Friday, March 07, 2008

The following story was found in the Bend Bulletin. It clearly shows how a life was lost due to suspicious circumstances. It clearly shows a system badly in need of an overhaul. It clearly shows the incompetence of those paid to protect and keep safe some of the most vulnerable people in our state. This story breaks my heart.

‘Please help me’

Cindy Powell had struggled with mental illness since she was 14. On Monday, she jumped to her death from a hospital balcony as she was being taken to a locked treatment facility. Here is her story.

Three days before jumping to her death from a balcony in St. Charles Bend’s main lobby, Cindy Powell drove to the hospital’s emergency room with multiple cuts on her arms from a kitchen knife.She was stitched up and sent home with ibuprofen, printed information about depression and bipolar disorder, and instructions to have the sutures removed in 10 days.

Powell, 51, who lived alone in a studio apartment in Redmond, had called the Deschutes County Mental Health Crisis Line twice that day. She later told an ER nurse that “it wasn’t much help, and they told her to come in Monday.” She was released from the hospital at 11:49 p.m. Friday, Feb. 22 — two hours after her arrival — with instructions to call the crisis line if she needed help.
Dr. Robin Henderson, the director of Behavioral Services at Cascade Community Healthcare, the parent company of St. Charles, said hospital workers made the right decision. At the same time, Henderson said, they basically had no choice under Oregon law.

The diagnosis: Borderline personality disorder

Borderline personality disorder is a severe mental illness characterized by unstable moods and bouts of anger, depression and anxiety. It occurs most often in young women. Patients often injure themselves but have no intent of committing suicide. They may have episodes of impulsive aggression, self-injury and drug or alcohol abuse. Feelings of isolation and lack of social support may result in frantic efforts to avoid being alone.

