk chair she had set inside. She tied the sheet tightly around her neck. She then stepped off the chair--and blacked out. It wasn't until the following day, May 30, 1993, that Debbie would tell this story to a nurse at Charter Hospital of the East Valley, a for-profit psychiatric hospital in Chandler where Debbie had gone to seek haven from the internal demons trying to destroy her. It was clear the demons were winning. Debbie told the nurse she didn't know why she had tried to choke herself. The nurse diligently recorded Debbie's words in her medical records and told her colleagues and Debbie's psychiatrist about the incident. They immediately put Debbie under constant, "one-to-one" observation--the highest suicide precaution, involving having a member of the staff with her at all times.
But one month and several suicide attempts later--all but one occurring while she was a patient at Charter--Debbie would retrace virtually the same steps she took in late May.
However, on June 28, she was no longer under one-to-one observation. On June 28, the 36-year-old wife and mother would succeed in taking her life.
Debbie's friends and family were devastated by her suicide, but they weren't entirely surprised. Undergoing treatment for childhood sexual abuse, she had been in and out of programs and counseling to try to overcome feelings of shame.
But the astonishing fact that Debbie was able to kill herself while enrolled in a program designed to protect her--where staff knew she was a high-risk patient--angered physicians and counselors who had worked with her.
"I was very deeply saddened and outraged that this could have happened inside a hospital," says Dr. Harvey Rifkin, a psychiatrist who had treated Debbie in a program for sexual-trauma victims in New Orleans. "Anybody who has worked with sexual-trauma patients most of the time can recognize when the patient is at high risk. . . . She was a very, very high-risk patient."
Gwat-Young Lie, an associate professor at Arizona State University's school of social work who led a support group for incest survivors that Debbie attended, says she knew how distressed Debbie was, but was still appalled by Debbie's death.
"Given that she had attempted [suicide] and she had a known history, I would have put her on around-the-clock observation and very close supervision," Lie says.
It is uncertain how many other patients have successfully taken their lives in other local psychiatric hospitals, but mental health professionals say it is a rare occurrence. What is known is that Debbie Townsend's suicide was the first in Charter's six-year history in the East Valley.
People who succeed at suicide in controlled settings typically show few suicidal tendencies. They tend to catch their protectors off-guard. Under normal circumstances, patients who repeatedly attempt and voice plans for suicide are considered high-risk and are closely monitored.
Former employees of the East Valley facility say an event like Debbie Townsend's suicide was bound to happen. They claim they were so overworked, it was only a matter of time before tragedy struck.
"It was ridiculous," says a nurse who left Charter two years ago, after warning superiors she could no longer guarantee patients' safety. "Something was going to break down. It was only a matter of time before it fell apart. That was apparent."
Charter administrators initially agreed to allow New Times to review staffing logs, but they reneged, on the advice of Charter attorneys. Charter did allow a tour of its Chandler facility.
Inadequate staffing led to other problems, as well, patients and former workers say. For example, sex between patients--even sex between patients and counselors--had occurred. A former Charter counselor was convicted of having sex with two minors he treated at the hospital. And while she was a patient there, Debbie Townsend started an affair with another patient, a relationship that apparently contributed decisively to her emotional deterioration.
Critics, including doctors, have also accused Charter of allowing economics to influence patient care. While other psychiatric hospitals have heard the same criticism, Charter's bottom-line culture was particularly prevalent, former employees say. The parents of a teenager who committed suicide two weeks after he left Charter have charged in a lawsuit that their son was discharged prematurely. The boy's father told police his son was discharged because insurance coverage was insufficient. Charter has denied the allegations in court documents.
In interviews, local and national Charter officials deny they could have prevented Debbie Townsend's suicide. They strongly deny that business considerations have any impact on patient care. Kimbrough Hall, administrator of Charter Hospital of the East Valley and Charter Hospital of Glendale, says those facilities are trying to meet the needs of their customers. "Charter has always been the predominant--the best--company at focusing in on patients," says Hall. While he hesitates to acknowledge past problems, he eagerly talks about improvements that have been made since he took over Charter Hospital of the East Valley last year. "I'm trying to focus on the future and doing things better. I think we've done some really good things." Many patients and current and former employees are quick to praise individual counselors and staff members at the facility. But none of Debbie Townsend's local counselors or doctors agreed to speak with New Times, even after Debbie's husband, Homer, signed a release waiving confidentiality.
Homer--a Vietnam veteran who is an officer in a national disabled veterans' organization--says, "I want people to know that my wife shouldn't have died. Why does my wife--who is highly suicidal--get admitted to a hospital so she can commit suicide?"
@body:Charter Medical Corporation's recent history is a familiar Eighties boom-and-bust story. In 1980, the Macon, Georgia-based company had 15 hospitals. By 1990, it had 102, and Charter was the largest psychiatric-hospital chain in the country.
The Arizona atmosphere was especially cordial for expansion-minded medical enterprises. In 1985, the requirement that hospitals obtain a "certificate of need" before opening in the state was abolished by the Arizona State Legislature. Under deregulation, hospitals no longer had to prove to the state that their services were necessary before they could open. It was a wide-open market, and Charter jumped in with both feet.
Within the same week in May 1987, Charter had grand openings for a 60-bed facility in Glendale (it would later add 30 more beds) and an 80-bed facility in Chandler. A Tucson facility opened later that year. The hospitals mounted aggressive marketing campaigns to fill those beds, bringing in Abigail "Dear Abby" Van Buren for one of the celebrations.
