The Register Citizen (Torrington, CT)
Suicide after hospital discharge angers sister
NEW HAVEN — Donald Henry Lee called Milford police and threatened to kill himself because he was being discharged from Yale New Haven Hospital and had no place to go.
After being escorted from the hospital and told to come back if he felt suicidal or homicidal, Lee went to Milford Hospital, telling the admissions nurse, “I just tried to kill myself.”
Lee died the next morning, the third anniversary of his mother’s death.
Lee’s sister, Tina Schwarz of Windham, Maine, was devastated by her brother’s death. But she is also concerned, as a pediatric registered nurse who has worked with patients who have mental health issues, that that area of care is not given the resources it needs.
The problem affects all ages, she said. “It just seems to be getting worse. I think it’s very difficult and it’s not an easy system for adults to access,” with long waiting lists and doctors who won’t see patients with diagnoses such as bipolar disorder or schizophrenia.
Also, according to Angela Mattie, professor of health care management and organizational leadership at Quinnipiac University, who also teaches at Quinnipiac’s Frank H. Netter MD School of Medicine, mental health treatment has become complicated by the opioid crisis, with many patients suffering both mental illness and addiction, “and we as a society and a hospital industry are not equipped to deal with it,” Mattie said.
“We’re flooding our emergency departments with these types of patients,” Mattie said. “They’re not equipped for any long-term care for patients with psychiatric diagnoses or addiction diagnoses.” There aren’t enough outpatient facilities either, she said.
Schwarz has another lesson she wants people to learn from her brother’s suicide. She wants health care providers “to help families be more aware of family members’ mental health issues, so that family members are aware of mental health needs and how desperate people can get.”
The bottom line for Schwarz, however, is “they should have monitored him for a longer period of time to assess him and possibly be able to access resources for him to not be so desperate ... or reach out to me to help him.” Those are guidelines from the Joint Commission, which accredits hospitals and other health care providers.
Vincent Petrini, senior vice president of policy and communications at Yale New Haven, issued a statement that said: “While we cannot comment on the specifics of this situation, it clearly underscores the extraordinary complexity that surrounds these types of cases. Our team is dedicated to ensuring that we provide the highest level of care for all patients in distress and work hard to address all underlying issues and concerns. We share in the grief of the family and friends of this patient and will continue to focus on addressing the devastating outcomes of illness.”
Schwarz had only recently been in regular contact with her brother; their relationship was not close in recent years. From what she was able to piece together from a police arrest report, hospital records and from Lee’s caseworker at the Bridges Healthcare agency in Milford, Schwarz came to the conclusion that Lee, 48, who had a history of threatening and attempting suicide, could have been saved.
The doctor who discharged her brother stated that Lee was suicidal because he was homeless, not because he was mentally ill (Lee was bipolar, according to hospital records), and therefore there was no reason to keep him in the hospital, records show. His sister said she believes that the reason for someone’s threat shouldn’t matter, and that since her brother told medical staff he would kill himself he should have been kept under watch.
‘At elevated risk for self-harm’
Lee had been brought to the hospital because he had threatened suicide during a court hearing for his arrest after getting into a fight with his roommate and losing his apartment.
He was admitted to the Emergency Department at Yale New Haven at 12:35 p.m. on Dec. 14, his hospital records show. The next morning, he was “irritable” and upset because his phone had been lost (the hospital sent it to Schwarz after her brother’s death).
According to a nurse’s notes in Lee’s chart, at 1 p.m. Dec. 15, Lee was “notified that he would be discharged today. [Patient] not in agreement with plan.” The nurse noted that Lee called Milford police “and expressed SI [suicidal ideation] during call.” The police in turn called a psychiatric social worker and the psychiatrist who was discharging Lee.
Yet, at 1:07, the doctor wrote, “[Patient] at elevated risk for self-harm but driver of presentation seems to be lack [of] housing as opposed to psychiatric illness. Unfortunately, [patient] rejecting of housing options (emergency shelter) that have been offered. Suicidal threats are conditional on housing. Do not think that [patient] has acute psychiatric condition that is treatable with further hospitalization.”
Forty-eight minutes later, Lee was “escorted off unit by staff,” according to the nurse’s notes.
“I think that he was in such a state of impulsiveness and just being distraught over the court issues and being homeless that if they had kept him another 24 hours, he might have gotten past that,” Schwarz said. “He was in such an acute state of distress. Who knows what would have happened.”
Schwarz tried to text her brother after he left the hospital, but, since his phone was lost, he never received it.
Lee showed signs of distress from the time he arrived at Yale New Haven, telling a nurse, “When you all discharge me from here I am going to kill myself as soon as I get out,” according to his records. He threatened to overdose on his medication and lie down on the railroad tracks.
Schwarz doesn’t know why her brother went to Milford Hospital but said a security officer saw Lee sitting on a bench before he entered the hospital. “From what I could piece together, from all the information I had, he was out there for about an hour taking all the medications he could take,” she said.
