‘You’re going to release him when he was hurting himself?’
Brother struggles to understand why Daniel Prude was released from hospital hours after suicidal behavior
status. Hauled ass like Carl Lewis,” Joe told ROCHESTER, N.Y. — Around 3 a.m. the next When Joe Prude called day, four hours after his Rochester, N.Y., police to release from the hospital, report his brother missing, emergency dispatchers he was struggling to unstarted fielding calls about derstand why Daniel Prude Daniel Prude. His brother had been released from the reported him missing, and hospital hours earlier. Joe a tow truck driver spotted Prude described his brothhim, naked and bloodied, er’s suicidal behavior. on West Main Street, police
“He jumped 21 stairs records show. down to my basement, Police body camera footheadfirst,” Joe said in a age shows that by 3:20 video recorded by the rea.m., Officer Mark Vaughn sponding officer’s body was pressing Daniel camera in the early hours Prude’s head into the paveof March 23. Joe’s wife, ment.
Valerie, described Daniel While restrained, Prude nearly jumping in front of stopped breathing. An a train on the tracks that ambulance crew resuscitatrun behind their house the ed him, but he was in critprevious day. ical condition. His brain
“The train missed him was damaged after being by this much,” Joe said, deprived of oxygen. He holding his thumb and died a week later at Strong pointer finger a few inches Memorial after being taken apart. off life support.
“When the doctor called The University of Rochme and told me that they ester Medical Center said released him, I’m saying, patient privacy laws bar it ‘How you going to sit here from discussing the specifand tell me you’re going to ics of Prude’s treatment release him when he was and release, but, in general hurting himself? Come on. terms, spokesperson Chip You weren’t sworn to do Partner said, the hospital is that,’ ” he said on the body bound by a New York state camera footage. law that requires patients
At the point of this reto be released within 24 corded conversation just hours unless they have a after 3 a.m., Joe and Valerie mental illness that is likely Prude knew only that Danto result in serious harm to iel was missing, delusional themselves or others and and vulnerable. They that requires immediate didn’t know his next enobservation, care and hoscounter with the police pital treatment. would be fatal. The details of Prude’s
Police would find Daniel encounters with law enminutes later — naked, forcement and the health acting irrationally. Because care system offer a look he spat in the direction of into the practice of emerofficers and allegedly said gency psychiatry, and how, he had the novel coronavias in many branches of rus, officers placed a white medicine in the U.S., mishood, called a “spit hood,” takes in that field are disover his head. When he proportionately borne by started trying to stand up, Black people. despite being restrained by Medical decisions in a handcuffs, an officer case like Daniel Prude’s are placed much of his body high-stakes, with little weight over Daniel’s head margin for error, said Dr. and pushed it into the Ken Duckworth, chief pavement. medical officer of the Na
Daniel died a week later tional Alliance on Mental when his family took him Illness. off life support. The county “Emergency psychiatric medical examiner’s autopsy assessment is very chaldescribed his death as a lenging, and the potential homicide and listed the for catastrophic outcomes immediate cause of death following your decision is as “complications of asvery real,” he said. phyxia in the setting of The hospital where physical restraint.” The Prude died has faced scruincident garnered widetiny over its treatment of spread attention as another psychiatric patients and example of a Black man discharge procedures bekilled after an encounter fore. with police. In April 2018, federal
Less attention has been inspectors found security paid to what happened to officers at the hospital had Daniel Prude in the preused law enforcement receding hours, when he was straint techniques against a treated and released after a pediatric psychiatry papsychiatric assessment at tient, breaking her arm Strong Memorial Hospital, and sending her to the run by the University of emergency room. Rochester Medical Center. Months later, inspectors
Joe Prude called police at found the hospital disabout 7 p.m. on March 22 charged a patient who was because he needed help in the emergency room getting Daniel to the hospiwith a history of dementia tal. Daniel had been having and multiple medical probproblems with a PCP adlems despite a discrepancy diction, Joe told officers. in her address between her Now he had begun telling medical record and the Joe and Valerie that people information she gave hoswere out to get him, and pital staff. he wanted to die. Two years earlier, in
By about 11 p.m., Daniel spectors found that hospiwas released from the tal staff had placed patients hospital, according to Joe in ankle and wrist reand police records. “He straints without an order was calm as hell when he to do so, and placed anothgot back here,” Joe told er patient in restraints police. without documenting when That didn’t last. the restraints were re“He was fine for a little leased. Restraints are bit, then all of a sudden meant to be used only with started acting crazy,” Joe a physician’s order, and said. He told police that federal rules require preDaniel asked him for a cise documentation of their cigarette,use.andwhenhe went to get one, Daniel None of these incidents took off running. He was at Strong Memorial Hospibarefoot, wearing only a tal garnered media attentank top and long johns in tion at the time they hap30-degree weather. pened or at the time the
“He was gone. Track star reports were made public.
Strong spokesperson Partner said that immediately after the April 2018 inspection the hospital changed its public safety protocol to eliminate the use of law enforcement techniques to manage a violent patient unless that patient is being arrested.