Once patients were admitted, critics charge, Charter did all it could to keep them there.
In 1989, Dan Kirkpatrick, who oversaw all three Charter hospitals in Arizona, wrote a memo encouraging psychiatrists to make sure patients stayed in for at least a month.
"Once again, we're striving for overall length-of-stay goals of 30 days for adults, 45 for adolescents and at least 50 for younger children," the memo read.
The state Department of Health Services investigated, but found no evidence that Charter kept patients longer than necessary. However, Dr. Rick Manganaro, a psychiatrist who admitted patients to Charter at that time, remembers the pressure to keep patients in--despite trends nationwide to decrease lengths of stay.
"They tried to get doctors to keep the patients longer than we felt was necessary, as long as they had insurance coverage," Manganaro says. "Charter [was] putting all this pressure on us to keep people longer."
In Tucson, two doctors sued Charter, alleging that they were pressured "to admit more patients for inpatient rather than outpatient care" because the hospital was motivated "solely by . . . financial greed." The doctors said when they refused, they were retaliated against. After Charter denied the allegations, the case was settled.
The law of supply and demand soon caused a downturn in the for-profit psychiatric industry. By 1990, there were 1,600 psychiatric beds available in the state, up from 700 in 1983.
"There were way too many beds," says Dr. John Scialli, former president of the Phoenix Psychiatric Council.
At about the same time, insurance companies began to cut back on mental health coverage, partly because of economics and partly because of abuses by doctors and hospitals nationwide.
As with many psychiatric hospitals, Charter's parent corporation fell on hard times. Employees say there were days when census levels locally were only a handful in each unit. The corporation--which at one point had 102 facilities around the country--began dumping hospitals, including its Tucson facility, which it sold in 1991. It currently owns 78 nationwide.
The corporation filed for bankruptcy in June 1992. That year, the occupancy rate at Charter Hospital of the East Valley was 31 percent--half of what it was in 1989. Its average daily census during that summer, for example, was in the teens. The hospital was losing money.
In September 1992, Charter consolidated its Valley operations, merging administrative functions for the Chandler and Glendale facilities. Several administrative and clinical employees lost their jobs or left voluntarily. The consolidation helped cut costs. Through 11 months of the current fiscal year, the East Valley facility posted a $68,000 profit, administrator Hall says. Hall and corporate spokesman Andy Brimmer insist Charter is on the upswing, and say the company's debt has been reduced from $1.8 billion to $400 million following the sale of its nonpsychiatric hospitals. "The bankruptcy is basically a miracle," Hall says, referring to a July 1993 restructuring that allowed Charter's creditors to become stockholders.
Meanwhile, Charter has notified the State of Arizona that it intends to boost its daily room rates from $800 to $920.
@body:In the Townsend home in Mesa, Debbie Townsend's husband and her son are finally coming to grips with her death.
Nineteen-year-old Jesse Blackard, Debbie's son from her first marriage, sits in the tidy living room. Debbie, he explains, was a meticulous housekeeper. In fact, before she became ill, she ran her own housecleaning business.
Homer Townsend moves in and out of the room in his wheelchair as Jesse recounts his own experience at Charter, where he was once treated for a chemical-dependency problem. Homer half-listens, adding explanations and his version of events. He is poring over a police report on his wife's death. He says Charter gave him very little information about what happened. He knows he should have been more vigilant about monitoring the hospital's actions, but he claims he was virtually kept out of his wife's treatment. He says he wasn't told about her suicide attempts until days afterward.
A stocky man with dark hair and penetrating eyes, Homer frequently clasps his hands together, resting them behind his head. Occasionally, he glances at a studio photograph of Debbie. In this one, unlike most of his pictures of Debbie, she is smiling, her long hair falling down around her shoulders.
Homer moved to Arizona from Maine almost two decades ago, after spending two years in a Veterans Administration hospital. He had done a tour of duty in Vietnam as an aircraft electrician. Shortly after he returned to the States, an auto accident left him a paraplegic.
Homer met Debbie at the Sunset Lounge in Mesa, where she was a bartender and where he, an avid pool player despite his disability, won many a bet on the table. The two were married in 1983, and Jesse and Debbie moved into Homer's house, where he lived with his own son from a previous marriage.
Debbie grew up in Mesa, the daughter of Mormon parents. But they separated when Debbie was 4, and Debbie's mother and sister moved to California. Debbie stayed with her father, who later remarried. At age 16, she married an Air Force mechanic; at 17, she gave birth to Jesse. She never graduated from high school, but she did get her GED.
Her life was never easy. Counselors and friends say she endured years of sexual abuse at the hands of her father and stepbrothers. Her first marriage didn't last long. After the divorce, she began using drugs. She stopped, however, when she met Homer. But two weeks after their wedding, at a time when her life should have been stabilizing, she was raped late one evening after she finished her shift at the bar. She saw counselors, but "she never really got over it," Homer says. Still, things improved. The Townsends shifted gears. They began attending church every Sunday. They stopped drinking and traveled often. Debbie had several siblings and stepsiblings, and the Townsends often took care of their relatives. "She was always trying to help others," remembers Helen Smith, a close friend, who worked with Debbie, cleaning. "She was a happy person then."
Debbie took some college courses, Homer says, earning high marks. Homer began to get involved with Paralyzed Veterans of America, and was named to an advisory committee to U.S. Senator John McCain.
Then, a few years ago, one of Debbie's nephews was molested. That night, Debbie finally stopped suppressing the painful memories of her childhood.
