Man searches city streets for miss­ing men­tally ill brother

Sib­ling ques­tions why clinic didn’t tell of dis­charge

Houston Chronicle - - CITY | STATE - By Cindy Ge­orge

Step­ping care­fully through the dusty sand in a home­less camp un­der the dim over­pass of the South­west Free­way, Ge­orge Ruano found a glim­mer of hope.

Some­one may have seen his miss­ing brother re­cently at Her­mann Park.

“Oh, thank you. Thank you,” Ruano replied grate­fully Thurs­day. “We’ve been ev­ery­where. He just dis­ap­peared.”

He piv­oted on one foot in the mo­ment, as if un­sure whether to leave or stay. Then he headed back to Her­mann Park, where ear­lier in the day a po­lice of­fi­cer had di­rected him to the con­gre­ga­tion of tran­sients among the tents and mat­tresses near down­town.

His brother — Daniel Al­mendi, who has been di­ag­nosed as schiz­o­phrenic with para­noia — has been miss­ing since Nov. 30, when he was dis­charged from the UTHealth Har­ris County Psy­chi­atric Cen­ter and dis­ap­peared into the ur­ban jun­gle.

No one no­ti­fied Ruano that his brother was be­ing re­leased, and Al­mendi’s where­abouts re­main un­known.

It’s an all-too-com­mon prob­lem for the fam­i­lies of men­tally ill peo­ple: They want to help but of­ten are stymied by the health sys­tem, ac­cord­ing to men­tal health ad­vo­cates. At­tempts to bal­ance the pri­vacy of adults and loved ones con­cerned about their safety can leave in­di­vid­u­als un­ac­counted for and rel­a­tives frus­trated.

“The fam­ily can be so help­ful, and the more in­volved they can be with the hospi­tal and the treat­ment, the more they can be sup­port­ive to their fam­ily mem­ber,” said Su­san Ford-

ice, chief ex­ec­u­tive of the non­profit Men­tal Health Amer­ica of Greater Hous­ton. “There is no pro­hi­bi­tion against the fam­ily be­ing very proac­tive in talk­ing to the treat­ment provider.”

Al­mendi, 34, needs his med­i­ca­tion. His ID, wal­let and cell­phone re­main at home, and there have been no trans­ac­tions on his bank ac­count.

There’s been no Am­ber Alert be­cause he isn’t a mi­nor and no Sil­ver Alert be­cause he’s not an older per­son with de­men­tia.

For six weeks, Ruano has vis­ited Hous­ton soup kitchens, home­less shel­ters, bus stops and high­way un­der­passes fran­ti­cally post­ing fliers in hopes that some­one had seen Al­mendi.

Al­mendi had been liv­ing with his brother but had stopped tak­ing the med­i­ca­tion that helps reg­u­late his con­di­tion. Ruano fi­nally ob­tained a men­tal health war­rant last year to have his brother ad­mit­ted to the hospi­tal for treat­ment.

A soft-spo­ken man who is shorter and smaller than his brother, Ruano, 53, is the el­dest of their mother’s four sons. Al­mendi is the youngest. Their mother cared for her youngest son un­til her death five years ago. Now the care­giver, Ruano works evenings and tries to keep up with his brother.

“I can’t watch him all the time,” he said.

Law ‘just so strict’

Two weeks af­ter be­ing com­mit­ted, Al­mendi was re­leased. With pre­vi­ous hos­pi­tal­iza­tions, a hospi­tal so­cial worker had called to have fam­ily mem­bers re­trieve him at dis­charge. This time, how­ever, no one con­tacted Ruano, though it’s pos­si­ble that rel­a­tives were not listed or had been re­moved at Al­mendi’s re­quest from the med­i­cal file.

The fed­eral Health In­sur­ance Porta­bil­ity and Ac­count­abil­ity Act, known as HIPAA, re­quires the con­fi­den­tial­ity of health care data.

“Pa­tient in­for­ma­tion can­not be dis­closed to any­one with­out pa­tient con­sent,” UTHealth spokes­woman Deborah Mann Lake said. She de­clined to con­firm the date of Al­mendi’s re­lease and re­ferred ques­tions about the psy­chi­atric cen­ter’s dis­charge pol­icy to the or­ga­ni­za­tion’s le­gal of­fice.

Ruano still doesn’t know what changed.

“The HIPAA law is just so strict,” Ruano said. “In this sit­u­a­tion, we have a men­tally ill per­son who’s in dan­ger be­cause he has no medicine. He’s just out there, and I don’t know if he’s alive or dead.”

Ruano said he, too, has been un­able to get any in­for­ma­tion from the hospi­tal.

“I don’t un­der­stand why the hospi­tal didn’t call me if I got the men­tal health war­rant and put him in the hospi­tal,” he said. “I don’t know if they just lis­ten to the pa­tient. They sta­bi­lize him for two weeks, but it takes a whole month for the med­i­ca­tion to kick in real well. I don’t un­der­stand what hap­pened at the hospi­tal.”