He said updated staff training and discharge protocol after these incidents now mitigates the risk of discharging someone who was not ready to be released. “These protocols were well established in 2020 and had absolutely no bearing on the evaluation or treatment of Daniel Prude on March 22,” Partner said.
Prude’s case is unusual because the consequences of the decision by doctors to release him have played out so publicly, said Duckworth. Usually, emergency room psychiatrists never find out what happened to their patients.
“You make a very big decision, which usually has no known outcome. You put this person in the hospital, you go on to the next patient. You send this person home, you go on to the next patient,” he said.
Duckworth said he would not second-guess the actions of Prude’s hospital team in the moment, but with the benefit of hindsight, “there’s overwhelming evidence that he had a psychotic illness and was quite vulnerable,” he said. “He didn’t need to die.”
In a statement, URMC said its treatment of Prude was “medically appropriate and compassionate.”
Several oversight organizations are investigating.
The Joint Commission, which certifies hospitals to receive federal funding, said it’s reviewing Prude’s treatment at Strong. New York state’s Justice Center is investigating on behalf of the state Office of Mental Health.
The university medical center itself is still conducting an internal clinical review.
In response to questions from NPR and KHN about whether the hospital’s treatment of Prude could have been affected by his race, Partner said the medical center asked Dr. Altha Stewart, past president of the American Psychiatric Association, “to conduct a third-party independent review through her lens as a national expert on racism and bias in psychiatric care.”
In a separate interview before the request from URMC, she described how unconscious bias can cloud
clinicians’ judgment and make it difficult for them to make the best possible decisions for their patients.
“It is very clear that in today’s health care system, bias is built in structurally,” Stewart said. “Seeing a tall, imposing Black man who is behaving aggressively puts in place a series of ideas and thoughts and assumptions that direct decision-making.”
Psychiatric disorders in Black patients are less likely to be taken seriously than in white patients, Stewart said. Unequal treatment starts early.
Black boys are viewed as adults more often than white boys of the same age, said Stewart, who is also the director of the Center for Health in Justice Involved Youth.
“So a Black child with a meltdown is described as aggressive, obstinate, oppositional,” she said, “as opposed to traumatized, depressed, anxious.”
Those expectations follow Black boys through adulthood and in the health care system, increasing the odds that doctors will view Black men as a lost cause and provide subpar care, Stewart said.
She stressed that she does not have any direct knowledge of deficiencies in the care of Daniel Prude, but she said that Black men, like Prude, are disproportionately likely to be misdiagnosed, mistreated and written off as a result of structural bias and unconscious racism.
A group of medical students at the University of Rochester wrote in an open letter that Daniel Prude was “sentenced to death by our failed healthcare system.”
“Not only do our current models of healthcare leave gaping holes for individuals such as Daniel to fall through, but they do so in manners which are fraught with racism,” the students wrote.
Partner, the medical center spokesperson, said the psychiatry department’s Office of Diversity, Inclusion, Culture and Equity will evaluate Daniel’s treatment for potential bias. He said the medical center “recognizes that we have a long way to go before we can confidently say that our policies and practices are universally culturally appropriate to the populations we serve.”
Both Stewart and Duckworth said reducing the role that police play in addressing mental health crises would increase the odds of survival for a person released too early from psychiatric care.
Federal inspection reports show that hospitals across the country have released patients who, like Prude, ended up in grave danger only shortly thereafter.
In March 2018, a patient with a history of schizophrenia, post-traumatic stress disorder and suicide attempts arrived at Russell County Hospital in Kentucky complaining of alcohol withdrawal, depression, anxiety and pain. An hour and a half later, the patient was discharged with instructions to “follow up with his/her primary care provider and take medications as prescribed.” Two hours later, the patient was back in the same hospital. A physician’s notes said the patient had drunk a bottle of Benadryl “in effort to kill self.”
In August 2018, federal
inspectors found that UT Health East Texas Pittsburg Hospital discharged a patient who had verbalized a plan for suicide. The patient got a ride to his truck from the county sheriff. Later that day, the patient was found dead in the truck from a self-inflicted gunshot wound.
Last summer at Stafford County Hospital in Kansas, a patient arrived in the emergency room saying she had drunk half a liter of vodka because she was upset and wanted to die. She told hospital staff that she started drinking that day after two years of sobriety and that she “did not feel safe to go home due to the presence of alcohol.” The hospital discharged her 11 minutes later.
Earlier this year, inspectors found that a patient with a history of psychosis went to the emergency room at Mercy Hospital in St. Louis and told staff she needed to get back on her medication. She was delusional, disoriented, homeless and unable to give her name. She was discharged with a voucher for cab fare but no followup appointments or services and no plan to ensure she got her medication.
A spokesperson for UT Health East Texas said the health system has since implemented a process for staff to more thoroughly document mental health concerns in patient records. Mercy Hospital in St. Louis said it takes the health and safety of each patient very seriously “regardless of race, ethnicity or ability to pay.”
Neither of the other hospitals responded to emails or calls seeking comment.