"She woke up in the middle of the night, screaming," Homer remembers, "and she told me that she remembered that her father had done things to her."
The "things" slowly came out as Debbie attended counseling sessions and incest-survivor groups. She told family members and therapists she had been abused for at least ten years, beginning when she was 5.
She was eager to get help, but she gradually grew worse. She began to have flashbacks and nightmares. Homer would come home and find her in the closet, weeping. She rarely ate. She tried to confide in friends from her church, but when the story of her abuse spread through the congregation, she lost faith. She began to feel her family and religion were abandoning her.
Her first suicide attempt, as far as family members can tell, came when she attempted to hang herself while she was a patient at another psychiatric hospital during the summer of 1992. She had gone in on the recommendation of her counselor. "She was startling and cutting at her wrists, and digging at herself all the time," Homer says. She was diagnosed as having posttraumatic stress disorder as a result of her years of abuse.
It was clear to her family that she needed more intense treatment. Homer took her to a sexual-trauma program at Methodist Psychiatric Pavilions in New Orleans. She spent several months there, improving dramatically.
When she was discharged, according to Dr. Harvey Rifkin, who ran the program, she was no longer an immediate suicide risk.
"It was clear to me she had a long, hard road left ahead of her. It was a start. But it was by no means anywhere near a full recovery. I did feel that she was a long-term risk. And she needed intensive and continuous therapy," Rifkin says.
When she got back from New Orleans last fall, friends and family noticed a marked improvement. She and Homer even attended Bill Clinton's inauguration.
She began seeing Dr. Adelaida Fernandez, a Chandler psychiatrist, last January. She also continued visits with Judy Fishman, a counselor she had seen for a while. But as time wore on, Debbie began to relapse. She tried to overdose on one of her medications, but Homer stopped her in time. He was traveling a lot for the disabled veterans' group--he was now a national officer--but he couldn't get his wife to go with him. By May 1993, both Fernandez and Fishman recommended that Debbie check into Charter. "I didn't really know all the reasons why she was going in," says Homer. "But I thought it would help."
@body:Charter's facility on Grace Boulevard in Chandler looks more like a resort than a hospital. It is surrounded by green grass, small palm trees and flowering shrubs. The facility is light pink on the outside; most of the interior is a nonthreatening light blue.
During a mid-September tour, the hospital appears well-staffed, with several nurses at the two stations on both floors. With three assistants in tow, Kimbrough Hall explains the hospital's operations. In general terms--without referring to Debbie Townsend's case--he explains the conflict between preparing patients to return to the outside world while trying to protect them. He explains the idea of least-restrictive treatment, of helping people deal with the pressures of home life and beyond.
But sometimes, if a patient is determined, he is going to take advantage of that and fool the staff into thinking he's okay, Hall says. "You can have a patient that is going to hide all those symbols from the clinical staff, if their goal is to succeed . . . ," he says. "Sometimes, somebody's going to do something to harm themselves."
Hall's generalizations may not necessarily explain the case of Debbie Townsend, who literally drew a picture of her imminent suicide. Police investigators found it in plain sight in her hospital room--a detailed drawing of a naked woman with a noose around her neck, with sharp Xs marked over the breasts and genitals. Charter records do not indicate whether the picture had been seen by hospital employees before the suicide.
Furthermore, Charter's critics allege, the hospital's cost-cutting and staff reductions have increased the odds that "determined" patients will succeed in hurting themselves or others. Charter contends current staffing levels are adequate.
As early as 1989, two years after Charter Hospital of the East Valley opened, Medicare threatened to terminate its contract with the hospital, citing deficiencies in its nursing staff. After repeated warnings, Charter corrected the problem and managed to keep its Medicare contract.
Currently, the full-time-employee-to-occupied-bed ratio is exactly the average for the Valley's specialty hospitals. Hall insists there is always at least one nurse in each of the hospital's four units, as well as a "floater."
But employees who have worked in the hospital over the years, as well as recent patients, say staff levels can be inadequate. "When you've got kids that are potentially suicidal, potentially violent, you've got bad situations, then it doesn't feel safe," says a current psychiatric technician. "We'd say, 'We need more people.' . . . A lot of times, it's like, 'Deal with it.'"
A counselor who left the hospital in 1991 says that, at times, he and a nurse were responsible for up to 14 patients. At the program he works for now, he says, he is rarely responsible for more than four patients. "It was just me and a nurse running two units," says the counselor, who worked mainly with adolescents. "I kept telling them, 'I need more techs [psychiatric technicians, or assistants]. I need more techs.' I was told for me to get another tech, something bad has to happen. I kept saying, 'We're going to have babies. I need more staff.'"
Former patients say that because of the small crew on the overnight shifts, sex between patients--particularly teenagers--did occur. Jesse Blackard, Debbie Townsend's son, claims he lost his virginity while he was at Charter. The mother of a 13-year-old Charter patient says a note her daughter wrote to a boy she had met at the hospital indicated that they were having sex.
Former employees claim kids were often caught in the act--once in a room adjacent to a nurses' station. Former patient Jennifer Hald says patients regularly sneaked into each other's rooms in the night. Charter's Hall says he doesn't know that sex occurs in the hospital now, but because "people try," a worker is posted in every hallway. "Obviously, that's not something that is acceptable. That's something that we try and deal with," he says. But in at least one other psychiatric unit in the Valley, precautions are taken a step further. "If we think a kid is being a perpetrator, we station someone outside the door," says Eric Benjamin, a psychiatrist at Phoenix Children's Hospital and president of the Arizona chapter of the American Academy of Child-Adolescent Psychiatry. "That shouldn't happen. You have to question the staffing ratios and the individualization of the treatment."