Ruano reached out to po­lice, lo­cal me­dia and miss­ing per­sons or­ga­ni­za­tions. Most of the groups that ac­tively search for miss­ing peo­ple place pri­or­ity on chil­dren, women and the el­derly, he found.

So Ruano and friends set out on their own man­hunt with fist­fuls of fliers show­ing the miss­ing man’s driver’s li­cense snap­shot with a se­cond photo that is a ren­der­ing of what he would look like with a scrag­gly beard. They dili­gently can­vassed ar­eas where Al­mendi might be co­cooned.

There is hope that he is sur­viv­ing on the streets, but his para­noia may make him more dif­fi­cult to find.

“He’s a very lov­ing per­son. He’s just very reclu­sive. He keeps to him­self,” Ruano said.

Of­fi­cials with the Har­ris County Med­i­cal Ex­am­iner’s Of­fice said they have re­ceived no bod­ies match­ing Al­mendi’s de­scrip­tion since Nov. 30.

‘Look­ing in wrong place’

On Thurs­day, Ruano learned that there had been a sight­ing of his brother in mid-De­cem­ber — clothed in the same items he was last seen wear­ing — in Her­mann Park. That’s not far from the psy­chi­atric cen­ter, a Texas Med­i­cal Cen­ter in­sti­tu­tion on South MacGre­gor Way.

“I’d been look­ing in the wrong place the whole time,” Ruano said.

On an un­usu­ally warm Jan­uary day this week, the frus­trated-but-hope­ful brother con­tin­ued look­ing in a dif­fer­ent sec­tion of Her­mann Park but found no sign of Al­mendi.

The search may be com­pli­cated by the re­cent up­heaval of tran­sient res­i­dents. There have been city ef­forts to re­lo­cate home­less peo­ple in re­cent weeks, and ad­vo­cates re­port hav­ing prob­lems keeping track of their loved ones.

The Hous­ton Po­lice Depart­ment opened a case on Al­mendi and en­tered his in­for­ma­tion into na­tional data­bases for miss­ing peo­ple.

“We also did a flier for him and that was sent out to law en­force­ment, trans­porta­tion ser­vices and med­i­cal fa­cil­i­ties,” said Of­fi­cer E. Claburn with HPD’s miss­ing per­son unit.

She and her part­ner went to Her­mann Park af­ter re­ceiv­ing a tip on Dec. 16 about a man who looked like Al­mendi sit­ting on a bench near a bath­room wear­ing the same clothes listed on the flier.

“We have gone out two or three times but were un­able to find him,” Claburn said. “We have a lot of peo­ple be­ing re­leased from these psy­chi­atric in­sti­tu­tions and their fam­i­lies aren’t called.”

Fordice ad­vises peo­ple to seek the sup­port, knowl­edge and ex­pe­ri­ence of other in­di­vid­u­als and fam­i­lies as well as re­sources avail­able through chap­ters of the Na­tional Al­liance on Men­tal Ill­ness, known as NAMI. She also said an ad­vance di­rec­tive for men­tal health treat­ment, which can ad­dress med­i­ca­tions and no­ti­fi­ca­tions, might also as­sist in main­tain­ing the pa­tient-fam­ily link.

“What I’ve heard from peo­ple liv­ing with a di­ag­no­sis is how em­pow­er­ing it was when they cre­ated an ad­vance di­rec­tive,” she said. “I sure hope this fam­ily finds their loved one.”

Hold­ing out hope

Al­mendi was young when his fa­ther left the fam­ily, Ruano said. Long­ing for his dad may have con­trib­uted to Al­mendi’s first dis­ap­pear­ance, when he was in his 20s.

He caught a flight from Hous­ton to Florida to look for his dad. Rel­a­tives co­or­di­nated with Florida au­thor­i­ties to have him com­mit­ted and trans­ported back to Hous­ton, Ruano said.

Ruano said Al­mendi’s men­tal health de­clined af­ter high school. He earned cre­den­tials from San Jac­into Col­lege to work as a phar­macy tech­ni­cian but never got his ca­reer go­ing.

The broth­ers have been reel­ing since colon cancer claimed their mother. The loss hit Al­mendi the hard­est, but Ruano hasn’t given up hope of find­ing his brother.

“Un­for­tu­nately,” he said, “his men­tal ill­ness just kept get­ting worse and worse over the years.”

Mark Mul­li­gan / Hous­ton Chron­i­cle

Ge­orge Ruano looks at a photo a woman thinks may be his miss­ing brother while he hands out fliers un­der­neath U.S. 59. The per­son in the pic­ture was some­one else.

Daniel Al­mendi, 34, has been miss­ing since be­ing re­leased on Nov. 30.

Mark Mul­li­gan / Hous­ton Chron­i­cle

Ge­orge Ruano has been search­ing for his brother, Daniel Al­mendi, since Al­mendi was re­leased from the Har­ris County Psy­chi­atric Cen­ter on Nov. 30

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