The Insanity Plea (9 page)

Galveston was blessed with
outstanding medical facilities for a town of 65,000 people. The hospitals had
their roots in the late eighteen hundreds when city fathers petitioned the
legislature to open a medical school in the prosperous boom town.
 
In the middle of the twentieth century a
philanthropist named John Sealy donated two hospitals, one named for him and
one named for Rebecca, his wife. Later, the Shriners built one of their children’s
hospitals across the street. The Rebecca Sealy Hospital housed the psychiatric
unit.

The lawyers elected to leave Duke’s car
in the jail parking lot and walked east toward the hospitals. It was a
sun-filled day and both lawyers needed time to digest what they were learning. In
ten minutes they entered the hospital and found the psychiatric unit on the
first floor. Wayne handed the receptionist a business card, saying that they
represented Dan Little and asked to see his doctor. The receptionist scrolled
through a computer screen and said, “The main psychiatrist seeing him is Dr. Adashek.
Please have a seat and I’ll see if he’s available.”

Wayne wandered around the waiting
area, noting the pastel blue walls and prints of mountain valleys, green
pastures and Caribbean islands surrounded by a placid ocean. Must be decorated
to calm the patients who waited here, he thought.

Duke sat on an old leather couch and
picked up a copy of
USA Today.
“Hey,
better than my doc’s office. This is today’s edition. I’m lucky to find one
less than a week old when I go in for my physical.” Duke flipped through the
sports section, commenting on the NBA scores and then went to the front section.
By now Wayne was gazing out the window as his mind replayed the visit with his
brother. Life’s not fair, he concluded. Dan was a hero in high school, did
everything right in college and law school, should have had the world by the
tail. Instead, he’s out of his mind and charged with capital murder for
something he couldn’t have done. “Shit!” he muttered. “Shit! Shit! Shit!”

It was a half hour later and the two
lawyers were growing impatient when a tall man in a white coat came through the
double doors. Dr. Adashek had black hair and a neatly trimmed gray goatee. His
accent was middle-European.

“My apologies, gentlemen. We had an
incident up on one of the floors and I had to supervise the take-down of one of
our patients who became a little unruly. You’re Mr. Little’s brother?” he asked
as he extended his hand.

“And I’m Duke Romack. I’m part of Mr.
Little’s defense team.”

“This way, gentlemen.”

They followed the physician to a
small yet efficient office, lined with shelves filled with books that
overflowed to stacks on the floor.

“I asked one of my nurses to pull
Dan’s file while I was upstairs.” He patted a three inch thick folder. “As you
can see, we’ve had Dan as a guest here and at the jail frequently over the
years.”

“Doctor, I’ll probably ask for a copy
of that file and any other records you folks may have. Meantime, can you give
us a thumbnail sketch of what’s been going on with my brother?”

Dr. Adashek glanced down at the
folder. “I really don’t need this. I’ve been dealing with Dan for too many
years. Where to begin?” he mused. “When he is taken off the streets, whether
for treatment here or jailed, he’s always had long, greasy hair and beard. Both
have turned gray over the years. Most people like him don’t have any concerns
for personal hygiene. Everything they own they have with them. Some just have
several layers of clothes with stuff in various pockets. You’ve probably seen
others pushing around a grocery cart or carrying a garbage bag over a shoulder.”

“I know what you’re talking about,
Doc,” Duke said. “Bunch of those people camp under a bridge in downtown
Houston.”

“As you know, your brother has a long
history of mental illness,” the doctor continued. “The medical diagnosis is schizophrenia,
paranoid type, chronic. I understand you know something about his early
diagnosis and first few years when he lived with your mother.”

Wayne grimaced as he thought back to
those years, then got up and paced the small office, head down, hands jammed in
pants pockets and shoulders slumped while he continued to listen.