Jennifer Hald, now 21, says she never had sex with another patient during her two extended stays at the hospital. However, she says she did have intercourse with Darren Spiker, a lead counselor she met and received therapy from at Charter. Spiker pleaded guilty last year to two counts of having sex with underage women he met and counseled at the hospital. He even slept with co-workers, including his supervisor at the hospital, court records show.
Hald and two minors filed civil suits against Charter and Spiker, which were settled out of court last June. Charter claims it immediately dismissed Spiker. "As soon as the allegations surfaced, he never came back to work," Hall says, "because that's our policy and that's absolutely inappropriate." But in her lawsuit, Hald claims she informed Charter officials of Spiker's advances toward her--even before he had sex with the two minors. Despite her warnings, Hald tells New Times, Charter didn't prevent him from counseling her again, or from running the hospital's aftercare program.
"You have this guy who is supposed to be helping you and he's telling me he wants to sleep with me," Hald says.
A counselor who worked with Spiker remembers the hospital brushing off Hald's warnings: "We felt she was full of shit," he says. "We were wrong."
A lack of staff affected care in other areas. One former clerical worker who had no training in counseling says that, at times, when she answered the hospital's main line, she couldn't find any clinician to field crisis calls. "There were a couple of times that I had to keep talking to people," she says. "A man called and said, 'I'm going to jump.' I kept saying, 'Hang in there. Hang in there.' What do you say? It was five minutes or longer. It seemed like forever." Hall says at least four people are on-site to receive crisis calls around the clock, and another carries a pager. "We have a busy switchboard," he says. "That is absolutely not our current policy [to have a nonclinician handle crisis calls]." Several workers have left over the last two years, complaining that the workload was dangerously high. As one nurse described workers at Charter: "They're taken advantage of and they're fast-food workers. The amount of work was affecting people physically."
A current social worker agrees: "What happened repeatedly at Charter was the work was piled up and the expectations were way too high. . . . Every administrator would come in with more responsibilities for them and it burns them out and they leave." Administrative turnover at Charter--particularly at the top--has been extremely high. There have been seven head administrators since Charter Hospital of the East Valley opened in 1987. They have been an assorted cast of characters. One "bugged" a conference room, claim several employees (including the director of plant operations at the time), so he could listen in as regulators who inspected the hospital met in confidence.
Another repeatedly borrowed money from the hospital cash drawer and had access to a hospital supply room, from which a box of hypodermic needles was stolen. The administrator was dismissed after six months on the job, when it was discovered that he had a drug problem.
Like other hospitals, Charter has also cut costs by employing temporary, or "pool," nurses. Hall says no more than 25 percent of its workers are pool. The corporation declined to provide staffing logs.
But psychiatrist Dr. Rick Manganaro, who no longer refers patients to Charter, says he would come in at times and that he "couldn't tell who the staff was and who the patients were."
"The staff didn't know the patients. They didn't know the doctors," Manganaro says. "It [made] it very difficult to maintain good care." @rule:
@body:Charter hospitals in Arizona are not the only ones to come under fire.
Last year, Charter agreed to a $3.25 million settlement with the Texas attorney general. According to published reports, the agreement bars Charter hospitals in that state from admitting patients without a prior evaluation by a psychiatrist, from giving employees financial incentives to meet occupancy goals and from offering schools the services of private Charter counselors who refer students to Charter facilities. In agreeing to the settlement, Charter admitted no wrongdoing.
In 1991, the company agreed to a $2 million settlement with the federal Department of Health and Human Services for overcharges to Medicaid and Medicare.
Critics of the for-profit psychiatric industry claim the alleged abuses have hurt care for patients. In the last few years, insurance companies have significantly reduced the number of inpatient days they will cover.
A business office worker who monitored insurance coverage for Charter Hospital of the East Valley says the doctors were kept up-to-date on exactly when a patient's insurance ran out.
"I would approach the doctors if a person ran out of money," she says. "I'd say, 'This person's insurance ran out. When do you think you can discharge him?'" She claims she and Christine White, the utilization review manager, had significant influence over whether patients stayed in the hospital. "If the patients could benefit from being in still, and Christine and I said out, they were out," she says. She insists, however, that patients with suicidal ideations were not discharged. Charter officials deny that economic considerations impact their doctors' medical decisions, and emphasize that the two employees making the allegations are no longer with the company.
In the case of Erik Peterson, a 17-year-old admitted to Charter for depression, a lawsuit charges that Peterson was discharged early. Charter denies all the charges made in the suit. Erik's parents, however, claim he was discharged because his insurance was inadequate.
On his admission on February 12, 1991, Erik's psychiatrist wrote an initial discharge plan, saying Erik should stay in the hospital for at least two to four weeks. But, his parents claim, when Charter found out the family's insurance wouldn't cover an inpatient stay of that long, Erik was quickly discharged to a less-expensive outpatient-care program. Erik's father would later tell police that his son had left the hospital "because the insurance would no longer allow him to stay." In their lawsuit, filed last March in Maricopa County Superior Court, Erik's parents allege that Charter "failed to appropriately and adequately evaluate Erik while he was an inpatient and they discharged him prematurely"--only a week after he was admitted. Charter says Erik was discharged because his mood had improved and he was no longer suicidal or homicidal.
