Coroner's Journal (13 page)

When I took on the job, I instinctively knew there'd be days when its two spheres of responsibility—mental health and death investigation—would overlap.

George was a Baton Rouge “personality” and was known to many as “Crazy George.” I never knew him personally but our paths had crossed, quite literally, on several occasions. George could be seen “directing” traffic on Government Street or dancing in the street and stopping traffic. He would wave, twirl about, and then bow.

People seemed amused by him and some would wave back. I think he was almost viewed as a street performer. Virtually everyone in town knew him either as “that guy” or “Crazy George.”

His real name was George Patrick James; he was fifty-four, from Baton Rouge, and had served in the air force during Vietnam. George was not a street performer—he was a victim of chronic mental illness, and he deserved our empathy, not our amusement.

He functioned adequately when he took his psychiatric medications. But for various reasons he went off them and his various pathologies overtook him. Records show that he had been diagnosed as paranoid schizophrenic, antisocial, bipolar, and an abuser of alcohol. He had many episodes of violent behavior. His family had him picked up on several occasions and brought to mental institutions.

I'm sure the people in their cars who laughed at him or indulged him had no idea that he had been arrested twenty-two times for battery, assault, and even concealed weapons. People who suffer from chronic mental illness often come to the attention of the police, though. George's last interaction with the police was a devastating one.

On February 28, 2001, at around 5:45 P.M., a Baton Rouge police officer was flagged down at the intersection of Perkins and Lehman streets by a female driver. She said that George had thrown a bottle at her car. George ran into a nearby house and came out with two knives. He retreated into the house when backup officers arrived. After attempts at negotiation, an officer broke through the door of the bedroom where George was holed up. Armed with a knife, he lunged at two police officers, who shot him. He died at a local hospital. We recovered three bullets from his body.

The ripple effect of George's death resulted in turmoil for his family, the police officers who shot him, their families, and the whole community. A grand jury cleared the officers of any wrongdoing. The NAACP called on the FBI to conduct a separate investigation. State senator Cleo Fields convened a town meeting on police brutality and also represented George's family in a civil law suit against the two officers. Baton Rouge Parish settled the police brutality suit for $257,000.

I think we as a community need to assess ourselves here. There is nothing humorous about mental illness. Referring to a person as “Crazy George” is derogatory and sets up the expectation that he will act crazy. Mental health advocates bemoaned the lack of adequate psychiatric services in Louisiana to deal with an overflow of potential patients. I agree. We do not have adequate mental health funding. Many of our facilities have long waiting lists, with the result that once patients are stabilized, they are sent back out. Then they relapse and need to get back in. It's referred to as “swinging-door hospitalization,” and the repeat patients are known as “frequent flyers.”

I am anxiously waiting for one of our local legislators to call a town meeting on
that
issue. A host of social ills converged to cause this disaster; I'm just sorry we didn't catch them sooner, for George's sake.

I saw a man standing on Government Street today. He was dressed in army fatigues and had a red bandana on. He looked to be in his mid-fifties. He had made up some posters that were nonsensical—at least to anyone but him. He saluted me and waved at the other people who had stopped at the traffic light there. I've heard he has threatened to kill some people who live in a house nearby.

My responsibilities look reasonable—on paper. If someone is acutely dangerous to himself or to others, or is gravely disabled and refuses to seek help, or is too impaired to seek help—I step in. Under an Order of Protective Custody, I literally order the person to be evaluated by a psychiatrist. It is my decision, and they don't get a vote. I have them picked up by the police and taken to a psychiatric facility. I have two full-time deputies assigned to me to help carry out the task: Larry Washington and Alexander Twine. They are seasoned vets and help me with many of the 2,000 cases we see every year.

After a prescribed stay in the hospital, the person is (one hopes) stabilized and then discharged to his or her home, or to some other safe place to live. Of course, the devil is in the details.

Committing someone to a mental institution is a major deal for everyone involved, and
lots
of folks are involved: the patient, the family, the office, the institution, the mental health advocacy attorneys, and the judicial system. When a request is made for an OPC, I must evaluate the motives and credibility of the request and act accordingly. If for any reason the petitioner lies under oath, there are penalties, and I'll push those penalties to the limit when that's warranted.

This is a composite of many, many different interviews I have done with both psychiatric and chemically dependent persons. They all tend to have the same common denominators. The patient is dangerous to himself or others. They may be suicidal or homicidal. They can also be disabled to the point of not being able to care for their needs. The patient is usually unwilling to seek treatment and the family has tried everything. Often they enable the patient by preventing him from suffering the consequences of his impaired behavior. The parents may do all the wrong things for all the right reasons. Family members are often embarrassed when they come to see me, as the coroner is often their last resort to save their loved one.

The man sitting across from my desk at 0730 hours was a man I'll call Harvey Preston. He appeared to be in his mid-fifties. He was appropriately dressed and groomed. He was relating a familiar story to me. It was about his daughter, but it could have been about any of the fifty or sixty cases the office would deal with that week. He was anxious and furrowed his brow frequently. It was as if he was pleading a case to me. In a way, I guess he was.

“The police told me to come down here and you would help me. It's about my daughter, Angela [not her real name]. She's driving me and her momma crazy, and we're too damn old for this.”