“Let me start at about that time. There
are a couple of rooming houses over near the Salvation Army. You might call
them flop houses. They rent rooms by the week. At first, Dan stayed there and showed
up over here, trying to get help. We mixed and matched medications, trying to
find some that he would take regularly. During the times we could keep him on
medications, he was even going to the medical school library, determined to
diagnose himself and find a cure.”

Dr. Adashek took off his wire-rimmed
glasses, rubbed his eyes, and put them back on, blinking as he continued. “I’m
sorry to say that we failed and Dan failed, too, although it certainly was not
his fault. A lot of schizophrenics, particularly men, can’t handle the
medications. The side effects, restlessness, twitching, Parkinson-like
symptoms, are often such that they just quit the meds. Dan did that. He also
decided after spending time in our library that he really was not sick and didn’t
need to be on any drugs.”

“I’m sorry, Doc,” Duke interrupted,
“but couldn’t you just have committed him, locked him away?”

“I wish we could, Mr. Romack. Our
society and judicial system won’t permit it. It’s a giant, dirty secret that
our public officials refuse to address. We have two million people with
schizophrenia or bi-polar disorder in this country, and at least half of them
are living on the street. Most of them prefer the street to an institution.

 
“As to Dan, over the years he has been picked
up on numerous occasions. Most of those times are documented in the file. Petty
stuff except for a couple of occasions when he had gotten in fights. He’s
slight of build, but pretty damn strong, particularly when the voices are
talking to him and saying that the person walking toward him is about to kill
him. Then, he gets really aggressive. Most of the time, though, he just wants
to be left alone.”

“If you can’t throw away the key, how
long can you keep him?” Duke asked.

“When he’s brought to us, we can
usually hold him for about thirty days. During that time, we force him to take
his meds, either orally or by injection. By that time, he’s no longer a threat
to himself or others, and the law requires us to discharge him.”

“Meaning you just toss him out on the
street again,” Duke said, disgust in his voice.

Dr. Adashek rose and walked around his
desk and stood, facing Duke, his arms folded as he confronted his accuser.
 
“No, Mr. Romack. We don’t just throw him out. We
usually tried to send him to a halfway house where there are caregivers who can
monitor the residents and encourage them to take their anti-psychotic drugs. I’m
sorry to say that’s when the cycle, the revolving door if you will, starts all
over again. The meds are working. Only with their side effects, Dan decides to
quit taking them.” He threw up his hand. “Here you go again.”

“Doc, you talked about voices. I’m
not sure I understand about these voices,” Duke said, confusion showing on his
face.

Dr. Adashek turned to the bookcases
behind him and surveyed the shelves until he saw the book he wanted. He pulled
it from the shelf and grabbed a tissue from a box to wipe dust from it. He
handed the book to Duke who laid it on the desk and continued.

“Mr. Romack, you’ll find several
chapters in this text. You can borrow it if you like. The voices are real to
the patients, more real than anything else. Many of them follow the commands of
the voices. Some actually see people who are not there. You remember the movie,
A Beautiful Mind
, starring Russell
Crowe, the one about Professor John Nash. It’s basically a true story. Nash was
smart enough to win a Nobel Prize as a young man. Then the disease took over
and he spent years thinking that he was doing work for a secret government
agent. Most of his productive years were wiped out by the disease.”

“Yeah, I saw that movie,” Duke
replied. “Let’s get back to Dan. Where do you go from here?”

Wayne was now standing, his back to
the other two men, studying a wall filled with diplomas and awards, almost as
if he wanted nothing to do with the conversation or the situation.

“Just this morning I was over at the
jail and visited with Dan. I’ve changed his anti-psychotics again. There’s a
new medicine that has been experimental and is now approved for investigational
use. Some patients see remarkable results. Unfortunately, a number of them
improve dramatically and then something happens and there’s a relapse. I hope
Dan will be one of the fortunate ones. Maybe he’ll be more responsive and have
a better understanding of what’s going on. Hopefully, he won’t relapse.”