Ten days after he was discharged, Erik showed up at the hospital asking to be readmitted. A counselor tells New Times he remembers telling Erik to go to the assessment section of the hospital, so he could be evaluated. "He said he wasn't feeling safe and he was feeling suicidal," the counselor says. "For whatever reason, he wasn't admitted."
In fact, when Erik went to admissions, a hospital employee noted that Erik wasn't suicidal; the employee called Erik's parents and told them to pick him up, hospital records say. The next day, Erik's psychiatrist increased the potency of Erik's medication, an antidepressant known as Imipramine.
Six days later, after returning from the day program at the hospital, Erik intentionally overdosed on the antidepressant and died. Erik's psychiatrist saw him the day before his death, but apparently noticed nothing out of the ordinary about his patient. However, Charter counselor Ryk Scott admits that on the day of Erik's death, Charter employees knew there may have been a problem.
"I could tell by the way he was sitting there and the way he responded that he was just out of it," Scott tells New Times. "He was down. We all knew something was wrong. That day, we had informed that doctor that someone needs to meet with this kid again. By then, apparently, [Erik] already had in mind that he was down enough."
Scott, the last Charter employee to see Erik alive, claims there was nothing Charter could have done for Erik, because he was in his parents' care that evening after leaving the day-care program. But the lawsuit charges that Charter and the psychiatrist "failed to conform to the standard of practice customarily recognized by psychiatric specialists and physicians practicing in the community. . . ."
Christine White claims the Petersons' situation was common: "That story was repeated over and over in numerous cases. Parents would be told over and over that their kids would be in for two to four weeks. And then, when their insurance benefits were verified, they had to leave."
@body:On May 18, Debbie Townsend took her counselors' advice and drove herself to Charter for what would be the first of two stays there over the next six weeks. Her medical bills would be covered by Champus, an entitlement program for veterans that is considered generous when it comes to psychiatric coverage.
Upon arriving, she told an evaluator that she didn't know what time or day it was. "I don't keep up with that," she said. She said she was obsessed with suicide.
During the next 17 days, Debbie ran up an $18,000 bill--while living out her obsession. Doctors placed her on and off one-to-one observation and shuttled her in and out of an observation room. Yet she continued to make what healthcare workers considered serious attempts at taking her life.
The staff documented that Debbie had tried to hang or choke herself with a bedsheet or a pillowcase on at least four separate occasions during that stay. Among those were the May 29 attempt, when she told the nurse about how she had hung the sheet over the bathroom door. Two days after that, a nurse stopped her while she tried to choke herself with a sheet. Still, on June 3, three days after that attempt, Debbie was discharged. She had shown her psychiatrist a suicide note on June 2, and had told her counselor it was "useless to stay here." But on the day of her discharge, her counselor indicated she was happier. Fernandez wrote that Debbie had no immediate suicidal plans and had done nothing to harm herself.
Debbie's friend Helen Smith, who went shopping with Debbie the week after she was discharged, remembers, "She wasn't in any better condition. She would have attacks where she would start shaking. She was still talking suicide." Ten days later, her son walked into her bedroom and found her sitting on her bed, loading bullets into a gun nobody knew she had. He immediately took her back to Charter, where she told staff she had planned to shoot herself in the head.
Indeed, despite her 17-day stay in May and early June, Debbie came back to the hospital in much worse shape. The staff put her on immediate around-the-clock observation.
On Debbie's second admission to Charter, she repeatedly stated that she no longer wanted to live and that the staff should just let her die. And she confided to counselors and her psychiatrists why she felt this way: After ten years of marriage, she had been unfaithful. "My husband now is beautiful," she told her counselor when she was admitted. Later, she expressed to another counselor that she couldn't control her actions. "I love him [Homer], and I can't promise him I won't do it again," she said.
On June 19, Dr. Kevin Wandler, Charter's medical director, took over for Dr. Fernandez, who went out of town. That day, Wandler noted that Debbie was "still highly suicidal." On June 21, however, he felt she had shown improvement, and decided to take her off constant observation.
The next day, Debbie somehow got her hands on a belt, put it around her neck and threatened to hang herself. A staff member walked into her room before she could harm herself.
Without the belt, but no longer on one-to-one observation, Debbie turned to the next potentially destructive device in her room: her bedsheet. It was an instrument she had tried before.
On June 23, a nurse found her crouching in her room, crying, softly hitting her head against the cabinet wall. In the bathroom, a counselor found the bedsheet with a knot tied in it. "Debbie had a very difficult night again last night where she attempted suicide, or at least had an active plan for attempting suicide," Wandler wrote in his notes. He also noted that Debbie "states she has suicidal ideations, wanting to hurt herself with the bedsheet." It was the second time she had made plans to kill herself since she was removed from one-to-one observation. After one of her May suicide attempts, staff took away Debbie's bedsheets. There is no reference in the medical records to indicate that that measure was taken in June.
That night, in a family-counseling session, Debbie told Homer about her affair--and Homer was understanding. He said he knew her behavior wasn't uncommon among incest victims, and that he stood behind her. The session went extremely well, according to the counselors and her doctor. But Homer remembers his wife telling him that if anything were to happen to her, she wanted "this done and this done and this done. I told the doctor that my wife was saying goodbye to me."
On June 25, Wandler decided to take Debbie off suicide precautions altogether. As he explained it: "Today, for the first time, while Debbie did have suicidal thoughts and did attempt to scratch herself with her finger and wanted to look for a sharp object, I feel she is ready to be taken off 15-minute checks."
