He wanted to kill himself; hospital sent him home
The health-care system can learn from Paul Ostrander’s death. He went to the psychiatric ER at St. Joe’s hospital and said he was suicidal and wanted to be admitted. He was not admitted and later took his own life.
He knew he was in deep trouble. So he asked for help.
His life depended on it.
Paul Ostrander told staff at St. Joseph’s Healthcare Hamilton psychiatric ER he wanted to kill himself. And he was thinking of killing others. He begged to be admitted.
But the hospital would not keep him. St. Joe’s sent him home.
Paul held on for another 20 days. Then, as strangers tried to stop him, he went over Niagara’s falls.
That was in December. His body has not been found.
Paul, and the family who loved him, did everything right. They were open about Paul’s mental health issues. They were educated and involved in his care. (Immediate family includes a psychiatrist, a nurse, a nurse practitioner and a medical student.) They went to all the right places and sought assistance from all the right people.
In the end, there were gaps wide enough for Paul to plunge through.
He was 62.
Paul was born in Niagara Falls, the second youngest of six children. He came into the world with a mild form of cerebral palsy which caused coordination and balance issues. His family says he also had cognitive challenges.
At 18 or 19, Paul was diagnosed with bipolar disorder.
For most of his life, Paul managed his mental
illness without medication. But there were dark times. In 1991, he tried to kill himself at Niagara Falls. He threw himself into the water but it was shallow and he waded out again.
Beginning in his teens, Paul abused alcohol. For one nine-year stretch, he stayed sober. He always wanted to beat his alcoholism and for a time, he did.
Paul usually found work. He drove a cab, worked at a men’s clothing store and as a tour guide.
He was also a life-long learner. A popular student at Niagara College, he took course after course, just for the pure love of learning.
Paul was usually “pretty upbeat,” says his sister Joan Ostrander, a nurse practitioner. He loved to talk and made friends easily, especially in the Niagara Falls retirement home he lived in and at the McDonald’s he frequented for coffee.
In August, Paul used some of his trust fund to travel — alone — to California. His family says he thoroughly enjoyed the experience.
Around the same time, he quit drinking and smoking and his medication for depression and anxiety was adjusted. Those changes led to a mid-September trip to the ER at Greater Niagara General Hospital in Niagara Falls because his blood pressure spiked.
By the end of that month, Paul was complaining that he was not sleeping well. When he did sleep, he dreamed of hurting people.
“We started seeing signs of depression and he started talking about horrible nightmares,” says Rob van Reekum, a psychiatrist married to Paul’s sister Laurie Ostrander, a nurse.
Paul said the devil had taken him over.
Nov. 21. Paul met with his social worker. Her notes say Paul “was having ongoing thoughts of killing himself” and could not sleep.
“Client was encouraged to go to the hospital to request admittance or medication.”
Nov. 22. Paul went to the ER at St. Catharines hospital and asked to be admitted. He told staff he wanted help.
“He didn’t want to harm anyone,” says Rob. “He didn’t want to harm himself. He was begging for admission.”
He was sent home.
Paul began withdrawing from family and friends. He became eerily calm. “Flat,” says his sister Nancy Ostrander, a retired Niagara College teacher. “No emotion.”
He stopped driving or calling his siblings, though that didn’t deter them from going to him and trying to find him help.
“He talked of just giving up,” says Nancy.
Nov. 25. Nancy believed suicide was imminent. She drove Paul to the one place she was certain he would get help: St. Joseph’s psychiatric ER in Hamilton. They arrived at 1:30 p.m.
Paul not only consented to being at the hospital, he was candid about his fear of harming himself and others.
“He couldn’t stand to be in his own mind or body anymore,” says Nancy. She listened as her brother tried to “convince” doctors to admit him.
At one point, clearly frustrated, Paul said: “What’s it going to take to get you to admit me? Do I have to tell you I’m going to ram my car into tourists at Niagara Falls?”
Staff asked if he was serious about that threat.
“No,” he answered.
At 3 a.m., St. Joe’s sent Paul and his sister home.
The hospital told Paul he’d hear from its out-patient centre to arrange follow-up care.
The centre called the day after Paul died.
Despite consent from Paul’s family for St. Joe’s to talk to The Hamilton Spectator specifically about his case, the hospital would not, apart from saying his death is a tragedy and an outcome that nobody wants.
The hospital did, however, agree to speak generally about psychiatric patients. Each year, 9,000 patients present at the St. Joe’s ER with mental health issues. Of those, 3,600 are referred for further assessment and out of those, 1,100 are admitted.
“Everybody’s perception is that hospitalization is probably what they need and what is going to be helpful,” says Holly Raymond, clinical director for general psychiatry at St. Joe’s.
She says no matter how crowded the hospital is, if a patient is assessed to need admission, they will be admitted. But for some patients, admission “is actually not helpful.” Moving someone into an unfamiliar environment without their usual support system may not be the best treatment.
Assessing if a patient is an imminent threat to themself or others is difficult because their mental state can fluctuate — even within the course of the assessment, says Raymond. “My assessment of someone now is a very poor indicator of what’s going to happen in three weeks.”
