Revolving door leaves one patient, entire community at risk

Staff writerMarch 10, 2013 

Feb. 27: Four sets of straps bind patient B.P. to the gurney.

She can’t feel them; swimming in a medicated dream, she snores like an old baby. Parked in a narrow hallway at Western State Hospital, she’s about to have her day in court – again.

B.P. is 26 and messed up. She’s a Level 2 sex offender. Sexually abused as a child, she inherited the curse. She’s shuffled through institutions since the ninth grade.

She’s a sleeping dilemma, the human center of a clash between authorities trying to decide what to do with her: a mental patient with a lengthy criminal record and diagnosed disorders, out of the reach of courts, too volatile and violent for the community, ripe for involuntary treatment and unable to get it because of a lack of beds.

Three times in the past six months, she’s been involuntarily committed at Western State. Three times, hospital officials released her, designating her as a voluntary patient. Three times, she assaulted people assigned to care for her at less-restrictive facilities, most recently Feb. 24.

At 14, she was convicted of child rape and sexual molestation. Her victims were two brothers – one 10, one 7. She threatened to cut their necks with a circular saw blade.

At 19, while incarcerated at the Washington Corrections Center for Women, she was convicted of third-degree assault with sexual motivation after she molested her cell mate, a 55-year-old, developmentally disabled woman.

After finishing her sentence on that conviction, B.P. was civilly committed to the Special Commitment Center for sex offenders at McNeil Island.

In January 2009, a psychologist asked her to rate her chances of committing another sex crime. Her answer: 100 percent, according to court records. Repeatedly, she said she would attack children again if released, and probably hurt them in the process. She was classified as a sexually violent predator.

In 2012, the same psychologist assessed her again. B.P. said she no longer felt the impulses that led her to commit crimes. That prompted a new evaluation. In the state’s eyes, she wasn’t a predator anymore. That meant she couldn’t stay at the SCC.

Next stop: Western State. B.P.’s history includes multiple diagnoses of mental disorders. Before arriving at the hospital, she told a psychiatric evaluator she hoped to stay there for five years and fix herself.

It hasn’t worked out that way.

ARGUING FOR DETENTION

Today marks her fourth visit to the involuntary commitment court since June. Her latest trip through the revolving door came Feb. 23, just 10 days after Court Commissioner Craig Adams signed an order to detain her for 90 days at Western State. Instead, Western State released her.

On Feb. 24, one day after her release to a group home for the mentally ill, B.P. assaulted a staff member. Pierce County sheriff’s deputies were called to intervene.

“We’re aware of her situation, and we’re not happy about that,” says sheriff’s spokesman Ed Troyer. “It does a disservice to her and everybody she’s around, and the public.”

Now she’s back at the courtroom doors, parked on the gurney. Adams is annoyed – but not with B.P. He reserves his ire for hospital officials who treated his detention order like a parking ticket and didn’t notify the court about her release.

“Why are we doing this again?” Adams asks.

“I’m not sure what happened there,” says Ken Nichols, the deputy prosecutor assigned to the commitment court.

Nichols represents the mental-health experts who argue for detention. A small group of defense attorneys from the county’s Department of Assigned Counsel represent the patients.

Adams refers to his recent order: 90 days of detention at Western State, seemingly ignored.

Nichols answers haltingly. The order says “up to” 90 days.

Adams is unimpressed.

“If the age-old definition of insanity is doing the same thing over and over, well – come on, folks,” he says. “I just signed a 90-day order. I am concerned that we are perhaps making the revolving door spin even faster.”

B.P. is too drugged up for her hearing. Other patients are waiting. Adams orders a new hearing March 1. B.P. returns to St. Clare Hospital in Lakewood, restrained and parked for lack of any other place to go.

GRAVELY DISABLED

March 1 comes and B.P. is back in the courtroom – conscious this time, but woozy. She sits at the defense table, represented by attorney Eula Garrison.

Garrison says B.P. wants to go to Western State, where she can get the treatment she needs.

Next to Garrison, B.P. mutters in a foggy voice. Garrison tries to shush her.

“I don’t feel good,” she says. “I don’t feel good.”

Jessica Shook, a designated mental health professional, sits next to Nichols and describes her recent attempt to assess B.P.’s mental health. The visit took place in a hospital room in Lakewood.

“I actually was not able to do a full mental status exam with her,” Shook says. “When I approached her, she escalated very quickly. I felt I needed to remove myself from the situation for both her and my safety. …

“When I addressed her, she sat up in bed suddenly and lunged toward me where I was standing at the door and screamed that I needed to get away from her.”

For those who know B.P., the description is familiar. Her history, chronicled in various court records, includes numerous violent incidents toward those who try to care for her. She can move from groggy to violent in an instant. She’s young and strong. She kicks, hits and spits.

Nichols, the deputy prosecutor, asks Shook whether B.P. is “gravely disabled,” a key legal phrase that justifies involuntary commitment.

“Yes,” Shook says.

Nichols asks whether B.P. is ready for a “less-restrictive alternative,” another key phrase meaning something less than detention at the state hospital.

“No,” Shook says.

It’s Garrison’s turn to question. She’s already said her client wants to go to Western State, but the duty of public defense requires a clear record. What makes B.P. gravely disabled, and how reliable is the evaluation under the circumstances?

Shook answers generally: It’s the behavior, including the latest assault incident at the group home.

“That puts her health and safety at risk,” she says.

Garrison calls B.P. to testify. Adams swears her in. She promises to tell the truth.

Where does she want to be, Garrison asks.

B.P. rambles a little.

“I want to stay in the hospital,” she says. “I can’t do it in the community no more. What I did was wrong and unacceptable – and there was no blood on the tissue.”

The testimony ends. Adams is ready to make a ruling – the same ruling he made days earlier.

“A week ago, I ordered her to go to Western State for 90 days,” he says. “She was released, unfortunately. I have typed on the very top of this order there shall be no release. There will be no releases. If someone wants to take it up, they will be back before me with an issue of contempt.

“If the estimate of a civilized society is how we treat our most vulnerable, we have failed.”

HOW DID THIS HAPPEN?

The ruling ends the hearing, but the debate isn’t over. Adams has asked for a separate hearing March 13 to find out why the woman was released from commitment despite the court’s order.

Who made the decision? Was it OptumHealth, the for-profit company that handles Pierce County’s mental-health services? Or did the order come from Western State officials, who refused to accept her at the hospital? Apart from that, what’s the justification for blowing past the court’s order?

“The case focuses the issue fairly acutely,” Adams says.

Sean Robinson: 253-597-8486
Sean.robinson@thenewstribune.com

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