He also noted prophetically: "Every time we gave her a little more freedom, she did attempt to hurt herself."
That day, a staff member denied Debbie's request for a pass to leave the hospital during the weekend. There is no record of a physician visiting Debbie on June 26, a Saturday; Hall says physicians are only required to do checks five days a week. Wandler did come in on June 27, and he granted Debbie the pass that staff had earlier denied her. He did so because she had gone 48 hours without a suicidal gesture that he knew of, Wandler's notes indicate. He also wrote in his notes that Debbie's "nightmares were worse last night than she has had in quite some time." Debbie told the doctor she had arranged her own transportation. With little fanfare, she left the hospital.
@body:None of Debbie's relatives knew she had been given a pass. A staff member later noted that Debbie left with a "former patient (male)."
When Debbie returned to Charter, a nurse said, she was "depressed, quiet . . . very upset. [She] stated that she spent the afternoon with someone who wasn't good." Debbie's counselor, Judy Fishman, would write the next day that "somehow, she had a pass, met with [the former patient], who took her to mall and then motel room." That night, a nurse found Debbie awake at 3 a.m., playing with her bedsheets and a stuffed animal. The nurse said she monitored Debbie "one-to-one for safety until patient slept."
During a highly emotional abuse-survivors' group session on June 28, patient Mary Henderson, a friend of Debbie's, claims Debbie revealed what had happened the day before. The group counselor would write the next day that Debbie was "agitated in group, brought up having a 'good' and 'evil' side."
Debbie left the group session before it was half over. "She bolted," Henderson says. Counselor Fishman elaborated on the intense session when she saw Debbie that afternoon. Debbie "began to shake out of fear. . . . Group leader had said something about not feeling safe after patient spoke of good and bad inside her and wanting to cut the bad out."
A nurse documented that Debbie was "quite agitated, with tremor, jumpy, excessive startle reflex . . . assessed to be extremely anxious . . . instructed to remain in quiet area--offered open seclusion for safety." The nurse did note, however, that Debbie relaxed later on. Dr. Fernandez, who had returned from out of town, noted none of the events of the day in her 8 p.m. entry in Debbie's hospital records, except that Debbie had left her group session early because she was having flashbacks. Fernandez did write that Debbie "claims that she had thought of burning herself with a cigarette, not to kill herself but to see what it would feel like."
Fernandez did write--three times in a three-paragraph entry--that Debbie denied having suicidal or homicidal ideations.
After seeing Fernandez, Debbie walked out of a wrap-up group session early, clearly distraught, according to another patient at the session. Debbie went back to her room, 307A, the closest to the nurses' station. There, she was alone. Although all of Charter's rooms are doubles, she had no roommate.
Charter wouldn't release records of the staffing at the hospital that evening, but corporate spokesman Andy Brimmer says it was "well within the normal industry staffing levels."
But Ralph Henderson, who came to visit his wife at about 6:30 p.m., remembers that a nurse allowed him to walk back to his wife's room unescorted, saying, "Just go ahead, because we're kind of short-handed tonight."
Brimmer concedes that "one person called in sick" that night.
Shortly after the wrap-up group meeting, at 9:45 p.m., a counselor claims he checked Debbie, who was lying in bed. When he left, Debbie carried through with her plan.
As she had several times before, she used her bedsheet. As she had in late May, she tied a knot at one end and flung it over the bathroom door. She wrapped the sheet around her neck several times and stepped from a chair in the bathroom.
The counselor, who claims he checked on her 15 minutes later, found her body in the bathroom. He summoned a nurse, and the two started CPR.
The Chandler Fire Department was called to Charter at 10:06 p.m. (A patient claims she dialed 911 on Debbie's behalf.) A fire department report indicates that when paramedics arrived, Debbie apparently had not been breathing for as long as 30 minutes. "It was a . . . mess when we walked in," Chandler paramedic Dan McFarland remembers. Upon his arrival, McFarland says, Charter workers stopped treating Debbie immediately and waited for his crew to take over. "They just got up and left," he says. "Normally, it's a little more organized transition. Normally, you try to get an idea of what was going on. . . . All of a sudden, everybody's up. It was like, 'Whoa, wait a minute.'"
McFarland would also note that the Charter staff appeared to have "very limited" knowledge of the patient's medical history. "They didn't want to talk about it," he says.
A half-hour later, Debbie was taken to Chandler Regional Medical Center, where she was pronounced dead. The county medical examiner would note that when her body was brought in, Debbie Townsend was wearing a black belt around her waist.
Fernandez, in notes written the next day, stated that Debbie "did not appear agitated or distraught. . . . Patient, staff, the writer, Dr. Wandler, her therapist and her husband all felt she had improved."
Homer Townsend disagrees with that assessment. He recalls a telephone conversation with his wife that evening, shortly before her death. "I'm coming home,'" Homer remembers her saying. "I'm a little scared and I don't feel I'm ready to come home. I still have a lot of problems.'"
And in Debbie's hospital room, police say they found several drawings on top of a dresser, "in plain view." The most startling drawing was of a naked woman, a noose around her neck, hanging from a door. @rule:
@body:The state Department of Health Services is investigating Debbie Townsend's suicide. The agency didn't learn about it until last August, when New Times inquired.
Hall says he was out of town at the time of the incident, and otherwise would have reported it himself. State law doesn't require hospitals to report suicides.
"It's unfortunate, but that's the way the law reads," says Virginia Johnson of the state Office of Hospital Licensure.
