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.

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Dave Newbart