He was admitted at 6:26 p.m. on Dec. 15, according to his Milford Hospital records, with a diagnosis of “poisoning by butyrophenone and thiothixene neuroleptics, intentional selfharm.” Both drugs are anti-psychotic medications.
But Milford Hospital’s medical records state, under “presenting symptoms”: “[Patient] states ‘I just tried to kill myself.’ States was released from Yale and told them he would so he took 45 Mg Klonopin, 15 tabs of haloperidol, 100 metoformin [sic] 100 mg and 3 bottles of lantus, and a bottle of glipizide, patient unsteady.”
Klonopin is used to treat anxiety, panic disorders and seizures. Haloperidol (sold as Haldol) is an antipsychotic drug; Metformin and Glipizide are used to treat diabetes. Lantus is a brand name for insulin.
The medical history goes on to state that Lee at first had stable vital signs and was “alert and oriented. He rapidly became lethargic and was intubated.” Lee’s blood pressure dropped and his heart rate rose to 140 beats per minute. As time went on, his kidneys failed. He went into shock.
At 9:28 a.m. Dec. 16, the records state, “The patient’s sister has been contacted and told that he is in critical condition and is unlikely to live through this. She will call his estranged children.” Lee had two daughters, Schwarz said.
Lee died at 9:43 a.m. “I tried to call back right after his death to try to talk to the doctors who were covering him and nobody called me back,” Schwarz said.
“My biggest regret is not calling my brother to follow up on that Friday (Dec. 15),” Schwarz said. “I assumed that I would be contacted if he was discharged or for follow-up discussion (as I had been called when he was admitted on Thursday … or that he would call me. I drove home from work Friday … thinking I should call him on my drive home, but did not have the number accessible. My next thought was I would call the next day on Saturday. I never had that chance.”
Confusion and anger
Schwarz said that, while her brother could be difficult, particularly with medical professionals, at Yale New Haven, “compared to other past hospitalizations, he was pretty cooperative overall until he found he was being discharged. He got pretty angry and upset.”
Schwarz, who began her career at Yale New Haven Children’s Hospital, said she believes that her brother’s threats to kill himself were a signal that he should not have been discharged.
“It confuses me and makes me angry, given this man, who had past suicide attempts … comes into the hospital saying he’s suicidal,” repeats his intention the next morning, “and he’s medically cleared because his suicidal thoughts weren’t due to any medical illness or psychiatric illness. It was just due to the fact that he didn’t have a home,” Schwarz said.
“In all of my professional practice, we always ask, ‘Do you have a plan?’ Because if you have a plan then that’s a problem,” she said. “His pattern in the past if a situation he was in overwhelmed him … he would get angry and impulsively ingest medication that he had available.” She said Lee had overdosed in the past on medication.
The Joint Commission issued a Sentinel Event Alert in February 2016 about “detecting and treating suicide in all settings.” Mattie said the Joint Commission’s guidance addresses suicide on three levels:
First, if a patient is in “acute suicidal crisis,” a “safe health care environment under one-to-one observation” is called for, Mattie said. If the patient is at low risk of self-harm, “they make referrals to behavioral health and other providers within one week,” she said. Finally, if someone is thinking about suicide but not planning to act on those thoughts, the provider should “give them the number to the national suicide hotline and restrict access to lethal means.” The hospital should assess the patient’s state of mind multiple times, according to the Joint Commission.
While Connecticut has one of the lowest suicide rates in the country, according to spokeswoman Diana Lejardi of the state Department of Mental Health and Addiction Services, the numbers have been rising. According to the state Office of the Chief Medical Examiner, the number of suicides has risen every year since 2013, from 333 to 402 in 2017. The National Suicide Prevention Lifeline ’s number is 800-273-TALK (273-8255).
But the guidance doesn’t always mirror the real world. “It’s all well and good in theory, but what happens is we don’t have psychiatric beds. We are woefully underbedded for psychiatric beds,” Mattie said.
“Our lack of ability to address these issues is really a poor statement for our society,” Mattie said. “It’s a problem that’s not going to go away. For every bed in the emergency room” taken up by a psychiatric patient who “we’re probably ineffectively treating … we’re causing a backup for someone who may be having a heart attack.”
‘Kind of a jokester’
Donald Lee had not had an easy life. He was bipolar and diabetic and struggled with drug abuse. “He was kind of a typical teenager” who got into trouble occasionally, “but he was pretty mild-mannered than most people I knew,” Schwarz said. “He was easy to get along with when we were growing up. He was kind of a jokester.”
But Lee grew apart from his family, Schwarz said. Also, three years before his death, two uncles had died close together and his mother had died 10 months later.
“When I would see him in passing over the years, he was very happy to see me in those moments of time, but it was difficult to maintain a relationship with him,” Schwarz said. “When he opened up this line of communication the last time, I was hopeful.”
“What I want is this to not happen to anybody else,” Schwarz said. “No family member to deal with this and I want to make sure that something happens there.”