From New York, Charter spokesman Andy Brimmer expresses his condolences. "Obviously, we're deeply saddened for the people involved, and it's our policy . . . to identify, at least, potentially self-destructive behaviors and provide as safe an environment as possible for patients who could harm themselves or others."
But Hall emphasizes that "from our perspective, the treatment was appropriate."
Homer Townsend has the fatal bedsheet. For some reason, police gave it to him.
He sits in the master bedroom of the home he shared with Debbie. It's late summer, and although she has been gone for more than a month, some of her possessions are in plain view.
"This is a shrine," he says.
Stuffed animals--important therapy tools for incest survivors--line the bed's headboard. Debbie's favorite stuffed animal, a hairy orangutan, sits on a desk. Since his wife's death, Homer has given about 30 of the stuffed toys away.
"I'm doing better every day," he says as he sorts some of his wife's drawings, pictures and notes--images and words he could not look at until recently.
They are the work of a troubled woman. There are childish crayon drawings. Pictures of little girls. Pictures of naked women with penises next to them. Pictures of the devil. Crosses. One picture depicts a little girl, hovering in the closet, imploring, "Daddy, let me out. I'm scared." In another, she is asking, "Daddy, why are you crawling into bed with me?"
Homer says softly, "She suffered horribly for the last three years. But we all thought that she would get better."
It appears, according to a note police found in her hospital room on the night of her death, that Debbie held out hope of putting her shattered life back together. The note says:
"I feel the hopelessness of the dying, pieces of me scattered in a million pieces--a jigsaw puzzle. I don't know how, can't figure out how to put myself together again . . . I have helpers working on this puzzle, but it feels too hard to try. I plug along, trying to rebuild myself again, searching for the missing pieces. Someday, I will be whole again."
@body:You can only listen to music for so long, and when that moment of wretched excess finally arrives, what do you do? Read about it, of course. Slip off those Doc Martens, settle back in the comfort of couch or park bench and let the pages turn. Dig on the fundamental nuances of jazz. Live vicariously through the titillating debauchery and unique triumphs of musical legends. Pick up helpful trivia: What famous jazzman said, if he had one hour left to live, he'd spend it strangling a white man? That's right--Miles Davis. Here's a look at seven volumes, some good, some not so good, that will help explain what went into what comes out of your stereo speakers.
Incredibly Strange Music, Volume 1
Step right up, ladies and gentlemen, for a glimpse at the first book ever to chronicle the history of all those nut cases, eccentrics and bad-taste mongers who somehow gained access to a recording studio. Incredibly Strange Music is titillating and truly a carnival side show for anyone wanting a lurid offering of psychopathology at 33 and 1/3.
Herein lie capsule reviews of kitsch music ranging from third-rate lounge singers' home recordings to religious ventriloquism on disc. Fake Beatle rip-offs, throwaway 60s surf music, stripper soundtracks, unbelievable attempts at spookiness by horror-movie TV hosts--all reviewed for you by the twisted collectors of this recorded quirkiness. The reader is left wondering which is stranger: a record called The Adventures of Muhammad Ali and His Gang Vs. Mr. Tooth Decay or the San Francisco oddball who lives to find such pearls in thrift-store racks.
Some music collectors will treasure Incredibly Strange Music for supporting their similar dementia, others will find the book to be a prurient look at the underbelly of the recording world.
Across the Great Divide: The Band and America
Seventeen years after the breakup of rock's ultimate backwoods quintet, the Band, comes a 400-page bio recording its freakish presence throughout the psychedelic and disco eras. Readers who recall the high points of the group's career--the early days backing Dylan, the final stand at the Last Waltz--will find Hoskyns' story validating their memories. What lies in the middle of The Great Divide is a dry stretch colored only by an endless procession of band-member tiffs and dope excesses.
Hoskyns makes up for the unavoidable hundred-plus pages of the Band's bland days by his heartbreaking portrayal of the late Richard Manuel, whose self-destructive drinking resulted in a 1986 suicide by hanging. Also intriguing is the attention given to Robbie Robertson: his post-Band career, friendship with director Martin Scorsese, and Levon Helm's resentment at Robertson's refusal to join the surviving members for another shot at the Big Time.
Across the Great Divide spills the goods on this once fiercely private group, and in doing so is forced to strip away the endearing moonshine n' cornhuskin' persona of the Band. By book's end, you'll never listen to "Cripple Creek" the same way again. Sadly, Hoskyns shows that for these five hokum inebriates, success was truly "a drunkard's dream if I ever did see one."
Ornette Coleman: A Harmolodic Life
(William Morrow and Company)
A Harmolodic Life somehow seems anticlimactic in comparison to the still-revolutionary music of jazz's supreme alto-sax rebel. Not that the author is at fault for watering down a colorful history--the quiet Coleman simply blows a more interesting story than he has lived.
Though Litweiler doesn't seem to be bothered by Coleman's behavior, readers may wince through certain passages. The musician was homophobic to an almost paranoid degree, and once wrote what he felt to be "the ultimate sport's anthem." "The Ball Song," written in Coleman's trademark cacophonous style, was to be performed at all major sporting events and sung by Frank Sinatra. This did not happen. Not only will the endless praise wear a bit thin for some, the detailed dissections of Coleman compositions will have nonmusicians flipping ahead in the book. Still, even these drawbacks should not keep jazz fans from this brave and informative attempt to comprehend Coleman's aberrant jazz approach. Most jazz biographers choose much easier and more traditional figures to expound upon. Litweiler has tackled a tough one and made some sense of jazz's most misunderstood musician.
Linda Martin and Kerry Segrave
Anti-Rock: The Opposition to Rock n' Roll
(Da Capo Press)
Elvis' hips didn't lose the Korean War for us, and in spite of those threatening Beatles, Jesus is as popular as ever. Authors Martin and Segrave have compiled a fascinating and detailed overview of four decades of politicians, preachers and educators--all common in their ranting that rock is the product of Communists, Satan, or both.
From stories of early-'50s paranoia regarding "the Negro threat" of doo-wop groups to Tipper Gore quotes from her PMRC jousts with Frank Zappa, Anti-Rock remains a head-shaking view of how the devil's music is most certainly going to bring about the decline of Western Civilization.
While the authors remain remarkably free of outrage, the reader probably will not. We expect the slew of compiled references on wicked folks like the Rolling Stones and Prince, but not some of the more ludicrous stories that the authors include. The oh-so-subversive Lovin' Spoonful was once considered a threat to democracy, and the Nitty Gritty Dirt Band took its lumps from a pious DJ for a musical reference to God. Yikes. Such refined logic is regularly churned out by our neighborhood churches and PTA groups, the authors remind us. The antirock quotes from figures like Bob Hope, Frank Sinatra and Jesse Jackson sound more ludicrous than appalling; we somehow expect them to sound as foolish as the rock bands they criticize. But the authors' intense research mainly centers on quotes from the kind of persuasive local community figures who affect lives with their soapboxing a lot more than Sinatra ever could. By the time you reach the recent suicide-for-Ozzy Osbourne brouhaha, the book has you realizing that all the years of Communist/Satanist/moral-threat accusations have yet to uncover any real bogeymen whacking away at those guitars.
Miles Davis for Beginners
(Writers and Readers Publishing)
A recent European discography of the late trumpeter Miles Davis spends almost 400 pages merely listing the recorded song titles and session men of the jazzman's career. For Beginners, on the other hand, valiantly attempts to cram his entire 65-year history into a TV Guide-size comic book for adults.
Surprisingly, writer/illustrator Daryl Long and his three collaborators do a killer job of it, pulling a very Milesish move in saying a lot about the Prince of Darkness in very few words. Although the eye-grabbing graphics steal more than half of the volume's space, the text still manages to squeeze in both major jazz history and trivia. Davis' role in bebop, cool jazz and fusion is sufficiently explained in fewer words than you'd find on a menu, with remaining space permitting mention of such minutiae as the horn player's appearance on Miami Vice in 1986.
For Beginners is a minor lecture on a major jazz figure, kept interesting through the interjection of famous rude quotes by Davis and the gruesome details of the trumpeter's love life. Anyone not willing to brave the matchless, two-volume (and counting) bio Milestones by Jack Chambers should give Long's booklet a shot. For Beginners' brevity may even help in assimilating the scope and complexity of Davis' monumental role in jazz history.
The Jazz Scene
In the history of the known universe, this is one of the greatest books on jazz ever written. The Jazz Scene details crucial elements of the music that many works overlook: Hobsbawm lets the reader know how jazz is treated by the business end of the recording industry, why certain players are exalted while their equally talented peers are not, and something of the personality of jazz fans. Along with James Lincoln Collier's The Making of Jazz: A Comprehensive History, this may be the only other truly necessary book for a jazz diehard to read.
Most of The Jazz Scene was first published nearly 30 years ago, when English author Hobsbawm used the pseudonym Francis Newton as a means of keeping his jazz writings separate from his books on history.
Now that the highly respected jazz writer Newton has decided to reveal his Clark Kent identity, we see that The Jazz Scene is really two books of history in one--the music's and Hobsbawm's 60-year obsession with it. Fortunately, this intellectual writes from his heart, and we're spared the usual, dry, dates-and-places approach to grasping jazz. The book is a passionate memory of his affairs with every school and era of the genre to date.
Van Morrison: Too Late to Stop Now
There are only two critical questions fans ask of any book on Van Morrison: 1) Does it explain Van the Man's spiritual beliefs better than his albums do? and 2) Are there a lot of those great stories about what a mean bastard he is?
Steve Turner's book actually deals with little else. In the religion department, the reader is given the impression that Turner looks to Morrison as his guru and wants to let us in on the Irishman's rather ethereal beliefs for the sake of our own edification. Little surprise that the author is disappointed with Morrison's recent disc, Too Long in Exile, since it strays from the mystical musing more than any release of Van's in a decade. The author instead uses quotes from the earlier recordings in an attempt to solidify Morrison's insoluble faith.
As for tales from the dark side, Turner is willing to repeat countless incidents of stood-up interviewers, fans insulted by Morrison and his tirades against the record industry. But he is not about to incur the wrath of his idol by commenting on the venom, let alone draw a conclusion regarding Morrison's Jekyll-and-Hyde personality.
No big deal. We're given a fine mix of piety and poison from the mouth of Morrison himself, making for an interesting read and an intriguing stab at psychoanalyzing the marvelous Mr. Moondance. Far too much space is given to his period with Them, the band that first brought him attention, but the wealth of rare photos makes up for the imbalance. A solid bio it's not, but the book's habit of leaving Van the predator to watch him pray is very engaging.
@hed:The Author Side of Music
@by:By Dave McElfresh
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this is the second feature for suntracks. book cover art is available.
Mac person: 33 and 1/3 needs to be fixed before making proof.
Proofer: No deck, per Jeremy.