Psych Observer – Exposing Bad Psychiatry

Sally Turnear knew her son was in trouble. She knew he could convince doctors he was fine to be released from the hospital, and her worst fears were realized when he killed himself Aug. 1, two days after being discharged from Broughton State Hospital.

Chuck Turnear is one of three men who died in a six-month span last year after being discharged from a state psychiatric hospitals. Members of all three men’s families spoke to the Citizen-Times about their loved ones’ deaths, which they believe should have been prevented.

Planning for patients’ treatment after discharge has been a problem at North Carolina’s state hospitals for several years, according to a report released this week by Disability Rights NC.

“This is just three deaths we know about,” said Vicki Smith, director of Disability Rights NC. “I believe there are likely to be other deaths we don’t know about yet. … We plan to look at other deaths and other concerns.”

Federal rules require hospitals to ensure plans are in place before patients leave state hospitals, and evaluations of North Carolina’s hospitals in 2004 and again earlier this year found discharge planning inadequate.

Intervening from afar

Turnear had called police when her 37-year-old son, Chuck, who lived in Iredell County, called her at her home in New Mexico and told her he had taken an overdose of Valium. He had a history of bipolar disorder and had been hospitalized two years earlier for threatening to commit suicide.

“I didn’t know who else to call, so I called the police,” she said. “I wasn’t familiar with Broughton at all when the police told me he was going there.”

Before police could get Chuck Turnear to Broughton, they had to stun him with a Taser. He had several guns in his house, which police confiscated.

Turnear couldn’t get any information about her son from Broughton personnel

— not even a confirmation that he was there.

“They kept quoting HIPPA,” she said, citing the federal health privacy law. “They finally gave me a number for a pay phone in the recreation room of one of the wards.”

Turnear called the ward again and again for several hours until a patient finally answered. He told her Chuck was there.

“I thought they’d keep him there until he was stabilized,” Turnear said. “But they let him out. I knew he had been cycling up and down and he needed help, but the people at the hospital didn’t see that.”

Chuck Turnear told doctors he hadn’t really intended to kill himself and promised to call his family doctor. That promise was the sum of his discharge plan. Broughton was over its patient limit that day, so it could not admit any new patients until others left. He was released, and a friend came and picked him up.

The next day he bought another gun and called his mother.

“We talked for about three hours,” she said. “It was a good talk.”

It was goodbye. On Aug. 3, Chuck Turnear shot himself in the head.

“I can’t tell you what it feels like to know my child is dead because he couldn’t get the help he needed,” Sally Turnear said. “I feel guilty because I didn’t go there right away, but I thought he was in good hands.”

‘In the wrong hands’

State law requires discharge planning, but the law is nonspecific and has not been enforced, said Smith, of Disability Rights NC.

Patients are supposed to leave the hospital connected to a provider in the community and with an appointment to see that provider within seven days. Many patients left with a list of desired services but no connection to the providers who offer them.

Brian Lowery, 30, left Dorothea Dix Hospital in Raleigh after 23 days last June, five days before he was to be admitted to a substance abuse facility. The police were supposed to bring him to a shelter in Lumberton, but the shelter was closed. He was dropped off at an emergency room, and the caseworker who had been working with him before he went to Dix was called.

“She didn’t even know he was being released,” said Brenda Lowery, Brian’s mother.

The caseworker got him a hotel room, but on Sunday, June 10, the day before he was to enter substance abuse treatment, Brian Lowery died of a drug overdose.

“They released him with the medications he needed but with no supervision,” Brenda Lowery said. “I put him in the wrong hands.”

The state is working to correct the problems in its psychiatric hospitals, said Mike Lancaster, co-director of the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services. One idea is to place bridge services at health departments and federally certified free clinics where newly discharged patients could get help until they could get appointments with regular service providers.

A new rule put in place early this month requires each local management agency to designate a person who will coordinate planning with the hospitals.

Some local management agencies, including Western Highlands, already were doing this type of planning. Don Herring, director of clinical services for Western Highlands, said the care coordinator is there to make sure caseworkers know a patient is being released and so that needed services can be in place.

A care coordinator also would have been aware the shelter where Brian Lowery was being sent was closed. He likely would have been kept in the hospital for the five days remaining until his admission date at the substance abuse program.

The biggest challenge now, Herring said, is housing.

“People need safe places to stay,” he said. “A shelter is not the best place. If you need to have someone go there, though, it needs to be coordinated with the care that person needs.”

‘The system is broken’

At age 16, Drew Thames already had been sick for nearly a decade. He couldn’t function in school, and his medications didn’t alleviate the pain of having bipolar disorder. When he was 13, he began to self-medicate with marijuana, and later with stronger drugs, said his father, Calvin Thames.

“At one time we had him arrested because there were services he could get in the justice system that we couldn’t get for him,” Thames said.

Drew Thames was placed in a substance abuse program in Greenville, but he was released because he wasn’t responding to treatment. He was placed in an outpatient treatment program at Duke University Medical Center and eventually in a therapeutic foster home.

“We had to work, and we couldn’t leave him alone,” Thames said.

But Drew’s condition got worse. He began to hear voices telling him to kill himself. Calvin Thames took his son to Duke, but since Duke doesn’t have an adolescent psychiatric unit, he was sent to John Umstead in Butner.

Doctors there took Drew off one medication and put him on a new one. But before they could evaluate whether the medication would work, the doctors decided to discharge him.

“The social worker assured us she would work with his caseworker to get him all the services he needed to stay safe,” Thames said. “But she couldn’t get in touch with his caseworker, so we brought him home without any discharge plan.”

Calvin Thames worked from his Chapel Hill home so he could keep an eye on his son. Patsy Thames worked during the day, napped in the evening and then tried to stay awake all night to make sure her only child was safe.

But on Dec. 14, Drew left the house when his mother dozed off. Two days later he was found dead of a drug overdose in a motel room.

“We tried every avenue we could discover,” Thames said. “We had to find everything by ourselves, by trial and error. The fact that they would release him like they did was appalling.”

But the couple want to stay positive. Patsy Thames will walk in her son’s memory at the May 17 fundraiser for NAMI, the National Alliance for Mental Illness, in Raleigh.

“There’s a human face on this,” Calvin Thames said. “These are real people who are dying because the system is broken. I just want to do something that will prevent this happening to somebody else.”