The pills: What she was taking
“She said, ‘I wasn’t trying to kill myself’ — she actually said that,” Henderson said. “At that point, we’re not seeing intent, and this particular injury was not holdable. If we do, then we’ve got a civil rights violation on our hands.” In Oregon, two physicians must find people are a danger to themselves or others before they can be put on a five-day psychiatric hold against their will. Because Powell said she didn’t want to kill herself and told a nurse that she never had a desire to hurt anyone else, St. Charles’ staff couldn’t keep her, Henderson said. “(Patient) extremely negative regarding her prognosis for mental health help,” wrote the nurse who processed her discharge.
It was a weekend, so the Deschutes County Mental Health Department, which had been treating Powell since late October, couldn’t see her. “And there is no respite care here, because there isn’t any funding,” Henderson said. “It’s a horrible situation.” Respite care is temporary, short-term care for patients with special mental health or social service needs, according to the Oregon Department of Human Services. Because it doesn’t exist in Central Oregon, hospital staff were left with two choices for Powell that Friday: Lock her up, or let her go.
What happened next
Powell told a nurse Friday night that she had flown into a rage and cut herself to diffuse the situation, according to medical records. That behavior is consistent with her diagnosis of borderline personality disorder, Henderson said, and is a common symptom of the illness. “The reality is that people who are lethally attempting to kill themselves do not drive themselves to the (emergency room),” she said. “It would have been contraindicated and harmful for her to be repeatedly hospitalized.”
There aren’t any records of a phone call from Powell to the mental health crisis line on Saturday. But at 5:41 p.m., she was found in St. Charles Bend’s ER waiting room, unresponsive and with shallow breathing.
After Powell’s death, two of her sisters would find more than a dozen pill bottles in a bathtub in her tiny apartment. Powell had been diagnosed with a long-standing addiction to prescription pain medications, and doctors who cared for her believe she had overdosed on a sedative. Powell stayed at the hospital overnight, and progress notes show she was fully awake by the next afternoon. She said she was hopeless and wanted to kill herself. “I have nothing,” a nurse quotes her as saying. “I don’t want anything other than to be let to die.”
In the evening, she talked to a nurse’s assistant about her life. The nurse’s notes say Powell had “a family history of alcoholic parents, (molested as a child), father who beat her, inability to live on her current income, she is often cold, hungry and wearing dirty clothes, has a distrust that anyone can help her, was seeing a counselor that committed suicide.”
Powell also had a long history of anorexia nervosa, or starving herself, and told nurses that “eating in the hospital will get her used to food, and then she will not be able to live without it once she goes home.” She continued to talk about killing herself, or getting someone else to do it, Sunday night and Monday, according to hospital records.
The move
Doctors decided to move Powell to St. Charles’ acute mental health care facility, Sage View, on Monday. Powell spent the day telling hospital staff that she did not want to go there. Progress notes show she refused to promise that she wouldn’t hurt herself if she was transferred. Her doctor wrote that Powell “has us over a barrel.” “She, I think, really is very manipulative wanting only to be taken care of, but refusing any direct care claiming that she wants to kill herself,” Dr. William Campbell wrote. “I think we are faced with having to evaluate whether to commit her or not and with that moving her to Sage View.”
That evening, after a half-hour meeting with a clinical social worker, Powell changed her mind and agreed to “contract for safety,” promising she wouldn’t hurt herself on the way to Sage View.
At 8 p.m., a clinical social worker and a member of Sage View’s staff picked up Powell from her room and took her downstairs to get her purse, which was still in the admitting area. Contrary to normal protocols, they walked her through the hospital’s main lobby. She was not restrained because she was not violent, and the organization that certifies the hospital does not allow it, Henderson said. Bend psychologist Mike Conner said he could not comment on Powell’s case but did note that the chances for a person diagnosed with borderline personality disorder to commit suicide are low. Conner did not treat Powell. But he said that, in seven years of arranging transports in Portland for borderline personality disorder patients with recent suicide attempts, he never allowed a transport without some restraint. “What’s the problem with putting them on a comfy little gurney with a belt?” he said.
Henderson said that the hospital is reviewing its transfer policies. They have started putting every transfer patient in a wheelchair and will no longer take them through the lobby, she said.
Powell’s escorts had been specifically trained not to grab for or go after patients who run from staff, Henderson said. “Grabbing them is a dangerous thing to do,” she said. “We train to call for assistance.” So when she bolted from them in the lobby at about 8:10 p.m., the two called for Powell but didn’t chase her. She ran up a staircase to a balcony that leads to the hospital’s cafeteria, paused for a moment and then jumped over the railing. The 25-foot fall caused massive head trauma, neck and back fractures, and broken ribs, hospital records show.
Medics were with her almost immediately, performing mouth-to-mouth resuscitation and CPR. She initially breathed on her own and moved a finger and her legs. Six minutes later, Powell was in the ER, blood leaking out of her left ear. She was put on life support, and doctors wrote that brain death was imminent. Her sisters, Bonda Powell, of Bend, and Jackie Feik, of Port Orchard, Wash., told hospital staff to honor Cindy Powell’s wishes to be an organ donor.
How she got there
Powell’s sisters both confirmed her reports that she’d been abused as a child. They grew up in violence with alcoholic parents. The family moved often, running from bill collectors, Feik said. The children regularly ran away and were placed in homes away from their parents at times. “She was real angry from a very young age,” Feik said about Cindy Powell.
Their father died in 1991, and Cindy Powell and her mother ended up in Redmond, where they became close, Bonda Powell said. Their mother cared for Cindy until she died in 2003. Then, Cindy turned to Bonda for help. “Bonda said, ‘She is a mess, she needs institutionalization,’” Feik said.
Cindy Powell met a man online and moved to Utah to be with him in 2004, the sisters said. During the relationship, she continued her suicide attempts, once on the wedding day of her boyfriend’s daughter. The two broke up, Feik said, and Cindy Powell moved back to Central Oregon in 2007.
On Oct. 30, just one day after she moved back from Utah, Powell turned up at Deschutes County Mental Health, complaining of anxiety problems and saying she’d come in because she was “trying to save my life.” Staff notes described Powell, then 50, as “older than her stated age, pale and thin.” The report shows that Powell was homeless at the time. She was given information about a Family Resource Center Web site and told to return after she became insured under the Oregon Health Plan.
Powell’s contact with Deschutes Mental Health dropped off for a full month. On Dec. 1, Bonda Powell called the Redmond Police Department to say her sister planned to “starve herself to death.” That day, police found Powell in her apartment, with a butcher knife, bleeding from several cuts to her head and appearing to be suffering the effects of a drug overdose. She had written “I tried” in blood on the wall above her bed, according to her sisters.
In and out of the hospital
Powell was taken to St. Charles Redmond, where doctors recommended transferring her to Bend. On Dec. 3, a clinician noted that Powell “states that she cut herself so she could be a martyr for those people who do not have access to medical care.”
Powell was moved to Sage View, where she met regularly with counselors. Three days later, Powell appeared to be feeling better. She told one staff member that the hospital stay had been “a turning point” and that she was excited about making friends in the facility. She was discharged shortly after.
For the rest of December, Powell went regularly to Deschutes County Mental Health for individual and group therapy sessions. She told counselors about her difficult childhood and detailed her dozens of earlier suicide attempts and about 10 hospitalizations. Records show that Powell reported eating only once a day. But by mid-December, she reported wanting to get herself “stabilized physically and mentally.”
January brought a turn for the worse, when Powell told counselors she was highly anxious, concerned about losing her Redmond apartment and ending up on the street. Doctors prescribed new medications, but it is unclear which ones she actually took; a record dated Feb. 20 notes that Powell had gone to the pharmacy but was unable to afford an $8 co-pay.
Two days later, Powell called the crisis line twice. During the first call at 5:48 p.m., notes say Powell said she’d called because she was experiencing severe mood swings and bouts of rage, and that while she was not thinking of harming herself, she wished that someone would harm her, according to Deschutes County Mental Health records. She was on the line for more than 40 minutes. By 8:05 p.m., when she called for a second time, Powell had cut her arm to “relieve some things” but did not intend to kill herself, the records show. After seven minutes of conversation, Powell said she planned to drive herself to the hospital and hung up the phone.
Seven hours later, at 2 a.m., Powell called the crisis line again and told the staff member on duty that she’d been to the hospital but said it was a “waste of time.” She agreed to call again on Monday to talk about a treatment plan.
But Monday came too late.
“We can all get caught up in the minutiae, but the mental health system failed this woman and continued to fail her,” Henderson said.
Left behind
Powell’s sisters spent much of last week together, gathering up Cindy’s unpaid bills and donating her meager belongings to a thrift store. They pored over detailed notes showing a desperate woman living a pained life. Powell wrote about her quest for help and inability to live on the $627 she got monthly from Social Security. Her rent alone was $350.
“She’s got ‘Please help me’ on so many of these papers that we have run across and, I mean, she knew she was sinking,” Feik said. Feik described her sister as “a real note taker” and said it had become a necessity. The medications she took affected her memory, Feik said, so Cindy Powell wrote down nearly everything she needed to remember. Powell wrote about doctor’s appointments and frustration about not getting better.
“It just feels like she can’t be the only one who experienced this,” Feik said, as she sat on a love seat in her dead sister’s apartment. It was decorated with a feminine pink and white bedspread, and a light coverlet over her small couch.
And before her sisters had even packed one box, Bonda Powell talked about the only thing her sister really wanted. “A couple of weeks ago, she said, ‘Bonda, all I want is to be happy, that’s what I ask God for every night.”
Cindy Powers can be reached at 617-7812 or Erin Golden can be reached at 408-2836 or

No comments: