A System Gone Mad

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Because of large court calendars, jurists must rely on a ward's attorney to raise objections to fiscal or other matters. Records in Donald's case show no instances of his attorney objecting to the agency's accountings.

"In the past, we'd never get notice from the court that AVSC had even filed its accountings," explains Connie Leon, Donald's attorney since 1992. "There was nothing to object to. That's the way it was until Judge Franks changed things a few months ago."

Court commissioner Robert Colosi says he and the other jurists who routinely approved AVSC billings over the years should bear some responsibility.

"It would be easy for me to say we don't have enough time to pore over every bill," he says, "but that's not a good enough excuse. . . . I hope it's not the tip of the iceberg."

A Protected Class
The outlook brightened in the early 1990s for Maricopa County's 10,000-plus seriously mentally ill people--SMIs in health-care vernacular.

Until then, Arizona had ranked at or near the bottom in spending on services for its SMI population.

That changed after 1989's Arizona Supreme Court ruling in the historic lawsuit known as Arnold v. Sarn. In a bold move, the court ordered Arizona lawmakers to start funding programs for SMIs.

Since 1992, the county's SMIs have been treated through ComCare--Community Partnership for Behavioral Health Care--under a contract the agency holds with the state.

As a member of the "protected class" in Arnold v. Sarn, Donald Ellison automatically became a ComCare client, meaning he had two systems designed to look after him--the Arizona Veterans Service Commission and ComCare.

"Of all the vets I have represented, Donald was among the most special," says Connie Leon. "He could be a very enchanting person when he was well, though even on his good days he would talk delusionally. His was a true psychosis induced by his experience in Vietnam. He couldn't help himself."

In March 1989, a car struck Donald as he wandered onto East Van Buren Street one evening. He declined medical treatment for an injured leg.

Days later, he again was involuntarily committed to the Arizona State Hospital. It happened after he turned on the stove in his latest residence--a rickety motel on Van Buren--and piled a stack of wood on his bed.

Doctors at the mental hospital ordered x-rays of Donald's injured leg: It was broken.

His ever-revolving-door--jail, mental hospital, discharge--continued. In 1995, Donald again was incarcerated after he allegedly threatened a Phoenix cop with a knife. That December 6, a judge ordered him to undergo one year of mental treatment--with a maximum of 180 days in a mental ward and the rest prospectively as an outpatient.

Such court-ordered treatment is allowed in Arizona when "a patient is unwilling to accept or incapable of accepting treatment voluntarily."

They could call it the Donald Ellison Law.
A variety of records makes it possible to retrace the last months of Donald's life almost by the hour.

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.

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Paul Rubin
Contact: Paul Rubin