The hospital will have a very different response, she says, if a patient says “I’m having thoughts about wanting to hurt people” versus “I’m having thoughts about wanting to shoot people and I have a gun in my pocket and I’m planning to do it on Tuesday.”
“This is not an exact science,” says Dr. Maxine Lewis, chief of mental health at St. Joe’s.
“We absolutely take into account what the family tells us but we also have to take into account our experience and we have to assess the patient in that moment.”
Lewis pointed to one improvement since Paul went to the St. Joe’s ER.
At the end of February, the Connect central access system began. She describes it as a portal that doctors and other health care professionals can access to arrange outpatient support for a patient. The new system reduces wait time to a week.
Nov. 27. Paul went alone to his family doctor, who adjusted his medication according to what he thought were the directives from St. Joe’s. Afterwards, it was learned the instructions were miscommunicated and the changes were wrong.
Nov. 28. The social worker noted that Paul continued to have “disturbing thoughts” that are “scaring” him. His symptoms “have never been this severe.”
Nov. 29. Paul is willingly admitted to a “safe bed” at a residential crisis shelter in St. Catharines.
Dec. 1. Paul told his social worker he “feels he should be in a lockdown unit and he has been to different hospitals and they won’t do this for him.”
Dec. 8. Paul left his nice retirement home and temporarily moved into a lodging home in St. Catharines. Paul said he went there because he was afraid he would hurt his friends at the retirement home.
Dec. 10. The social worker gave Paul a number for COAST (Crisis Outreach and Support Team). She said she’d try to get him into St. Joe’s psychiatric unit in Hamilton.
Dec. 13. Paul saw his family doctor and his medication dosage was subtly increased. The doctor put in an urgent request for Paul to be referred to a psychiatrist.
Dec. 15. Paul met his sister Joan Ostrander, a nurse practitioner, for coffee.
“He was talking about the devil and he could no longer stand to be in his own body,” she says. “He wanted to give me his ring because he was going to kill himself. He said ‘I am no good. I am finished.’”
After leaving Paul, Joan went home and called her sister Laurie.
Laurie called COAST at 4:05 p.m. and said she believed her brother was “at immediate risk to himself,” according to a COAST report obtained by Paul’s family. “Caller believes her brother is homicidal as well as suicidal,” the report notes. COAST told her to call 911.
Joan called 911 as she drove to the lodging home in St. Catharines. She knew there were special teams that paired police officers with mental health workers. She expected one of those teams would be sent to Paul.
When she arrived at the home a short time later, three uniformed Niagara Regional Police officers were walking out of the house. They had already dealt with Paul.
The NRP occurrence report, obtained by Paul’s family, says Paul “was in good spirits and had no utterances of self harm.”
Yet it also notes “Paul advised that the voices are telling him to kill.”
The report says officers spoke with a supervisor at the home. He told them “Paul was of normal behaviour … and showed no signs of being in crisis.”
Police reported “there were no ground (sic) for police apprehension under the Mental Health Act.”
Though Paul’s family consented to having NRP talk about his case to The Spectator, the service says it can’t, because it is “legislatively bound to protect the privacy of an individual, even one deceased.”
It would say that its Mobile Crisis Rapid Response Team, which pairs uniformed officers with mental health professionals, responds to calls “based upon the availability of the on-duty unit and the current volume of calls for service.”
It also says uniform officers receive training in mental health crisis response as cadets at the Ontario Police College and as they progress through their career.
After police left, Joan sat with Paul and asked him to go with her to the hospital. He had always agreed to go in the past. But not this time.
“He said he was tired and wanted to sleep,” Joan says.
Dec. 16. Joan got a call at home from the Niagara police. She was asked to come to the station. Joan assumed it was to do a followup report.
She drove herself to the station, arriving at about 2:40 p.m. and was taken into a room and questioned about her brother. She was there a while before the officer got to the point.
Paul went over the falls.
His car was there, by Table Rock just above the Horseshoe Falls. In the back seat were brochures for COAST and the Canadian Mental Health Association.
At 10:50 that morning, at least four witnesses watched him climb over the wall and clamber down to the water. One man went after him asking if he needed help.
Paul didn’t say a word. Instead, he “dove” into the churning water and was swept over the falls.
Paul’s family has decided to share his story, in the hopes it may help “fix the broken system.”
There is a lack of funding, a lack of coordination and communication in our health care system that allowed Paul to die even when he begged to be saved, they say.
They are left with many questions.
Why did St. Joseph’s Hospital send Paul home? If a psychiatric ER won’t admit a mentally ill man who says he is going to hurt himself and others and is begging for help — who will be admitted?
Why would Niagara Regional Police not do more for Paul? Why didn’t a mental health professional go on the lodging home call with officers? Why wasn’t he taken into custody under the Mental Health Act?
Why didn’t St. Joe’s and police give more weight to the concerns of Paul’s family?
Paul’s family has a lot of expertise in mental health and the health system. They did everything they could think of for Paul and it was not enough.
“Because we work in the system, we see its failures better than most,” says Rob. “The system can learn from Paul.”