I accepted his sincerity at face value. His demeanor was appropriate for the situation. He made direct eye contact and responded to my questions without hesitation.

“What is her mental health history?” I asked him.

“She lives with us. Well, off and on. She can't seem to make it on her own. We're raising her two-year-old. We're too old for that, Doc. She's had problems since she was a teenager, but it's worse now. She met some damn guy who is just no good. He got her on cocaine. We've had her to a psychiatrist and they say she's bipolar, but she won't take her medication.”

“He run off a long time ago. She gets into some bad relationships. He don't pay no child support. We just want her to get well and take care of our grandson. We're afraid she'll cart him around with her and put him in danger. I'll be honest, she's done that before. Scares the hell out of us.”

“She went on a real tear last night. We had to call the police out but they wouldn't take her 'cause she calmed down. My wife really don't want her committed to some asylum, but we are at our wits' end here. We don't want her to take the baby and run off. She's threatened to do that.”

“She was in a hospital a few years back and got on some medicine and acted better for a long time. Then that son of a bitch got her on that cocaine. Excuse me. Anyway, she says she ain't never going back to some nuthouse. That's what she calls it.”

No excuse needed here.
I let him go on without interruption. Open-ended questions tend to yield much more information in this situation. He was calmer now. This catharsis of talking it through was therapeutic for him. It is so important to have someone listen when you need it.

“She threatened to hit her momma last night—that ain't right, Doc. Then she said everyone might be better off if she wasn't around anymore. My wife is at home right now watching her sleep. We're afraid to leave her alone.”

“I've got enough to issue an order of protective custody. That means I can have police officers pick her up and bring her to a hospital for a psychiatric evaluation. That evaluation must be done within twelve hours of her arrival. Now, for the real kicker—does she have health insurance coverage?”

“Nope. Not a cent. My wife and I have been talking about this. We're willing to pay, but we ain't rich folks. . . . But she needs the help.”

My gut tightens up a little. I've seen good people like this go through their life savings trying to get someone to accept help. You can't make people get well, but you can stabilize them and try to motivate them. My grandfather's words serve me well here: “You can lead a horse to water but you can't make him drink. But you can also keep him there long enough until he gits thirsty—
then
he will.”

We do have a handle on this one—if she cares enough about her son. She might try for his sake, or maybe she will ultimately decide to do it for herself, and then it will stick. That's a lot of “if.” Maybe I can get her a bed at the state psychiatric facility. Maybe she can stay long enough to get some good out of it. Maybe we can send her on to outpatient care. Maybe we can set her up with a halfway house for her and her kid. Maybe . . .

I explained this to Mr. Preston, with the caveat that there are no guarantees. We may send her for an evaluation only to have her released the same day. I've seen that happen. We just don't have the resources. If that does happen, I'll be sitting here again with Mr. Preston and we may well begin a swinging-door process of putting her into treatment only to have her discharged prematurely and relapse and be sent back into treatment. A coroner's hold can only keep a person in the hospital for fourteen days.

 

 

 

Less than twenty-four hours later, I am at the state psychiatric hospital visiting with Angela Jeanne Fontaine. Greenwell Springs Hospital was originally a tuberculosis hospital. The inside has the look of an old institution, its tile walls a pale shade of lime. The dark finished woodwork comes from a time when craftsmanship meant something. My footsteps echoed down the shiny tiled hallway. I go there so often that I have my own keys to the locked wards. I pass through those doors and am immediately recognized.

“The coroner's here. Who all do we have for him?”

One of the nurses had escorted Angela into the interview room and was kind enough to stay with us during our visit. Angela's hair needed the attention of a brush or comb. She was dressed in the standard-issue GWS hospital pajamas and robe.
Where do they get those damn things?
The robe hung loosely about her malnourished frame.

The room is not exactly conducive to establishing rapport. Lighting consists of a fluorescent ceiling fixture and whatever daylight can trickle in through the single barred window there. It has an exam table, circa 1950, with a wobbly examination light beside it.

The only other furniture in the room consists of a World War II-era battered gray desk and three chairs of various color and design, all of them chosen for their functionality. That means that if patients have urinary or bowel incontinence while sitting on them, the chairs can be easily cleaned. I'm not sure why my chair, too, is like that, and then I start to wonder about who has been sitting in it and about what previous fate it has endured.

Angela was staring at the floor when I walked in, but she managed the energy to look at me when I introduced myself. Her eyes were framed in sunken sockets.

My obligation was to determine whether she truly fit the criteria to keep her in treatment against her will. Her responses were monotone and cryptic.

“I know who you are,” she began. “My parents had me picked up. They are always trying to control me. I would have come on my own if they had asked me . . . just not right now.”

“Yeah. I'da come, but I don't need to be an inpatient. I got a kid, you know.”

She has poor insight into this situation, and she is already trying to play the kid card. It's a rather primitive defense at this point and I confront her on it.

She tears up. “Hey, I love him! Okay? I'd do anything for him . . . except this . . . I don't need it that bad. I need to be with him.”

Is she an acute danger to self or others? That is the question.
“Have you had thoughts of suicide?”

“Yeah, I thought about it, but I would never really do it. I know I need to stay around for my little boy. Hell, his daddy is nowhere to be found. . . . Sometimes I do think everyone would be better off without me around. . . . I overdosed a couple of times, but I don't think I was really serious.”