“Brings up another question, Doc,”
Duke said. “Is he competent to stand trial? Can he aid in his own defense?”

“Right now the answer would have to
be absolutely not. These meds I started this morning may change that. We’ll
have to give them a few days, maybe a couple of weeks.”

That got Wayne’s attention. He
whirled around and stepped toward the doctor’s desk, his face filled with anger
and his voice raised. “Wait just a damn minute, Dr. Adashek. Once we get
through all of this, I’d love to have Dan on a medication that worked. Right
now anyone who sees him can tell he’s crazy. What you’re saying is you are
putting him on one that might actually get him back close to normal. Sorry,
Doc, but I want the jury to see him as he is now and was at the time of the
murder. At least for now, forget the new medication.”

Doctor Adashek shook his head and
again folded his arms across his chest. “Can’t do it, Mr. Little. When he was
arrested, there was a forced-medication hearing. Based on the charge of capital
murder and his history, the court ruled that he was an imminent danger to
himself and others. I’m under a court order to medicate him.”

“Wayne, the doctor is right,” Duke
said. “I had a client a few years ago where that happened.”

 
Wayne got face to face with the doctor, his
voice now almost a shout. “Well, that’s a god damn shitty system. Man’s crazy
when a crime is committed and by the time he goes to trial, the jury is going
to see a completely different personality.”

Dr. Adashek backed away from Wayne
and circled around to the other side of his desk. As he did so, he put his
hands out, palms forward. “Please, Mr. Little, calm down. Let me tell you how
to get around this problem. Show the jury the intake video of your brother. I’ve
watched it and it’s the best evidence you can have of his condition at the
time. It’s clear the voices were controlling him. Whatever they told him to do,
he was going to obey.”

“I apologize, Dr. Adashek,” Wayne
said as he took his seat, realizing that it wasn’t going to do any good to yell
at the doctor. “Let me get some more information. I’m going to have to know
about whatever dirty linen the state’s going to hang out there. Has Dan been on
drugs?”

“I’m afraid so. Don’t blame him. It’s
very common. When they quit the prescription drugs, they self-medicate with
booze, marijuana or cocaine, whatever they can get their hands on. A lot of
them say that alcohol and street drugs shut up the voices for a while. On one
of the occasions that Dan was arrested for fighting, he had cocaine in his
system.”

“Look, Doc. You guys are curing cancer,
heart disease, you name it,” Duke interrupted. “Shit, even my old man can get
an erection. Why in the fucking hell can’t you solve this problem? And, pardon
me. I apologize for the profanity.”

Dr. Adashek leaned forward, his hands
resting on his desk. “No problem, Mr. Romack. I deal with this disease on a
daily basis and there’s no one more frustrated than me. We’re trying, believe
me, we’re trying, and making some progress, but it’s been baby steps. New drugs
are coming out with fewer side effects and more patients are able to tolerate
them. Still, far too many are like Dan. If only the National Institutes of
Health or someone would put another few hundred million toward research. Let’s
just hope the one I started Dan on today works.”

“Doctor Adashek, let me ask a
question as my brother’s lawyer, is he insane?”

Dr. Adashek drummed his fingers on
his desk, then pulled at his goatee. “Mr. Little, schizophrenia
is
madness. Those who have the chronic
disease act bizarrely. They are possessed by unknown and unseen forces who
direct their actions. Most of us in the mental health professions know that
they can’t be held accountable for their actions. Yes, Mr. Little, Dan is mad.”

With that, Dr. Adashek let out a
whooshing breath and slowly shook his head in obvious recognition that modern
medicine had failed Dan.

Wayne stared at the books behind the
doctor while silence filled the room. The only sound to be heard was the
clicking of an old clock on the wall as the second hand made its perpetual
journey. Duke started to get up and lead Wayne out the door when Wayne spoke.

“Doctor, I knew the answer to that
question, but I had to hear it from his treating psychiatrist. You know Dan has
been charged with murder. Will you testify for him in court?”